Every finding on record at Vistacare USA, LLC

Upon patient record review, 1 of 19 (Patient #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 7: Duplicate drug therapy on medication profile: Dulcolax 10mg suppository PRN daily as needed for constipation. Glycerin adult suppository PRN as needed for constipation. No evidence of instructions given as to which medication to give first.

Upon patient record review, 2 of 19 (Patient #9,19) 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 9: Initial bereavement risk assessment late. Admitted on 07/08/2023, assessment completed on 07/19/2023. Patient 19: Initial bereavement risk assessment late. Admitted on 04/08/2023, assessment completed on 04/14/2023.

Upon patient record review, 1 of 19 (Patient 3) 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: Volunteer services added to recert POC order, 11/01/2023. Family refused volunteer services at the time of admit and continues to refuse those services. POC updated during survey.

Upon patient record review, 1 of 19 (Patient #7) 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 7: Duplicate drug therapy Dulcolax 10mg suppository PRN daily as needed for constipation. Glycerin adult suppository PRN as needed for constipation. No evidence of instructions given as to which medication to give first.

Upon patient record review, 1 of 19 (Patient #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 11: Active stage 3 wound to sacrum. No evidence of an order to add wound care supplies to current plan of care, only wound cleanser. POC updated during survey.

Upon client record review, 11 of 19 (Patient #1,2,4,6,7,8,9,11,12,13,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Volunteer evaluation/referral no evidence of a follow up from Volunteer coordinator. All corrected on site.

Upon patient record review 3 of 19 (Patient #5,9,11) 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 5: POC has aide frequency listed at twice weekly. No evidence that 2 visits occurred for the week of 11/19, only one documented on 11/21. No missed visit note documented and no order to decrease weekly visits. Corrected on site Patient 9: POC has aide frequency listed at twice weekly. No evidence that 2 visits occurred for the week of 11/19, only one documented on 11/21. No missed visit note documented and no order to decrease weekly visits. Corrected on site Patient 11: POC has aide frequency listed at 5 times a week. No evidence that 5 visits occurred for the week of 11/19, only three visits documented for the week, 11/20,11/21,11/22. No missed visit notes documented and no order to decrease weekly visits. Corrected on site

Upon patient record review, 1 of 19 (Patient #14) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient 14: CTI narrative copied and pasted of admitted RN narrative. No evidence that narrative was an original document. MD did add that "the patient's life expectancy is 6 months or less if the illness runs its normal course" to the end of admit RN narrative.

Upon patient client record review, 5 of 19 (Patient #1,6,10,12,13) 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 1: Missed visit note entered on 11/16,11/14, 11/09, 11/08, 11/07,10/27,10/26, 10/24,10/22 not completed fully. All had "x" beside "other reason" but no information was added to tell why the visit was missed. Patient 6: Missed visit note entered on 10/24 left blank. No information was added to tell why the visit was missed. Patient 10: Missed visit note entered on 11/03 not completed fully. "x" beside "other reason" but no information was added to tell why the visit was missed. Patient 12: Missed visit note entered on 11/03 not completed fully. "x" beside "other reason" but no information was added to tell why the visit was missed. Patient 13: Missed visit note entered on 11/01 not completed fully. No information was added to tell why the visit was missed. Corrected on site