Amici Hospice, Inc.

“Upon patient record review, 4 of 14 (Patient #5, #7, #9, #10) did not contain evidence 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 #5: Order date 12/17/25; Voltaren 1% gel “apply small amount to affected area 2x daily as needed. No indication of “affected area.” Order date 12/05/25; Olopatadine hydrochloride 0.1% “instill 1 drop in affected eye 2x daily.” No indication of “affected eye.” Patient #7: Oder date; Hydrocortisone 2.5% cream “apply thin layer to affected area 2x daily prn.” No indication of “affected area.” LVN reported using A&D ointment and calmosepetine to wounds, on multiple dates, but neither of these were listed on the medication record. Patient #9: Order date 04/30/25; Lidocaine + Menthol 4%-1% Roll-On “1 patch topical, apply to affected area daily.” No indication of “affected area” and order was for a Roll-On medication but directions state to apply “1 patch.” Patient #10: Order date 01/09/25; Voltaren 1% gel “apply to affected areas every 24 hours as needed.” No indication of “affected area.””

“Upon patient record review, 1 of 14 (Patient #2) 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 #2: CA POLST/DNR was attached to patients chart but POC did not reflect this code status as it was left blank.”

“Upon patient record review, 4 of 14 (Patient #5, #7, #9, #10) did not contain evidence that the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #5: Updated POCs beginning on 12/17/25 reflected; Voltaren 1% gel “apply small amount to affected rea 2x daily as needed. No indication of “affected area.” Updated POCs beginning on 12/05/25 reflected; Olopatadine hydrochloride 0.1% “instill 1 drop in affected eye 2x daily.” No indication of “affected eye.” Patient #7: Updated POCs beginning on 12/10/25 reflected; Hydrocortisone 2.5% cream “apply thin layer to affected area 2x daily prn.” No indication of “affected area.” Wound orders dated 10/24/25, 10/31/25, 11/14/25, 12/05/25, 12/12/25, 12/19/25, 12/26/25 and 12/28/25 were as follows “cleanse would with quarter strength Dakin’s solution, pat dry with gauze. Apply calcium alginate with silver. Cover with abdominal pad, wrap with roll gauze, followed by coflex. SN may change 2-3x/week and as needed if soiled or dislodged.” There was no wound area indicated for any of these orders. LVN reported using A&D ointment and calmosepetine to wounds, on multiple dates, but neither of these were listed on the medication record. 09/13/25 order; Left heel stage 3: wet to moist packing with vashe using 4x4 gauze covered by silicone foam dressing daily. Change dressing every SN visit or as needed if soiled or dislodged.” Right heel wound (pressure ulcer stage III): wet to moist packing with vashe using 4x4 gauze covered by silicone foam dressing daily. Change dressing every SN visit or as needed if soiled or dislodged.” SN frequency on POC on this date was 2x/weekly. Order is unclear due to two different change frequencies. All wound orders dated 10/24/25, 10/31/25, 11/14/25, 12/05/25, 12/12/25, 12/19/25, 12/26/25 and 12/28/25 were as follows “cleanse would with quarter strength dakins solution, pat dry with gauze. Apply calcium alginate with silver. Cover with abdominal pad, wrap with roll gauze, followed by coflex. SN may change 2-3x/week and as needed if soiled or dislodged.” There was no indication of what wound(s) were to be dressed with these orders. Patient #9: Initial POC/updated POCs reflected; Lidocaine + Menthol 4%-1% Roll-On “1 patch topical, apply to affected area daily.” No indication of “affected area” and order was for a Roll-On medication but directions state to apply “1 patch.” Patient #10: Initial POC/updated POCs reflected; Voltaren 1% gel “apply to affected areas every 24 hours as needed.” No indication of “affected area.””

“Upon patient record review, 1 of 14 (Patient #7) did not contain evidence that the plan of included all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #7: on dates 09/16/25 and 09/23/25 patient did not have proper supplies for wound care per LVN notes. On 09/16/25 patients wound orders called for medihoney and silicone border foam. There was no medihoney available and 3 border foam were needed for wounds and only one was available in the home. On 09/23/25 there continued to be no medihoney present in home and there were no silicone border foams available for three dressing changes.”

