Every finding on record at Wellness Proxy Resources, LLC

Upon patient record review, 1 of 14 (Patient #11) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #11 - On the Election of Hospice Benefit form, page 5 of 6 contained a section labeled "Right to Choose Attending Physician". This section was left blank and did not contain patient choice of electing or not electing their choice of attending physician.

Upon patient record review 1 of 14 (Patient #8) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #8 - Patient was admitted on 06/18/25. There is no evidence that the chaplain contacted patient to complete the spiritual care comprehensive assessment until 07/29/25.

Upon patient record review 2 of 14 (Patient #3,8) 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 #3 - Patient was admitted on 10/02/25. On 10/04/25, the spiritual care coordinator made contact with the patient to schedule a comprehensive assessment. Patient declined spiritual care. There was no evidence of the components of the spiritual assessments completed by the RN or MSW. Patient #8 - Patient was admitted on 06/18/25. There is no evidence of a spiritual comprehensive assessment completed. The nursing comprehensive dated 06/18/25 and the psychosocial comprehensive dated 06/23/25, both indicated that the chaplain would perform this assessment. The medical record showed the chaplain made a call to the patient on 07/29/25, where the patient ultimately refused spiritual care.

Upon patient record review, 1 of 14 (Patient #4) 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 #4 - The medication profile contained Tylenol 650 mg take twice daily, along with Tylenol 325 mg take 2 tabs every 4 hours as needed. There was no evidence that a daily maximum acetaminophen dose was listed.

Upon patient record review, 3 of 14 (Patient #3,4,8) 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 #3 - The nursing comprehensive dated 10/02/25, the MSW comprehensive dated 10/06/25, and the Spiritual Care comprehensive dated 10/06/25, did not include an initial bereavement assessment. There is no other evidence in the medical record that this was completed. Patient #4 - The nursing comprehensive dated 02/18/25, and the MSW and Spiritual Care comprehensive assessments both dated 02/19/25, did not include an initial bereavement assessment. There is no other evidence in the medical record that this was completed. Patient #8 - The nursing comprehensive dated 06/18/25 and the MSW comprehensive dated 06/23/25, did not include an initial bereavement assessment. There is no other evidence in the medical record that this was completed.

Upon patient record review, 5 of 14 (Patient #3,4,7,8,9) 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 #3 - The medication profile indicated patient was utilizing a fleets enema prn, Senna 2 tabs twice daily, and Dulcolax suppository prn all for constipation. There was no evidence of problems, goals, or interventions related to constipation on the plan of care. Patient #4 - The medication profile indicated patient was on Eliquis daily as a blood thinner. There was no evidence of problems, goals, or interventions related to bleeding risk. Patient #7 - The patient's advanced directives indicated patient wished to be a full code. There was no evidence of problems, goals, or interventions related to that full code status. Patient #8 - The patient's advanced directives indicated patient wished to be a full code. There was no evidence of problems, goals, or interventions related to that full code status. Patient #9 - The patient's advanced directives indicated patient wished to be a full code. There was no evidence of problems, goals, or interventions related to that full code status.

Upon patient record review, 1 of 14 (Patient #4) 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 #4 - The patient record contained an order for Tylenol 650 mg take twice daily, along with Tylenol 325 mg take 2 tabs every 4 hours as needed. There was no evidence that a daily maximum acetaminophen dose was listed.

Upon patient record review, 1 of 14 (Patient #4) 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 #4 - There was an order dated 12/31/25 for Azithromycin 250 mg take 2 tabs on day 1 and then 1 tab daily for 2 days. There was no evidence of problems, goals, or interventions related to infection on patient plan of care.

Upon patient record review 3 of 14 (Patient #5,6,10) 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 - The patient record contained an order dated 06/18/25 for aide frequency at 5 times per week. For the week of 02/09/26, there were only visits documented on 02/09/26, 02/10/26, and 02/12/26. There was no missed visit documentation noted. Patient #6 - The patient record contained an order dated 06/18/25 for aide frequency at 5 times per week. For the week of 02/09/26, there were only visits documented on 02/09/26, 02/10/26, and 02/12/26. There was no missed visit documentation noted. Patient #10 - The patient record contained an order dated 12/31/25 for aide frequency at 2 times per week. There is no evidence that aide visits have occurred since then and no order to discontinue aide service.

