Every finding on record at Vmed Hospice, Inc.

Upon patient record review 11 of 11 (Patient #1,2,3,4,5,6,7,8,9,10,11) 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. Patient #1,2,3,4,5,6,7,8,9,10,11 SC documented in narrative completed emotional and spiritual assessment, no assessment documented within note of assessment.

Upon client record review, 4 of 11 (Patient #3,4,5,8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3, Order frequency SN 2x/week and RN every 14 days. Only one SN visit completed the weeks of 10/9/22, 10/16/22, 10/23/22, 10/30/22 and 11/6/22. RN visit every 14 days, visits 9/20/22, 10/2/22, 11/1/22. RN visit on 10/2 should have been on 10/4/22 and missed visit the week of 10/18/22. Patient #4, Order frequency SN 1x/week, visits 7/7/20, 7/9/22, visits completed 2x/week. Patient #5, Order frequency SN 1x/week then order on 10/27/22 SN 2x/week. Visits on 10/24/22, 10/26/22, 10/29/22, visits completed 3x/week this week. Patient #8, Order Frequency 2xweek. Only 1 SN visits weeks of 9/27/22, 10/4/22, and 10/18/22.

Upon patient record review 3 of 6 applicable (Patient #5,6,7) 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, On 11/1/22 task on care plan for safety razor was not completed without documentation of reason or reporting to RN. Patient #6, On 9/15/22, 9/28/22, 10/1/22, 10/8/22, 10/26/22, Care plan states to provide incontinent care every visit, which was not completed. Patient #7, On 9/13/22, 9/28/22, 10/4/22, Aide documented bed bound/chair to bed which was not on care plan to complete.

Upon patient client record review, 8 of 11 (Patient #4,5,6,7,8,9,10,11) 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 #4, Missing MD signature on IDG, 6/29/22,7/13/22, 7/27/22, 8/10/22, 8/24/22, 9/7/22, 9/21/22, 10/5/22, 10/19/22, 11/2/22. Patient #5, Missing MD signature on IDG, 4/27/22, 5/4/22, 5/18/22, 6/1/22, 6/15/22, 6/29/22,7/13/22, 7/27/22, 8/10/22, 8/24/22, 9/7/22, 9/21/22, 10/5/22, 10/19/22, 11/2/22. Patient #6, Missing MD signature on IDG, 6/12/22, 6/15/22, 6/29/22,7/13/22, 7/27/22, 8/10/22, 8/24/22, 9/7/22, 9/21/22, 10/5/22, 10/19/22, 11/2/22. Patient #7, Missing MD signature on IDG, 3/31/22, 4/13/22, 4/27/22, 5/4/22, 5/18/22, 6/1/22, 6/15/22, 6/29/22,7/13/22, 7/27/22, 8/10/22, 8/24/22, 9/7/22, 9/21/22, 10/5/22, 10/19/22, 11/2/22. Patient #8, Missing MD signature on IDG, 8/7/22, 8/10/22, 8/24/22, 9/7/22, 9/21/22, 10/5/22, 10/19/22, 11/2/22. Patient #9, Missing MD and SC signature on IDG, 10/21/22, 11/2/22. Patient #10, Missing MD, RN, MSW, SC signature on IDG11/2/22 and MD,RN,SC signature on 11/4/22. Patient #11, Missing MD and SC signature on IDG for 6/5, 6/15 and 6/29/22.