Every finding on record at Unique Care Hospice Inc

Upon patient record review, 1 of 6 (Patient #4) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #4: The record indicates that per bereavement plan of care a call was due to bereaved in June and August of 2024. There is no evidence of call being made in record. The Bereavement Coordinator was contacted by agency staff and she indicated calls were made on 6/25/24 and 8/23 but had not yet been documented. Corrected on site by late entry documentation.

Upon patient record review, 2 of 6 (Patient #1,#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 Patient #1: There is no evidence in the record that the notice of rights form or the election statement were signed by family/patient. The record indicates forms were signed by a caregiver that work in ALF. Patient does have a daughter that is actively involved in care. Corrected on site. Patient #2: There is no evidence in the record that the notice of rights form or the election statement were signed by POA. The record indicates forms were signed by a caregiver that work in ALF. Patient does have a granddaughter that is actively involved in care and is legal POA. Corrected on site.