“Upon patient record review, 2 of 14 (Patient #1, #4) did not contain evidence that a revised plan of care included information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #1: Bereavement POC remained “unresolved” with a target date of 11/25/25. Current goals reflected “Bereaved will have knowledge of how to utilize bereavement services in 5 days.” Current interventions reflected “bereavement coordinator will visit the patient as needed to provide coping for grieving.” Patient #4: Bereavement POC remained “unresolved” with a target date of 11/25/25. Current goals reflected “Bereaved will have knowledge of how to utilize bereavement services in 5 days.” Current interventions reflected “bereavement coordinator will visit the patient as needed to provide coping for grieving.” Spiritual Care was refused on 11/02/25 but the POC remains “unresolved.” Current goals reflected “spiritual counselor to introduce spiritual program of hospice, conduct initial spiritual assessment and identify spiritual issues in 5 days.” Current interventions reflected “initiate referral to spiritual counselor.””

“Upon client record review, 1 of 14 (Patient #7) did not contain evidence that the IDG ensured that the care and services were provided in accordance with the plan of care. Patient #7: 09/13/25 sacral wound order (remained current order for visit dates); apply medihoney and cover with silicone foam dressing daily. Change dressing every SN visit or as needed if soiled or dislodged.” 09/13/25 right heel wound order (remained current order for visit date); wet to moist packing with vashe using 4X4 gauze, covered with silicone foam dressing daily. Change dressing every SN visit or as needed if soiled or dislodged. SN ordered visit frequency 2x/weekly continued for this period. LVN note dated 09/16/25; “no medihoney present and only 1 silicone border foam present. Patient was then applied calcium alginate and covered with border foam gauze to sacrum wound.” LVN note dated 09/23/25; when further assessing the patient wounds, patient wound to sacral area healed and right heel were attempted to be changed per orders. The patient only had manuka honey, no silicone border gauze, and down to half a small bottle of vashe. Manuka honey was applied to the sacral wound as a substitute. Foul order present to right heel wound.” 10/24/25 orders; “cleanse with dakins quarter strength solution and pat dry with gauze. Apply calcium alginate with silver. Cover with abdominal pad, wrap with rolled gauze, followed by coflex. SN may change 2-3x/week and as needed if soiled or dislodged.” (did not state what wound to dress) “Right heel wound pressure ulcer ulcer 3-cleanse with dakins quarter strength solution and pat dry with gauze. Apply calcium alginate with silver. Cover with abdominal pad, wrap with rolled gauze, followed by coflex. 3x/week and prn if soiled or dislodged.” LVN note dated 10/28/25; “patients wound was then cleansed with vashe, pat dried, and was applied calcium alginate with silver. Wound was then covered with abdominal pad and wrapped with rolled gauze, followed by coflex.” LVN note dated 11/20/25; “the patients coccyx was assessed with skin impairment noted as well as a small opening to the center of the back. The patient was then applied A&D ointment to the coccyx area and had the small opening covered with silicone board gauze.” There was no order for this. LVN note dated 12/16/25; “wound dressings were changed per orders. The patient coccyx area was then applied calmoseptine and center of back was covered with the silicone borderd gauze.” There was no order for this. LVN note dated 12/21/25; “Patient was applied calmoseptine to coccyx and back area. There was no order for this. LVN note dated 12/30/25; “The patient had his wound dressing changed per orders, and was applied calmoseptine to his back.” There was no order for this. 10/02/25 order; left heel wound pressure ulcer stage 3: apply 4x4 gauze wet with vashe and cover with silicone foam dressing daily.” Per the LVN notes this wound was never addressed.”

