Reliable Hospice, Inc.

“Based on interview and record review, the hospice failed to ensure the care and services were provided in accordance with the POC for two of three sampled patients (Patients 1 and 2). This failure had the potential for not providing appropriate, consistent, and quality care to these patients.Findings: 1. Review of Patient 1’s closed clinical record was initiated on 8/12/26. The clinical record showed the SOC was 12/26/23. The patient was certified for hospice services during the certification periods from 2/14/26 to 4/14/26 and 4/15/26 to 6/13/26. The patient was discharged from the hospice on 5/15/26.a. The POC/IDG Reviews dated 2/17, 3/3, 3/17, 3/31 and 4/14/26, cited SN visits 1-2 x a week (one to two times a week) plus 3 PRN visits. The care plan for endocrine showed an intervention to monitor/assess effectiveness of current medications: Lantus Solostar and Glimepiride for hyperglycemia.Review of the Visit Note RN dated 2/17, 2/28 and 3/24/26, showed the RN documented “DM management effective per report.”However, there was no documented evidenced of the blood sugar level monitoring or how the SN assessed the effectiveness of diabetic medications as per the intervention on the POC. b. The POC/IDG Reviews dated 2/17, 3/3, 3/17, 3/31 and 4/14/26, cited MSW one time per month plus three PRN visits.However, review of the closed clinical record failed to show documented evidence of the MSW visits for the month of February and March as ordered in the POC.On 8/14/26 at 1305 hours, an interview and concurrent closed clinical record review was conducted with the DPCS and Administrator. They were informed and acknowledged the findings. 2. Review of Patient 3’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 12/27/24. The patient was certified for hospice services during the certification periods from 2/22/24 to 4/20/26 and 4/21/26 to 6/19/26. The patient was discharged from the hospice on 5/15/26.Review of the Current Treatment/Medication/DME List dated 12/27/24, showed an order for MSW visit one time per month for psychosocial needs.However, review of the closed clinical record failed to show documented evidence of the MSW visit one time a month as ordered by the physician.Further review of the Current Treatment/Medication/DME List dated 12/27/24, showed HA visits 3x per week for ADL care.Review of the HA visit Notes showed the HA visited the patient two times on 4/13 and 4/15/26, during Week 9 (4/12 to 4/18) instead of three times as ordered in the POC. On 8/14/26 at 1120 hours, an interview and concurrent closed clinical record review was conducted with the Administrator and DPCS. They were asked if MSW services was discontinued. The DPCS replied MSW services was not discontinued; however, there were missing notes and the POC was not followed. They were informed and acknowledged the findings.”

“Based on interview and record review, the hospice failed to ensure the individualized care plans were developed for one of three sampled patients (Patient 2). This failure created the potential risk to cause an inconsistent delivery of care which can result in the decline or lack of improvement of the patients’ health conditions.Findings: 1. Review of Patient 2’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 2/17/26. The patient was certified for hospice services during the certification periods from 3/1/26 to 4/30/26 and 5/1/26 to 6/29/26. The patient was discharged from the hospice service on 5/15/26. Review of the Visit Note LVN dated 3/24/26, showed LVN 2 had performed the skin assessment. The narrative section for skin assessment showed the patient was assessed to have a new DTI to the mid back. The SN cleansed with Normal Saline, patted dry, applied barrier cream to wound edges and xeroform to DTI, and covered with a foam dressing.Review of the POC/IDG dated 3/31/26, showed an IDG had discussed the patient’s new DTI to the mid back. However, there was no documented evidence the IDG had developed an individual POC to address the patients’ new DTI to the mid back. On 8/14/26 at 1320 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was informed and acknowledged the findings.”

