Every finding on record at Wren Hospice, LLC

Upon patient record review, 7 of 19 (Patient #1,#3,#4,#5,#6,#10,#13) 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#1: RN documents patient has ongoing issues with vascular dementia. Patient also requires daily meds for constipation. Also, 4/3/25 visit note from RN states patient now using Cetaphil and lotrimin powder for itching and skin irritation that has not resolved to the chest and groin area. There is no evidence of problems, goals, or interventions related to these issues. Corrected on site. Patient#3: Patient requires daily meds for constipation. There is no evidence of problems, goals, or interventions related to this issue. Patient#4: The record indicates patient was admitted for terminal diagnosis of senile degeneration of the brain. There is no evidence of problems, goals, or interventions related to this diagnosis. Corrected on site. Patient takes daily medication for anxiety. It is also documented by RN that patient becomes very anxious and stressed. There is no evidence of problems, goals, or interventions related to this problem on the plan of care. Corrected on site. Patient#5: The record indicates patient requires daily medication for constipation. Also, RN documents patient has excoriation to skin on buttocks requiring zinc oxide and skin care, There is no evidence of problems, goals, or interventions related to these issues on plan of care. Patient#6: The record indicates patient has had issues with edema since admit. On RN visit 3/14/25 it is documented that edema is worsening. There is no evidence of goals or interventions related to this issue on plan of care. Corrected on site. Patient#10: The record indicates patient was admitted with +3 edema to arms legs and midsection which remains an current issue. There is no evidence of goals or interventions related to this problem on plan of care. Corrected on site. Patient#13: The record indicates patient was admitted for terminal diagnosis of multiple sclerosis. There is no evidence of problems, goals, or interventions related to this diagnosis. Corrected on site.

Upon client record review, 3 of 19 (Patient #1, #4, #5) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient#1,#4: The record indicates the patient/family chose Dr C. B. as their attending physician. There is no evidence of documentation of consultation or collaboration with this attending physician. Patient#5: The record indicates the patient/family chose Dr L. F. as their attending physician. There is no evidence of documentation of consultation or collaboration with this attending physician.

Upon patient record review, 3 of 19 (Patient #17,#18,#19) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient#17,#18,#19: There is no evidence of a bereavement plan of care that notes the kind of bereavement services to be offered and/or the frequency of service delivery in patient chart.

Upon patient record review, 3 of 19 (Patient #2,#3,#4) 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#2,#3: The plan of care it is indicated that patient requires aspiration precautions. There is no evidence of aspiration precautions on the aide plan of care. Corrected on site. Patient#4: The plan of care indicated that patient requires oxygen precautions. There is no evidence of oxygen precautions on the aide plan of care. Corrected on site.

Upon patient client record review, 3 of 19 (Patient #3,#5,#13) 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: The record indicates the patient/family elected to receive the addendum. The agency does have an email showing they emailed the addendum to the family on 10/6/24. However, the addendum in patient chart does not have evidence of date received or a signature to verify receipt. Patient#5: The record indicates patient/family did elect to receive the addendum. There is no evidence that the addendum was sent be agency or received by patient/family. Patient#13: The record indicates the agency sent addendum to family as requested. However, the form states patient/family did not receive until 3/19/25. Patient was admitted on 3/5/25.

Upon patient record review, 1 of 13 (Patient #7) 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 #7 - Pt started on Pyridium and Amoxicillin for a UTI and burning on urination. No evidence of care plans updated to reflect change in patient condition, order was obtained.

Upon patient record review, 1 of 13 (Patient #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 # 13- No evidence of DME being used on the patients plan of care. Pt in a hospital bed and uses a mattress by the bed in case of falls. (corrected on site)

Upon client record review, 1 of 13 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1 - RN note of 3/2/22 states -Nurse cleaned wound with wound cleanser, pat dry and apply triple antibiotic ointment, left open to air. The signed physician order did not include the addition of the triple antibiotic ointment.

Upon patient client record review, 1 of 13 (Patient #12) 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 #12 - 12/14/20 on admission PCG requested the "Patient Notification of Hospice Non Covered Items, Services and drugs". Form was completed and found upon request in DPC services office - unsigned by pt/PCG. No evidence of the delivery of requested form in patient record nor how it was delivered.

Upon client record review, 2 of 2 applicable (Patient #6, 10) did not have evidence that the discharge summary includes all required information. Patient #6 - No evidence of discharge instructions, presence of Advance Directives or end of life decisions on discharge summary. Patient #10 -No evidence of end of life decisions or Advanced Directives on discharge summary.