Hospice Del Valle, Inc.

“Based on interview and record review, the agency failed to ensure nursing services and drugs and biologics were available on a 24-hour basis 7 days a week. Specifically, the agency did not ensure a registered nurse was on-call, or that a pharmacy was contracted to dispense drugs and biologics at all times, including weekends. Findings include:1. A sample of five patient medical records (two active patients and three discharge patients) were reviewed on 10/21/25, and revealed a range of two to eight days between patient referrals to the hospice and patient start of care for hospice services. a) Patient #1, with a terminal diagnosis of malignant neoplasm of head of pancreas, was referred to the hospice on 9/2/25. Record review revealed a start of care date of 9/4/25.b) Patient #2, with a terminal diagnosis of nonrheumatic aortic stenosis, was referred to the hospice on 10/9/25. Record review revealed a start of care date of 10/17/25.c) Patient #3, with a terminal diagnosis of cerebral infarction, was referred to the hospice on 8/29/25. Record review revealed a start of care date of 9/2/25. d) Patient #4, with a terminal diagnosis of malignant neoplasm of unspecified ovary, was referred to the hospice on 4/2/25. Record review revealed a start of care date of 4/7/25.e) Patient #5, with a terminal diagnosis of spastic quadriplegic cerebral palsy, was referred to the hospice on 6/30/25. Record review revealed a start of care date of 7/8/25.2. During an interview with the hospice administrator at 10:20 a.m. on 10/21/25, the administrator stated the reason for many of the delays between the time a referral was received and the start of care for a patient could be attributed to not having medications available from a pharmacy over weekends. Additionally, the administrator stated delays in starting care could also be attributed to having a licensed practical nurse (LPN) on call over some weekends. She stated the initial assessments at the start of care must be completed by an RN and the hospice did not always have an RN available.3. Review of the agency’s on-call schedule for nursing coverage, the agency’s policies and procedures, and the agency’s contracts revealed the following:a) Review of the on-call nursing schedule for August 2025 through October 2025 was completed on 10/21/25:i) For two weekends in August 2025, an LPN was on call, with an RN on call for the other three weekends in August.ii) For two weekends in September 2025, an LPN was on call, with an RN on call for the other two weekends in September.iii) For two weekends in October 2025, an LPN was on call, with an RN on call for the other two weekends in October.b) Review of the agency’s policies and procedures was completed on 10/21/25, and revealed the agency did not have a policy for pharmacy or back-up pharmacy coverage, or a policy for RN coverage. c) Review of agency contracts for pharmacy coverage was completed on 10/21/25, and revealed contracts with two pharmacies:i)The contract for the first pharmacy included “On Demand Clinical Services” which were available seven days a week and 24 hours per day for telephone consultations and pharmacy plan of care activities, but did not include providing medications seven days a week and 24 hours per day.ii) The contract for the second pharmacy included 24-hour call center services, and “mail service shipping” of medications, but did not include providing medications seven days a week and 24 hours per day.4. During an interview with the hospice administrator at 4:19 p.m. on 10/21/25, the administrator verified the agency did not have a policy for RN coverage and did not have a policy for pharmacy or back-up pharmacy coverage.5. Additional interviews revealed the following:i) During an interview with an agency RN (Staff #3) at 2:05 p.m. on 10/21/25, the RN stated that each Friday morning the agency made “tuck in” calls to all their patients to ensure the patients had the medications they would need for the weekends. The RN stated if a patient needed medication on a weekend, the hospice would try to contact a local pharmacy the agency was not contracted with to fill the prescription. The RN also stated due to the rural area, there were not many RNs available. She stated due to the large geographical area the hospice covered, pharmacy options were limited and the agency tried to complete admissions only Monday through Friday.ii) During an interview with an agency LPN (Staff #4) at 2:22 p.m. on 10/21/25, the LPN stated admissions were not usually done on weekends due to limited RN and pharmacy options. The LPN stated that if a hospital had a patient they wanted to admit to the hospice over a weekend, the hospital would have to send medications with the patient “because our hands are tied.”iii) During an interview with the hospice medical director at 2:38 p.m. on 10/21/25, the medical director stated the local emergency rooms knew they would need to send medications with patients for any admissions that occurred over a weekend because the agency was “at the mercy of the pharmacies.” Additionally, he stated it was difficult to find enough RN staff for the agency.6. During an interview with the hospice administrator at 10:45 a.m. on 10/22/25, the administrator stated the agency’s plan for ensuring RN coverage was for an RN, who was not the nurse on-call, to be called in to help when needed. The administrator stated only one RN was currently working at the agency. In regards to back-up for the RN, the administrator stated there was the possibility of another RN, who was previously in an administrative role with the agency, to step in to help, if available. However, the administrator acknowledged the agency did not have policies and procedures in place to ensure RN coverage, or policies and procedures in place for pharmacy or back-up pharmacy coverage to ensure drugs and biologics were available on a 24-hour basis 7 days a week.”