Quality Choice Hospice, Inc.

“Upon patient record review, 7 of 14 (Patient #1,2,4,5,7,8,9) 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 • Drug therapy currently associated with laboratory monitoring Patient 1: Current medication record contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Corrected on-site, medication record updated. Patient 2: Current medication record includes orders for Tylenol Extra strength dosage is described as “11 ta”. Corrected on-site, Medication record updated. Patient 4: Most recent medication record contains orders for Lidocaine 4% topical patch without site of application. Corrected on-site, medication record updated. Patient 5: Current medication record contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Current medication record contains orders for nystatin topical powder to be applied twice daily as needed, indication fungal rash. There is no site of application indicated. Corrected on-site, Medication record updated. Patient 7: Current medication record contains orders for ABH Cream 1/25/1mg apply 1 ml topically every 4 hours as needed. Order does not include description of dose or site of application. Current medication record contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Corrected on-site, Medication record updated. Patient 8: Current medication record contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Corrected on-site, Medication record updated. Patient 09: Current medication record contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Current medication record contains orders for ABH Cream 1/25/1mg apply 1 ml topically every 4 hours as needed. Order does not include description of dose or site of application. Corrected on-site, Medication record updated.”

“Upon patient record review, 4 of 14 (Patient #4,6,8,9) 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 4: Patient most recent POC dated 10/29/25 contains orders for Aspirin and Plavix without a risk for bleeding care plan with appropriate interventions and goals. Corrected on-site, POC updated. Patient 6: Patient most recent POC dated 10/29/25 contains orders for Prednisone and Xarelto without a risk for bleeding care plan with appropriate interventions and goals. Corrected on-site, POC updated. Patient 8: Patient most recent POC dated 10/29/25 contains orders for Coumadin without a risk for bleeding care plan with appropriate interventions and goals. Corrected on-site, POC updated. Patient 9: Most recent POC dated 10/29/25 contains orders for ASA without a risk for bleeding care plan with appropriate interventions and goals. Corrected on-site, POC updated.”

“Upon patient record review, 1 of 14 (Patient #9) 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 measurable outcomes are anticipated from implementing and coordinating the plan of care for each patient by using data elements identified by the hospice and is used as part of the Hospice’s QAPI program. Patient 9: Most recent POC includes orders for 1000ml free water flush via G tube and G-Tube residual checks every feeding. There is no evidence of a care plan with measurable goals, interventions and outcomes. Corrected on-site, POC updated.”

“Upon patient record review, 7 of 14 (Patient #1,2,4,5,7,8,9) 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. Patient1: Current POC contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Corrected on-site, POC updated. Patient 2: Current POC includes orders for Tylenol Extra strength Dosage is described as “11 ta”. Corrected on-site, POC updated. Patient 4: Current POC contains orders for Lidocaine 4% topical patch without site of application. Corrected on-site, POC updated. Patient 5: Current POC contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Current Medication Record/POC contains orders for Nystatin topical Powder to be applied twice daily as needed, indication fungal rash. The is no indication of site of application. Corrected on-site, POC updated. Patient 7: Current POC contains orders for ABH Cream 1/25/1mg apply 1 ml topically every 4 hours as needed. Order does not include description of dose or site of application. Current POC contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Corrected on-site, POC updated. Patient 8: Current POC contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Corrected on-site, POC updated. Patient 9: Current POC contains orders for Norco 10/325mg 1 tab every 4 hours as needed and Acetaminophen 650mg supp every 6 hours as needed. Orders do not contain a directive not to exceed 4g daily from all sources of Acetaminophen. Current POC contains orders for ABH Cream 1/25/1mg apply 1 ml topically every 4 hours as needed. Order does not include description of dose or site of application. Corrected on-site, POC updated.”

“Upon patient record review, 7 of 14(Patient #1,2,3,6,7,8,10) 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 current aide POC contains direction for turn and reposition, dress, encourage fluids as tolerated if not contraindicated and change patient linens without frequency. Corrected on-site, POC updated. Patient 2: The current aide POC contains direction for turn and reposition, street clothes encourage fluids as tolerated if not contraindicated without frequency. Corrected on-site, POC updated. Patient 3: The current aide POC contains direction for turn and reposition, street clothes and shampoo without frequency. Corrected on-site, POC updated. Patient 6: The current aide POC contains direction for turn and reposition, encourage fluids as tolerated if not contraindicated without frequency. Corrected on-site, POC updated. Patient 7: The current aide POC contains direction for turn and reposition, encourage fluids as tolerated if not contraindicated, and street clothes without frequency. Corrected on-site, POC updated. Patient 8: The current aide POC contains directions for change patient linens without frequency. Corrected on-site, POC updated. Patient 10: The current aide POC contains directions for turn and reposition, and dress without frequency. Corrected on-site, POC updated.”