Every finding on record at Unique Hospice Care Inc.

Upon patient record review 5 of 14 (Patient #4,6,7,8,14) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient #4,6,7,8,14, Bill of rights did not have signature confirming they received a copy of the patient's rights.

Upon patient record review, 3 of 14 (Patient #1,3,13) 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 #1,3,13, order states oxygen 2-5l/nc, documented under DME and not on the medication list.

Upon patient record review, 7 of 14 (Patient #4,8,9,10,11,12,14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #4,8,9,10,11,12,14, Bereavement assessment was incomplete stating patient declined this service.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #6, RN visit 7/5/23, RN visit 7/21/23. RN visit was 16 days between, no comprehensive assessment updated within 15 days.

Upon patient record review, 6 of 14 (Patient #1,2,3,6,8,11) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1,2,6,11, no MSW or SC care plan. Patient #3,8, no MSW care plan.

Upon patient record review, 2 of 14 (Patient #11,12) 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 #11,12, No DME documented on POC.

Upon client record review, 13 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,12,13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1,2,3,4,5,6,7,8,9,10,11,12, no orders for SW tele visits that were preformed. Patient #1, SN frequency 1x/week , patient seen 7/25/23, 7/28/23, patient seen twice in the first week. Patient #7, SN frequency 1x/week, patient seen 7/5/23 and 7/8/23, patient seen twice in the first week. Patient #8, SN frequency 1x/week, patient seen 7/4/23 and 7//8/23, patient seen twice in the first week. Patient #11, SN frequency 1x/week, patient seen 7/25/23 and 7/29/23, patient seen twice in the first week. Patient #13, SN frequency 1xweek, patient seen 3/7/23 and 3/10/23, patient seen twice in this week.

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. Patient #1, RN washed hands in sink and turned off the handle without a paper towel and had re contaminated her hand. RN wheeled bag across street, upon entering home, RN place wheeled bag on table with paper barrier. Patient #2, RN removed gloves and replaced with new gloves without sanitizing hands before placing new gloves. Patient #3, RN washed hands, placed gloves on and went in and out of bag with gloves.

Upon patient record review 2 of 14 (Patient #1 and 12) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1, Aide ordered 1x/week then order for service for aide was declined on 7/25/23. Patient was seen 7/27/23, 8/4/213, 8/11/23 without orders. Patient #12, Aide frequency 1x/week, no visit the first week was completed. Aide care plan states to tidy room, this task was not completed on 7/10/23.