Every finding on record at Zill Holdings Inc.

Upon observation, there was no evidence of contracts/agreements with other facilities/agencies/hospices to receive patients in the event the hospice cannot provide care to their patients during an emergency. There was no evidence of an agreement with another agency to receive patients in the event the hospice cannot provide care during an emergency.

Upon patient record review, 5 of 14 (Patient #1,#2,#4,#5,#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 • Drug therapy currently associated with laboratory monitoring Patient #1: The medication profile listed Nystatin was to be applied to "affected area" without evidence of a specific route. Patient #2: The medication profile listed MiraLAX, but without evidence of instructions for a diluent. Patient #4: Doxycycline was ordered on May 24, 2026 for 5 days, but remained active on the med profile with no evidence of a discontinuation date. Patient #5: Lasix was ordered for 2 weeks on March 16, 2026, but remained active on the medication profile with no evidence of a discontinuation date. Preparation H was ordered as needed, but there was no evidence of a reason listed on the medication list. Patient #9: During home visit, Buspirone was on the hospice medication profile and Zyprexa was on the facility medication profile which is inconsistent.

Upon patient record review, 1 of 14 (Patient #2) 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 #2: The order for MiraLAX did not have evidence of instructions for a diluent. Haldol was ordered for as needed, but there was no reason evidence of a reason listed on the order.

Upon client record review, 1 of 14 (Patient #1) 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: The initial plan of care was created on 02/03/26, but there was no evidence the individualized plan of care, including the nursing input, was updated until 02/25/25 which is greater than 15 days.

Upon home visit observation during 1 of 3 visits, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #9: There was no evidence of the LVN using a bag to transport equipment and supplies per policy and procedure for bag technique.

Upon patient record review, 5 of 14 (Patient #1,#5,#8,#10,#13) did not have evidence in the patient record that hospice aide assignments and duties are: • 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 dated 2/3/26 and 2/11/26 indicated back rub, skin care, tidy are ordered "as needed" which is not specific. Patient #5: At admission, the aide care plan indicated shower, peri-care, and hair care were ordered "as tolerated" which is not specific. Patient #8: The aide care plan dated 5/11/26 indicated peri-care, and skin care were ordered "as tolerated" which is not specific. Patient #10: The aide care plan dated 1/22/26 showed shower and bed bath both were assigned which is not specific. Patient #13:The aide care plan dated 10/21/25 indicated both shower and bed bath were assigned which is not specific.

Upon patient record review, 10 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10) 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 1, 2, 3, 4, 5, 6, 7, 8, 9, 10: Oxygen was not included on the patient's medication list. (corrected onsite)

Upon patient record review, 1 of 14 (Patient #4) 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. Patient 4: The MSW and chaplain both visited the patient at the time of hospice admission and performed a comprehensive initial assessment. At that time, further services and visits from both disciplines were refused by the patient/family. However, ongoing PRN only visit orders were written for both the MSW and chaplain. Of note, no additional visits have been made or scheduled. (corrected onsite)

Upon client record review, 1 of 14 (Patient # 2) 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 narrative portion of the SN visit note on 03.14.2023 indicated wound care was performed per orders to a wound on the left lower leg, and on 03.22.2023 and 03.30.2023 indicated wound care was again performed. However, the plan of care does not include treatment orders for this wound care. (corrected onsite)

Upon patient record review, 4 of 14 (Patient #1, 6, 8, 9) 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 hospice aide care plan, dated 04.05.2023, indicates the patient may receive either a shower or a bed bath per the patient's preference or ability on each visit. The care plan must specify which tasks the aide is to perform on every visit. (corrected onsite) Patient 6: The hospice aide care plan, dated 06.07.2023, indicates the patient may receive either a shower or a bed bath per the patient's preference or ability on each visit. The care plan must specify which tasks the aide is to perform on every visit. (corrected onsite) Patient 8: The hospice aide care plan, dated 04.06.2023, indicates the patient may receive either a shower or a bed bath per the patient's preference or ability on each visit. The care plan must specify which tasks the aide is to perform on every visit. (corrected onsite) Patient 9: The hospice aide care plan, dated 03.07.2023, indicates the patient may receive either a shower or a bed bath per the patient's preference or ability on each visit. The care plan must specify which tasks the aide is to perform on every visit. (corrected onsite)

Upon patient client record review, 1 of 14 (Patient #3) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 3: The notification of election form did not indicate an effective date for the initiation of hospice services.