Right Choice Hospice Care

“Upon patient record review, 7 of 14 (Patients #1,2,4,5,8,9,10) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #1: Patient admitted with self identified threshold of 2. At each visit since admission, pain ranges between 8 and 10 out of 10. The patient is prescribed MS Contin 15mg BID as well as Percocet for breakthrough pain. There has not been an evaluation or change in pain medications. There is no documentation of collaboration with the medical director regarding pain management. There is no evidence of increased frequencies in nursing visits for pain management, there is no evidence of a change to the pain management plan as a result of pain being above the Self Identified threshold since admission. Patient #2: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level above the self identified threshold. There has not been an evaluation or change in pain medications except for the addition of Gabapentin 800mg bid for right stump pain. There is no documentation of collaboration with the medical director regarding pain management. There is no evidence of increased frequencies in nursing visits for pain management, there is no evidence of a change to the pain management plan as a result of pain being above the Self Identified threshold at every visit. Patient #4: Patient admitted with back pain. Self identified threshold is listed as #3. At every nursing visit, patient complains of pain of level 8. There has not been an evaluation or change in pain medications. There is no documentation of collaboration with the medical director regarding pain management. There is no evidence of increased frequencies in nursing visits for pain management, there is no evidence of a change to the pain management plan as a result of pain being above the Self Identified threshold since admission. Patients #5, 8, 9, 10: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level 8 or above, above the self identified threshold. There has not been an evaluation or change in pain medications. There is no documentation of collaboration with the medical director regarding pain management, evidence of increased frequencies in nursing visits for pain management, or evidence of a change to the pain management plan as a result of pain being above the Self Identified threshold at every visit.”

“Upon patient record review 8 of 14 (Patients #1, 2, 5, 6, 7, 8, 9, 10) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process. Patients #1, 2, 5, 6, 7, 8, 9, 10: There is no evidence of an initial spiritual assessment. During the RN admission assessment, there is a screening only that does not assess the spiritual needs of the patient.”

“Upon observation and patient record review, 10 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10) 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 #1,2,3,4,5,6,7,8,9,10: The IDT, in its entirety, does not supervise the care and services provided. The IDT notes only show participation of the RN and MD for all patients. The social worker and spiritual care provider are not involved and do not show evidence of involvement in the care of the patient.”

“Upon patient record review, 7 of 14 (Patient #1, 2, 4, 5, 8, 9, 10) 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 #1: Patient admitted with self identified threshold of 2. At each visit since admission, pain ranges between 8 and 10 out of 10. Also at each visit, patient blood pressure is above normal, reaching as high as 210/114 at visit on 03/01/26. There is no evidence that the RN provides follow up phone call or visit with patient for 7 days based on routine frequencies. Patient #2: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level above the self identified threshold. There is no evidence that the RN provides follow up phone call or patient visit for 7 days based on routine frequencies. Patient #4: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level above the self identified threshold of 3. The patient has oxygen saturation of below 90% on room air at recent visits on 02/11/26, 02/18/26, 03/04/26, 03/18/26, 03/25/26. Oxygen is available in the home. There is no documentation that the RN made a follow up phone call or patient visit for 7 days after each visit. Patient #5: Patient admitted with self identified threshold of 3. At each visit since admission, pain assessed at 8 out of 10. Also at each visit, patient blood pressure is above normal, reaching as high as 171/102 at visit on 03/16/26. The patient has oxygen saturation of below 90% on room air at recent visits on 02/01/26, 02/08/26, 0/2/15/26, 03/02/26, 03/16/26, 03/23/26, and 03/30/26. Oxygen is available in the home. There is no documentation that the RN provides follow up phone call or visit for 7 days based on routine frequencies. Patient #8: Patient admitted with self identified threshold of 3. At each visit since admission, pain assessed at 9 out of 10. Also at each visit, patient blood pressure is above normal, reaching as high as 166/107 at visit on 03/18/26. The patient has oxygen saturation of below 90% on room air at recent visits on 02/04/26, 02/18/26, 0/2/25/26, 03/04/26, and 03/18/26. Oxygen is available in the home. There is no documentation that the RN provides follow up phone call or patient visit for 7 days based on routine frequencies. Patient #9: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level above the self identified threshold. There is no evidence that the RN provides follow up phone call or patient visit for 7 days based on routine frequencies. Patient #10: At each visit, pain is consistently reported at a level 8 out of 10, above the self identified threshold of 3. There is no evidence that the RN provides follow up phone call or patient visit for 7 days based on routine frequencies.”

