Accord Hospice of Sedona Valley, LLC

“It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed the agency did not ensure that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 5: The patient elected the hospice benefit on 06/20/ 2026 with a diagnosis of atherosclerotic heart disease of the native coronary artery without angina pectoris. A review of the clinical record revealed that a physician’s order dated 07/10/2026 ordered Eliquis 2.5 mg oral tablet, 1 tablet 2 times daily. The interdisciplinary (IDG) plan of care dated 07/15/2026 did not provide documented evidence that it was updated to include goals and interventions related to anticoagulant therapy, bleeding, or anticoagulant precautions. During an interview on 07/30/2026, the Clinical Supervisor (Personnel Record 2) stated, “The patient’s plan of care does not include interventions and goals for anticoagulant therapy and/or bleeding precautions. The plan of care has been updated to include those goals and interventions.””

“It is required that each patient’s individualized written plan of care: reflects patient and family goals; identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatments necessary to meet the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that each patient’s individualized written plan of care reflected patient and family goals, identified planned interventions based on problems identified in the initial and updated comprehensive assessments, included all services necessary for the palliation and management of the terminal illness, including treatments necessary to meet the needs of the patient. CLINICAL RECORD 13: The patient elected the hospice benefit on 09/04/2025 with a diagnosis of encephalopathy. A review of the clinical record revealed that the Registered Nurse (RN) documented in the initial nursing assessment dated 09/16/2025 that the patient had a PEG (Percutaneous Endoscopic Gastrostomy) tube [a soft, flexible feeding tube inserted directly through the abdominal wall into the stomach]. The Medication record listed medications to be given via PEG tube, including: Keppra 500 mg, take 1500 mg 3x/day via PEG; Tylenol 325mg, 2 tabs via PEG every 4 hours as needed for mild fever. The initial plan of care did not include interventions and goals related to care of the PEG tube site, administration of medications via the PEG tube, and/or how to ensure PEG tube patency. During an interview on 07/30/2026, the clinical supervisor (Personnel Record 2) stated, “The patient’s plan of care does not include goals and interventions for care of the PEG tube, administration of medications via the PEG tube, or flushing or maintaining patency of the PEG tube. The plan of care is now updated.””

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 4 of 13 (31%) clinical records reviewed of patients receiving hospice aide services, the agency did not ensure that written patient care instructions for a hospice aide were prepared by a registered nurse (RN) who is responsible for the supervision of the hospice aide. CLINICAL RECORD 1: The patient elected the hospice benefit on 04/07/ 2026 with a diagnosis of other pulmonary embolism without acute cor pulmonale. A review of the clinical record revealed that the initial plan of care dated 04/07/2026 included aspiration, fall, and oxygen precautions. The hospice aide care plan dated 04/07/2026 did not include precautions for aspiration, falls, or oxygen. CLINICAL RECORD 2: The patient elected the hospice benefit on 07/15/2025 with a diagnosis of ischemic cardiomyopathy. A review of the clinical record upon admission (07/15/2025) and from 05/11/2026 to 07/09/2026 revealed that the plan of care update dated 05/11/2026 to 07/09/2026 included bleeding and oxygen precautions. The hospice aide care plan dated 07/15/2025 and the hospice aide care plan updated on 07/01/2026 did not include bleeding and oxygen precautions. CLINICAL RECORD 5: The patient elected the hospice benefit on 06/20/2026 with a diagnosis of atherosclerotic heart disease of the native coronary artery without angina pectoris. A review of the clinical record revealed that a physician’s order dated 07/10/2026 ordered Eliquis 2.5 milligrams orally, 1 tablet 2 times daily. The hospice aide care plan dated 06/20/2026 did not include bleeding precautions and was not updated on 07/10/2026 to include bleeding precautions. CLINICAL RECORD 8: The patient elected the hospice benefit on 04/16/2026 with a diagnosis of unspecified heart failure. A review of the clinical record revealed that the Registered Nurse documented in the initial comprehensive assessment dated 04/16/2026 that the patient was using oxygen. The initial plan of care dated 04/16/2026 included oxygen 2-8 liters/minute via nasal cannula as needed for shortness of breath. The hospice aide care plan dated 04/16/2026 did not include oxygen precautions. During an interview on 07/30/2026, the Clinical Supervisor (Personnel Record 2) stated, “The aide care plans did not include the precautions identified. They have been updated at this time, and staff will be educated to be sure the aide plan of care includes related precautions.””

