Every finding on record at Vista Hospice Care, LLC

Upon patient record review, 1 of 19 (Patient 9) 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 #9: Medication order for comfort medications are not included on the medication profile to include special instructions for what comfort medication to give for effectiveness: Morphine Instructions: Use second for SOB if Oxygen is ineffective after 5 minutes. Call Hospice if ineffective after 30 minutes

Upon patient record review, 1 of 19 (Patient #8) 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 #8: SW and SC were declined however there are interventions and goals on POC without current orders for those disciplines

Upon patient record review, 5 of 19 (Patient #6,7,10,12,18) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6 1/2/25 order states "TB test to be drawn", no evidence that nursing performed test nor collected findings. Patient #7 SN order effective 12/12/24 1w1, 2w2, 4 prn, Visits 12/12/24, 12/19, 12/22- no second visit performed in week #2 no evidence of a missed visit. Patient #10 MSW is ordered effective 11/18/24, 1m1, 3m1, 2m1 visits occurred 11/8/24, missed visit-11/23, 12/23, missed visit-12/31, 1/15. MSW did not perform a third visit for Dec. No evidence of missed visits. Patient #12 On SN visit 11/9/24, 11/13, 11/20 no vital signs were documented or O2 sat noted. POC dated 11/8/24 orders SN to collect pulse ox q visit Patient #18 SC order effective 1/24/25 1m1, 2m1 however SC did the January visit on 1/20/25 and did not denote a missed visit after 1/24/25 for January visit.

Upon patient record review, 2 of 19 (Patient #7,9) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #7 12/19/24 SNV denoted patient refused care, no notice to MD. Patient #9 1/23/25 SNV documented observation of patient with hematoma to forehead. SN notified son, no documentation in SN note that physician was notified or new orders obtained

Upon patient record review 5 of 19 (Patient #6,11,12,13,15) 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 #6 Aide order effective 12/12/24 2w1, 4w2, 2w1 only one visit performed first week on 12/12/24 no evidence of missed visit Patient #11 On 1/21/25, 1/23, 1/28, 2/4 aide did not perform shaving that is assigned q visit on aide care plan dated 1/4/24 Patient #12 On aide visits 1/29/25 and 1/31 linens were changed but aide care plan dated 1/29/25 assigns change once week therefore aide performed too frequently. Patient #13 On aide visit 11/2/25 aide did not perform shower, shampoo or hair care but it was on aide care plan dated 10/25/24 Patient #14 On aide visit 11/26/24 aide did not perform shower, shampoo or hair care with is assigned q visit on aide care plan dated 9/16/24

Upon patient record review 1 of 19 (Patient #6) 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 #6: RN supervision of the aide not timely 12/12/24 then 12/27/24 which is 15 days.

Upon patient record review, 8 of 16 applicable records (Patient #1, #3, #4, #5, #8, #10 ,#11 ,#12 ) 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. Patient 1: On 1/13/2022 the medication profile contained Nitrostat 0.6mg SL as needed, there was no evidence of a reason for the PRN. Corrected on site. Patient 3: On 1/13/2022 the medication profile contained Miralax 17 GM. There was no evidence of a diluent. On 1/25/2022 the medication profile contained Triamcinolone topical cream thin layer to affected area. There was no evidence of location of affected area. Both items were corrected on site. Patient 4: On 8/9/2021 the medication profile contained O2 4l continuous. There was no evidence of a route. On 8/9/20201 contained Polyethylene glycol 17 GM. There was no evidence of a diluent. Both were corrected on site. Patient 5: On 9/5/2021 the medication profile contained O2 2L as needed. There was no evidence of a route. Corrected on site. Patient 8: On 2/14/2022 the medication profile contained Miralax 17GM po. There was no evidence of a diluent. Corrected on site. Patient 10: On 10/8/2021 the medication profile contained Miralax 17 GM oral daily. There was no evidence of a diluent. Corrected on site. Patient 11: On 9/8/2021 the medication profile includes O2 continuous. There was no evidence of a route. Corrected on site. Patient 12: On 9/21/2021 the medication profile includes Medical oxygen 2L PRN. There was no evidence of a route. Corrected on site.

Upon patient record review, 1 of 16 applicable records (Patient #13) 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. Patient 13: Patient was admitted 1/16/2022. The record indicates the bereavement assessment was not completed until 2/5/2022.

