Blendship, Inc.

“Upon observation and patient record review 2 of 14 (Patient #6,9), there was no evidence the hospice has an interdisciplinary group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. Interdisciplinary group members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. Patient 6: The IDG notes only contain evidence of the RN and MD attending the IDG, there are no notes from SC or MSW. No evidence the SC or MSW attended IDG. There is no evidence the IDG was composed of all disciplines to meet the physical, medical, psychosocial, emotional, and spiritual needs of the patient. Patient 9: The medical record contains evidence that MSW and SC are seeing the patient and there is no evidence of goals or interventions for SC or psychosocial care or evidence that MSW or SC are attending IDG. There is no evidence the IDG was composed of all disciplines to meet the physical, medical, psychosocial, emotional, and spiritual needs of the patient.”

“Upon patient record review, 1 of 14 (Patient #8) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 8: The SN assessment on 3/18/25, pt. had a blood pressure of 219/78, SN rechecked at 204/74, on 2/20/25 the patient had a blood pressure of 190/69, the SN did not inform the physician and dialysis center and stated the “high BP was due to dialysis”. There is no evidence in the medical record that the SN is assessing an AV fistula for signs and symptoms of infection or monitoring ESRD.”

“Upon patient record review, 8 of 14 (Patient #2,4,5,6,7,8,9,10) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 2: The comprehensive assessment contains documentation that the patient is bed bound. There is no at risk for skin breakdown care plan with goals and interventions. Corrected on site. In addition, the plan of care 2/26/25 the SC is ordered one time a month there is no evidence of SC goals or interventions. Patient 4: The POC 3/28/25 contains an order for Eliquis daily there is no risk of bleeding care plan with goals and interventions. Corrected on site. Patient 5: The comprehensive assessment on 3/12/25 has documentation that patient is using walker and cane and there is no risk of falls care plan with goals and interventions. Corrected on site. In addition, the plan of care 2/26/25 the SC is ordered one time a month there is no evidence of SC goals or interventions. Patient 6: The comprehensive assessment on 12/28/24 has documentation that patient is using walker with impaired balance and there is no risk of falls care plan with goals and interventions. The SN documented on 2/5/25 “Encouraged to turn and reposition every 2 hours and documented “applied barrier cream on 1/3/25”. There is no at risk for skin breakdown added with goals and interventions. The SN documented on 2/14/25 “aspirations precautions discussed with daughter”. There was no risk for aspirations care plan added with goals or interventions. Corrected on site. Patient 7: The SN documented on comprehensive assessment 12/14/24 and IDG note 3/20/25, Patient is at risk for aspiration. There was no risk for aspiration care plan developed with goals and interventions. Corrected on site. Patient 8: The SN documented on comprehensive assessment on 10/22/24 that the patient has a walker, there is no risk for falls on the POC. The SN documented on 10/22/24 that the patient is a risk for aspiration, there is no risk for aspiration on the POC with goals and interventions. Pt is on hemodialysis 3 times per week, there are no goals or interventions on the POC related to ESRD or dialysis. Corrected on site. Patient 9: The medical record contains evidence that MSW and SC are seeing the patient, there is no evidence of goals or interventions for SC or psychosocial care. Patient 10: The SN documented on 3/21/24 risk for aspiration, there is no risk for aspiration on the POC with goals and interventions. In addition, the MSW is ordered to see the patient and there is no evidence of MSW goals or interventions on the POC.”

“Upon patient record review, 5 of 14 (Patient #4,6,8,9,11) 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 4: The POC 3/28/25 contains an order for foley catheter insertion and change, does not state who is to insert/change the foley catheter. Corrected on site. Patient 6: The POC for 4/8/25 does not contain a disaster level and contains diet orders for NPO, regular, and mechanical soft and pureed diet with thickened liquids as tolerated. Corrected on site. Patient 8: The 10/22/24 POC contains an order for Polyethylene Glycol 17g and did not have a diluent in the order. The initial comprehensive assessment the SN documented patient is on hemodialysis 3 times per week. There were no orders related to hemodialysis, assessment of AV fistula on POC. Corrected on site. Patient 9: SN documented that a foley catheter was inserted and flushed the foley on 3/13/25. There is no evidence of an order for foley insertion or flushes. Corrected on site. SN documented 3/25/25 applied Tetracyte, collagen powder and covered with emulsion gauze there is no order for this type of wound care. In addition, the 2/13/25 POC contains an order for wound care and does not state who will perform the wound care. Corrected on site. Patient 11: The POC contains an order for wound care. The order does not say who is to perform the wound care.”