“Upon patient record review, 3 of 14 (Patient #4,5,8) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient #4: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level above the self identified threshold of 3. The patient has oxygen saturation of below 90% on room air at recent visits on 02/11/26, 02/18/26, 03/04/26, 03/18/26, 03/25/26. Oxygen is available in the home. There is no documentation of oxygen use being encouraged and education provided or pain management education. Patient #5: Patient admitted with self identified threshold of 3. At each visit since admission, pain assessed at 8 out of 10. Also at each visit, patient blood pressure is above normal, reaching as high as 171/102 at visit on 03/16/26. The patient has oxygen saturation of below 90% on room air at recent visits on 02/01/26, 02/08/26, 0/2/15/26, 03/02/26, 03/16/26, 03/23/26, and 03/30/26. Oxygen is available in the home. There is no documentation of oxygen use being encouraged and education provided or pain management education. Patient #8: Patient admitted with self identified threshold of 3. At each visit since admission, pain assessed at 9 out of 10. Also at each visit, patient blood pressure is above normal, reaching as high as 166/107 at visit on 03/18/26. The patient has oxygen saturation of below 90% on room air at recent visits on 02/04/26, 02/18/26, 0/2/25/26, 03/04/26, and 03/18/26. Oxygen is available in the home. There is no documentation of oxygen use being encouraged and education provided or pain management education.”

“Upon patient record review, 9 of 14 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 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 #1: The patient is on Aspirin. There is no evidence of interventions or goals for bleeding precautions or the use of anticoagulants. The patient is using nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. Patient #2: The patient is on Aspirin. There is no evidence of interventions or goals for bleeding precautions or the use of anticoagulants. The patient is a full code. There is no evidence of interventions or goals related to advanced care planning in the POC. Patient #3: The patient is a full code. There is no evidence of interventions or goals related to advanced care planning in the POC. Patient #4: The patient is on Aspirin. There is no evidence of interventions or goals for bleeding precautions or the use of anticoagulants. Patient #5: The patient is using nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. The patient is a full code. There is no evidence of interventions or goals related to advanced care planning in the POC. Patient #6: The patient is on Eliquis. There is no evidence of interventions or goals for bleeding precautions or the use of anticoagulants. The patient is a full code. There is no evidence of interventions or goals related to advanced care planning in the POC. Patient #7: The patient is on Aspirin. There is no evidence of interventions or goals for bleeding precautions or the use of anticoagulants. The patient is a full code. There is no evidence of interventions or goals related to advanced care planning in the POC. Patient #8: The patient is on Aspirin. There is no evidence of interventions or goals for bleeding precautions or the use of anticoagulants. The patient is using nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. Patient #10: The patient is using nebulized medications. There is no evidence of interventions or goals for use of a nebulizer on the POC. The patient is a full code. There is no evidence of interventions or goals related to advanced care planning in the POC.”

“Upon patient record review, 9 of 14 (Patient #1, 2, 4, 5, 6, 7, 8, 9, 10) 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: RN assessed the need for a hospital bed, walker, shower chair, oxygen concentrator with E-Tank. There is no DME listed on the POC. Patient #2: RN assessed the need for hospital bed, overbed table, WC and shower chair. There is no DME listed on the POC. Patient #4: RN assessed the need for hospital bed, over bed table, walker, WC, shower chair, oxygen concentrator with E tank. There is no DME listed on the POC. Patient #5: RN assessed the need for a bedpan, walker, wheelchair, nebulizer, oxygen concentrator and e tank. There is no DME listed on POC. Patient #6: RN assessed the need for a hospital bed, overbed table, oxygen concentrator and e tank. There is no DME listed on the POC. Patient #7: RN assessed the need for a hospital bed, overbed table, walker, wheelchair, shower chair, oxygen concentrator, and e tank. There is no DME listed on the POC. Patient #8: RN assessed the need for a hospital bed, overbed table, walker, nebulizer, oxygen concentrator and E tank. There is no DME listed on the POC. Patient #9: RN assessed the need for hospital bed, overbed table, walker, shower chair, nebulizer, oxygen concentrator and e-tank. There is no DME listed on the POC. Patient #10: RN assessed the need for an overbed table, walker, shower chair, nebulizer, oxygen concentrator and e-tank. There is no DME listed on the POC.”

“Upon patient record review, 10 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient’s #1-10: There is no evidence of the plan of care being updated through IDG after the start of care. The IDG notes are incomplete with no updates to full codes status or funeral planning for full code patients. Patients #1, 2, 4, 5, 8, 9, 10: These patients have a Pain Care plan that states: “Bring down pain to < 3 or stated comfort level of pain by patient. Keep pain below SIT level for comfort”. At each patient visit the pain is assessed at higher that the SIT level with no changes to interventions and updates to the plan of care and no further orders from the medical director. Patient #5: Patient has a Respiratory care plan with interventions that include assessment of respiratory status each visit. Identify SOB as effected by activity. Oxygen as ordered via NC at 2-5liters/minute.” The Pulse oxygenation is below 90% on Room air on the past 5 of 6 visits. There are no updates to the plan of care.”

