Every finding on record at Wings of Hope Hospice, Inc.

Upon personnel record review, 1 of 12 (Personnel #2) did not have evidence the alternate administrator's personnel record verifies that: • The employee has appropriate education and experience requirements • There is a signed job description for this role • The employee has been orientated to this role Personnel #2 No signed job description or evidence of being orientated to role of alternate administrator. Corrected on site.

Upon patient record review, 3 of 11 (Patient #2,3,7) 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 - Election of benefits statement not signed by POA at the time of admit. Patient 3 - Election of benefits statement not signed by hospice representative at the time of admit. Corrected during survey. Patient 7 - Election of benefits statement not signed by POA at the time of admit.

Upon personnel record review, 1 of 12 (Personnel #11) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel 11 - No evidence of criminal background check.

Upon personnel record review, 2 of 12 (Personnel #10, #11) did not have evidence that all personnel have been fully vaccinated for COVID-19. Personnel 10: No evidence that SP has been fully vaccinated or has received medical/religious exemption for COVID 19. Personnel 11: No evidence that OT has been fully vaccinated or has received medical/religious exemption for COVID 19.