Every finding on record at Vermel Hospice, Inc

Upon patient record review, 2 of 15 (Patient #3,5) 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 #3 - The medication profile showed patient was taking aspirin daily as a blood thinner. The plan of care did not include problems, goals or interventions related to the bleeding risk. Patient #5 - The nursing comprehensive assessment showed the patient was assessed a 6 on the Braden scale. There was no evidence of any integumentary problems, goals, or interventions.

Upon patient record review, 11 of 15 (Patient #1,2,3,4,5,7,8,9,10,11,12) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1,2,3,4,5,7,8,9,10,11,12 - The medical records showed frequency orders for the social worker and the spiritual care coordinator at "1 visit every month, recertification, and prn." A discipline's ordered visit frequency cannot include a PRN visit frequency, without a baseline frequency to support it and must include the number of PRN.

Upon patient record review, 1 of 15 (Patient #2) 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 - The medication profile showed patient was utilizing Duoneb 3/0.5 mg 1 vial neubulize every four hours as needed. The plan of care did not include a neubulizer as a DME item.

Upon patient record review, 1 of 15 (Patient #9) 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 #9 - Patient expired on 08/08/25. There was no evidence of any bereavement follow up post date of death. There is no bereavement plan of care present.

Upon patient record review 2 of 15 (Patient #1,11) 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 - The initial plan of care and the aide care plan of care dated 10/02/25, showed a frequency order for two times per week. For the weeks of 10/13/25, 10/20/25,10/27/25 and 11/3/25, the medical record showed only one visit each week. There was no evidence of an order to change frequency of those visit or no documented missed visits. Patient #11 - The initial plan of care as well as the aide plan of care dated 12/07/24, showed a frequency order for aide visits to occur three times per week. There was no evidence of any aide visits or change in frequency order.

Upon observation, there was no evidence the Emergency Plan communication plan includes all of the following: • Names and contact information for the following: • Hospice employees and Patients physicians. Corrected on site.

Upon observation, there was no evidence the Emergency Plan communication plan includes contact information for Federal and state emergency preparedness staff. Corrected on site.

Upon observation, there was no evidence the Emergency Plan communication plan must includes a primary and alternate means for communicating with hospice's employees and Federal and state emergency management agencies. There was no evidence of a list of current employees or contact information for employees. Corrected on site.

Upon patient record review, 2 of 5 (Patient #4, #5) 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 4 and 5: The comprehensive assessment and POC identify the patient at high risk for falls. There was no evidence of fall risk on the HHA POC/assignment sheet.