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s needs. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 1 of 13 (8%) clinical records reviewed of patients accepting hospice aide services, the agency did not ensure that the hospice aide was supervised by a registered nurse who made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s needs. CLINICAL RECORD 1: The patient elected the hospice benefit on 04/14/2026 with a diagnosis of other pulmonary embolism without acute cor pulmonale. A review of the clinical record revealed that the initial plan of care dated 04/17/2026 - 07/15/2026 ordered hospice aide visits 2 times per week. Hospice aide visits were documented on 05/15/2026, 05/19/2026, 05/22/2026, 05/26/2026, 05/29/2026, 06/02/2026, 06/05/2026, 06/12/2026, 06/16/2026, 06/19/2026, 06/23/2026, 06/26/2026, and 06/29/2026, There was no documented evidence that a supervisory visit was conducted by the Registered Nurse from 05/26/2026 through 06/29/2026726. This was 34 days, which exceeded the minimum 14-day requirement. During an interview on 07/30/2026, the clinical supervisor (Personnel Record 2) stated, “There is no documented evidence that the registered nurse conducted a supervisory visit for the patient from 05/26/2026 through 06/29/2026. We will initiate a best practice for hospice aide supervisory visits to be conducted weekly going forward.””

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 3 of 5 (60%) clinical records reviewed of patients that received aide services it was revealed that the agency did not ensure the hospice aide provided the services included in the plan of care. THIS IS A CONTINUED PRIOR REQUIRED ACTION Clinical Record 1: The aide visit note dated 07/25/2024, the aide documented in the narrative “...applied barrier cream...” The aide care plan dated 07/25/2024 did not include a task or order to “Apply barrier cream and location”. Clinical Record 4: The aide care plan dated 02/24/2024 ordered the bath task of “Shower Chair”. The aide visit note dated 02/24/2024 stated “Done” for the task “Shower Chair”, but in the narrative the aide documented “Assisted patient with bed bath”. The aide did not provide the task “Shower Chair” as ordered on the aide care plan. Clinical Record 5: The aide care plan dated 12/22/2023 ordered the bath task “Shower Chair”. The aide visit note dated 12/27/2023 stated “Unable to Document: Not applicable this visit” for the task “Shower Chair”. The aide documented in the narrative, “Assisted patient with bed bath”. The aide did not provide the task “Shower Chair” as ordered on the aide care plan. The Owner/Director of Nursing, Owner, Executive Director, Registered Nurse Case Manager/Alternate Director of Nursing, and Business Office Manager stated in an interview on 08/02/2024 that the agency did not ensure the hospice aide provided services only as ordered in the plan of care. CONTINUATION OF REQUIRED ACTION”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by clinical record review and interview. In 3 of 5 (60%) clinical records reviewed of patients that received hospice aide services it was revealed that the agency did not ensure the hospice aide reported changes in the patient’s medical needs to the registered nurse (RN) as the changes related to the plan of care (POC). Clinical Record 1: The aide visit note dated 07/25/2024, the aide documented in the narrative “...applied barrier cream...” The aide care plan dated 07/25/2024 lacked evidence of a task ordered “Apply barrier cream and location”, The record lacked evidence of the aide notifying the RN that the aide care plan lacked an ordered task to apply barrier cream and a location”. Clinical Record 4: The aide care plan dated 02/24/2024 ordered the bath task “Shower Chair”. The aide visit note dated 02/24/2024 stated “Done” for the task “Shower Chair”, but in the narrative the aide documented, “Assisted patient with bed bath”. The record lacked evidence of the aide reporting changes in the patient’s medical needs to the RN as related to the bath task ordered. Clinical Record 5: The aide care plan dated 12/22/2023 ordered the bath task “Shower Chair”. The aide visit note dated 12/27/2023 stated “Unable to Document: Not applicable this visit” for the task “Shower Chair”, but in the narrative the aide documented, “Assisted patient with bed bath”. The record lacked evidence of the aide reporting changes in the patient’s medical needs to the RN as related to the bath task ordered. The Owner/Director of Nursing, Owner, Executive Director, Registered Nurse Case Manager/Alternate Director of Nursing, and Business Office Manager stated in an interview on 08/02/2024 that the agency did not ensure the hospice aide reported changes in the patient’s medical needs to the registered nurse (RN) as the changes related to the plan of care (POC).”