Every finding on record at Wiregrass Hospice of South Carolina, LLC

Upon patient record review 1 of 5 (Patient #5) 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 5 admitted on 3/22/24, and initial spiritual assessment completed on 3/28/24.

Upon patient record review, 1 of 5 (Patient #2) 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 2 initial social work evaluation completed on 1/23/24 per order. Order on 1/23/24 to update/add several problems and care plans for the social worker complete with interventions, yet no evidence of an order for continued social work visits and no additional visits completed to date.

Upon client record review, 2 of 5 (Patient #3, 5) 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 on 4/11/24 for SW and SC effective 4/13/24 for 1x month and 2prn. No evidence of SW or SC visits completed from 4/13/24-4/30/24. Patient 5 order on 3/28/24 for SW and SC effective 3/30/24 for 1x month and 2prn. No evidence of SW or SC visits completed from 3/30/24-3/31/24.

Upon patient record review 1 of 5 (Patient #3) 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 3 ordered 3x week. Aide visits completed on 5/1/24 and 5/3/24 no evidence of a third visit or refusal for this week.

Upon patient client record review, 1 of 5 (Patient #1) 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 1 RN visit 5/7/24 documents wound care provided to sacrum and heel, and also documents protective barrier applied. Unclear as to which wounds were provided which care.

Upon client record review, 1 of 5 (Patient #4) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 4 order on 3/7/24 for SW and SC effective 3/9/24 for 1x month and 2prn. No evidence of SW or SC visits completed from 3/9/24-3/31/24.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence of the appropriate documentation for release of confidential information. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided.

Upon patient record review, 1 of 19 (Patient #11) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient record review, 7 of 19 (Patient #3,#4,#5,#6,#7,#10,#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 #3: The med profile included Proair HFA inhaler PRN however, there was no evidence of a dose or PRN reason (stated rescue inhaler for COPD). In addition, remedy antifungal powder without evidence of specified area(s) for application. corrected on site Patient #4: The med profile included lorazepam 0.5mg 1-2 tablets Q4 hours PRN anxiety/agitation and morphine 0.5-1mL PRN pain/air hunger however, there was no evidence specific instructions for dosing based on symptoms. In addition, contained acetaminophen 325mg PRN pain/fever and there was no evidence of type or amount of pain to administer acetaminophen or morphine. corrected on site Patient #5: The med profile included acetaminophen 500mg, 1 tablet Q4hours PRN pain/fever and Tylenol 650mg, 2 tablets daily potentially exceeding 4 gm however, there was no evidence of a maximum allowable amount. In addition, Aspercreme without evidence of specified area(s) for application. corrected on site Patient #6: The med profile included clortimazole topical cream without evidence of specified area(s) for application. corrected on site Patient #7: The med profile included clobeta topical cream without evidence of specified area(s) for application. corrected on site Patient #10: The med profile included active medrol pack for 6 days ordered 04/12/23. corrected on site Patient #13: The med profile included venlafaxine as an active medication however, there was an order 09/14/23 "removed venlafaxine from MAR patient not taking". corrected on site

Upon patient record review, 1 of 19 (Patient #8) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #8: The patient had documentation of a wound that developed 08/08/23 however, there was no documentation of wound measurements since 08/08 and per agency leadership wounds are to be measured weekly.

Upon patient record review, 4 of 19 (Patient #3,#11,#13,#14) 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 plan of care did not include problems/interventions/goals for falls after the patient was a high fall risk since admission. corrected on site Patient #11: The patient did not have a guardian or funeral arrangements however, there was no evidence of problems/interventions/goals to address these concerns. corrected on site Patient #13: The patient did not have funeral arrangements however, there was no evidence of problems/interventions/goals to address these concerns. corrected on site Patient #14: The patient did not have funeral arrangements however, there was no evidence of problems/interventions/goals to address these concerns. corrected on site

Upon patient record review, 2 of 19 (Patient #1,#3) did not have evidence that the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions which including interventions to manage pain and symptoms. Patient #1: The plan of care did not include problems/interventions/goals for pain management and the patient has documented RUA and neck pain since admission. corrected on site Patient #3: The plan of care did not include problems/interventions/goals for pain management and the patient has documented R lung burning and R shoulder pain. corrected on site

Upon patient record review, 5 of 19 (Patient #3,#4,#5,#6,#7) 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 #3: The order for Proair HFA inhaler PRN did not contain evidence of a dose or PRN reason (stated rescue inhaler for COPD). In addition, remedy antifungal powder order without evidence of specified area(s) for application. corrected on site Patient #4: The orders for lorazepam 0.5mg 1-2 tablets Q4 hours PRN anxiety/agitation and morphine 0.5-1mL PRN pain/air hunger did not contain evidence of specific instructions for dosing based on symptoms. In addition, orders for morphine and acetaminophen 325mg PRN pain/fever and there was no evidence of type or amount of pain to administer acetaminophen or morphine. corrected on site Patient #5: The orders for acetaminophen 500mg, 1 tablet Q4hours PRN pain/fever and Tylenol 650mg, 2 tablets daily potentially exceeding 4 gm did not contain evidence of a maximum allowable amount. In addition, Aspercreme did not contain evidence of specified area(s) for application. corrected on site Patient #6: The order for clortimazole topical cream did not contain evidence of specified area(s) for application. In addition, the patient was using a CPAP per nursing documentation however, there was no evidence of an order for CPAP settings, after agency investigated they report patient is no longer using CPAP. Patient #7: The order for clobeta topical cream did not contain evidence of specified area(s) for application. corrected on site

