Every finding on record at Vital Hc, Inc.

Upon patient record review, 7 of 14 (Patient #1,2,4,6,8,9,10) 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: Medication list with order for Miralax: 17 grams powder by mouth daily as needed for constipation if no bowel movement in 24 hours. There is no evidence of diluent for this medication in the medication list. COS. In addition, medication list with no evidence of oxygen 2-4 liters per minute via NC PRN listed on the profile. Patient 2: Medication list with order for Miralax: 17 grams powder by mouth daily as needed for constipation if no bowel movement in 24 hours. There is no evidence of diluent for this medication in the medication list. COS Patient 4: Medication list with no evidence of oxygen 2-4 liters per minute via NC PRN listed on the profile. Patient 6: Medication list with order for lidocaine 5 percent transdermal patch: apply one patch to affected area for 12 hours, then remove for 12 hours as needed for pain. There is no evidence of application site in the medication list. COS Medication list with order for triamcinolone 0.1 percent topical cream: apply one inch to affected area every 6 hours as needed for itching. There is no evidence of application site in the medication list. COS Patient 8: Medication list with order for Miralax: 17 grams powder by mouth daily as needed for constipation if no bowel movement in 24 hours. There is no evidence of diluent for this medication in the medication list. COS Patient 9: Medication list with order for ketoconazole 2 percent topical cream: Apply 1-2 grams topical daily for nail infection. There is no evidence of application site in the medication list. COS Patient 10: Medication list with order for ammonium lactate 12 percent: Apply topically to affected area twice daily for dry skin. There is no evidence of medication type or application site in the medication list COS

Upon patient record review, 3 of 14 (Patient #8,11,13) 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. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 8: Patient admitted 08/30/2023. Initial bereavement assessment documented 01/26/2024. Patient 11: Patient admitted 11/18/2023. Initial bereavement assessment documented 02/15/2024. Patient 13: Patient admitted 08/15/2023. Initial bereavement assessment documented 08/22/2023.

Upon patient record review, 3 of 14 (Patient #4,6,9) 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 4: Identified needs: pain, neuro/confusion; agitation; respiratory with oxygen; nutrition with aspiration precautions; risk for skin breakdown; high risk for falls. No evidence of problems, goals, or interventions on the plan of care: risk for skin breakdown. Patient 6: Identified needs: pain, anxiety, cardiac, weakness, respiratory with dyspnea and oxygen; constipation, insomnia, high risk for skin breakdown; fall, neuro/TIAs. No evidence of problems, goals, or interventions on the plan of care: oxygen, insomnia, TIAs. Patient 9: Identified needs: neuro/confusion; respiratory with dyspnea, gastrointestinal with nausea; nutrition with anorexia and aspiration; high risk for skin breakdown; falls, bleeding risk due to Plavix 75mg by mouth daily. No evidence of problems, goals or interventions on the plan of care: respiratory with dyspnea, high risk for skin breakdown; bleeding risk due to Plavix 75mg by mouth daily.

Upon patient record review, 6 of 14 (Patient #1,2,6,8,9,10) 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 1,8: Plan of care with order for Miralax: 17 grams powder by mouth daily as needed for constipation if no bowel movement in 24 hours. There is no evidence of diluent for this medication in the plan of care. COS Patient 2: Plan of care with order for Miralax: 17 grams powder by mouth daily as needed for constipation if no bowel movement in 24 hours. There is no evidence of diluent for this medication in the plan of care. COS Patient 6: Plan of care with order for lidocaine 5 percent transdermal patch: apply one patch to affected area for 12 hours, then remove for 12 hours as needed for pain. There is no evidence of application site in the plan of care. COS Plan of care with order for triamcinolone 0.1 percent topical cream: apply one inch to affected area every 6 hours as needed for itching. There is no evidence of application site in the plan of care. COS Patient 9: Plan of care with order for ketoconazole 2 percent topical cream: Apply 1-2 grams topical daily for nail infection. There is no evidence of application site in the plan of care. COS Patient 10: Plan of care with order for ammonium lactate 12 percent: Apply topically to affected area twice daily for dry skin. There is no evidence of medication type or application site in the plan of care COS

Upon patient record review, 2 of 14 (Patient #7,8) 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 7: Identified DME needs: hospital bed with alternating air mattress; overbed table. No evidence of DME on plan of care: overbed table. Patient 8: Identified DME needs: oxygen, hospital bed with alternating air mattress; overbed table, wheelchair, shower chair, hoyer lift; nebulizer. No evidence of DME on plan of care: nebulizer.

Upon patient record review, 2 of 14 (Patient #2,5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 2: SC visit frequency order is monthly and 1prn. There is evidence in the medical record of visits made: 10/16/2024, 10/30/2024, 11/06/2024, 11/21/2024. These visits are all documented as scheduled (not PRN) visits. Patient 5: SC visit frequency order is monthly and 1prn. SC visit documented in November: 11/7/24-unscheduled. No evidence of scheduled November 2024 SC visit. December: 12/19/24-unscheduled. No evidence of scheduled December 2024 SC visit.

Upon patient record review, 3 of 14 (Patient #1,2,5) 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 1,2,5: tasks on the aide care plan without frequencies: documentation of last BM; change linen COS

Upon patient record review, 5 of 14 (Patient #3,6,7,8,10) 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 3: On hospice notice of election signed 10/17/2024, addendum choice provided yes and no choices. Neither choice was made. There is no evidence of start of care date documented on hospice notice of election. Patient 6: On hospice notice of election signed 08/16/2024, addendum choice provided yes and no choices. Neither choice was made. On notice of election addendum document provided to patient: no evidence: date of request documented on form. There is no evidence of date document was furnished. Area of document titled, “non-covered items, services, drugs” is blank. Notice of election: 08/17/2024 start of care date chosen, 08/16/2024 start of care documented by the hospice. Patient 7: On hospice notice of election signed 05/02/2024, addendum choice provided yes and no choices. Neither choice was made. On notice of election addendum document provided to patient: there is no evidence of signer’s relationship or date document was signed. Document: consent for primary caregiver. No primary caregiver is named in document. Top of document: “I (print name) -area blank- agree to accept the role of primary caregiver for (print name)-patient’s name-who is requesting admission to -Hospice’s Name- program of care.” Patient 8: On notice of election addendum document provided to patient: there is no evidence of reason patient was unable to sign despite area provided on form for this documentation. Admission consent: POA signed document for patient. No reason given for patient not signing (space provided for documenting this). Notice of election: in Right to Choose Attending Physician section- both choices “I do not wish to choose an attending physician” and “my choice for attending physician is:” are chosen. Attending physician S.S. written in. No NPI or address documented. Patient 10: On hospice notice of election signed 01/29/2025, addendum choice provided yes and no choices. Neither choice was made.

Upon inpatient contract review, Contract 1 of 3, #1(Center at Val Vista) did not have evidence that the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge. Contract#1: Center at Val Vista-there is no evidence that there is a requirement in the contract that facility will provide hospice with discharge summary and copy of medical records.

Upon SNF/NF contract review, Contract 1 of 3, #1 (Center at Val Vista) did not have evidence of the manner in which the SNF/NF and the hospice are to communicate with each other and how each will document such communications to ensure that the needs of patients are addressed and met 24 hours a day. Contract #1: Center at Val Vista-there is no evidence in the contract that the facility will be required to allow hospice 24 hour access to facility.