“Upon client record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patients #1, 2, 3, 5, 6, 7, 8, 9,10: There were orders for an NP to see the patient for a F2F visit every cert period after the third benefit period. The NP did not see patients for F2F visits. Patient #2: Patient ordered to have MSW each month and 1 as needed. No documented visits in February 2026, November 2025, or October 2025. No evidence of orders for missed visits. Patient #3: SC ordered to see patient each month and as needed. There is no documentation of an SC visit since 01/24/25. MSW ordered to see patient each month and 1 prn. The last documented visit for the MSW was 07/31/25 which was labeled as a missed visit. No further visits. Patient #4: MSW ordered once each month and 1 as needed. There is no documented visit since 02/02/26. Patient #5: Patient has a Respiratory care plan with interventions that include assessment of respiratory status each visit. Identify SOB as effected by activity. Oxygen as ordered via NC at 2-5liters/minute.” The Pulse oxygenation is below 90% on Room air on the past 5 of 6 visits. The nurse does not document that oxygen was provided.”

“Upon patient record review, 7 of 14 (Patient #1,2,4,5,8,9,10) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #1: Patient admitted with self identified threshold of 2. At each visit since admission, pain ranges between 8 and 10 out of 10. The patient is prescribed MS Contin 15mg BID as well as Percocet for breakthrough pain. There has not been an evaluation or change in pain medications. There is no documentation of collaboration with the medical director regarding pain management. Patient #2: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level above the self identified threshold. There has not been an evaluation or change in pain medications except for the addition of Gabapentin 800mg bid for right stump pain. There is no documentation of collaboration with the medical director regarding pain management. Patient #4: Patient admitted with back pain. Self identified threshold is listed as #3. At every nursing visit, patient complains of pain of level 8. There has not been an evaluation or change in pain medications. There is no documentation of collaboration with the medical director regarding pain management. Patient #5: Patient has a Respiratory care plan with interventions that include assessment of respiratory status each visit. Identify SOB as effected by activity. Oxygen as ordered via NC at 2-5liters/minute.” The Pulse oxygenation is below 90% on Room air on the past 5 of 6 visits. There is no documentation of communication with the Medical Director. Patients #1, 4, 5, 8: Patients have a Cardiovascular plan of care that states, “BP will be managed with medication. Adjust BP medication if ineffective, notify MD of new order.” There is elevated BP results at nearly every visit and there has been no documentation of communication with the medical director or changes/updates in orders. Patients #1, 2, 4, 5, 8, 9, 10: These patients have a Pain Care plan that states: “Bring down pain to < 3 or stated comfort level of pain by patient. Keep pain below SIT level for comfort”. At each patient visit the pain is assessed at higher that the SIT level with no documentation of changes to interventions and no further orders from the Medical Director. Patients #5, 8, 9, 10: The patient is admitted with self identified threshold of 3. At each visit, pain is consistently reported at a level 8 or above, above the self identified threshold. There has not been an evaluation or change in pain medications. There is no documentation of collaboration with the medical director regarding pain management.”

“Upon patient record review, 2 of 14 (Patient #13, 14) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patients #13, 14: The hospice put on the initial bereavement assessment at admission that bereavement services were declined and there was no follow up. There was no documented bereaved information as to who had declined. In review of bereavement tracking, there had been no bereavement activity since 2024. There was no bereavement plan of care.”

“Upon personnel record review, 1 of 12 (Personnel #9) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #9: The aide competency assessments completed verbally but not with direct supervision for required tasks.”

“Upon observation, there was no evidence the hospice documented the cost savings achieved through the use of volunteers. Documentation must include the following: • The identification of each position that is occupied by a volunteer • The work time spent by volunteers occupying those positions • Estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions identified in paragraph (d)(1) of CFR 418.78 for the amount of time specified in paragraph (d)(2) of CFR 418.78 The agency had no evidence of a cost savings report present for survey.”

“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 governing body and Administrator of the hospice failed to assume full legal authority and responsibility for the the care of each hospice patient and personnel. Clinical records lacked required spiritual assessments, and personnel files were incomplete, including absence of documented orientation for the Administrator Designee and Director of Patient Care Services (DPCS) Designee. Required therapy disciplines (PT, OT, ST) had no supporting personnel files. Clinical care deficiencies were identified, including failure to follow up on abnormal findings such as pain and blood pressure, lack of physician notification, and absence of corresponding updates to the individualized plan of care. Durable medical equipment (DME) was not consistently included in the plan of care, and patient education related to oxygen use and pain management was insufficient or not documented. Ordered visit frequencies were not adhered to, and patient needs were not consistently met by the IDG. Additionally, hospice aide services were provided without evidence of a completed competency evaluation. Interdisciplinary Group (IDG) processes were deficient, with no documentation of regular meetings or evidence of participation by all required disciplines. Collectively, these findings demonstrate a failure to ensure coordinated, comprehensive care for each hospice patient.”