Every finding on record at Vistacare USA, LLC

Upon patient record review 4 of 19 (Patient #10, #11, #12,#14) 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 10: Plan of care has hospice aide visits ordered at 2 times a week. No evidence that aide visits occurred during week 1, 06/08/2023 and 06/10/2023. Patient 11: Plan of care has hospice aide visits ordered at 4 times a week. No evidence that aide visits occurred during week 1, 08/10/2023-08/12/2023. No evidence that a missed visit note was entered or that an order was obtained to change frequency. Patient seen by the hospice aide on 08/15/2023, 08/17/2023, 08/18/2023 on week 2. Patient 12: Plan of care has hospice aide visits ordered at 4 times a week. Hospice aide visits were completed twice week 1, on 06/29/2023 and 06/30/2023. No evidence that a missed visit note was entered or that an order was obtained to change frequency. During week 3, hospice aide visits were completed on 07/11/2023, 07/12/2023, and 07/13/2023. Patient 14: Plan of care has hospice aide visits ordered at 4 times a week. No evidence that aide visits occurred during 8/11/2023-08/12/2023.

Upon patient client record review, 1 of 19 (Patient #2) 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 2: Caregiver elected to receive "Notice of hospice non-covered items, services, and drugs" at the time of admit. No evidence that addendum was provided to caregiver. Corrected on site.

Upon patient client record review, 3 of 19 (Patient #6, #9, #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 6: Verbal certification obtained from patient's attending physician at the time of admit, 05/15/2023. Attending CTI was generated. No evidence that the CTI was signed by the attending at the time of survey. Agency has policy that all doctors have 30 days to sign orders. Patient 9: Verbal certification obtained from patient's attending physician at the time of admit, 05/19/2023. Attending CTI was generated. CTI was signed by the attending on 08/22/2023. Agency has policy that all doctors must sign orders within 30 days. Patient 13: On recertification CTI narrative for 2nd BP, MD states that patient admit diagnosis is Alzheimer's. Hypertension heart disease listed as admit diagnosis on patients POC, Alzheimer's listed as not related to terminal illness on POC.