Every finding on record at Viaquest Hospice LLC

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, state, tribal, regional, and local emergency management agencies. • Hospice's employees - Corrected on site. Alternate communication added for personnel. • Federal, state, tribal, regional, and local emergency management agencies-Agency in process of updating these entities.

Upon patient record review, 8 of 19 (Patient #1,2,3,4,7,8,9,14) 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: The medication profile did not include Acetaminophen maximum dose warning. This patient had Acetaminophen 500mg 1 tab Q4 hr, Acetaminophen Suppository 650mg Q4hr/PRN and Hydrocodone/Acetaminophen 5-325mg TID. Additionally, during medication reconciliation at the ALF the following meds/dosages varied as follows-Hospice medication profile included: •Aquaphor 41% Ointment BID / The ALF profile indicated frequency of Q Wed, PRN soiled & Q Diaper change •Calamine Lotion /This treatment was not on the ALF profile • Haloperidol 0.5mg Q4 hr. / The ALF profile indicated frequency of Q2 hr. • Nystatin / The ALF profile indicated Nystatin 100,00 Q gram BID • Zinc Oxide 25% / The ALF profile indicated Pinxav (has zinc and other meds in the product) All Corrected on Site Patient #2: The medication profile did not include Acetaminophen maximum dose warning. This patient had Acetaminophen 500mg 2 tabs Q6 and , Acetaminophen 500mg 2 tabs Q Bedtime. Additionally, during medication reconciliation at the ALF the following meds/dosages varied as follows-Hospice medication profiled included: • Calmoseptine / The ALF profile indicated to apply PRN coccyx • Duoneb / The ALF profile indicated Duoneb 0.5/3mg 3mL Nebulizer PRN TID • Miralax 17gm with no diluent / The ALF profile indicated 1/2 cap or 8.5g gel cap • Morphine 0.25mL Q1h / The ALF profile indicated dosage and frequency of 0.5 mL and PRN • Oxycodone 10 mg / The ALF profile indicated dosage of 5mg • Potassium Cl 20 MEQ BID / The ALF profile indicated frequency of QD • Visine 1% eye gtts / The ALF profile indicated Artificial Tears 1.4% • Zinc oxide 40% / The ALF profile did not include this medication All Corrected on site Patient #3: The medication profile did not include Acetaminophen maximum dose warning. This patient had Acetaminophen 325mg 2 tabs Q4 and , Acetaminophen 325mg 2 tabs PRN and Hydrocodone 5-325mg Q8. Additionally, during medication reconciliation at the ALF the following meds/dosages varied as follows-Hospice medication profile included: • Bisacodyl 10mg QD / The SNF profile indicated frequency and instructions of Q3 days after MOM ineffective • Magnesium Hydroxide 10mL / The SNF profile did not include this medication • Acetic Acid 25% irrigation solution BID / The SNF profile did not include this treatment All meds Corrected on Site Patient #4: The medication profile did not include Acetaminophen maximum dose warning. This patient had Acetaminophen 325mg 2 tabs Q4. All meds for this patient Corrected on Site (COS) with clarification orders/updates to medication profile. Patient #7: The medication profile indicated Nitroglycerin 0.4 mg SL "as directed". There was no dose frequency (e.g. PRN) or maximum dosage amount. Corrected on Site with clarification orders on 8/21/25. Patient #8: Medication profile did not include Acetaminophen maximum dose warning. This patient had Acetaminophen 325mg 2 tabs Q6 PRN and Acetaminophen Suppository 650 mg Q4 PRN. Additionally, the Miralax 17 gm did not include a diluent. Corrected on Site with clarification orders. Patient #9: Medication profile did not include Acetaminophen maximum dose warning. This patient had Acetaminophen Suppository 650mg Q4 PRN. Corrected on Site with clarification orders. Patient #14: The plan of care did not include Acetaminophen maximum does warning. This patient had Acetaminophen 325mg 2 tabs Q6 PRN and Acetaminophen 500mg 2 tabs BID. Corrected on Site with clarification orders.

Upon patient record review, 5 of 19 (Patients #4,10,13,17,18) 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: Patient start of care was 4/23/25. The bereavement risk assessment was completed by the BC on 4/30/25. Per nursing comprehensive, the bereavement risk assessment was checked "yes" as completed. However, there was no scoring of "low, moderate or high risk." Patient #10: Patient start of care was 3/31/25. The bereavement risk assessment was completed by BC on 7/7/25. Per nursing comprehensive. the bereavement risk assessment was checked "yes" as completed. However, there was no scoring of "low, moderate or high risk." Patient #13: Patient start of care was 12/24/24. The bereavement risk assessment was completed by BC on 8/7/25. Per nursing comprehensive, the bereavement risk assessment was checked "yes" as completed. However, there was no scoring of "low, moderate or high risk." Patient #17: This patient did not have an initial bereavement risk assessment in the clinical record to date. Patient# 18: Patient start of care was 7/28/23. The bereavement risk assessment was completed by BC on 5/23/24. Per nursing comprehensive, the bereavement risk assessment was checked "yes" as completed. However, there was no scoring of "low, moderate or high risk."

