All America Hospice Care, Inc.

“Upon patient record review and home visits, 3 of 14 (Patient #1,2,3) 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 Discrepancies found during home visit. Assisted living MAR contained the following medications that were not on the Hospice Medication profile: “Preservision Cap daily”, “Refresh Optive one drop both eyes, twice daily”, “Gentle Tear ointment both eyes at bedtime” and “Thera-M tab daily”. Hospice Medication Profile contained the following medications that were not on the facility MAR: “Oxygen 2-10L/min PRN dyspnea”, “Carvedilol 3.125mg tab. twice daily”, “Tylenol suppository 650mg, Rectally, every 6 hours PRN, pain/fever”, “Hyoscyamine 0.125mg, sublingual, every 4 hours PRN secretions”, “Lorazepam 0.5mg oral every 6 hours prn, anxiety/agitation”, “Prochlorperazine Maleate 10mg oral every 6 hours PRN N/V”, “Dulcolax suppository 10mg, rectally daily Prn constipation”, “Morphine sulfate concentrate 100mg/5ml oral 0.25ml every 3 hours prn pain/shortness of breath”. Dosage discrepancies as follows: Hospice Medication profile, Norvasc 5mg oral daily and Losartan 25mg oral daily. Facility MAR, Norvasc 10mg oral daily and Losartan 50mg oral daily. Patient #2 Discrepancies found during home visit. Hospice medication profile, Seroquel 25mg oral nightly. Facility MAR, Seroquel 50mg oral twice daily. Patient #3 Hospice Medication profile contained the following medications that were not on the facility MAR: “Tylenol suppository 650mg, Rectally, every 6 hours PRN, pain/fever”, “Morphine sulfate concentrate 100mg/5ml oral 0.25ml every 3 hours prn pain/shortness of breath”. Frequency discrepancies as follows: Hospice medication profile, Lorazepam 0.5mg oral every 4 hours PRN anxiety/agitation. Facility MAR, Lorazepam 0.5mg oral daily PRN”

“Upon patient record review, 3 of 14 (Patient #1,2,3) 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 #1 Discrepancies found during home visit. Assisted living MAR contained the following medications that were not on the Hospice plan of care: “Preservision Cap daily”, “Refresh Optive one drop both eyes, twice daily”, “Gentle Tear ointment both eyes at bedtime” and “Thera-M tab daily”. Hospice plan of care contained the following medications that were not on the facility MAR: “Oxygen 2-10L/min PRN dyspnea”, “Carvedilol 3.125mg tab. twice daily”, “Tylenol suppository 650mg, Rectally, every 6 hours PRN, pain/fever”, “Hyoscyamine 0.125mg, sublingual, every 4 hours PRN secretions”, “Lorazepam 0.5mg oral every 6 hours prn, anxiety/agitation”, “Prochlorperazine Maleate 10mg oral every 6 hours PRN N/V”, “Dulcolax suppository 10mg, rectally daily Prn constipation”, “Morphine sulfate concentrate 100mg/5ml oral 0.25ml every 3 hours prn pain/shortness of breath”. Dosage discrepancies as follows: Hospice plan of care, Norvasc 5mg oral daily and Losartan 25mg oral daily. Facility MAR, Norvasc 10mg oral daily and Losartan 50mg oral daily. Patient #2 Discrepancies found during home visit. Hospice plan of care, Seroquel 25mg oral nightly. Facility MAR, Seroquel 50mg oral twice daily. Patient #3 Hospice plan of care contained the following medications that were not on the facility MAR: “Tylenol suppository 650mg, Rectally, every 6 hours PRN, pain/fever”, “Morphine sulfate concentrate 100mg/5ml oral 0.25ml every 3 hours prn pain/shortness of breath”. Frequency discrepancies as follows: Hospice plan of care, Lorazepam 0.5mg oral every 4 hours PRN anxiety/agitation. Facility MAR, Lorazepam 0.5mg oral daily PRN”

“Upon patient record review, 1 of 14 (Patient #2) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #2 On 9/4/25 an on-call visit was made due to a fall, with injury, and patient exhibiting a change in mental status/behavior. The visit note documented “blood down hall and on walls from patient’s arm” and that his wife wanted him sent to the hospital. Patient was admitted to the hospital for acute care. The patient remained hospitalized until 9/15/25 upon which the patient returned to the ALF. During the time frame of 9/4-9/15, there was only one note made by the RNCM on 9/10 stating missed visit due to patient still hospitalized. Narrative stated he spoke with family member via phone. There was no other documentation during this time. This patient returned to facility on 9/15/25 and the RNCM made a visit, documenting patient was “Active” and “Comatose”. There were no updates to the plan of care.”

“Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #2 On 9/4/25 an on-call visit was made due to a fall, with injury, and patient exhibiting a change in mental status/behavior. Patient was admitted to the hospital for acute care. (interview and discussion with the clinical director whom stated “I made the decision that the patient would not be discharged from hospice service since the hospitalization was not related to terminal condition”). The clinical director stated that she did notify the Hospice Medical Director. The patient remained hospitalized until 9/15/25 upon which was returned to the ALF. During the time frame of 9/4-9/15, there was only one note made by the RNCM on 9/10 stating missed visit due to patient still hospitalized. Narrative stated he spoke with family member via phone. There was no other documentation during this time. There was no evidence in the record of any discussion with the Medical Director.”

“Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the IDG shares information on a on-going basis with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. Patient #2 On 9/4/25 an on-call visit was made due to a fall, with injury, and patient exhibiting a change in mental status/behavior. Patient was admitted to the hospital for acute care. During the time frame of hospitalization 9/4-9/15, there was only one note made by the RNCM on 9/10 stating missed visit due to patient still hospitalized. Narrative stated he spoke with family member via phone. There was no other documentation of communication between the hospice and hospital during this time.”

“Upon patient record review, 1 of 14 (Patient #11) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient’s attending physician: • A copy of the hospice discharge summary • The patient’s clinical record, if requested Patient #11 Revocation form signed and dated effective 2/09/25. Discharge summary uploaded in record only stated “revoked hospice 2/10/25”. End of care documented in EMR as 2/10/25. No evidence of any information faxed to a physician or facility.”