Every finding on record at Virtue Hospice and Palliative Care Inc

Upon patient record review 9 of 14 (Patients #1, 2, 3, 5, 6, 7, 8, 9, 10) 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. Patients #1, 2, 3, 5, 6, 7, 8, 9, 10: Although the RN performed a screening for spiritual care, the initial nursing assessment did not include elements of the spiritual care initial assessment including but not limited to spiritual beliefs and rituals, as well as the nature and scope of spiritual concerns and needs.

Upon patient record review, 6 of 14 (Patients #1, 3, 4, 6, 8, 9) 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: The patient is admitted for diagnosis of cerebral infarct. Related diagnosis include HTN, unspecified heart failure, type 2 diabetes and hyperlipidemia. The patient plan of care does not include interventions or goals for cardiac. The patient sees the MSW, though there are no interventions or goals for the MSW. Patient #3: The patient was admitted for Breast Cancer. She is also on aspirin prophylactically for prevention of stroke. There are no interventions or goals related to bleeding precautions and anti coagulant therapy on the plan of care. There are no interventions or goals for the symptoms/needs related to Breast cancer. Patient #4: The patient is on service for heart failure. He is prescribed Morphine for frequent pain that reaches a level 6 frequently throughout day. There are no interventions or goals for pain on the plan of care. Patient #6: The patient was on service for pancreatic cancer. She has atrial fibrillation and takes Plavix. She experiences frequent nausea and vomiting. There are no interventions or goals for Cardiac, Pain, Pancreatic cancer, or for nausea and vomiting. There are no interventions or goals related to bleeding precautions and anti coagulant therapy on the plan of care. Patient #8: The patient was on service with cerebral infarct. She also was prescribed Eliquis. There are no interventions or goals related to bleeding precautions and anti coagulant therapy. There are no interventions or goals related neuro and the primary diagnosis. Patient #9: The patient was on service with Cerebral infarct. There are no interventions or goals related to neuro and primary diagnosis of Cerebral infarct. The patient takes Ibuprofen and Robaxin prn for pain. There are no interventions or goals related to pain. She is also on aspirin prophylactically for prevention of stroke. There are no interventions or goals related to bleeding precautions and anti coagulant therapy on the plan of care.

Upon client record review, 9 of 14 (Patients #1, 2, 3, 5, 6, 7, 8, 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. Patients #1, 2, 3, 5, 6, 7, 8, 9, 10: There was no evidence in the patient record of collaboration in IDG for Spiritual Care. There are no SC signatures on IDT meeting notes for each patient to show evidence the plan of care was reviewed, revised as needed for patients.

Upon patient record review, 3 of 14 (Patients #3, 5, 7) 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 #3: On 09/10/25, patient reported difficulty sleeping and increased anxiety as well as pain. Tramadol was discontinued and Dilaudid was started. There is no change in the plan of care to reflect insomnia, anxiety, or change in pain medications. Patient #5: On 11/10/24, patient complained of congestion and cough. Promethazine was ordered for cough. There is no update to the plan of care to include interventions or goals related to cough. On 12/02/24 the patient complained of increasing joint pain in bilateral lower extremities. There was no update to the plan of care to address change in patient status and change in medication.. On 12/28/24, the patient was started on Diflucan for a reported yeast infection. There were no interventions of goals added to the plan of care for infection. Patient #7: The patient had an order placed to initiate continuous care due to actively dying on 02/09/25. There were no interventions or goals added to the plan of care for continuous care or for imminent death.

Upon patient record review, 1 of 14 (Patient #1) 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: The Aide assignment did not have frequencies for complete bed bath, shampoo, comb hair, mouth care, clean and file nails, pericare, mobility assist, passive ROM, change linens, straighten patient area. This Aide assignment was corrected during survey.

Upon patient record review, 2 of 11 (Patient #1, #7) 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 medical record contains nursing documentation identifying patient use of oxygen. There was no evidence of oxygen listed on the medication profile. Corrected on site. Patient #7: The medical record contains incomplete Medication profile, missing indications for all medications.

Upon patient record review, 7 of 11 (Patient #1, #2, #3, #5, #6, #7, #11) 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: The medical record contains nursing documentation on admission identifying patient use of a oxygen, oxygen tanks, ventilator, transfer bed/chair, and nebulizer . There was no evidence of the oxygen, oxygen tanks, ventilator, transfer bed/chair, and nebulizer included as equipment on the plan of care or in the DME list. Corrected on site. Patient #2: The medical record contains nursing documentation on admission identifying patient use of a walker and wheelchair. There was no evidence of the walker and wheelchair included as equipment on the recertification plan of care or in the DME list. Corrected on site. Patient #3: The medical record contains nursing documentation on admission identifying patient use of a walker. There was no evidence of the walker included as equipment on the plan of care or in the DME list. Corrected on site. Patient #5: The medical record contains nursing documentation on admission identifying patient use of a oxygen and wound supplies. There was no evidence of the oxygen and wound supplies included as equipment or supplies on the DME and supplies list. Patient #6: The medical record contains nursing documentation on admission identifying patient use of a wheelchair. There was no evidence of the wheelchair included as equipment on the plan of care or in the DME list. Patient #7: The medical record contains nursing documentation on admission identifying patient use of a cane and walker. There was no evidence of the cane and walker included as equipment on the plan of care or in the DME list. Patient #11: The medical record contains nursing documentation on admission identifying patient use of a wheelchair and walker. There was no evidence of the wheelchair and walker included as equipment on the plan of care or in the DME list.

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: Equipment (blood pressure cuff, stethoscope) was contaminated after dropping on the floor and was not disinfected properly. Hand sanitizer was used to clean equipment and manufacturers instructions does not note that product can be used on equipment. Instructions state "Place product on hands to cover all surfaces. Rub hands together until dry. For use when soap and water are not available." Clean and dirty areas were not designated during home visit. Patient 3: Clinician wore stethoscope around neck for entirety of visit, it touched both designated clean and dirty areas multiple times. Clinician cleaned equipment and put in designated clean area and put dirty cleaning wipe on cleaned equipment.