“Upon patient record review, 7 of 14 (Patient #1,3,4,5,6,8,9) 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 equipment and supply needs. Patient 1: In the comprehensive assessment on admission the SN stated that the patient has a wheelchair, bed, over the bed table, nebulizer. These items are not included on the POC. Patient 3: The comprehensive assessment 1/31/25 contains evidence that the patient has a walker. The walker is not included on the POC. Patient 4: The comprehensive assessment 3/28/25 indicates the patient has a hospital bed, over the bed table and a hoyer lift, these items were not included on the POC. Patient 5: The comprehensive assessment 3/12/25 indicates patient has a cane and walker to get around. These items were not included on the POC. Patient 6: The SN documented on 1/3/25, “Pt up with a walker” this was not included on the POC. Patient 8: The SN document in IDG 3/28/25 patient up with a walker, This was not included in the POC. Patient 9: There is an order on 4/9/25 for Albuterol aerosols and there is not a nebulizer ordered on the POC.”

“Upon patient record review, 3 of 14 (Patient #2,5,10) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient’s condition requires but no less frequently then every 15 calendar days. Patient 2: Per plan of care 2/26/25 the SC is ordered one time a month the IDG notes do not contain any documentation by the SC. The disciplines were actively involved with the patient therefore there was no evidence of collaboration since there was no signature to validate participation. Patient 5: Per POC on 3/12/25 contains an order for SC one time a month the IDG notes do not contain any documentation by the SC. The disciplines were actively involved with the patient therefore there was no evidence of collaboration since there was no signature to validate participation. Patient 10: On the POC the MSW is ordered to see the patient routinely and there was no evidence of the MSW being at IDG. The disciplines were actively involved with the patient therefore there was no evidence of collaboration since there was no signature to validate participation.”

