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Hospice

Foxmere Harbor Hospice · Hospice · Foxmere Harbor, ME

Noor Eberhardt is the care coordinator at Foxmere Harbor Hospice, a community hospice on the Maine coast, and she relies on this to track every license, safety round and quality audit an inspector might want to see, plus the steps that get the building ready before a surveyor walks in.

HealthcareComplianceChecklists5 tables · 6 views · 1 form · 1 digest · 1 checklist · 1 notification · 1 stage rule set · 1 agent
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All checks

Checks
CheckRecordDone onChecked byResultItems looked atItems that failed
CK-26-130Comfort-kit expiry checkOct 1, 2026Philippa Anselmo-RourkeFailed206
CK-26-129Hand hygiene observationSep 26, 2026Yevgenia Strand-OkoyePassed with notes371
CK-26-128Oxygen cylinder storage checkSep 13, 2026Ximena Valcourt-DubePassed90
CK-26-127Controlled-drug countSep 5, 2026Philippa Anselmo-RourkePassed480
CK-26-126Plan-of-care signature auditAug 28, 2026Ottoline Draycott-MbekiFailed205
CK-26-125Patient rights notice auditAug 21, 2026Barnaby Ellsworth-KanePassed with notes182
CK-26-124Staff license and CPR roster checkAug 4, 2026Bartholomew QuennellPassed340
CK-26-123Hand hygiene observationJul 27, 2026Yevgenia Strand-OkoyePassed330
CK-26-122Controlled-drug countJul 9, 2026Ximena Valcourt-DubePassed420
CK-26-121Fire extinguisher and exit walkJun 29, 2026Casimir Wetherell-TranFailed222
CK-26-120Plan-of-care signature auditJun 17, 2026Ottoline Draycott-MbekiPassed280
CK-26-119Oxygen cylinder storage checkJun 7, 2026Casimir Wetherell-TranPassed90

18 more rows

Tables

Checks

30 sample rows · 12 columns

Every licensing, safety and quality check the hospice has run, what it found and what the fix costs.

CheckRecordDone onChecked byResultItems looked atItems that failed
CK-26-130Comfort-kit expiry checkOct 1, 2026Philippa Anselmo-RourkeFailed206
CK-26-129Hand hygiene observationSep 26, 2026Yevgenia Strand-OkoyePassed with notes371
CK-26-128Oxygen cylinder storage checkSep 13, 2026Ximena Valcourt-DubePassed90
CK-26-127Controlled-drug countSep 5, 2026Philippa Anselmo-RourkePassed480
CK-26-126Plan-of-care signature auditAug 28, 2026Ottoline Draycott-MbekiFailed205
CK-26-125Patient rights notice auditAug 21, 2026Barnaby Ellsworth-KanePassed with notes182
CK-26-124Staff license and CPR roster checkAug 4, 2026Bartholomew QuennellPassed340
CK-26-123Hand hygiene observationJul 27, 2026Yevgenia Strand-OkoyePassed330
CK-26-122Controlled-drug countJul 9, 2026Ximena Valcourt-DubePassed420
CK-26-121Fire extinguisher and exit walkJun 29, 2026Casimir Wetherell-TranFailed222
CK-26-120Plan-of-care signature auditJun 17, 2026Ottoline Draycott-MbekiPassed280
CK-26-119Oxygen cylinder storage checkJun 7, 2026Casimir Wetherell-TranPassed90

18 more rows

Check types

8 sample rows · 6 columns

The recurring checks an inspector expects to see, and how many months may pass between them.