Upon patient record review, 6 of 19 (Patient #1,#3,#6,#8,#11,#13) 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 #1: The plan of care did not include the wheelchair, shower chair, and oxygen. corrected on site Patient #3: The plan of care did not include the nebulizer, cane, and shower chair. corrected on site Patient #6: The plan of care did not include the cane. corrected on site Patient #8: The plan of care did not include the wheelchair. corrected on site Patient #11: The plan of care did not include the hospital bed, overbed table, and oxygen. corrected on site Patient #14: The plan of care did not include the bedside commode and shower chair. corrected on site

Upon patient record review, 1 of 19 (Patient #5) 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 #5: The patient developed a skin tear in September that was receiving treatment however, there was no evidence of skin integrity/wound problems/interventions/goals. corrected on site

Upon client record review, 8 of 19 (Patient #2,#4,#5,#6,#7,#8,#9,#10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: The spiritual care visit frequency order 08/18/23 was 2M and 2PRN however, there was only evidence of one visit (initial evaluation) on 08/21. corrected on site Patient #4: The nurse visit frequency order 10/08/23 was 5W1, 8W1, 7W4 however, the week of 10/08 there was only evidence of 4 routine visits on 10/10, 10/12, 10/13, and 10/14. In addition on 09/20 the social work and spiritual order was 1m1 however, there was only evidence of one visit by each on 09/28. corrected on site Patient #5: The social work visit frequency order 06/05/23 was 1W 3 PRN however, there was no evidence of any visits in July. In addition, the nurse documented 09/25 "wound care provided as ordered" and on 10/05 "dressing change done as ordered" without evidence of details for care provided. Patient #6: The social work visit frequency order 08/22/23 was 2W and 4 PRN however, there was only evidence of visits performed 08/23, 09/13, 09/27, and 10/11. corrected on site Patient #7: The nurse visit frequency order 06/29/23 was 2W, 4 PRN and 09/27/23 1W1, 2W12, 4 PRN however, the week of 09/10 there was only evidence of one visit on 09/13 and the week of 10/01 one visit on 10/04. In addition, the social work and spiritual care order 06/29/23 was 2M, 5 PRN and 2M, 4 PRN respectively however, there was only evidence of one visit for each discipline on 06/30. In addition, 10/04 the nurse documented education provided to patient for low sodium diet however, patient is not on a low sodium diet per agency and should be diet as tolerated. corrected on site Patient #8: The nurse visit frequency order 06/23/23 was 1W1, 2W12, 1W1, 4 PRN however, the week of 07/02 there was only evidence of a visit on 07/05. Patient #9: The nurse visit frequency order 08/25/23 was 2W8, 4 PRN however, the week of 09/03 there was only evidence of one visit on 09/06 and the week of 10/22 there was no evidence of any routine visits. In addition, the social work frequency order 08/25 was 1M2, 2 PRN however, there was no evidence of visits in August or September. corrected on site Patient #10: The social work visit frequency order 09/01/23 was 1M2, 2 PRN however, there was no evidence of visits in September and social work note stated no SW visits identified at this time. SW to coordinate with RNCM. corrected on site Patient #12: The social work visit frequency order 08/26/23 was 1M3, 2 PRN however, there was no evidence of visits in September. corrected on site

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient #3: The patient had a fall on 09/29/2023 however, there was no evidence of an occurrence report for hospice to investigate. corrected on site

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Upon visits #1, #4, #8 the clinician used the super Sani-wipe however, did not wait the full 2 minutes for wet contact prior to placing back in bag.

Upon patient record review, 1 of 19 (Patient #1) 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: The aide plan of care did not include oxygen precautions. corrected on site

Upon patient record review 4 of 19 (Patient #5,#7,#8,#9) 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 aide visit frequency order 08/06 3W however, the week of 08/06 one visit on 08/06. corrected on site Patient #7: The aide visit frequency order 07/02/23 was 2W however, the week of 07/02 there was only evidence of one visit on 07/06. Patient #8: The aide visit frequency order 09/24/23 1W12 however, the week of 09/24 there was no of visits. corrected on site Patient #9: The aide visit frequency order 08/25/23 was 1W1, 5W8, 1W1 however, the week of 09/03 there was only evidence of visits on 09/05, 09/06, 09/07 and one missed visit note for 09/08. corrected on site

Upon patient client record review, 1 of 19 (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: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon patient client record review, 1 of 19 (Patient #7) 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 #7: The missed visit note for 07/14 was documented by the nurse as "6/14". corrected on site

Upon client record review, 1 of 19 (Patient #11) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #11: The election of benefit and additional forms were signed by MD at facility where patient resided, based on SC statute MD meets the definition of a Health Care provider and a person who is a paid caregiver or a provider of health care services to the patient, as this person is as he is a physician of the SNF therefore cannot give consent.

Upon contract review 1 of 4, (the Lake Emory Post Acute Care) contract did not have evidence that the inpatient facility has identified an individual within the facility who is responsible for the implementation of the provisions of the agreement. corrected on site

Upon contract review 1 of 4, (the Lake Emory Post Acute Care) did not have evidence of a method for verifying that the requirements for ACHC standard HSP1-8B and CFR 418.108c (1)-418.108c(5)are met. corrected on site

Upon patient record review, 2 of 19 (Patient #2,#4) did not have evidence that the hospice provided the following information to the SNF: • The most recent hospice plan of care specific to each patient, chart for patient #4 missing aide POC • Physician certification and recertification of the terminal illness specific to each patient present however, not signed or completed with narrative by MD on both patient #2 and #4 • Names and contact information for hospice personnel involved in hospice care of each patient for patient #2 All items corrected on site