Every finding on record at Xclusive Hospice Care, Inc.

Upon patient record review, 14 of 14 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14) 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. Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 13, 14: Patient's most current plan of care contained orders that did not contain a frequency for PRN visits, a) "MSW every benefit period and as needed for psychosocial support", and b) "Spiritual Care every benefit period and as needed for spiritual support". Patients # 11, 12: Patient's most current plan of care contained orders that did not contain a frequency for PRN visits. The plan of care stated, "Spiritual Care every benefit period and as needed for reassessment or further spiritual support".

Upon patient record review, 2 of 14 (Patients # 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 # 3: The aide plan of care dated 6/2/25 stated, turn and reposition patient. There was no frequency documented for this task. Patient # 4: The aide plan of care dated 5/10/25 stated, feeding assistance for patient. There was no frequency documented for this task.

Observed in Tracer Activities. Upon review of the admission packet and patient handbook it was noted that the organization failed to provide in writing an approximate dollar amount the patient will be responsible for, even if that amount is zero. The organization's consent form has a financial liability section yet if failed to provide an approximate dollar amount that the patient will be responsible. This observation was reviewed with the Administrator/DPCS Designee.

Observed in Record Review. In 4 of 5 patient records reviewed, the organization failed to ensure that the plan of care include all services necessary for the palliation and management of the terminal illness based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. For example: in review of HV#2 and RR#5 the patient's primary diagnosis was Cardiac with issues with edema yet there were no goals and interventions in the care plans to address these issues. In RR4 and HV#3 the patient's were admitted with dementia/Alzheimers and RR#4 noted issues with combative behavior however there were no goals and interventions in the care plans to address the issues identified in the assessment. These observations were reviewed with the Administrator/DPCS Designee.