“Upon patient record review 7 of 14 (Patient #1, #3, #4, #5, #6, #8, #9) did not contain evidence of documentation that a hospice aide provides services that were included in the plan of care: Patient #1: Updated POC/IDG indicated visit frequency 2x/weekly. Week of 12/28/25 there was only one visit made. Aide POC did not indicate for the aide to complete “assist with oral medications per nurse instructions” but this was checked as completed on 12/04/25 and 12/12/25. Patient #3: Initial POC/IDG and all updated indicated visit frequency 2x/weekly. Weeks of 11/04/25 - 12/28/25 there were 3 visits made weekly. Patient #4: Initial POC/IDG and all updated indicated visit frequency 2x/weekly. Patient was admitted on 10/30/25 and only one visit was made that week as well as week of 12/28/25. Patient #5: Updated POC indicated visit at frequency 2x/weekly. Week of 12/28/25 there were 3 visits completed. Patient #6: Initial POC/IDG indicated visit frequency 2x/weekly. Week of 12/28/25 and 01/04/25 there were no visits made. Patient #8: Initial POC/IDG and all updated indicated visit frequency 3x/weekly. Week of 12/28/25 there were only 2 visits completed. Aide POC indicated need to monitor of aspiration precaution, at every visit, and this was not completed per notes dated 12/01/25, 12/03/25, 12/05/25, 12/08/25, 12/10/25, 12/15/25 and 12/29/25. Notes dated 12/15/25 and 12/29/25 did not contain any completion of care plan under Patient Status/Additional Care section although the RN did complete this section. Note dated 12/03/25 did not show completion of peri care under the Bathing/Hygiene section and this was to be completed at every visit. Patient #9: Aide visit note dated 11/14/25 indicated areas of POC not being followed; Transfer section had a box checked, as completed by aide, that was not assigned by RN. Under feeding section there was nothing assigned by RN but aide had box checked. Bathing/hygiene did not contain check marks with everything indicated by RN. Dressing section indicated patient to be dressed in “street clothes” but this box was not checked but a box not indicated by RN was. Patient Status/Additional care had ROM Active-Passive completed by RN at every visit but this was not checked completed by aide. RN indicated for aide to provide companion services with each visit and this was not marked as completed by aide.”

“Upon patient client record review, 8 of 14 (Patient #1, #2, #5, #6, #7, #8, #9, #10) did not contain evidence that all entries were legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records: Patient #1: Aide visit note on 11/24/25 was not signed/dated. Patient #2: SC visit assessment note on 12/14/25 was not signed/dated. Patient #5: RN visit notes from 11/05/25 - 12/29/25 were not signed/dated. Patient #6: SC visit note on 10/03/25 was not signed/dated. MSW visit notes on 12/06/25 and 12/17/25 were not signed/dated. Bereavement assessment note on 10/02/25 was not signed/dated. Aide visit notes on 12/24/25, 12/29/25 and 12/31/25 were not signed dated. RN visit notes from 10/02/25 - 12/24/25 were not signed/dated. Patient #7: LVN note dated 09/16/25 stated “the right heel wound was then changed per orders.” LVN note dated 10/20/25 “the patients wound was attended to.” LVN note dated 12/16/25 “wound dressings were changed per orders.” LVN note dated 12/30/25 “the patient has his wound dressing changed per orders.” NP note dated 12/27/27 “dressing change performed wound care as per order.” Patient #8: MSW visit not on 12/16/25 was not signed/dated. MSW also did the initial bereavement assessment on 08/25/25 and this was not signed/dated. SC visit note on 08/28/25 was not signed/dated. SC then did an additional bereavement assessment on 11/21/25 and this was not signed/dated. LVN visit notes on starting on 08/26/25 and many through 12/30/25 were not signed/dated. RN visit notes 08/24/25 - 12/18/25 were not signed/dated. Aide visit notes from 12/1/25 - 01/05/26 were not signed/dated. Patient #9: Aide visit notes from 08/14/25 - 12/26/25 were not signed/dated. Visit note on 01/02/26 was not fully completed nor signed/dated. Patient #10: MSW visit notes dated 01/14/25, 03/06/25, 12/27/25 were not signed/dated. SC monthly visits notes from 02/28/25 - 11/21/25 were not signed/dated. Aide visit notes dated 01/11/25 - 03/04/25 were not signed/dated. LVN visit note 12/12/25 was not signed/dated.”