“Upon patient record review, 11 of 14 (Patient #1,3,4,5,6,7,8,9,10,11,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: On 4/4/25 skilled nurse documented that wound care was performed on the left great toe. There is no order for the left great toe. The POC date 3/31/25 contains an order for SN one times per week. The SN visited the patient on 3/31/25 and 4/4/25 there is no evidence of either visit being prn. Patient 3: The POC contains an order for skilled nursing 2 times per week. The first week patient admitted 1/31/25 and the patient was not seen a second time that week. The weeks of 2/2/25-2/8/25 and 2/9/25-2/15/25 only one visit was made each week. There was no missed visit documentation, evidence of refusal, or an order to decrease the visit those weeks. Patient 4: The POC on 3/28/25 contains an order for skilled nursing two times per week. The SOC week the patient was seen 1 time that week. The SN documented wound care and covered the wound with a dry dressing, the POC 3/28/25 contains an order to cover the wound with a foam dressing. The wound is to be changed by skilled nurse according to the POC orders twice weekly and was only done one time that week. There is no evidence of refusal or that the caregiver provided wound care. Patient 5: The POC 3/12/25 contains an order for SN two times a week. The first week the patient was seen 1 time for admission. The week of 3/23/25-3/29/25 the skilled nurse visited on 3/24/25. There was no second visit made that week, no documentation of refusal, no missed visit documentation, or order to decrease visits. Patient 6: The POC 12/28/24 contains an order for SN two times a week, there was no second visit made the week of 12/22/24-12/28/24. No evidence of refusal or missed visit documentation. Patient 7: The POC 12/14/24 and 3/28/25 contains orders for SN once a week. There were no visits made by the nurse the week of 3/23/25 to 3/29/25. There was no missed visit documentation or evidence of refusal. Patient 8: The POC 1/20/25 contains an order for SN twice weekly the week of 2/9/25-2/15/25 patient was seen 2/10/25, the week of 2/23/25-4/1/25 the patient was seen 2/26/25, the week of 3/23/25-3/29/25 patient was seen 3/29/25, The week of 3/30/25-4/5/25 patient was seen on 4/3/25. There was no evidence of an order to decrease the visits to once per week and no evidence of refusals for these visits. Patient 9: The POC 2/27/25 contains orders for SN once per week. The week of 3/16/25-3/22/25 the patient was seen by the SN on 3/20/25 and 3/21/25 there is no evidence either visit was PRN. The week of 3/23/25-3/29/25 there were no SN visits made. No evidence of refusal and no missed visit documentation. In addition, the SN documented that a foley catheter was inserted and flushed the foley on 3/13/25. There is no evidence of an order for foley insertion or flushes. Corrected on site. SN documented 3/25/25 applied Tetracyte, collagen powder and covered with emulsion gauze there is no order for this type of wound care. Patient 10: The POC 1/11/25 contained an order for SN one time per week. The week of 1/12/25-1/18/25 there were no SN visits made, no evidence of refusal or any missed visit documentation. Patient 11: The POC 12/1/24 contains an order for SN one times per week, there is evidence that the SN saw the patient on 12/5/25 for the visit and the visit was not PRN. The SN documented on 12/28/24 “washed with wound cleanser and covered with 6x6 island dressing”, the POC 12/27/24 states to cleans with hydrogen peroxide cover with gauze and secure with tape. Patient 14: The POC 4/18/24 contains an order for skilled nursing one times per week, the patient was seen on 4/18/24 and 4/19/24 the second visit of the week was not PRN and was documented as routine”

“Upon patient record review 2 of 14 (Patient #2,8) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient 2: On 3/5/25 the skilled nurse documented “SN suggested low air loss mattress and IDT made aware and will provide proper equipment”. There is no evidence of a low air loss mattress and no evidence that one was provided. Patient 8: The SN assessment on 3/18/25, pt. had a blood pressure of 219/78 and SN rechecked at 204/74, on 2/20/25 the patient had a blood pressure of 190/69. There is no evidence of sharing information with the dialysis provider.”

“Upon observation, there was no evidence the hospice is in compliance with accepted professional standards and principles for all non-core services which includes physical therapy, occupational therapy and speech-language pathology. Patient 2: There is evidence in the note that the aide made visits on 3/8/25, 3/21/25, 4/1/25. The March dates were all signed by the administrator and the 4/1/25 date was signed by the RN. There is no evidence that the aide signed their documentation. Patient 3: There is evidence in the note that the aide made visits on 4/1/25, 3/27/25, 3/6/25, 3/4/25 were authenticated by the administrator. The 4/1/25 was authenticated by the RN. There is no evidence that the aide signed their documentation. Patient 7: There is evidence in the note that the aide made visits on 3/13/25, 3/18/25, 3/20/25, 3/25/25 and the notes were not signed by the aide the notes were signed off by the administrator. There is no evidence that the aide signed their documentation”

“Upon patient record review, 6 of 14 (Patient #1,2,3,4,7,10) did not have evidence in the patient record that hospice aide assignments and duties are: Patient 1: The aide POC 3/31/25 has an order to turn and reposition with no frequency. Corrected on site. Patient 2: The aide POC on 2/26/25 has an order to turn and reposition with no frequency. Corrected on site. Patient 3: The aide POC on 2/4/25 contains orders to turn and reposition and change linens without frequencies. Corrected on site. Patient 4: The aide POC on 3/28/25 has an order to turn and reposition and empty foley collection bag without frequencies. The aide plan of care has directives that the patient is a risk for aspiration there is no plan of care with goals and interventions. Corrected on site. Patient 7: The aide POC on 12/14/24 has an order for oxygen prn with no dose and change patient linens with no frequency. Corrected on site. Patient 10: The aide POC on 9/20/24 has an order to turn and reposition the patient without a frequency. Corrected on site.”

