Every finding on record at Ts Compassion Hospice & Palliative Care Inc

Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the patient chooses a health care provider, including an attending physician. #2-There is no evidence in the patient record that the patient/caregiver chose an attending physician. This section of the election of benefit/admission documents was left blank.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. #2-LVN performed fingerstick blood sugar without wearing gloves - using gauze, visible with patient's blood, to apply pressure to the finger.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 #2-The right to choose and attending physician was not marked "yes or no" on consent forms and when questioned by surveyor at home visit, the patient and daughter both stated they had not been offered the option of choosing an attending physician.

Upon patient record review, 4 of 14 (Patient #2,3,5,6) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. #2,3,5,6-Patient records lack clear and legible clinician signatures on the election of benefit and consent documents.

Upon patient record review, 3 of 5 (Patient #3, #4 and #5) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #3 Oxygen not on med list dated 12-27-21. There was a physician supplemental order for Oxygen 2L/Min PRN SOB on 12-27-21. Agency nurse added to medication list while on survey. Corrected on Site. Patient #4 Oxygen and Nebulizer treatment not on med list dated 12-29-21. There was a physician supplemental order for Oxygen 2L/Min PRN SOB on 12-29-21. There was a physician order for nebulizer machine on 12-29-21. However, there was no order for nebulizer medications. The medication list had comfort meds that did not include oxygen or nebulizer meds in the record. Patient revoked from hospice within 10 days from SOC. Patient #5 Oxygen and Nebulizer treatment not on med list dated 12-15-21. There was a physician supplemental order for Oxygen 2L/Min PRN SOB on 12-15-21. There was a physician order for nebulizer machine on 12-15-21. However, there was no order for nebulizer medications. The medication list had comfort meds that did not include oxygen or nebulizer meds in the record.

Upon patient record review, 2 of 5 (Patient #4, #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #4 There was a physician order for nebulizer machine on 12-29-21. However, there was no order for nebulizer medications. Patient #5 There was a physician order for nebulizer machine on 12-15-21. However, there was no order for nebulizer medications.

Upon patient record review, 2 of 5 (Patient #3 and #5) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #3 Wheelchair and walker were observed during home visit in patients room. The clinical record did not have an order for these items nor were these on POC. Agency obtained order from MD during survey. Corrected on site. Patient # 5 The clinical record reflected the patient has wheel chair and oxygen. These items were not on POC or ordered. During survey agency obtained an MD order for these items. Corrected on site.