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
Use this templateAll checks
Checks| Check | Record | Done on | Checked by | Result | Items looked at | Items that failed |
|---|---|---|---|---|---|---|
| CK-26-130 | Comfort-kit expiry check | Oct 14, 2026 | Philippa Anselmo-Rourke | 20 | 6 | |
| CK-26-129 | Hand hygiene observation | Oct 9, 2026 | Yevgenia Strand-Okoye | 37 | 1 | |
| CK-26-128 | Oxygen cylinder storage check | Sep 26, 2026 | Ximena Valcourt-Dube | 9 | 0 | |
| CK-26-127 | Controlled-drug count | Sep 18, 2026 | Philippa Anselmo-Rourke | 48 | 0 | |
| CK-26-126 | Plan-of-care signature audit | Sep 10, 2026 | Ottoline Draycott-Mbeki | 20 | 5 | |
| CK-26-125 | Patient rights notice audit | Sep 3, 2026 | Barnaby Ellsworth-Kane | 18 | 2 | |
| CK-26-124 | Staff license and CPR roster check | Aug 17, 2026 | Bartholomew Quennell | 34 | 0 | |
| CK-26-123 | Hand hygiene observation | Aug 9, 2026 | Yevgenia Strand-Okoye | 33 | 0 | |
| CK-26-122 | Controlled-drug count | Jul 22, 2026 | Ximena Valcourt-Dube | 42 | 0 | |
| CK-26-121 | Fire extinguisher and exit walk | Jul 12, 2026 | Casimir Wetherell-Tran | 22 | 2 | |
| CK-26-120 | Plan-of-care signature audit | Jun 30, 2026 | Ottoline Draycott-Mbeki | 28 | 0 | |
| CK-26-119 | Oxygen cylinder storage check | Jun 20, 2026 | Casimir Wetherell-Tran | 9 | 0 |
Tables
Checks
30 sample rows · 12 columnsEvery licensing, safety and quality check the hospice has run, what it found and what the fix costs.
| Check | Record | Done on | Checked by | Result | Items looked at | Items that failed |
|---|---|---|---|---|---|---|
| CK-26-130 | Comfort-kit expiry check | Oct 14, 2026 | Philippa Anselmo-Rourke | 20 | 6 | |
| CK-26-129 | Hand hygiene observation | Oct 9, 2026 | Yevgenia Strand-Okoye | 37 | 1 | |
| CK-26-128 | Oxygen cylinder storage check | Sep 26, 2026 | Ximena Valcourt-Dube | 9 | 0 | |
| CK-26-127 | Controlled-drug count | Sep 18, 2026 | Philippa Anselmo-Rourke | 48 | 0 | |
| CK-26-126 | Plan-of-care signature audit | Sep 10, 2026 | Ottoline Draycott-Mbeki | 20 | 5 | |
| CK-26-125 | Patient rights notice audit | Sep 3, 2026 | Barnaby Ellsworth-Kane | 18 | 2 | |
| CK-26-124 | Staff license and CPR roster check | Aug 17, 2026 | Bartholomew Quennell | 34 | 0 | |
| CK-26-123 | Hand hygiene observation | Aug 9, 2026 | Yevgenia Strand-Okoye | 33 | 0 | |
| CK-26-122 | Controlled-drug count | Jul 22, 2026 | Ximena Valcourt-Dube | 42 | 0 | |
| CK-26-121 | Fire extinguisher and exit walk | Jul 12, 2026 | Casimir Wetherell-Tran | 22 | 2 | |
| CK-26-120 | Plan-of-care signature audit | Jun 30, 2026 | Ottoline Draycott-Mbeki | 28 | 0 | |
| CK-26-119 | Oxygen cylinder storage check | Jun 20, 2026 | Casimir Wetherell-Tran | 9 | 0 |
Check types
8 sample rows · 6 columnsThe recurring checks an inspector expects to see, and how many months may pass between them.