Check typeCodeAreaMonths betweenChecks done
Controlled-drug countRT-101Medication safety1CK-26-101, CK-26-106, CK-26-111, CK-26-117, CK-26-122, CK-26-127
Comfort-kit expiry checkRT-102Medication safety3CK-26-107, CK-26-118, CK-26-130
Hand hygiene observationRT-103Infection control1CK-26-102, CK-26-108, CK-26-116, CK-26-123, CK-26-129
Fire extinguisher and exit walkRT-104Fire and building3CK-26-103, CK-26-112, CK-26-121
Oxygen cylinder storage checkRT-105Fire and building3CK-26-110, CK-26-119, CK-26-128
Patient rights notice auditRT-106Patient rights6CK-26-114, CK-26-125
Plan-of-care signature auditRT-107Quality1CK-26-104, CK-26-109, CK-26-115, CK-26-120, CK-26-126
Staff license and CPR roster checkRT-108Staff credentials3CK-26-105, CK-26-113, CK-26-124

Licenses and permits

8 sample rows · 8 columns

Every license and permit that lets the hospice operate, who issued it and the day it runs out.

LicenseNumberIssued byIssuedRuns outYearly feeStanding
Volunteer program registrationLC-26-108State volunteer services officeSep 10, 2025Sep 23, 2026$50Expired
Town business licenseLC-26-107Foxmere Harbor town clerkOct 25, 2025Oct 25, 2026$75Renewal due
Fire marshal certificate of occupancyLC-26-104Town fire marshalOct 30, 2025Oct 30, 2026$90Renewal due
Pharmacy permit for comfort-kit stockLC-26-103State pharmacy boardDec 9, 2025Dec 9, 2026$260Current
Elevator inspection certificateLC-26-105State elevator safety officeJan 28, 2026Jan 28, 2027$120Current
Medical waste hauler registrationLC-26-106State environmental officeApr 8, 2026Apr 8, 2027$175Current
Medicare certificationLC-26-102Federal certification contractorDec 20, 2023Aug 31, 2027$0Current
State hospice licenseLC-26-101State health department licensing unitNov 4, 2024Nov 9, 2027$2,400Current

Inspector visits

7 sample rows · 9 columns

Every visit by a state, town or federal inspector, from the date it is announced to the day its findings are closed.

VisitKind of visitInspecting bodyVisit onHospice leadFindingsFindings closed on
IV-26-301State licensing surveyState health department licensing unitAug 31, 2025Bartholomew Quennell3Sep 20, 2025
IV-26-302Fire marshal walk-throughTown fire marshalOct 30, 2025Casimir Wetherell-Tran1Nov 14, 2025
IV-26-303Pharmacy board visitState pharmacy boardFeb 17, 2026Philippa Anselmo-Rourke2Mar 9, 2026
IV-26-304Medicare recertification reviewFederal certification contractorJul 2, 2026Noor Eberhardt4—
IV-26-305Mock survey by outside consultantIndependent hospice consultantOct 19, 2026Ottoline Draycott-Mbeki——
IV-26-306Elevator safety inspectionState elevator safety officeNov 12, 2026Casimir Wetherell-Tran——
IV-26-307Fire marshal walk-throughTown fire marshalNov 29, 2026Casimir Wetherell-Tran——

Views

Inspector visit board

Inspector visits
Scheduled2
IV-26-306Elevator safety inspectionState elevator safety office
IV-26-307Fire marshal walk-throughTown fire marshal
Preparing1
IV-26-305Mock survey by outside consultantIndependent hospice consultant
Ready0
Visited1
IV-26-304Medicare recertification reviewFederal certification contractor
Findings closed3
IV-26-301State licensing surveyState health department licensing unit
IV-26-302Fire marshal walk-throughTown fire marshal
IV-26-303Pharmacy board visitState pharmacy board

Forms and booking

Check report

Form
Check reportWhat a staff member fills in right after a round, count or walk-through.
Which check did you do? *
Who are you? *
What day did you do it? *
How did it come out? *PassedPassed with notesFailedFixed after retest
How many items did you look at?
How many did not pass?
What did you find?Leave blank if everything passed.
File the report

Also included

  • Before the surveyor arrivesChecklist
  • Inspector visit boardStage rules
  • License running outNotificationWarns Noor six weeks before a license or permit lapses.
  • Monday failed checksDigest

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