Every finding on record at Virgo Hospice, Inc.

Upon patient record review, 2 of 14 (Patient #1, 3) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient 1: Patient acknowledgement form is completely blank but is signed by the patient and the hospice staff. Does not have any boxes checked identifying whether or not bill of rights, advanced directives, informed consent and treatment was explained to or left inside the home. Patient 3: Patient acknowledgement form is completely blank but is signed by the patient and the hospice staff. Does not have any boxes checked identifying whether or not bill of rights, advanced directives, informed consent and treatment was explained to or left inside the home.

Upon patient record review, 3 of 14 (Patient #1, 3, 5) 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 1: Patient acknowledgement form is completely blank but is signed by the patient and the hospice staff. Does not have any boxes checked identifying whether or not bill of rights, advanced directives, informed consent and treatment was explained to or left inside the home. Patient 3: Patient acknowledgement form is completely blank but is signed by the patient and the hospice staff. Does not have any boxes checked identifying whether or not bill of rights, advanced directives, informed consent and treatment was explained to or left inside the home. Patient 5: No evidence that patient received a copy the Patient's Rights and Responsibilities. No evidence of signed Patient acknowledgement sheet on chart.

Upon patient record review, 2 of 14 (Patient #4,6) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 4 and 6: No evidence that an attending physician was chosen at the time of admit.

Upon patient record review, 2 of 14 (Patient #1, 3) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient 1: Patient acknowledgement form is completely blank but is signed by the patient and the hospice staff. Does not have any boxes checked identifying whether or not bill of rights, advanced directives, informed consent and treatment was explained to or left inside the home. Patient 3: Patient acknowledgement form is completely blank but is signed by the patient and the hospice staff. Does not have any boxes checked identifying whether or not bill of rights, advanced directives, informed consent and treatment was explained to or left inside the home.

Upon patient record review 2 of 14 (Patient #5,6) 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 5: HHA visits ordered twice a week on SOC POC. No evidence that aide visits have occurred since 06/28/2023. Agency policy is for all visit documentation to be completed within 7 days of completing the visit. Patient 6: Aide visits ordered twice weekly on SOC POC. No evidence that aide visits occurred between 03/24/2023 and 05/02/2023. Aid visits did not start until 05/03/2023 at twice a week frequency.

Upon patient record review 4 of 14 (Patient #1,2,3,5) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 1: Record indicates that RN supervisory visit occurred on 05/17/2023, next RN supervisory visit did not occur until 06/14/2023. No evidence that supervisory visit occurred during 05/17/2023 and 06/14/2023. Patient 2: No evidence that RN supervisory visit occurred every 14 days, last supervisory visit occurred on 06/16/2023. No evidence that a RN supervisory visit occurred between 6/17/2023 and 07/13/2023. Patient 3: No evidence that RN supervisory visit occurred every 14 days, last supervisory visit occurred on 06/21/2023. No evidence that a RN supervisory visit occurred between 6/21/2023 and 07/13/2023. Patient 5: No evidence that RN supervisory visit occurred every 14 days. No evidence that a RN supervisory visit occurred between 4/28/2023 and 05/25/2023.

Upon patient client record review, 7 of 14 (Patient #1,2,3,4,6,8,11) 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: No evidence that "Notice of non-covered items, services, and drugs" was addressed at time of admission. No evidence of effective date on election statement. Patient 2: Caregiver representative elected to receive "Notice of non-covered items, services, and drugs" addendum at the time of admission. No evidence that addendum was ever provided to caregiver at the time of admit or at any other time while on hospice. Patient 3: No evidence that "Notice of non-covered items, services, and drugs" was addressed at time of admission. No evidence of effective date on election statement. Patient 4: No evidence that attending physician was identified at the time of admit. No hospice representative signature present on election statement. Patient 6: No evidence that attending physician was identified at the time of admit. Patient elected to receive "Notice of non-covered items, services, and drugs" addendum at the time of admission. No evidence that addendum was ever provided to patient at the time of admit or at any other time while on hospice. Patient 8: No evidence of effective date on election statement. Patient 11: No evidence of effective date on election statement.

Upon patient client record review, 1 of 14 (Patient #3) 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 3: Missing signature date by hospice representative on election statement.

Upon client record review, 1 of 14 (Patient #5) 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 5: POC has SN visits weekly and RN supervisory visits every 14 days. No evidence that patient was seen by LVN or RN since 06/22/2023. No missed visits notes entered or order entered to change visit frequency.