Applied Palliative and Hospice Services, Inc.

“Observed in Record Review. In 11 of 14 patient records reviewed, During review of patient POCs, it was noted the stated goals did not contain specific information that could be used to accurately determine the patient’s progress toward achieving goals. RRHV1 the following goals were not measurable; Patient will exhibit decrease in subjective distress within the benefit period, Patient will not experience bleeding with blood pressure and pulse within normal range within this benefit periodRRHV2 the following goals were not measurable; patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within 1 certification period, Patient will be able to participate in activities of daily living along with normal vital signs within this benefit period. During RRHV3 the following goals were not measurable; Patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within the certification period, Patient will have blood glucose levels within acceptable levels within one certification period. Patient will not experience bleeding with blood pressure and pulse within normal range within 1 certification period. During RR2 it was noted the goals were not measurable; Patient will consume adequate nourishment within this benefit period, Patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within this benefit period During RR4 it was noted goals that were not measurable; Patient’s quality of life will be improved by managing their symptoms and promoting comfort through appropriate medication management, sensory interventions, and emotional support within this benefit period. During RR5 it was noted goals that were not measurable; Patient will show adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within normal limits, return to baseline activity level, and display adequate breathing as evidenced by appropriate oxygen saturation level and absence of adventitious breath sounds within this benefit period. Patient will not experience bleeding with blood pressure and pulse within normal range within this benefit period, the patient will report ability to breathe comfortably within this benefit period. During RR7 it was noted goals that were not measurable; goals: Patient’s quality of life will be improved by managing their symptoms and promoting comfort through appropriate medication management, sensory interventions, and emotional support within this benefit period. During RR10 it was noted goals that were not measurable;Patient will manifest adequate cardiac output as evidenced by the following: Stable vital signs Patient will adhere to lifestyle modifications of exercise and weight loss. in the diabetic section Patient will consume adequate nourishment within this benefit period. Patient’s quality of life will be improved by managing their symptoms and promoting comfort through appropriate medication management, sensory interventions, and emotional support within this benefit period.During RRHV2, 3 and RR8 it was noted the same intervention for the chaplain documented as a goal on the POC; Chaplain will facilitate the patient, family, and caregiver in freely verbalizing their needs for desired spiritual and emotional support. Patient and/or family will receive ongoing emotional and psychosocial support to promote comfort, dignity, and quality of life throughout the end-of-life process.During RR6 it was noted the MSW intervention, “Patient and family will be provided with emotional support and empathetic listening throughout end of life process was documented on the POC as a goal. During RR10 it was noted the MSW intervention was documented as a goal on the POC; To improve patient psycho-social functioning of pt throughout hospice stay. During RRHV1, 4, and RR2-5 and 7 it was noted the MSW and the chaplain documented the same intervention as a goal on the patients’ POCs; Chaplain will facilitate the patient, family, and caregiver in freely verbalizing their needs for desired spiritual and emotional support. Patient and/or family will receive ongoing emotional and psychosocial support to promote comfort, dignity, and quality of life throughout the end-of-life process.The goals were discussed with the organization leadership.”

“Observed in Record Review. In 1 of 14 patient records reviewed, It was noted during RR4 there were multiple wound care orders that were not documented as provided according to hospice plan of care. The patient had an order for daily wound care to a wound over her left eyebrow secondary to a fall prior to the hospice, from the beginning of September 2025 to the end of September. In addition there were pressure ulcers on the left heel, right heel, and a wound on her left great toe with wound care to be provided every 3 days and PRN if soiled from the SOC the beginning of September to the last week in September. The SN frequency on the POC was 2x/week. There was lack of documentation if the wound care was performed by the facility staff in between SN visits. This was discussed with the organization leadership.”