“Based on interview and record review, the hospice failed to ensure the POCs included measurable outcomes for three of three sampled patients (Patients 1, 2, and 3). This failure had the potential for not evaluating the POC and providing appropriate care and services to these patients.Findings: 1. Review of Patient 1’s closed clinical record was initiated on 8/12/26. The clinical record showed the SOC was 12/26/23. The patient was certified for hospice services during the certification periods from 2/14/26 to 4/14/26 and 4/15/26 to 6/13/26. The patient was discharged from the hospice service on 5/15/26.The hospice’s P&P titled IDG Care Planning revised February 2022 showed an individualized written plan of care of care is developed for each patient. The plan of care reflects patient and family goals and interventions based on the problems based on the problems identified in the initial, comprehensive and updated assessments. Measurable outcomes anticipated from implementing and coordinating the plan of care. The POC/IDG Reviews dated 2/17, 3/3, 3/17, 3/31, 4/14, 4/28, 5/12, and 5/18/26, showed the patient’s identified problems with the established goal and interventions as follows:-Endocrine: Blood sugar management for patient comfort.-Gastrointestinal: will be able to tolerate present dietary order of mechanical soft diet with thickened liquids.-Nutrition: will have adequate food and fluids as tolerated or desired.However, there was no documented evidence of measurable goals as to what adequate food and fluids and tolerate dietary order for patient comfort was. In addition, there was no documented evidence of measurable goals for the patients’ blood sugar level to maintain comfort. On 8/14/26 at 1158 hours, an interview and concurrent closed clinical record review was conducted with the DPCS and Administrator. They were informed and acknowledged the findings. 2. Review of Patient 2’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 2/17/26. The patient was certified for hospice services during the certification periods from 3/1/26 to 4/30/26 and 5/1/26 to 6/29/26. The patient was discharged from the hospice service on 5/15/26.The POC/IDG Review dated 3/3, 3/17, 3/31, 4/14, 4/28, and 5/12/26, showed the patient’s identified problems with the established goal and interventions to include pain. The goal for pain was for the patient to show no subjective or objective signs of pain and or discomfort and remain free or at a comfortable level of pain with medication management throughout the benefit period. However, there was no documented evidence of measurable goals as to what a comfortable level of pain was for the patient. On 8/14/26 at 1320 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was informed and acknowledged the findings. 3. Review of Patient 3’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 12/27/24. The patient was certified for hospice services during the certification periods from 2/22/24 to 4/2/26 and 4/21/26 to 6/19/26. The patient was discharged from the hospice service on 5/15/26.The POC/IDG Reviews dated 3/3, 3/17, 3/31, 4/14, 4/28, 5/12 and 5/18/26, showed the patient’s identified problems with the established goal and interventions as follows:-ADL: All needs are met, the patient will have optimal comfort.-Cardiovascular: to achieve and maintain peripheral circulation for patient comfort and the patient will have optimal comfort.-Gastrointestinal: elimination needs met at an acceptable level-Mobility: the patient will have optimal comfort.-Musculoskeletal: the patient will have optimal comfort.-Genitourinary: elimination needs met at an acceptable level.-Nutrition: the patient will have adequate food and fluids as tolerated or desired.However, there was no documented evidence of measurable goals as to what an acceptable level and adequate food and fluids for the patient’s comfort would be. On 8/14/26 at 1120 hours, an interview and concurrent closed clinical record review was conducted with the Administrator and the DPCS. They were informed and acknowledged the findings.”