Upon patient record review, 5 of 16 applicable records (Patient #5, #6, #9, #10, #13) 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 #5: Patient admitted with Parkinson's disease, the record demonstrated the patient having tremors, incontinent of bowel and bladder, drooling and with swallowing issues, the nurse was providing education related to aspiration. There was no evidence of problems identified related to the patients neurological disease. In addition no problems related to nutrition/dietary/skin or incontinence. Corrected on site. Patient 6: On admission diagnosis was Cerebral Atherosclerosis, 12/28/2021 diagnosis changed to Cardiac disease. There was no evidence in the care plan containing a problem/ interventions/plan for cardiac. Corrected on site. Patient 9: On admission patient had recent history of fall with sub arachnoid hematoma. On assessment note included 1-2 falls in past 3 months, balance poor, 1-2 high risk meds in use, and a fall risk score of 16. There was no evidence of problem/interventions in the care plan for fall risk. Corrected on site. Patient 10: Patient has diagnosis of bone cancer, recent history of a fall with fracture, fall risk score of 16. There was no evidence of problem/interventions in the care plan for fall risk. Corrected on site. Patient 13: Patient admitted 1/16/2022 with terminal diagnosis of Malignant neoplasm of brain, history of seizures. There was no evidence in the Plan of care for a problem/interventions for Neuro. Corrected on site.

Upon patient record review, 8 of 16 applicable records (Patient #1, #2, #3, #4 , #8, #10, #11, #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. Patient1: On 1/3/2022 the medication profile contained Nitrostat 0.6mg SL PRN, there was no evidence of a quantifier for the medication. This was corrected on site. Patient 2: On 2/19/22 the SN made the HHA visit. Documented Spouse removed dressing, patient requested it be left open to air. There was no evidence of an order to leave the wound open to air. Corrected on site. Patient 3: On 1/13/20200 the medication profile contained Miralax 17 GM daily. There was no evidence of diluent included in instructions. Dated 1/25/2022 the medication profile contained Triamcinolone 1% topical cream thin layer to affected area. There was no evidence of affected area for application. Both were corrected on site. Patient 4: The medication profile dated 8/9/2021 contains O2 4L continuous, there was no evidence of a route of administration. Dated 8/9/2021 contains an order for Polyethylene glycol. There was no evidence of a diluent. Both items were corrected on site. Patient 8: On 2/14/2022 the medication profile includes Miralax 17GM. There was no evidence of a diluent. Corrected on site. Patient 10: On 10/8/2021 the medication profile includes Miralax 17GM PO daily. There was no evidence of a diluent. Corrected on site. Patient 11: On 9/8/2021 the medication profile includes O2 continuous. There was no evidence of a route. Corrected on site. Patient 12: On 9/21/2021 the medication profile includes Medical oxygen 2L PRN. There was no evidence of a route. Corrected on site.

Upon patient record review, 2 of 13 applicable records (Patient #3, #9) did not have evidence in the patient record that hospice aide assignments and duties specifically indicate what tasks are to be done by the Aide and the frequency of these tasks. Patient 3: The aide plan of care indicated to shower every visit and to provide a bed bath at every visit if unable to shower. Corrected on site. Patient 9: The records indicate the patient fell prior to admission and sustained a sub arachnoid hematoma. In the Nursing Start of care assessment the patient had a fall risk scale of 16. There was no evidence in the care plan for fall risk. Corrected on site.

Upon patient record review 4 of 13 applicable records (Patient #1, #8, #12, #13) 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: Aide Plan of care dated 2/9/22 indicated to change linens and shave patient at every visit. For the date of 2/9 the aide documentation revealed the task was not done, per frequency not needed. For the dates of 2/14, 2/16 and 2/21 the task of shave patient at every visit revealed the task was not done, per frequency not needed. Patient 8: Aide care plan dated 1/1/2022 orders all tasks each visit. The aide charted on 1/6/2022 for oral care and nail care, per frequency not needed this visit. On 1/22/2022 the aide charted for oral care, per frequencies not needed this visit . Patient 12: Aide plan of care dated 9/20/2021 orders all tasks every visit. The aide charted on 1/11, 1/13, 1/18, 1/25, 1/27 and 2/2, per frequency not needed on tasks turn position in bed, transfer chair to bed, transfer bed to chair, and bed bath. Patient 13: The Home Health Aide plan of care on admission orders all tasks every visit. The aide charted on 1/27/2022 shampoo, per frequency not needed this visit.

Upon patient client record review, 1 of 16 applicable records (Patient #5) did not have evidence that each patient record contains Advance Directives. Patient 5: Admission legal paperwork stated there was an Advance directive. There was no evidence of an Advance directive. Corrected on site.

Upon patient client record review, 3 of 16 applicable charts (Patient #4, #10, #12) 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. Patient 4: On the third benefit period plan of care there is an order for MSW EOW start 3/1. There was no evidence of a policy supporting this abbreviation. Patient 10: The patient is female gender per other components of the chart. Leadership staff confirmed the patient was female. Certificate of terminal illness dated 12/28/2021 begins with 92 year old female, then documentation changes to He now weighs, He's sleeping 18-22 hours, His daughter reports, He has increasing frequency of bowel incontinence, He recently pulled out the blood sugar monitor. Corrected on site. Patient 12: On 2/17/2022 Order for Chaplin and Social Worker states EOW starting 3/1/2022 in the description. There was no evidence of a policy supporting this abbreviation.