Every finding on record at V Care Hospice Services of Illinois

Upon patient record review, 8 of 19 (Patient #1,2,3,4,7,8,9,10) 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 1,2,7,8,9,10: The medication profile lists Tylenol 650mg rectal every 4 hours as needed and Tylenol 650mg oral ordered every 4 hours as needed, the dose for each order does not state a limit on the amount of Tylenol that can be given in a 24 hour period. Patient1: Upon home visit, the hospice medication profile lists metoprolol succinate ER 50mg on the SNF there is an order for Metoprolol Tartate 50mg, these medications do not match. Corrected on site. Patient 3: Upon home visit, the hospice agency has Zofran 4mg every 8hrs prn on the medication profile, the SNF does not have this on the medication profile. Corrected on site. Patient 4: Upon home visit, the patient has O2 2lpm nc as need on the hospice medication profile, there is no evidence that the patient has an oxygen concentrator in the home, caregiver stated that patient refused oxygen and the DME took it back. Corrected on site. Patient 12: There is MiraLAX 17grams on medication profile, however there is no diluent for the medication.

Upon patient record review, 7 of 19 (Patient #1,2,7,8,9,10,12) 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 medications and treatments. Patient 1,2,7,8,9,10: The orders for Tylenol 650mg rectal every 4 hours as needed and Tylenol 650mg oral ordered every 4 hours as needed, the dose for each order does not state a limit on the amount of Tylenol that can be given in a 24 hour period. Patient 12: There is an order for MiraLAX 17grams, there is no diluent for the medication.

Upon patient record review, 3 of 19 (Patient #2,7,8) 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 2: In the patient record there is documented a need for a nebulizer, low air loss mattress, Hoyer lift, wheelchair cushion, these items are not on the plan of care. Patient 7: The RN documented “Pt. up to Broda chair”, there is not a Broda chair on the plan of care. Patient 8: There is documentation in the patient chart of a Hoyer lift, Broda chair, 2 wedges, floor mat, these items are not on the POC.

Upon patient record review, 1 of 19 (Patient #4) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 4: On IDG note 6/11/25 the RN documented” at risk for skin integrity”. This risk for skin breakdown is not on the plan of care. Corrected on site.

Upon client record review, 4 of 19 (Patient #1,3,5,11) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 1: On 6/30/25 the RN documented, “applies foam dressing to her lower back as a preventative measure". The hospice plan of care does not include a risk for skin breakdown. On the SNF plan of care there is an order for bilateral heel lifts to be worn when in bed, the heel lifts are not on the hospice POC. The SNF plan of care states, “use resting splint to left hand contracture", the splint is not on the hospice plan of care. Corrected on site. Patient 3: In the patient record there is documentation, “pt. is bedbound, she is unwilling to leave her bed , she has a new skin tear on her right upper arm and continues to be a risk of skin breakdown” there is no risk of skin breakdown on the plan of care. Corrected on site. Patient 5: There is documentation in the patient chart that the patient is at risk for falls and skin breakdown, there is no risk of falls or risk of skin breakdown on the plan of care. Corrected on site. Patient 11: On the RN initial assessment the RN documented, “Pt. uses wheelchair and 2 assist", there is no risk of falls on the plan of care. On the RN assessment there is documentation of three wounds with wound care ordered, the wound care is not on the plan of care. Corrected on site.

Upon patient record review 1 of 12 (Patient #1) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 1: There was no evidence of a psychosocial assessment completed.

Upon patient record review, 4 of 12 records (Patient #2, #7, #8, #10) 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 2: Medication profile dated 6/3/2022 includes Clotrimazon external cream 1%, 1 app daily wound care apply to affected area. There was no evidence of an area identified. Corrected on site. Patient 7, 8, 10: Medication profile included Miralax. There was no evidence of a diluent. Corrected on site.

Upon patient record review, 1 of 12 records (Patient #1) 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 1: There was no evidence of a bereavement assessment completed within 5 days of SOC.

Upon patient record review, 1 of 12 records (Patient #7) 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 7: Patient identified as high risk for falls on SOC assessment, there was no evidence of a fall risk care plan. Corrected on site.

Upon patient record review, 4 of 12 records (Patient #2, #7, #8, #10) 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 2: POC order dated 6/3/2022 includes Clotrimazon external cream 1%, 1 app daily wound care apply to affected area. There was no evidence of an area identified. Corrected on site. Patient 7, 8, 10: Care plan included Miralax. There was no evidence of a diluent. Corrected on site.

Upon client record review, 3 of 12 records (Patient #2, #9, #10) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient 2: POC updates on 6/7/2022 and 6/29/2022. Per DCPS notes IDG was held on 6/15/2022, and can show a SC note in system. There was no evidence of a POC update every 15 days. Patient 9: POC update recorded in EMR on 1/21/2022 and 2/9/2022- 19 days apart. There was no evidence of a POC update every 15 days. Patient 10: POC update recorded in EMR on 11/23/2021 and 12/15/2021- 22 days apart. There was no evidence of a POC every 15 days.

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: HV with RN, who has religious exemption for Covid 19 vaccine. Per Agency policy required to wear N95 masks with all patient care. The RN wore a standard mask, not a N95. There was no evidence hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient 12: HV with MSW. The MSW did not use hand sanitizer or wash hands prior to or upon entering pts room. There was no evidence hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions.

Upon patient record review, 5 of 12 records (Patient #1, #4, #5, #7, #11) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 1, 4, 5, 7, 11: On RN SOC assessment pt. is high risk for falls. There is no evidence of fall precautions on the HHA POC. Corrected on site for active patients.

Upon patient client record review, 1 of 12 records (Patient #7) 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. Patient 7: EMR states pt SOC as 3/21/2022. All consents and Admission assessment occurred on 3/22/2022. There was no evidence of an appropriately authenticated SOC date. Corrected on site.

Upon client record review, 1 of 1 applicable records (Patient #9) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient 9: Pt revoked as felt was improving and no longer needed Hospice services. There was no evidence of a discharge summary.

Upon personnel record review, 1 of 7 applicable records (Personnel #1) did not have evidence of criminal background checks being obtained in accordance with state requirements. In the absence of state requirements, criminal background checks are obtained within three months of the date of employment for all states that the individual has lived or worked in the past 3 years. Personnel 1: There was no evidence of a criminal background check.