“Based on interview and record review, the hospice failed to ensure the IDG had reviewed/revised the patients’ POCs no less frequently than every 15 calendar days for two of three sampled patients (Patients 2 and 3). This failure created the potential risk for not providing appropriate, consistent, and quality care to these patients. Findings: The hospice’s P&P titled IDG Care Planning Process revised February 2022 showed the hospice has designated an interdisciplinary group which, in consultation with patient’s attending physician, prepares a written plan of care for each patient. The group consists of: A physician member who is the Hospice Medical Director or another Hospice physician who mis employed by or under contract with hospice, Registered Nurse, Social Worker and Pastoral or another counselor. A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs. The IDG (in collaboration with the patient’s attending physician, if any) reviews, revise and documents the individualized plan as frequently as the patient’s condition requires, but no less frequently than every 15 calendar days. 1. Review of Patient 2’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 2/17/26. The patient was certified for hospice services during the certification periods from 3/1/26 to 4/30/26 and 5/1/26 to 6/29/26. The patient was discharged from the hospice on 5/15/26.Review of the Current Treatment/Medication/DME List showed an order dated 2/17/26, for SN visits five times per week and 3 PRN visits for pain and symptom management. a. The POC/IDG Reviews dated 3/3, 3/17, 3/31, 4/14, and 4/28/26, showed HA visits 2 times per week for ADL care, and MSW 1 visit per month plus 2 PRN visits.*Review of the closed clinical record showed the following SN visits: -During Week 1 (3/2 to 3/7/26), the SN visited two times on 3/3 and 3/5/26.-During Week 2 (3/8 to 3/14/26), the SN visited two times on 3/10 and 3/12/26.-During Week 3 (3/15 to 3/21/26, the SN visited two times on 3/17 and 3/19/26.-During Week 4 (3/22 to 3/28/26), the SN visited five times on 3/24, 3/25, 3/26, 3/27, and 3/28/26.-During Week 5 (3/29 to 4/4/26), the SN visited three times on 3/30, 4/1, and 4/3/26.-During Week 6 (4/5 to 4/12/26), the SN visited three times on 4/6, 4/18, and 4/10/26.-During Week 7 (4/13 to 4/18/26), the SN visited three times on 4/14, 4/1 5, and 4/17/26.-During Week 8 (4/19 to 4/25/26), the SN visited three times on 4/20, 4/122, and 4/24/26. -During Week 9 (4/26 to 5/2/26), the SN visited three times on 4/27, 4/29, and 5/1/26.However, the IDG did not revise the POC to reflect the SN visit frequency.On 8/14/26 at 1336 hours, an interview and concurrent closed clinical record review were conducted with the DPCS. The DPCS was informed and acknowledged the findings. b. The POC/IDG Review dated 4/28, 5/12, and 5/18/26, showed HA visits 2 times per week for ADL care, and MSW visit 1 time per month plus 2 PRN visits.Review of the closed clinical record showed the following SN visits: -During Week 1 ( 5/1 to 5/2/26), the SN visited one time on 5/1/26.-During Week 2 (5/3 to 5/9/26), the SN visited four times on 5/4, 5/6, 5/6, 5/8, and 5/9/26.-During Week 3 (5/10 to 5/16/26), the SN visited six times on 5/10, 5/11, 5/12, 5/13, 5/14, and 5/15/26.However, the IDG did not revise the POC to reflect the SN visits.On 8/14/26 at 1320 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was informed and acknowledged the findings. c. Review of the Visit Note LVN dated 3/24/26, showed LVN 2 had performed the skin assessment. The narrative section of the skin assessment showed the patient was assessed to have a new DTI to the mid back. The SN cleansed with Normal Saline, patted dry, and applied barrier cream to wound edges and xeroform to DTI, and covered with a foam dressing.Review of the POC/IDG dated 3/31/26, showed an IDG and care plan discussion was conducted.However, the IDG failed to revise a care plan to address the patients’ new DTI to the midback.On 8/14/26 at 1320 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was informed and acknowledged the findings. 2. Review of Patient 3’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 12/27/24. The patient was certified for hospice services during the certification periods from 2/22/24 to 4/2/26 and 4/21/26 to 6/19/26. The patient was discharged from the hospice on 5/15/26.a. Review of the Current Treatment/Medication/DME List showed an order dated 12/27/24, for SN visit 1 -3 times per week (one to three times per week) and PRN for pain and symptom management; SC visit 1 time per month for spiritual needs; MSW visit 1 time per month for psychosocial needs; and HA visits 3 times per week for ADL care.The POC/IDG Reviews dated 4/28, 5/12, and 5/18/26, showed only Volunteer visit frequency documented as declined. The revised POC did not include other disciplines visit frequency, including SN, MSW, SC, and HA. *Review of the closed clinical record showed the following SN visits: -During Week 1 (4/21 to 4/25/26), the SN visited one time on 4/21/26.-During Week 2 (4/26 to 5/2/26), the SN visited one time on 4/29/26.-During Week 3 (5/10 to 5/16/26), the SN visited one time on 5/13/26.b. The POC/IDG Reviews dated 3/3 and 3/31/26, showed an IDG meeting was conducted. The Medical Director, DPCS and RN 1 electronically signed the meeting notes. However, there was no documented evidence of the MSW and Chaplain attended the IDG meeting minutes as the sections for the electronic signatures were left blank. *The POC/IDG Review dated 3/17 and 4/14/26, showed an IDG meeting was conducted. The Medical Director, DPCS, RN 1 and SC had electronically signed the meeting. However, there was no documented evidence of the MSW attended the IDG meetings as the section for the electronic signature was left blank. On 8/14/26 at 1120 hours, an interview and concurrent closed clinical record review was conducted with the Administrator and DPCS. They were informed and acknowledged the findings.3. Review of Patient 1’s closed clinical record was initiated on 8/12/26. The clinical record showed the SOC was 12/26/23. The patient was certified for hospice services during the certification periods from 2/14/26 to 4/14/26 and 4/15/26 to 6/13/26. The patient was discharged from the hospice service on 5/15/26. *The POC/IDG Review dated 4/28/26, showed an IDG meeting was conducted. The Medical Director electronically signed the meeting note. However, there was no documented evidence of the RN, MSW, and Chaplain attended the IDG meeting minutes as the sections for their electronic signatures were left blank. *The POC/IDG Review dated 5/12 and 5/18/26, showed an IDG meeting was conducted and the POC was discussed. The Medical Director and RN 1 had electronically signed the meeting. However, there was no documented evidence of the MSW and Chaplain attended the IDG meeting minutes as the sections for theie electronic signatures were left blank. *The POC/IDG Reviews dated 2/17, 3/3, 3/17, 3/31, and 4/14/26, showed an IDG meeting was conducted and the POC was discussed. The Medical Director, RN 1, DPCS and SC had electronically signed the meeting notes. However, there was no documented evidence of the MSW attended the IDG meeting minutes as the section for the electronic signature was left blank. On 8/14/26 at 1158 hours, an interview and concurrent closed clinical record review was conducted with the DPCS and Administrator. They were informed and acknowledged the findings.”