Upon patient client record review, 1 of 14 (Patient #11) 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 #11 - On the Election of Hospice Benefit form, Page 6 of 6 contained an area for patient or POA to documented the effective date of when hospice should begin. This was left blank. In addition, on the Election of Hospice Benefit form, page 5 of 6 contained a section labeled "Right to Choose Attending Physician". This section was left blank and did not contain patient choice of electing or not electing their choice of attending physician.

Upon patient record review, 2 of 13 (Patient #12 and 13) 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 #12: Medication profile states Tylenol 650 mg po q 4 prn- No prn reason given/documented. Diclofenac 1% gel 4g q 4hrs prn. No prn reason given or documented. Patient #13: Medication profile states Tylenol 650 mg q6hrs prn. No prn reason given/documented.

Upon patient record review, 4 of 13 (Patient #1, 2, 3, 6) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #1:POC dated 10/26/21 orders both the Chaplain and the SW "to be seen as needed" Patient #2:IPOC dated 2/11/22 orders CH without a duration. Written CH 1x________. The blank is not completed. Patient #3:IPOC dated 5/25/22 orders both the Chaplin and SW to be seen PRN Patient #6:IPOC dated 4/27/22 orders both the Chaplin and SW to be seen PRN

Upon patient record review, 4 of 13 (Patient #1, 2, 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. Patient #1:IPOC dated 9/24/21 Oxygen 2-5 L pm via NC documented. No evidence of documentation of prn or continuous. Patient #2:IPOC dated 2/11/22 Oxygen 2L n/c prn documented. No evidence of prn reason documented. Patient #11:IPOC dated 12/20/22 documents medication names and dosages but no evidence of route or frequency. Medications listed as Morphine 20mg/ml, Lorazepam 2mg/ml, Tylenol 650 mg supp. Patient #12:IPOC dated 1/20/23 documents medication names only. No documentation of route, dosage or frequency. Medications listed as Tylenol, Amlodipine, Simvastatin, Iron, Fish oil, Vit D, Lidocaine patch 5%, Diclofenac 1%.

Upon client record review, 5 of 13 (Patient #1, 2, 3, 4, 5, 13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1:IPOC dated 9/24/21 orders MSW 1xmo. SW did not visit on October, November or December. Also POC dated 10/26/21 orders Chaplain as PRN and Chaplain made visits 11/9/21 and 12/21/21. Patient #2: IPOC dated 2/11/22 orders SW as PRN, Visits made 2/11 and 2/23. Same IPOC orders Chaplain PRN and visit made on 2/15/22. Patient #3: IPOC dated 4/7/22 SW ordered 1xmo and SW did not visit May or June. No orders for the Chaplain on the IPOC and Chaplain went on 5/17/22 without orders. SN ordered on same IPOC as q 2 weeks, visits made 4/7, 4/8, 4/12, and 4/26/22. Frequency greater than ordered. Patient #4: IPOC dated 2/8/22 orders Chaplain 1x with no duration. Chaplain went on 2/11. Same IPOC ordered Vol 1x month. No visits made by Volunteer in February. Patient #5: SN ordered q2weeks on IPOC dated 4/7/22. SN visits on 4/7, 4/8, 4/12, and 4/26. Frequency greater than ordered. Patient #13: IPOC dated 1/2/23 SN ordered 1xwk, Visits made 1/2, 1/3 and 1/10/23. Frequency greater than ordered.

Upon patient record review 3 of 13 (Patient #1,2,6) 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 #1: IPOC dated 9/24/21 order Aide 2x week. Aide started visits on 9/27/22. No evidence of missed visit for week one. Patient #2: IPOC dated 2/11/22 orders Aide 2xweek. Aide did not start until 2/12. No evidence of visits for the first week. Patient #6:IPOC dated 4/8/22 orders Aide 3x week. No evidence of visits for the first week.