| Check type | Code | Area | Months between | Checks done |
|---|---|---|---|---|
| Controlled-drug count | RT-101 | 1 | CK-26-101, CK-26-106, CK-26-111, CK-26-117, CK-26-122, CK-26-127 | |
| Comfort-kit expiry check | RT-102 | 3 | CK-26-107, CK-26-118, CK-26-130 | |
| Hand hygiene observation | RT-103 | 1 | CK-26-102, CK-26-108, CK-26-116, CK-26-123, CK-26-129 | |
| Fire extinguisher and exit walk | RT-104 | 3 | CK-26-103, CK-26-112, CK-26-121 | |
| Oxygen cylinder storage check | RT-105 | 3 | CK-26-110, CK-26-119, CK-26-128 | |
| Patient rights notice audit | RT-106 | 6 | CK-26-114, CK-26-125 | |
| Plan-of-care signature audit | RT-107 | 1 | CK-26-104, CK-26-109, CK-26-115, CK-26-120, CK-26-126 | |
| Staff license and CPR roster check | RT-108 | 3 | CK-26-105, CK-26-113, CK-26-124 |
Licenses and permits
8 sample rows · 8 columnsEvery license and permit that lets the hospice operate, who issued it and the day it runs out.
| License | Number | Issued by | Issued | Runs out | Yearly fee | Standing |
|---|---|---|---|---|---|---|
| Volunteer program registration | LC-26-108 | State volunteer services office | Sep 23, 2025 | Oct 6, 2026 | $50 | |
| Town business license | LC-26-107 | Foxmere Harbor town clerk | Nov 7, 2025 | Nov 7, 2026 | $75 | |
| Fire marshal certificate of occupancy | LC-26-104 | Town fire marshal | Nov 12, 2025 | Nov 12, 2026 | $90 | |
| Pharmacy permit for comfort-kit stock | LC-26-103 | State pharmacy board | Dec 22, 2025 | Dec 22, 2026 | $260 | |
| Elevator inspection certificate | LC-26-105 | State elevator safety office | Feb 10, 2026 | Feb 10, 2027 | $120 | |
| Medical waste hauler registration | LC-26-106 | State environmental office | Apr 21, 2026 | Apr 21, 2027 | $175 | |
| Medicare certification | LC-26-102 | Federal certification contractor | Jan 2, 2024 | Sep 13, 2027 | $0 | |
| State hospice license | LC-26-101 | State health department licensing unit | Nov 17, 2024 | Nov 22, 2027 | $2,400 |
Inspector visits
7 sample rows · 9 columnsEvery visit by a state, town or federal inspector, from the date it is announced to the day its findings are closed.
| Visit | Kind of visit | Inspecting body | Visit on | Hospice lead | Findings | Findings closed on |
|---|---|---|---|---|---|---|
| IV-26-301 | State licensing survey | State health department licensing unit | Sep 13, 2025 | Bartholomew Quennell | 3 | Oct 3, 2025 |
| IV-26-302 | Fire marshal walk-through | Town fire marshal | Nov 12, 2025 | Casimir Wetherell-Tran | 1 | Nov 27, 2025 |
| IV-26-303 | Pharmacy board visit | State pharmacy board | Mar 2, 2026 | Philippa Anselmo-Rourke | 2 | Mar 22, 2026 |
| IV-26-304 | Medicare recertification review | Federal certification contractor | Jul 15, 2026 | Noor Eberhardt | 4 | — |
| IV-26-305 | Mock survey by outside consultant | Independent hospice consultant | Nov 1, 2026 | Ottoline Draycott-Mbeki | — | — |
| IV-26-306 | Elevator safety inspection | State elevator safety office | Nov 25, 2026 | Casimir Wetherell-Tran | — | — |
| IV-26-307 | Fire marshal walk-through | Town fire marshal | Dec 12, 2026 | Casimir Wetherell-Tran | — | — |
Also included
- Before the surveyor arrives
- Inspector visit board
- License running outWarns Noor six weeks before a license or permit lapses.
- Monday failed checks
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