“Based on interview and record review, the hospice’s Administrator failed to be responsible for the day-to-day operations of the organization and maintain the administrative and supervisory responsibility for all care provided. This failure had the potential for not providing appropriate care and services to this patient. Findings: Review of the Administrators’ Job Description undated showed the Administrator organizes and directs the day-to-day operations of the hospice, plans, develops, implements, and evaluates hospice service, programs, activities in accordance with hospice’s philosophy, Governing Body directives, and applicable state and federal law.The hospice’s P&P titled Physician Orders revised June 2016 showed verbal orders are put in writing, signed, and dated with the date of receipt by a RN (or therapist) responsible for furnishing or supervising ordered services. Review of Patient 1’s closed clinical record was initiated on 8/12/26. The clinical record showed the SOC was 12/26/23. The patient was certified for hospice services during the certification periods from 2/14/26 to 4/14/26 and 4/15/26 to 6/13/26. The patient was discharged from the hospice on 5/15/26.a. Review of the Discharge Summary showed the EOC was 5/15/26. The reason for discharge was an extended prognosis.Review of the closed clinical record showed the Current treatment/Medication/DME List.However, the Current treatment/Medication/DME List failed to show documented evidenced of the physicians order for discharge.On 8/14/26 at 1158 hours, an interview and concurrent closed clinical record review was conducted with the DPCS and Administrator. They were asked if a discharge order was given. The DPCS reviewed the closed clinical record and stated it was done verbally, but nothing was written. They were informed and acknowledged the findings. b. The hospice’s P&P titled Timely Submission of Patient Documentation revised June 2019 showed hospice will ensure the timely and proper submission of patient documentation. The purpose was to comply with state/federal laws and regulations related to timely to timely submission of all patient documentation. Itineraries, with all visit reports attached, must be submitted the next scheduled work day, not exceeding three (3) business days. Patient 1’s POC/IDG Reviews dated 2/17, 3/3, 3/17, 3/31, and 4/14/26, cited SN 1-2 x a week plus 3 PRN visits.Review of the Visit Note Short Form dated 3/23, 3/30, 4/6, and 4/23/26, showed LVN 1 had conducted an in-person visit. Pain assessment and Vital signs were documented. However, the section for chief complaint, comment, and narrative, electronic signature, and date were left blank. On 8/14/26 at 1305 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was asked if it was a visit. The DPCS reviewed the closed clinical record and stated yes, it was incomplete notes. The DPCS was also asked as to the timeline for the completion of the visit notes. The DPCS replied per the policy, it should be submitted within 48 hours from the visit date. The DPCS was informed and acknowledged the findings.”