“Upon patient record review 4 of 14 (Patient #1,2,4,7) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 1: The POC on 3/31/25 has an order for an aide to see patient 2 times per week. There is no evidence that an aide has visited the patient from SOC to present, there is no evidence of a discharge of aide order. Patient 2: The aide POC on 2/26/25 contains an order for aides three times a week. The week of 3/9/25 - 3/15/25 the aide visited 3/11/25 and 3/14/25. The week of 3/16/25 - 3/22/25 the aide visited 3/11/25 and 3/21/25. The week of 3/23/25 -3/29/25 the aide visited 3/28/25. The week of 3/30/25 - 4/5/25 the aide visited 4/1/25. There was no missed visit documentation or evidence of refusal of visit, there was no order to decrease the visits. Patient 4: The POC 3/28/25 contains an order for aides 3 times a week, the week of 3/23/25- 3/29/25 there were no visits made by the aide. The week of 3/30/25-4/5/25 there were no aide visits made. There is no evidence of a discontinued of aid visits, no refusal, or missed visit documentation. Patient 7: The POC contains Aide visits for 2 times per week there was no evidence of aide visits completed past 3/27/25.”

“Upon observation, there was no evidence the hospice is directed by a Board of Directors/governing body which assumes full legal authority and responsibility for the operation of the hospice. The agency has multiple SN and aide missed visits for most of their patients which indicates charts are not being reviewed. The administrator is not monitoring for missed visits or monitoring the plan of care for orders. The agency has a patient on hospice that is on hemodialysis and this was not included on the POC and has no care plans to monitor for signs and symptoms of infection of the AV fistula or Blood Pressure. In addition, the Administrator Designee (Personnel #2) does not have similar qualifications as the administrator. The employee does not have the appropriate education and experience required. The Administrator designee is a Home Health Aide with 14 years of experience as an aide. There is no evidence the designee has 2 years of supervisory experience or 2 years of administrative experience that the job description qualifications requires.”

“Upon contract review, 1 of 4 (Davita) did not have evidence the agreement to furnish any services under arrangement included that the hospice must retain administrative and financial management, and oversight of staff and services for all arranged services, to ensure the provision of quality care. Arranged care/services are supported by written contract/agreement that requires all care/services are: • Authorized by the hospice • Furnished in a safe and effective manner by qualified personnel • Delivered in accordance with the patient’s plan of care Contract Davita: The agency does not have a contract with Davita and the patient is receiving treatment for dialysis at this center.”

“Upon patient record review, 7 of 14 (Patient #1,4,5,6,7,9,11) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1: SN documented on 4/4/25 wound to left heel and left great toe, education performed. There is no evidence of a wound to the left great toe. The orders are for the wound on the right great toe. Patient 4: The SN documented on 4/1/25 “Having an episode of M/b” and “F/c stained with blood there is no evidence that these are approved abbreviations. The SN documented on 4/1/25 “received orders to change F/c, this was done using sterile technique”. The SN documented on 4/1/25 “received orders to change F/c, this was done using sterile technique”. There’s no evidence that the skilled nurse documented the foley catheter, balloon size used. Patient 5: The skilled nurse documented on 3/17/25 “Call helpline for any COC or concerns. There is no evidence that COC is an approved abbreviation. Patient 6: The patient record contains a DNR form the father in law signed the DNR on the patient signature line and not the caregiver line. The SN documented on 3/11/25, “has discomfort to buttocks area assess area noted some irrigation, applied Calmoseptine”. Patient 7: There is no evidence that the aide signed their documentation. The SN documented on 2/25/25 “pt. will have increased bx in the night”. There is no evidence of this abbreviation. Patient 9: SN documented 4/9/25 performing wound care by restating the order. It was not changed to past tense to indicate the wound care was completed. Patient 11: The SN documented on 1/30/25 “wound care provided as MD ordered” there is no evidence that the SN followed the POC. On 12/28/24 foley changed, there is no evidence sterile technique was used.”