Every finding on record at Young at Heart Hospice, Inc.

Upon patient record review, 2 of 14 (Patient #8, 9) 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 Patient 8: The medication list indicates hydrocodone/APAP 10/325mg 1 tab po tid for moderate to severe. This is an incomplete entry on the medication list as the indication for the medication is incomplete. The related physician's order clarifies this medication is indicated for the treatment of moderate to severe pain. (corrected onsite) Patient 9: An order was generated & signed in the EMR on 05.07.2024 for DuoNeb 0.5/3mg per 3mL use 1 inhalation via nebulizer q 4 hours PRN SOB/wheezing. However, this medication was not added to the patient's medication list at that time, or at any subsequent time. (corrected onsite)

Upon patient record review, 4 of 14 (Patient #1, 2, 4, 6) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 1: The last time there is evidence of a RN completing a comprehensive assessment was on 04.19.2024. To clarify, the LVN has been seeing the patient each week to provide support and assess for needs; however the RN has not been present at least every 15 days as required. Patient 2: The RN made a visit on 04.01.2024 to perform a comprehensive assessment; the next visit by a RN for an update to the comprehensive assessment was on 04.29.2024. To clarify, the LVN has been seeing the patient each week to provide support and assess for needs; however the RN was not present at least every 15 days as required. Patient 4: The RN made a visit on 03.25.2024 to perform a comprehensive assessment; the next visit by a RN for an update to the comprehensive assessment was on 04.22.2024. To clarify, the LVN has been seeing the patient each week to provide support and assess for needs; however the RN was not present at least every 15 days as required. Patient 6: The RN made a visit on 04.04.2024 to perform a comprehensive assessment; the next visit by a RN for an update to the comprehensive assessment was on 05.02.2024. To clarify, the LVN has been seeing the patient each week to provide support and assess for needs; however the RN was not present at least every 15 days as required.

Upon patient record review 1 of 14 (Patient #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 10: Discipline visit orders were present indicating the HA is to see the patient 2 x weekly. However, during the week of 04.07.2024, there was only evidence of the HA making one visit to the patient, on 04.10.2024. There was also no indication of a missed visit.

Upon patient record review 1 of 14 (Patient #6) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 6: The RN made a supervisory visit for the HA on 04.04.2024, and the next supervisory visit was made on 05.02.2024. This exceeds the 14 day requirement.