“Based on interview and record review, the hospice failed to ensure the clinical records were complete and accurate for three of three sampled patients (Patients 1, 2, and 3). These failure had the potential risk of substandard care provided to the patient as the clinical information were not accurate and complete. Findings: The hospice’s P&P titled Patient Record Content revised June 2019, showed hospice will provide an accurate and current patient record for every patient seen by hospice. Hospice will initiate and maintain an individual and accurate patient record containing past and current findings for each patient receiving care in compliance with all federal/state laws and regulations. The record must contain correct clinical information. All entries be legible, clear, complete and and appropriately authenticated. 1. Review of Patient 1’s closed clinical record was initiated on 8/12/26. The clinical record showed the SOC was 12/26/23. The patient was certified for hospice services during the certification periods from 2/14/26 to 4/14/26 and 4/15/26 to 6/13/26. The patient was discharged from the hospice service on 5/15/26.The POC/IDG Review dated 4/14/26, cited HA visits 3 times per week. Review of the HA Visit Notes dated 4/15, 4/17, 4/20, 4/22, 4/24, 4/27, 4/29, 5/4, and 5/6/26, showed the HA assignments and tasks. The HA assignments included a check mark on the Oxygen and Vital signs sections for the HA to check every visit. Further Review of the HA Visit Notes dated 4/15, 4/17, 4/20, 4/22, 4/24, 4/27, 4/29, 5/4, and 5/6/26, showed the HA had checked the patient’s oxygen as documented by a “check.”However, there was no documented evidence of the Vital signs were taken as cited in the HA assignment.On 8/13/26 at 0948 hours, The DPCS was asked if the HA checked the oxygen and Vital signs. DPCS replied, “No, we don’t usually ask the HA to do vitals, it was a clerical error.”On 8/14/26 at 1158 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was informed and acknowledged the findings. 2. Review of Patient 3’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 12/27/24. The patient was certified for hospice services during the certification periods from 2/22/24 to 4/20/26 and 4/21/26 to 6/19/26. The patient was discharged from the hospice on 5/15/26.The POC/IDG Review dated 4/14/26 cited HA visits 3 times per week. Review of the HA Visit Notes dated 4/22, 4/24, 4/27, 4/29, 5/1, 5/4, 5/6, 5/8,5/11, 5/13, and 5/14/26, showed the HA assignments and tasks. The HA assignment included a check mark on the Oxygen and Vital signs sections for the HA to check every visit. Further Review of the HA Visit Notes dated 4/22, 4/24, 4/27, 4/29, 5/1, 5/4, 5/6, 5/8,5/11, 5/13, and 5/14/26, showed the HA had checked the patient’s oxygen as documented by a “check.”However, there was no documented evidence of the Vital signs taken as cited in the HA assignment.On 8/14/26 at 1120 hours, an interview and concurrent closed clinical record review was conducted with the Administrator and DPCS. They were informed and acknowledged the findings. 3. Review of Patient 2’s closed clinical record was initiated on 8/13/26. The clinical record showed the SOC was 2/17/26. The patient was certified for hospice services during the certification periods from 3/1/26 to 4/30/26 and 5/1/26 to 6/29/26. The patient was discharged from the hospice on 5/15/26.Review of the SN Visit Notes dated 5/7, 5/8, 5/9, 5/19, 5/11, 5/12, 5/13, 5/14, and 5/15/26, included the skin assessment. The skin assessment showed the patient had a pressure injury to the right upper back. The documentation showed the following:-description: unstageable-Stage: 2However, the description of Stage 2 pressure injury was inaccurate. On 8/14/26 at 1320 hours, an interview and concurrent closed clinical record review was conducted with the DPCS. The DPCS was informed and acknowledged the findings.”

“Observed in Record Review. In 7 of 10 patient records reviewed, the Surveyor noted the initial bereavement assessment (BR) had not been completed. For example, in RRHV#1, the patient had not had an initial BR documented since coming onto service 12 days prior. RRHV#3 the patient had no documented initial BR and had been on service for 29 days. RRNHV#4, the patient has been on service since December 2024 (162 days), and there has been no documented initial BR. RRNHV#6 had been on service since December and no initial BR had been documented. RRNHV#7 had been on service since 2023, and no initial BR had been documented. RRNHV#8 the patient had been on service since 2022 and there had been no initial BR present in the record. RRNHV#9, no initial BR had been documented and pt on service of over 1 year and in RRNHV#10 there had been no initial BR documented and patient had been on service since December 2024. This was validated with the DOPCS.”

“Observed in Record Review. In 2 of 10 patient records reviewed, the Surveyor noted plan of care goals that had been generic, without a time frame for achievement or not measurable. For example, in RRHV#3 the patient had for Incontinent of urine- Family/PCG will verbalize having urinary elimination needs met at an acceptable level throughout benefit period. For Integumentary (Pt had 2 stage 2 pressure injuries)- Altered skin will resolve without complications by... (blank), and for pain- Pain will remain at comfortable level during care throughout benefit period. In RRNHV#4, the patient had the time frame for achievement of goals as during the level of care and other goals that had not been clear. For example, Patient will remain safe and free of any injury related to anxiety during the level of care, and for respiratory Patient will no develop respiratory infection that prevention of respiratory distress. This was validated with the DOPCS”

“Observed in Patient Home. In 1 of 3 home visits conducted, the Surveyor noted the medication list in the electronic medical record had not reflected all the medications the patient had been currently taking. For example, in RRHV#1, the patient had been taking AREDS 2, Cranberry tabs, Vitamin C, Diclofenac 1% and a small HHN Albuterol since admission and these had not been recorded in the patient medication profile. This was validated with the DOPCS. Observed in Record Review. In 2 of 10 patient records reviewed, the Surveyor noted the active medication list had not been accurate to what the patient was currently being administered. For example, in RRNHV#6, the medication list still had an antibiotic (Azithromycin) that was prescribed in early April for a 5 day course. The patient in RRNHV#7 had a time limited medication ordered (Mupirocin twice a day for 10 days) written in February 2025 that was still on the active patient medication list. This was validated with the DOPCS.”