Crescent Hospice

“Upon patient record review, 3 of 14 (Patient #2,5,8) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 2: Polyethylene glycol 3350 on the active medication profile does not have instructions on how to dilute. COS - Order written to included instructions on how to dilute. Patient 5: The RN documentation indicated that the patient is using oxygen at 2LNC. No evidence on medication profile for the oxygen at 2LNC. The current medication profile is for oxygen 4LNC. COS - New order written to update during survey. Patient 8: The RN documentation indicated that the patient is titrating oxygen at 4LNC, 4.5LNC, and 6LNC. No evidence on medication profile for the oxygen by titrated. The current medication profile is for oxygen is 5LNC. COS - New order written to update during survey.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 1: No evidence that a comprehensive assessment was completed every 15 days between the following dates: 12/20/2024 and 01/07/2025, 25 days between assessments, and 02/17/2025-03/07/2025, 18 days between assessments.”

“Upon patient record review, 2 of 14 (Patient #7,9) 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 7: The record indicates that patient developed a wound to the right buttock on 06/24/2025. No evidence that the wound was measured for the weeks of 07/07/2025 and 07/21/2025. Agency policy is for wounds to be measured weekly. Patient 9: The record indicates that patient was admitted with a wound to the sacrum. No evidence that the wound was measured for the weeks of 06/16/2025, 07/07/2025, and 07/21/2025. Agency policy is for wounds to be measured weekly.”

“Upon patient record review, 1 of 14 (Patient #2) 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 medical record indicated that the patient was admitted with a foley catheter and takes Enoxaparin injections as a blood thinner for history of pulmonary embolus. No evidence of problems, goals, and interventions related to risk for bleeding, Genito/urinary system, or risk for infection due foley catheter included in the plan of care. The medical record indicated that the patient was admitted with a foley catheter.”

“Upon patient record review, 4 of 14 (Patient #2,5,7,8) 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 2: Plan of care has an active order for Polyethene glycol that does not have instructions on how to dilute. The record indicated the patient was admitted with indwelling Foley catheter. No evidence of related orders for the care and management of the Foley catheter. COS- New order written add instruction of how to dilute polyethene glycol and for foley catheter management. Patient 5: The RN documentation indicated that the patient is using oxygen at 2LNC. No evidence that an order was received for the oxygen at 2LNC. The current order is for oxygen 4LNC. COS-New order written for oxygen titration order during survey.The medical records indicated that patient had a foley catheter at the time of admit. No evidence that an order was received to identify who was responsible for performing care/maintenance of the foley catheter, hospice staff or facility staff. COS -New physician order to identify who was responsible for performing care/maintenance of the foley catheter during survey. Patient 7: The medical record indicated that the patient had wounds to the left and right buttocks. No evidence that an order was received for wound care to be provided to those wounds and frequency for the wound care to be provided. Patient 8: The RN documentation indicated that the patient is titrating oxygen at 4LNC, 4.5LNC, and 6LNC. No evidence that an order was received for the oxygen by titrated. The current order is for oxygen 5LNC. New order written to update during survey.”

“Upon patient record review, 3 of 14 (Patient #1,3,4) 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: The clinical documentation indicated that the patient uses a rolling walker to help with altered mobility. No evidence that a rolling walker was included on the current DME list. COS - order written to add rolling walker to the current DME list. Patient 3: No evidence that supplies related to foley catheter insertion or maintenance was included in the current supply list. COS - order written to add foley catheter to the current supply list. Patient 4: The medical record indicated that the patient uses a walker for help with altered mobility. No evidence that a walker was included on the current DME list. COS - order written to add walker to the current DME list.”

“Upon patient record review, 1 of 14 (Patient #10) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 10: The aide POC has active DNR precautions. The medical record indicated that the patient’s current code status is full code. COS - Aide plan of care undated to remove DNR precautions.”

“Upon patient record review 3 of 14 (Patient #4,7,9) did not have evidence documentation in the patient record that a Registered Nurse 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 meet the patient’s needs. Patient 4: No evidence that the RN completed a supervisory visit every 14 days. The record indicated that an aide supervisory visit was conducted on 07/03/2025 and not completed again until the start of survey. Patient 7: No evidence that the RN completed a supervisory visit every 14 days. The record indicated that an aide supervisory visit was conducted on 06/17/2026 and not completed again until 07/08/2025. Patient 9: No evidence that the RN completed a supervisory visit every 14 days between the following dates: 05/20/2025 and 06/04/2025 (15 days), and 07/01/2025 and 07/30/2025 (29 days).”

“Upon client record review, 1 of 14 (Patient #2) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 2: The medical records indicated that patient had a foley catheter at the time of admit and a wound to the sacrum. No evidence that an order was received to identify who was responsible for performing wound care, the hospice staff or facility staff. No evidence that the order received from the physician for the foley catheter included the size, change frequency, and who was responsible for performing care/maintenance of the foley catheter, hospice staff or facility staff. COS -New physician order both the foley catheter and wound care received during survey.”