Upon patient record review, 2 of 19 (Patients #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 nursing comprehensive showed evidence that the patient is a diabetic and is taking an oral anti-diabetic medication. There was no evidence of problems, goals, or interventions related to the Endocrine system. Corrected on site. Plan of care updated. Patient #5: The nursing comprehensive showed evidence that the patient is a diabetic and is taking an oral anti-diabetic medication and insulin sub-Q per sliding scale. There was no evidence of problems, goals, or interventions related to the Endocrine system. Corrected on site. Plan of care updated.

Upon patient record review, 6 of 19 (Patients #3,5,10,11,12,13) 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. Patients #3,5,10,12,13: The plan of care indicated "volunteer for companionship." These orders did not indicate a visit frequencies. Corrected on Site with clarification orders on 8/21/25. Patient #11: The Chaplain plan of care reflected visit frequency from 1or 2 per month and 10 PRN (5/23/25). There have been no PRN visits for this discipline and record does not indicate a need for 10 PRN's.

Upon patient record review, 8 of 19 (Patients #1,2,3,4,7,8,9,14) 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: The plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen 500mg 1 tab Q4 hr, Acetaminophen Suppository 650mg Q4hr/PRN and Hydrocodone/Acetaminophen 5-325mg TID. Corrected on Site with clarification orders. Patient #2: The plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen 500mg 2 tabs Q6 and , Acetaminophen 500mg 2 tabs Q Bedtime. Additionally, the Miralax 17 gm did not include a diluent. Corrected on Site with clarification orders. Patient #3: The plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen 325mg 2 tabs Q4 and , Acetaminophen 325mg 2 tabs PRN and Hydrocodone 5-325mg Q8. Corrected on Site with clarification orders. Patient #4: The plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen 325mg 2 tabs Q4. Corrected on Site with clarification orders. Patient #7: The plan of care indicated Nitroglycerin 0.4 mg SL "as directed". There was no dose frequency (e.g. PRN) or maximum dosage amount. Corrected on Site with clarification orders on 8/21/25. Patient #8: plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen 325mg 2 tabs Q6 PRN and Acetaminophen Suppository 650 mg Q4 PRN. Additionally, the Miralax 17 gm did not include a diluent. Corrected on Site with clarification orders. Patient #9: The plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen Suppository 650mg Q4 PRN. Corrected on Site with clarification orders. Patient #14: The plan of care did not include Acetaminophen warning of NTE 3gm/24 hours. This patient had Acetaminophen 325mg 2 tabs Q6 PRN and Acetaminophen 500mg 2 tabs BID. Corrected on Site with clarification orders.

Upon patient record review, 8 of 19 (Patients #1,2,3,4,7,8,9,10) 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 equipment and supply needs. Patient #1: This patient had a bed and shower chair. These were not included on the Plan of Care. Corrected on Site (COS) updated order obtained 8/21/25. Patient #2: This patient had a rollator. This was not included on the Plan of Care. COS updated order obtained 8/21/25. Patient #3: This patient had a bed-side table and Hoyer lift. These were not included on the Plan of Care. COS updated order obtained 8/21/25. Patient #4: This patient had a bed-side table and guard-rail. This was not included on the Plan of Care. COS updated order obtained 8/21/25. Patient #7: This patient had a cane. This was not included on the Plan of Care. COS updated order obtained 8/21/25. Patient #8: This patient had a bed-side table, wheel chair and non-invasive ventilator. These were not included on the Plan of Care. COS updated order obtained 8/21/25. Patient #9: This patient had a cane, walker, APP overlay, chair lift and raised toilet seat. These were not included on the Plan of Care. COS updated order obtained 8/21/25. Patient #10: This patient had a cane and walker. These were not included on the Plan of Care. COS updated order obtained 8/21/25.

Upon patient record review 2 of 19 (Patients #1,2) 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 Patient #1:The Aide care plan indicated to assist with feeding, "if needed." There is no documentation in the record indicating the patient is functionally and cognitively able to make the choice. Patient #2: The Aide care plan indicated toileting, bed bath, shower, dressing and shampoo "per patient request" and empty urinal bag "PRN." There is no documentation in the record indicating the patient is functionally and cognitively able to make the choice.

Upon contract review, 1 of 4 ( Complete Therapy PT/OT/ST contract) did not have evidence the agreement to furnish any services under arrangement included that the hospice must retain administrative and financial management, and oversight of staff and services for all arranged services, to ensure the provision of quality care. Arranged care/services are supported by written contract/agreement that requires all care/services are: • Furnished in a safe and effective manner by qualified personnel

Upon client record review, 1 of 19 (Patient #16) did not have evidence that the discharge summary includes all required information as follows: • The patient's latest physician discharge orders

Upon patient record review, 5 of 19 (Patients #4,7,9,16,18) did not have evidence in the patient record that the interdisciplinary group, as part of the review of the plan of care, determines the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. If the patient and/or family are not capable of safely administering drugs and biologicals in the home, the hospice must address this issue in the patient's plan of care. Patients #4,7,9,16,18: There was no IDG assessment noting the ability of the patient/caregiver ability to safely administer medications in the home.

Upon patient record review, 1 of 19 (Patient #3) did not have evidence that the hospice provided the following information to SNF. Patient #3: The following items were not in patients chart at the SNF: • The most recent hospice plan of care specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient