Generations Hospice Care Inc.

“Based on staff interview, surveyor observation, policy review and agency documents review, the agency failed to notify the State agency (SA) of their intent to add a multiple location, provide the necessary documentation and obtain approval for a multiple location prior to providing services to agency patients from that multiple location. Failure to obtain approval for a multiple location office prior to providing services, placed agency patients at risk for inadequate and unsafe care. According to the agency policy, titled Governing Body, dated April 2017, the Governing Body will assume full legal authority, responsibility and accountability for the operation of the hospice agency. According to the agency policy, tilted Branch Control, dated April 2017, the hospice must notify Centers for Medicare & Medicaid Services (CMS) and the state survey agency, in writing of the proposed location. a. On 7/21/25 at 1:00 PM, the Administrator reported they have a hospice office (multiple location site) located in a skilled nursing facility in Clarinda, IA and the agency has adequate staff to support the office. The hospice has not had patients in that area since May 2025; however, they are actively marketing for that office. The hospice office is open and functioning. The Interdisciplinary Group (IDG) completes meetings for both areas. b. On 7/22/25 at 9:00 AM, the surveyor called the hospice, Clarinda, IA office. The phone actively rang and audibly rolled over to the main office, Missouri Valley, IA. c. On 7/22/25 at 8:55 AM, the surveyor completed an internet search and found information identifying the hospice’s multiple location site at 600 Manor Drive, Clarinda, IA 51632. d. On 7/23/25 at 9:50 AM, the surveyor entered the office located at 600 Manor Drive, Clarinda, IA 51632. The surveyor observed the office to have a hospice sign beside the door and the office was furnished with a desk, computer, and other hospice items. Hospice staff were not on site at this proposed multiple location during the surveyor visit. e. On 7/23/25 at 10:25 AM, the Administrator stated the hospice agency requested a multiple location site for their hospice. The hospice completed a questionnaire and a contracted person (unsure who), did a visit to evaluate the office. The Administrator noted they were following the National Hospice and Palliative Care Organization (NHPCO) guide. The Administrator identified the multiple location site in Clarinda, IA has a computer, working phone and other supplies. When the multiple location site is not staffed, calls are forwarded to the parent office in Missouri Valley, IA. The Administrator stated they did not receive a Medicare Administrative Contractor (MAC) letter of approval for the multiple location. The hospice failed to obtain approval for a multiple location prior to providing services to agency patients from the multiple location office. The above findings were reviewed with the Administrator and Director of Clinical Services.”

“Based on a home visit observation, patient interview, clinical record reviews and policy reviews, the hospice failed to ensure the Plans of Care for 2 of 4 sampled patients (Patients #1 and #2) identified all medical equipment and supplies necessary to meet identified patient needs. Failure to include all needed items of medical equipment and supplies the patient used on the Plans of Care placed patients at risk of unanticipated decline or injury and of needs not met. Findings include: 2. Patient #2 had a start of care date of 9/6/24. a. b. The POC, dated 9/6/24 to 12/4/24, identified the patient required the use of the following DME: hospital bed, oxygen and incontinence wipes. c. The skilled nurse note at the time of admission, dated 9/6/24, included documentation the patient required the use of a walker/cane, wheelchair/geri chair and incontinence brief. d. The hospice aide note, dated 9/26/24, included documentation the patient required the use of a walker/cane, wheelchair/geri chair and incontinence brief. e. The IDG meeting notes, dated 9/11, 9/25/24, 10/9, 10/23/24 and 11/6/24 identified no additional DME and/or supplies used by the patient. Hospice staff failed to identify all DME used by the patient on the POC and IDG notes including a walker/cane, wheelchair/geri chair and incontinence brief. The above findings shared with the Administrator and Vice President of Clinical Services. According to the hospice policy titled Plan of Care, dated April 2017, a written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted to the hospice program. The plan of care will be based on the initial, comprehensive and ongoing comprehensive assessments performed by members of the interdisciplinary group and will be reviewed on a regular basis but no less than every fifteen days. The plan of care will include but, will not be limited to the following: Diagnoses, functional limitations, durable medical equipment and supplies, frequency of services and drugs and treatment. 1.Patient #1 had a hospice admission date of 6/14/24 and received hospice services in a private residence. Review of the clinical record revealed the following: a. The Plan of Care (POC), dated 9/12/24 to 12/10/24, identified the patient had the following durable medical equipment (DME) and supplies: Oxygen concentrator/supplies and nebulizer. b. On 11/12/24 at 1:00 PM, during a home visit observation with Staff C, Registered Nurse (RN), the surveyor identified the patient had a shower chair in her bathroom. In an interview, during the same home visit observation, Patient #1 stated he/she has used the shower chair for several months. c. The Interdisciplinary Group (IDG) meeting notes, dated 9/25/24, 10/9/24, 10/23/24 and 11/6/24 identified no additional DME and/or supplies used by the patient. The POC and IDG meetings to update the POC failed to identify all DME used by the patient including shower chair.”

“Based on staff interviews, clinical record reviews and hospice policy reviews, the hospice failed to ensure the substantial provision of a core hospice service, medical social services, complied with the educational and supervisory requirements for personnel providing medical social services for 4 of 4 sampled hospice patients who received social worker services (Patients #1, #2, #3 and #4). Failure of the hospice to ensure a qualified social worker provided and documented regular and timely supervision of the delivery of medical social services increased the risk the delivery of this core service may not have adequately or safely met the needs of hospice patients and/or families. Findings include: The clinical records of Patients #1, #2, #3 and #4 included documentation the patients received social work services by Staff D, Social Worker (SW). On 11/13/24 at at 2:25 PM, during interview, Staff D, SW, reported having a baccalaureate degree in Psychology and more than one year of social work experience working in a healthcare setting. Staff D started working for the agency on 9/4/24 and trained under the former baccalaureate level social worker for approximately one month. Staff D stated the plan is for her to receive supervision from Staff E, Master of Social Work (MSW); however, she has not received MSW supervision as of 11/13/24. On 11/13/24 at 2:00 PM, during an interview, Staff E, Masters of Social Work (MSW), hired on 10/24/24 stated she is expected to supervise Staff D, SW. Staff E, MSW, reported she has not provided and/or documented supervision as of 11/13/24 due to just being hired by the agency. On 11/13/24 at 1:30 PM, during an interview, Staff B, Vice President of Clinical Services reported the agency does not have a policy to address supervision of baccalaureate level social workers. Staff B stated the agency has depended on the Master of Social Work job description which identifies the MSW ensures compliance with all state, federal and Community Health Accreditation Partner (CHAP) social service regulatory requirements, supervises the assessment, planning, implementation and evaluation of social service clinical care by members of the social work team and assures proper documentation of social services in clinical records. The agency failed to ensure a qualified Master of Social Work provided and documented regular supervision of the baccalaureate level hospice social worker. The above findings were reviewed with the Administrator and Vice President of Clinical Services.”

“Based on clinical record review, hospice policy review and hospice staff interview, the hospice failed to: 1) Ensure hospice interdisciplinary group members reviewed all of the patients prescription and over the counter drugs to identify effectiveness of drug therapy, drug side effects, drug interactions, duplicate drug therapy and drug therapy associated with laboratory monitoring (see L0530); 2) Ensure an initial bereavement assessment was completed and incorporated into the plan of care (see L0531); and 3) Ensure hospice interdisciplinary group members updated the comprehensive assessment no less frequently than every 15 days and hospice nurse members included wound assessments/measurements (see L0533). The cumulative effects of these systemic practices resulted in the failure of the hospice to ensure the Interdisciplinary Group of personnel completed a comprehensive assessment of all patient care and treatment needs to their hospice patients.”

“Based on hospice clinical record review, hospice policy review, and hospice staff interview, the hospice failed to: 1) Ensure all hospice care and services furnished to patients and families followed an individualized written plan of care (L0543); 2) Ensure a detailed statement of scope and frequency of services necessary was identified to meet patient and family needs (L0547); 3) Ensure all treatments necessary to meet the needs of the patient were on the plan of care (L0549); 4) Ensure all medical supplies and appliances necessary to meet the needs of the patient were on the plan of care (L0550); and, 5) Ensure review of the plan of care occurred no less than every 15 days as required (L0552). The cumulative effects of these systemic practices resulted in the failure of the hospice to ensure the Interdisciplinary Group of personnel promoted and supported the safe, comprehensive and effective delivery of patient care to their hospice patients.”

“Based on review of hospice policy review, staff interview and clinical record review, the hospice failed to: 1) ensure hospice aides provided services that were ordered by the interdisciplinary group and included on the plan of care (L626); 2) ensure the registered nurse provided supervision of hospice aides no less frequently than every 14 days (L629); and 3)ensure the registered nurse assessed the hospice aides ability to demonstrate competency with assigned tasks (L633). The cumulative effects of these systemic practices resulted in the failure of the hospice to ensure hospice aides provided patient care in a manner to meet the individualized needs of all patients effectively and safely.”

“Based on hospice staff interviews, clinical record reviews, and agency policy reviews, the hospice failed to: 1) Ensure the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes are included in the patient’s medical record (L0672) 2) Ensure physician’s orders are complete (L0678) 3) Ensure all entries in the clinical record are appropriately authenticated in accordance with hospice policy and currently accepted standards of practice (L0679), and 4) Ensure all revoked or discharged patients have a discharge summary completed and forwarded to the patient’s attending physician (L0683). The cumulative effects of these systemic practices resulted in the failure of the hospice to ensure the plans of care were completed and signed by core members of the hospice interdisciplinary group in accordance with currently accepted standards of practice.”

“Based on review of emergency preparedness training rosters, review of the emergency preparedness plan and policies and staff interview, the hospice failed to ensure training inemergency preparedness for all staff and volunteers, consistent with their expected roles for the calendar years of 2024. The agency hired in 2024 a total of 6 direct employed staff in 2024. Lack of emergency preparedness training for staff puts patients at risk should an emergency situation arise and staff would be needed to assist patients to ensure patient safety. Findings Include: During an interview on 6/12/24 at 10:17 AM, the Administrator reported having no documentation of emergency preparedness training for Staff C, RN, Staff H, LPN, Staff G, Spiritual Advisor, Staff I, Master Social Worker, Staff J, Volunteer and Staff A, Administrator. The above findings were reviewed with the Administrator and the Vice President of Clinical Services.”

“Based on agency staff interview and review of training documentation the agency failed to ensure participation in emergency preparedness in 2022, 2023 and 2024. Failure to conduct or participate in emergency preparedness exercises placed patients at risk for not having trained and prepared staff to assist them in the event of an emergency. Findings include: On 6/12/24 at 10:17 AM, Staff A, Administrator reported that she could not find any emergency preparedness exercises that was completed for the years of 2022, 2023 and 2024. The above findings were reviewed with the Administrator and the Vice President of Clinical Services.”

“Based on hospice staff interview, clinical record review, and hospice policy review, the hospice failed to ensure the interdisciplinary group performed an accurate and complete drug regimen review for 10 of 14 sampled patients (Patients #1, #2, #4, #5, #6, #7, #8, #11, #13, #14). Failure to ensure the Interdisciplinary Group (IDG) members involved in the assessment of patient needs identified all components in the drug profile that could affect drug therapy increased the risk of unidentified side effects and interactions of medications. Findings include: 8. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed: a. Skilled nurse comprehensive assessments, dated 4/25/24 and 5/22/24, lacked documentation of a completed DRR (drug regimen review). b. The IDG (interdisciplinary group) meeting notes, dated 4/12/24, 4/26/24, 5/6/24, and 5/23/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs no less than every 15 days as required. 9. Patient #7 had a hospice admission date of 8/25/23, and received hospice services while residing in a nursing home. Clinical record review revealed: a. Skilled nurse comprehensive assessments, dated 4/11/24, 4/26/24 and 5/21/24, lacked documentation of a completed DRR. b. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24, and 5/23/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs no less than every 15 days as required per regulations. 10. Patient #14 had a hospice admission date of 8/31/23, a discharge date of 2/26/24, and received hospice services while residing in a private home. Clinical record review revealed: a. Skilled nurse comprehensive assessments, dated 1/4/24, 1/17/24, 1/31/24 and 2/14/24, lacked documentation of a completed DRR. b. The IDG meeting notes, dated 1/5/24, 1/19/24, 2/2/24, and 2/16/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs no less than every 15 days as required per regulations. The Administrator and Vice President of Clinical Services received the above findings and hospice staff provided no further information prior to the end of the survey. 7. Patient #6 had a hospice admission date of 1/24/24, and received hospice services while residing in a private home. Clinical record review revealed: a. Skilled nurse comprehensive assessments, dated 1/24/24 and 5/22/24, lacked documentation of a completed DRR (drug regimen review). b. The IDG (interdisciplinary group) meeting notes, dated 2/2/24, 2/16/24, 5/6/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs no less than every 15 days as required. 5. Patient #4 had a hospice admission date of 3/24/24, and received hospice services while residing in a private residence. Clinical record review revealed: a. Skilled nurse initial comprehensive assessment, dated 3/24/24, lacked documentation of a completed DRR. b. Skilled nurse routine comprehensive assessments, dated 4/23/24, 5/7/24, and 6/4/24, lacked documentation of a completed DRR. c. The IDG meeting notes, dated 3/29/24 (Initial IDG), 4/12/24, 4/26/24, 5/10/24, 5/24/24, and 6/7/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs on admission and no less than every 15 days as required. 6. Patient #8 had a hospice admission date of 4/29/24, and received hospice services while residing in a nursing home. Clinical record review revealed: a. Skilled nurse initial comprehensive assessment, dated 4/29/24, lacked documentation of a completed DRR. b. Skilled nurse comprehensive assessment, dated 5/20/24, lacked documentation of a completed DRR. c. The IDG meeting notes, dated 5/7/24 (Initial IDG), 5/23/24, and 6/7/24 lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs on admission and no less than every 15 days as required. Patient #13 had a hospice admission date of 1/10/24 and received hospice services while residing in a private residence. Clinical record revealed: The drug regime review (DRR) signed by a physician on 1/10/24 failed to include the component to include medications that may require laboratory testing. Failure to include all required components of the DRR places the patient at risk of not receiving necessary treatment or services. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a nursing home. Clinical record review revealed: a. The skilled nurse initial comprehensive assessment performed by Staff K, Registered Nurse (RN) on 3/5/24, lacked documentation of a completed DRR. b. Skilled nurse routine comprehensive assessments, dated 4/11/24 performed by Staff K and 6/3/24 performed by Staff RN lacked documentation of a completed DRR. c. The interdisciplinary group (IDG) meeting notes, dated 3/15/24 (Initial IDG), 4/12/24, 4/26/24, 5/6/24, 5/23/24, and 6/3/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRRs on admission and no less than every 15 days as required. Patient #2 had a hospice admission date of 6/7/24 and received hospice services while residing in a nursing home. Clinical record revealed: Skilled nurse initial comprehensive assessment, dated 6/7/24, lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRR on admission. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: Skilled nurse initial comprehensive assessment performed by Staff K on 4/4/24, lacked documentation of a completed DRR. The interdisciplinary group (IDG) meeting note, dated 4/12/24 lacked documentation of a completed DRR. The clinical record lacked documentation of completed DRR on admission.”

“Based on hospice policy review, clinical record review and staff interview, the hospice failed to perform an initial bereavement assessment, within 5 days of the patient’s election to the hospice benefit and as part of the initial comprehensive assessment, to determine patient and/or family bereavement needs and risk factors in a timely manner for 1 of 14 sampled patients (Patient #7). Failure to complete an initial bereavement assessment increased the risk that patient or family/caregiver grieving and bereavement needs would not be addressed appropriately, leading to prolonged or dysfunctional grieving and potentially increased the risk of self harm for hospice patients or survivors. Findings include: According to the hospice policy, titled Initial Assessment, dated 4/2017, revealed the admitting registered nurse will determine the other disciplines to complete the appropriate sections of the comprehensive assessment based on identified problems and needs during the initial assessment. Nursing and bereavement sections will always be identified. During an interview on 6/11/24 at 2:50 PM, with Administrator, she reported the initial bereavement risk assessment is completed by the social worker/bereavement coordinator, but the Administrator is unsure where this is located in the clinical record. During an interview on 6/12/24 at 9:33 AM, Staff F, Social Worker/Bereavement Coordinator, reported the bereavement assessment is completed 1-2 weeks after the patient death and is usually documented as a verbal assessment under the bereavement tab in the electronic medical record. Patient #7 had an admission to hospice on 8/25/23 and received services in a nursing home. Clinical record review revealed: a. The initial comprehensive assessment completed by the skilled nurse, dated 8/25/23, lacked an initial bereavement risk assessment. b. The initial comprehensive assessment completed by the social worker, dated 8/26/23, lacked an initial bereavement risk assessment. The hospice failed to complete a bereavement risk assessment on all sampled patients. The Administrator and Vice President of Clinical Services received the above findings.”

“Based on hospice interview, clinical record review, and hospice policy review, the hospice interdisciplinary team (IDT) registered nurses (RN) failed to perform comprehensive patient assessments no less than every 15 days for 7 of 14 patients (Patients #1, #4, #5, #6, #7, #8, #9) and perform comprehensive weekly wound assessments for 2 of 3 patients with wounds (Patients #1 and #11). Failure of the (IDT) RNs to perform comprehensive patient assessments or perform comprehensive weekly wound assessments placed the patient at risk for ineffective staff collaboration and communication regarding the patients hospice care and care of the patients wound including effectiveness of treatments and interventions. Findings include: 7. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24, and 5/23/24,, included IDG orders for skilled nursing services 2 times per week. b. The skilled nurse visit notes, dated 4/25/24 and 5/22/24, included documentation a comprehensive assessment was completed, 27 days apart, 12 days late per regulations. c. The skilled nurse visit notes, dated 4/25/24, 5/22/24 and 6/6/24, included documentation of a wound under the left breast with dry cracked skin, left open to air. Wound measurements included length and width but lacked documentation of depth. The hospice failed to complete comprehensive assessments no less than every 15 days and include complete wound measurements for each comprehensive assessment. 8. Patient #7 had a hospice admission date of 8/25/23, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24, and 5/23/24, included IDG orders for skilled nursing services of 2 times per week. b. The skilled nurse visit notes, dated 4/26/24 and 5/21/24, included documentation a comprehensive assessment was completed, 25 days apart, 10 days late per regulations. The hospice failed to complete comprehensive assessments no less than every 15 days. The Administrator and Vice President of Clinical Services received the above findings and hospice staff provided no further information prior to the end of the survey. 5. Patient #4 had a hospice admission date of 3/24/24, and received hospice services while residing in a private residence. Clinical record review revealed: a. The Comprehensive Plan of Care, dated 3/24/24 to 6/21/24, included orders for skilled nursing services 1 time per week. b. The skilled nurse visit notes, dated 4/8/24 and 5/7/24, included documentation a comprehensive assessment was completed, 29 days apart, 14 days late per regulations. c. The skilled nurse visit notes, dated, 5/7/24 and 6/4/24, included documentation a comprehensive assessment was completed, 28 days apart, 13 days late per regulations. The hospice failed to complete comprehensive assessments no less than every 15 days. 6. Patient #8 had a hospice admission date of 4/29/24, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 5/6/24, 5/23/24, and 6/7/24, included IDG orders for skilled nursing services 1 time per week. b. The skilled nurse visit notes, dated 4/29/24 and 5/20/24, included documentation a comprehensive assessment was completed, 21 days apart, 6 days late per regulations. c. The skilled nurse visit notes, dated 5/20/24 and 6/6/24, included documentation a comprehensive assessment was completed, 17 days apart, 2 days late per regulations. The hospice failed to complete comprehensive assessments no less than every 15 days. According to hospice policy titled, Interdisciplinary Group Coordination of Care dated April 2017 directed, in pertinent part, the interdisciplinary group (in collaboration with the attending physician, if any) will conduct assessments, develop and update the plan of care, and review the effectiveness of care a minimum of every 15 calendar days. The attending physician will receive a copy of the care plan updates. In an interview on 6/11/24 at 2:50 PM, the Administrator reported that she will need to read the wound care policy to know what the expectation is for wound assessment. 3. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a nursing home. Clinical record review revealed: Comprehensive assessments were performed on 4/11/24 by Staff K, Registered Nurse (RN) and 6/3/24 performed by Staff C. IDT note on 4/12/24 included a nursing visit note from Staff A, Licensed Practical Nurse (LPN) on 4/2/24 that the patient had a Band-Aid to his left knee from a rug burn that isnt healing. The left knee wound was not comprehensively assessed with only length and width measurements on 4/11/24, 4/16/24, 5/3/24, and 5/16/24. The left knee wound had no assessment on the weeks of 4/21/24, 5/5/24, 5/19/24, 5/26/24, and 6/2/24. The patient did not have comprehensive assessments no less than every 15 days and did not have weekly comprehensive wound assessments. 4. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The initial comprehensive assessment performed by Staff K on 4/4/24 included measurement of the length and width of the left elbow skin tear. The patient did not have a weekly wound assessment the week of 4/7/24 and the clinical record lacked documentation that the patients wound healed. The patient did not have a comprehensive wound assessment at admission and did not have a weekly wound assessment. According to hospice policy titled, Comprehensive Assessment dated April 2017, the comprehensive assessment is updated by the interdisciplinary group as frequently as the patient requires, but at a minimum every 15 days. 1.Patient #6 had a hospice admission date of 1/24/24, and received hospice services in a private home. Clinical record review revealed: a. The Comprehensive Plan of Care, dated 1/24/24 to 5/29/24, lacked physician orders for skilled nursing frequency. b. The skilled nurse visit notes, dated 4/8/24 and 5/22/24, included documentation a comprehensive assessment was completed, 43 days apart, 28 days late per regulations. The hospice failed to complete comprehensive assessments no less than every 15 days. 2. Patient #9 had a hospice admission date of 5/9/24, and received hospice services in a skilled nursing facility. Clinical record review revealed: a. The Comprehensive Plan of Care, dated 5/9/24 - 8/6/24, included included orders for skilled nursing services 1 time per week. b. The skilled nurse visit notes, dated 5/9/24 and 5/22/24, included documentation a comprehensive assessment was completed, documentation lacked another comprehensive assessment by the end of the survey 21 days from the last comprehensive assessment, 6 days late per regulations. The hospice failed to complete comprehensive assessments no less than every 15 days.”

“Based on hospice clinical record review, nursing home record review, and hospice policy review, the hospice failed to ensure the provision of care in accordance with the patient’s plan of care for 8 of 14 patients sampled (Patients #3, #4, #5, #6, #7, #8, #9, and #12). Failure to follow the patient’s plan of care (POC) as directed by the Interdisciplinary Group (IDG) puts the patients at risk of inconsistent care that may not meet the needs of the patient. Findings include: 7. Patient #7 had a hospice admission date of 8/25/23, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24 and 5/23/24, included orders for skilled nursing services two times per week and hospice aide services three times per week. b. The hospice failed to complete skilled nurse visits the weeks of 5/5/24. c. The skilled nurse visit notes, dated 4/26/24, 5/3/24, 5/12/24, 5/21/24 and 5/29/24, were completed. The hospice failed to complete a second skilled nurse visit for the weeks of 4/21/24, 4/28/24, 5/12/24, 5/19/24 and 5/26/24. d. The hospice aide visit note, dated 4/22, 4/25, 4/29, 5/1, 5/6, 5/9, 5/13, 5/15, 5/20, 5/22, 5/31 and 6/3/24, were completed. The hospice aide failed to complete a second and third visit for the week of 5/26/24, and a third visit for the weeks of 4/21, 4/28, 5/5, 5/12, 5/19 and 6/2/24. e. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24 and 5/23/24, lacked documentation of any missed visits by skilled nurses or hospice aides. 8. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 4/26/24, 5/6/24 and 5/23/24, included orders for skilled nursing services two times per week and hospice aide services two times per week. b. The hospice failed to complete skilled nurse visits the weeks of 4/28/24 and 5/5/24. c. The skilled nurse visit notes, dated 5/16/24, 5/22/24 and 5/29/24, were completed. The hospice failed to complete a second skilled nurse visit for the weeks of 5/12/24, 5/19/24 and 5/26/24. d. The hospice aide visit note, dated 5/31/24, was completed. The hospice aide failed to complete a second visit for the week of 5/26/24. e. The IDG meeting notes, dated 5/6/24 and 5/23/24, lacked documentation of any missed visits by skilled nurses or hospice aides. The Administrator and Vice President of Clinical Services received the above findings. 5. Patient #6 had a hospice admission date of 1/24/24 and received hospice services while residing in a private residence. Review of the clinical record revealed: a. The Plan of Care (POC), dated 4/25/24 - 8/24/2024, lacked orders for skilled nursing services frequency. b. Routine skilled nurse visits occurred, 4/30/24, 5/7/24, 5/14/24, 5/21/24, 5/28/24, and 6/4/24. The skilled nurse failed to obtain frequency orders for nursing visits and update the plan of care. c. The IDG (interdisciplinary group) note dated, 5/6/24, failed to identify skilled nurse frequency orders. d. Hospice Chaplain services were ordered 1 time per month. The medical record failed to identify any chaplain visits during the month of may. e. The IDG note, dated 5/6/24 did not include any new orders or changes to existing orders in regards to visit frequencies. 6. Patient #9 had a hospice admission date of 5/9/24 and received hospice services in a skilled nursing facility. Review of the clinical record revealed: a. The POC dated, 5/9/24 - 8/6/24, included orders for the skilled nurse to visit one time per week. b. Skilled nursing visits occurred on 5/9/24, 5/10/24, 5/13/24, 5/22/24,5/29/24 and 6/11/24. The skilled nurse failed to visit 1 times per week as ordered. c. The IDG (interdisciplinary group) note dated, 6/7/2024 did not include any new orders or changes to existing orders in regards to visit frequencies. Review of the undated policy, titled the Plan of Care, identified a written individualized patient and family/caregiver plan of care (POC) will be established and maintained for each individual admitted to the hospice program. The POC will be based on the initial, comprehensive and ongoing comprehensive assessments performed by members of the Interdisciplinary Group (IDG) and will be reviewed no less than every 15 days. The care provided to the patient must be in accordance to the POC. 1.Patient #3 had a hospice admission date of 5/7/24 and received hospice services while residing in a private residence. Review of the clinical record revealed: a. The POC, dated 5/7/24 to 8/4/24, included orders for skilled nursing services 1 time per week and 4 as needed (PRN) visits; social work visits 1 time a month and 3 PRN visits; chaplain visits 1 time a month with 3 PRN visits; and hospice home care aide visits 2 times a week. b. Routine skilled nurse visits occurred on 5/7/24, 5/9/24, 5/15/24, 5/17/24, 5/21/24, 5/24/24, 5/28/24, and 5/30/24; the skilled nurse visited 2 times per week in the month of May exceeding the order for nursing visits 1 time per week. The skilled nurse failed to follow visit frequency orders on the POC. c. Hospice home care aide visits occurred on 5/17/24, 5/21/24, 5/23/24, 5/30/24, and 6/6/24. The hospice home care aide failed to visit 2 times per week as ordered. d. Hospice Chaplain services were ordered 1 time per month. The medical record failed to identify any chaplain visits. e. The IDG notes, dated 5/23/24 and 6/7/24, did not include any new orders or changes to existing orders in regards to visit frequencies. 2. Patient #4 had a hospice admission date of 3/24/24 and received hospice services while residing in a private residence. Review of the clinical record revealed: a. The POC, dated 3/24/24 to 6/21/24, included orders for skilled nursing visits1 time per week, chaplain visits 1 time per month, social work visits 1 time per month, and hospice home care aide services 2 time per week. b. Routine skilled nurse visits occurred on 4/8/24, 4/11/24, 4/15/24, 4/18/24, 4/23/24, 4/26/24, 4/29/24, 5/7/24, 5/14/24, 5/17/24 and 5/30/24. The skilled nurse provided 2 visits per week, the weeks of 4/7/24, 4/14/24, 4/21/24, 5/12/24, and 5/26/24. No nursing visits were provided to the patient the week of 5/19/24. The skilled nurse failed to follow visit frequency orders on the POC. c. Hospice home care aide visits occurred on 4/30/24, 5/3/24, 5/7/24, 5/10/24, 5/14/24, 5/17/24, 5/23/24, and 5/30/24. The hospice aide failed to provide 2 visits per week the weeks of 5/19/24 and 5/26/24. d. The IDG notes, dated 3/29/24, 4/12/24, 4/26/24, 5/10/24, 5/23/24, and 6/7/24 did not include any new orders or changes to existing orders in regards to visit frequencies. 3. Patient #8 had a hospice admission date of 4/29/24 and received hospice services while residing in a nursing home. Review of the clinical record revealed: a. The POC, dated 4/29/24 to 7/27/24, included orders for skilled nursing services 1 time per week, hospice home care aide services 2 times per week, chaplain visits 1 time per month, and social work visits 1 time per month. b. Routine skilled nurse visits occurred on 4/29/24, 5/1/24, 5/6/24, 5/9/24, 5/14/24, 5/17/24, 5/20/24, 5/28/24, and 5/30/24. The skilled nurse visit 2 times a week every week except the week of 5/19/24. The skilled nurse failed to follow visit frequency orders on the POC. c. Hospice home care aide visits were ordered 2 times per week. The hospice home care aide visited only 1 time the week of 5/26/24. The hospice home care aide failed to follow visit frequency orders on the POC. d. Hospice Chaplain services were ordered 1 time per month. The medical record failed to identify any chaplain visits. e. The IDG notes, dated 5/10/24, 5/23/24, and 6/7/24, did not include any new orders or changes to existing orders in regards to visit frequencies. 4. Patient #12 had a hospice admission date of 1/17/24, a death date of 1/20/24, and received hospice services while residing in a private residence. a. The POC, dated 1/17/24 to 4/15/24, included orders for skilled nursing services 3 times per week, hospice home care aide services 2 times a week, and social worker services 1 time per month. b. The IDG notes, dated 1/19/24, included orders to change the skilled nursing services to 5 times per week. c. Routine skilled nurse visits occurred on 1/17/24, 1/18/24, 1/19/24, and 1/20/24. The skilled nurse failed to follow visit frequency orders on the POC.”

“Based on clinical record review and hospice policy review, the hospice failed to obtain visit orders that included frequency for 1 of 14 patients (Patient #1) and failed to obtain orders for a discipline prior to that discipline starting visits for 1 of 14 patients (Patient #11). Failure to obtain orders for visits and follow the patients Plan of Care as directed by the interdisciplinary group puts the patient at risk of inconsistent care that may not meet the needs of the patient. Findings include: Review of the hospice policy, titled Interdisciplinary Group Meeting dated April 2017 included, in pertinent part, level of services will be reviewed for new and ongoing patients based on hospice team assessments. Increases or decreases in frequency of visits by team members and reason for the change. During an interview with Administrator on 6/11/24 at 2:50 PM, when asked to clarify the Patient #1s discipline orders from his Plan of Care (POC), she agreed that she was not able to know what the patients visit frequency was ordered, based on what was included in the POC. 1. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a nursing home. Clinical record review revealed: The POC, printed on 6/11/24 for benefit period 2, included active orders for Licensed Nurse (LVN/LPN) - month, Social Worker - month, and Spiritual advisor - month. The visit frequency orders did specify the number of times per month each discipline was ordered to visit the patient. 2. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The patient had aide visits on 4/9/24 and 4/11/24 performed by Staff E, hospice aide. Patient #11 did not have orders for aide visits. The Administrator and Vice President of Clinical Services received the above findings.”

“Based on observation, clinical record review and hospice policy review, the hospice failed to ensure the hospice plan of care included all necessary medications and treatments and/or a complete order for all medications and treatments to meet the needs of the patient for 3 of 14 sampled patients (Patients #1, #9, and #11). Failure to ensure the plan of care included complete orders for medications and treatments placed patients at risk to receive inappropriate treatment of symptoms and/or not meet the needs of the patients. Findings include: 3. Patient #9 had a hospice start of care date of 5/9/24 and received hospice services in a skilled nursing facility. a. The Plan of Care (POC), dated 5/9/24 - 8/6/24 documented that patient utilized oxygen. b. The comprehensive assessment, dated 5/22/24 documented the patient was utilizing oxygen for comfort. c. The Interdisciplinary Group (IDG) note, dated 6/11/24 indicated the patient is utilizing oxygen. The above findings were reviewed with the Administrator and Clinical Manager. d. The clinical record and medication profile lacked specific physician orders for oxygen use by the patient. Review of the hospice policy, titled The Plan of Care (POC) dated April 2017, in pertinent part, included the written plan of care will contain, but will not be limited to, the following: DME (durable medical equipment) and medical supplies necessary to meet patient needs, drugs and treatments, and physician (or other authorized licensed independent practitioner) orders. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a LTC facility. In a concurrent interview and observation on 6/10/24 at 12:00 PM, a area on the patients left knee was covered in an adhesive bandage. The patient reported he had a wound to this area. The skilled nursing visit performed by Staff K, Registered Nurse (RN) on 4/11/24 included documentation that the patient had a wound to his left knee. The long term care (LTC) facility order summary report included an order with a start date of 3/1/24 to apply medihoney to left knee wound and cover with border gauze every other day for wound healing. No order was found for wound treatment for the left knee wound. 2. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The POC, printed on 6/11/24 for benefit period 1, included an oxygen concentrator as durable medical equipment (DME). The interdisciplinary team (IDT) note on 4/12/24 included visit documentation from 4/8/24 that the patient used oxygen and that the patient had a skin tear to his left arm that was cleansed and dressed during the visit. No order was found in the clinical record for oxygen or the wound treatment for the left arm skin tear.”

“Based on home visit observations, patient interviews, clinical record reviews and agency policy reviews, the hospice failed to ensure Plans of Care (POC) for 6 of 14 sampled patients (Patients #1, #2, #3, #8, #9, and #11) identified all medical equipment and supplies necessary to meet identified patient needs. Failure to include all needed items of medical equipment and supplies the patient used on the POC placed the patients at risk of unanticipated decline or injury and of needs not met. Findings include: 6. Patient # 9 had a hospice admission date of 5/9/24, and received hospice services in a skilled nursing facility. a. The Plan of Care (POC) , dated 5/9/24 - 8/6/24, did not identify any durable medical equipment (DME) being utilized. b. The POC identified the patient was utilizing oxygen and a nebulizer machine. (machine used to inhale medication for respiratory needs) c. The POC included an intervention for the hospice aide to change adult briefs when soiled. d. The Interdisciplinary Group (IDG) meeting notes, dated 5/23/24 and 6/7/24 identified no medical equipment and supplies used by the patient. e. The POC, and IDG meetings to update the POC, failed to identify the DME of oxygen concentrator and supplies, nebulizer, CPAP, and incontinency supplies being used by the patient. The above findings were reviewed with the Agency Administrator and the Clinical Manager. 3. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a LTC facility. Clinical record revealed: The POC, printed on 6/11/24 for benefit period 1, included the hospice aide task with a created date of 3/5/24 to change adult brief. The long term care (LTC) facility order summary report included an order with a start date of 3/1/24 to apply medihoney to left knee wound and cover with border gauze every other day for wound healing. The IDG on 4/12/24 included that the patient used compression stockings. In an interview on 6/10/24 at 12:00 PM, the patient reported that he uses a device to assist with his left hand contractures. The POC or IDG notes failed to include all of the DME the patient used. 4. Patient #2 had a hospice admission date of 6/7/24 and received hospice services while residing in a nursing home. Clinical record revealed: In an observation on 6/10/24 at 12:30 PM, the patient used a walker to assist with ambulation. The POC, printed on 6/11/24 for benefit period 1, dated 6/11/24 directed to perform brief changes as needed. The POC or IDG notes failed to include all of the DME the patient used. 5. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The IDG note on 4/12/24 included visit documentation by Staff K, Registered Nurse (RN) on 4/5/24 that the patient had a skin tear to his left arm that was cleansed and dressed during the visit. The POC, printed 6/11/24 for benefit period 1, included a hospice aide task to weigh the patient which did not specify to whom the scale belonged to, either the hospice or the patient. The POC or IDG notes failed to include all of the DME the patient used. Review of the undated hospice policy, titled the Plan of Care, identified the patient’s written plan of care (POC) will contain Durable Medical Equipment (DME) and medical supplies necessary to meet patient needs. 1.Patient #3 had a hospice admission date of 5/7/24 and received hospice services in a private residence. Review of the clinical record revealed the following: a. The POC, dated 5/7/24 to 8/4/24, identified the patient had the following medical equipment and supplies: wheelchair. b. The skilled nurse visit note, dated 6/1/24, identified the skilled nurse applied edema wear to the patient’s lower extremities. On 6/10/24 at 2:00 PM, during a home visit observation with Staff C, Registered Nurse (RN), the surveyor identified the patient also used a walker, oxygen concentrator and supplies, heating pad, nebulizer, and CPAP. In an interview, during the same home visit observation, the patient’s primary caregiver reported the patient has used the walker for a long time, the heating pad for years, the oxygen since prior to hospice care, and the nebulizer and CPAP for a long time. c. The Interdisciplinary Group (IDG) meeting notes, dated 5/23/24 and 6/7/24 identified no additional medical equipment and supplies used by the patient. The POC, and IDG meetings to update the POC, failed to identify the additional DME of walker, oxygen concentrator and supplies, heating pad, nebulizer, CPAP, and edema wear used by the patient. 2. Patient #8 had a hospice admission date of 4/29/24 and received hospice services in a nursing home. Review of the clinical record revealed the following: a. The POC, dated 4/29/24 to 7/27/24, identified the patient had the following medical equipment and supplies: wipes, disposable briefs, walker, wheelchair, and electric bed. b. The skilled nurse visit note, dated 4/29/24, identified the patient ambulated to the bathroom with the one assist, gait belt and walker. c. The skilled nurse visit note, dated 6/6/24, identified the patient was utilizing edema wear. d. The IDG meeting notes, dated 5/10/23, 5/23/23, and 6/7/23, identified no additional medical equipment and supplies used by the patient. The POC, and IDG meetings to update the POC, failed to identify the additional DME of gait belt and edema wear used by the patient.”

“Based on staff interviews, clinical record review, and hospice policy review, the hospice failed to ensure the individualized plan of care was reviewed and revised based on the comprehensive assessment at least every 15 days for 5 of 9 active patients. (Patient #1, #3, #5, #6 and #7) Failure of the interdisciplinary group (IDG) to review and update the individualized plan of care at least every 15 days placed hospice staff at risk of not knowing what care and services to provide to meet the patient’s assessed needs and/or placed the hospice patients at risk for not receiving appropriate care to have needs met. 4. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed documentation of IDG meetings conducted on 5/6/24 and 5/23/24, 17 days apart, which exceeded the requirement by 2 days. 5. Patient #7 had a hospice admission date of 8/25/23, and received hospice services while residing in a nursing home. Clinical record review revealed: Clinical record review revealed documentation of IDG meetings conducted on 5/6/24 and 5/23/24, 17 days apart, which exceeded the requirement by 2 days. The Administrator and Vice President of Clinical Services received the above findings. 3.Patient #3 had a hospice admission date of 5/7/24 and received hospice services while residing in a private residence. Clinical record review revealed: The hospice conducted an initial IDG meeting for this patient on 5/23/24 to review and update the patient’s plan of care. The hospice failed to conduct an IDG meeting to review and update the patient’s plan of care no less frequently than every 15 calendar days. 2. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a LTC facility. Clinical record revealed: The hospice conducted an IDG on 5/6/24 to review and update the patient’s plan of care. b. The hospice conducted the next IDG meeting on 5/23/24 to review and update the patient’s plan of care. The hospice failed to conduct an IDG meeting to review and update the patient’s plan of care no less frequently than every 15 calendar days. Review of the hospice’s policy, titled Interdisciplinary Group Meetings, dated 4/2017, identified the interdisciplinary group (IDG) reviews and updates each patient’s POC at least every 15 days, or more frequently, if needed. During an interview on June 12th, at 2:00pm, the administrator could not recall why the IDG meetings were not held on the normal every other Friday schedule during the month of May 2024. 1.Patient #6 had a start of care date, of 1/24/24 and received hospice services in a private home. a. The hospice conducted an interdisciplinary group meeting (IDG) on 5/6/24 to review and update the patient’s plan of care. b. The hospice conducted the next IDG meeting on 5/23/24 to review and update the patient’s plan of care. The hospice failed to conduct an IDG meeting to review and update the patients plan of care no less frequently than every 15 calendar days.”

“Based on home visit observations, staff interviews, clinical record reviews, and agency policy review, the agency failed to ensure staff performed tasks during home visits in a manner to prevent contamination and/or the spread of infection for 3 of 3 home visit observations (Patients #1, #2, and #3). Failure to ensure services during home visits followed accepted standards of practice for infection control, increased the risk of contamination and/or the spread of infection. Findings include: 3. Patient #3 had a hospice admission date of 5/7/24 and received hospice services while residing in a private home. Review of the clinical record revealed: The plan of care (POC), dated, 5/7/24 to 8/4/24, included Interdisciplinary Group (IDG) orders for skilled nursing services. On 6/10/24 at 2:00 PM, during a home visit observation, Staff C, Registered Nurse (RN), assessed the patient’s vital signs utilizing a pulse oximeter, thermometer, blood pressure cuff, and stethoscope. Staff C placed the used equipment back into her nursing bag without sanitizing it. The hospice nurse failed to follow accepted standards of practice to prevent the transmission of infections and communicable diseases. The above findings were shared with the Administrator and Vice President of Clinical Services. Review of the hospice policy, titled Infection Control and Safety Management dated March 2022, in pertinent part, the hospice follows accepted standards of practice to prevent the transmission of infections and communicable diseases. In an interview on 6/11/24 at 10:17 AM, the Vice President of Clinical Services reported that staff are trained to perform hand hygiene and use a barrier under items when going into a visit, then use standard basic infection control. 1. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a long term care (LTC) facility. The plan of care (POC), printed 6/11/24 for benefit period 2, included order for skilled nursing services. On 6/10/24 at 12:00 PM, during a home visit observation, Staff C, Registered Nurse (RN), assessed the patient’s vital signs utilizing a pulse oximeter, thermometer, blood pressure cuff, and stethoscope. Staff C placed the used equipment back into her nursing bag without sanitizing it. The hospice nurse failed to follow accepted standards of practice to prevent the transmission of infections and communicable diseases. 2. Patient #2 had a hospice admission date of 6/7/24 and received hospice services while residing in a nursing home. Clinical record revealed: The POC, printed 6/11/24 for benefit period 1, included orders for skilled nursing services. On 6/10/24 at 12:30 PM, during a home visit observation, Staff C, Registered Nurse (RN), assessed the patient’s vital signs utilizing a pulse oximeter, thermometer, blood pressure cuff, and stethoscope. Staff C placed the used equipment back into her nursing bag without sanitizing it.”

“Based on staff interviews, clinical record reviews, and hospice policy review, the hospice failed to ensure hospice aides provided services as ordered by the Interdisciplinary Group (IDG) according to the individualized plan of care for 2 of 13 sampled patients who received hospice aide services (Patient #5 and #8). Failure to provide hospice aide services as ordered on the plan of care increased the risk that hospice patients’ personal care needs were not met. Findings include: 2. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated, 4/12/24, 4/26/24, 5/6/24 and 5/23/24, included IDG orders for hospice aide services. b. The plan of care, printed 6/11/24, identified as Benefit Period 10, included hospice aide instructions from the Registered Nurse to obtain patient weight 1 time every 2 weeks, created date, 8/31/22. c. The hospice aide visit note, dated 5/6/24, included documentation the aide obtained a weight of 124.5 pounds. d. The hospice aide visit notes, dated 5/8, 5/13, 5/15, 5/20, 5/22, and 5/31/24, included documentation the aide did not obtain a weight, it was not applicable to the visit. The hospice aide failed to obtain a weight 1 time every 2 weeks as instructed by the Registered Nurse. The Administrator and Vice President of Clinical Services received the above findings. According to the hospice policy, titled Hospice Aide/Homemaker Services, dated March 2022, the hospice aide services are provided by written instructions prepared by the Registered Nurse (RN), who is responsible for the supervision of the hospice aide. The hospice aide follows the written assignment developed for the patient. During an interview on 6/11/24 at 10:17 AM, the Vice President of Clinical Services reported the hospice aide contacts the RN Case Manager if a task is not completed and documents the reason why it was not completed. 1.Patient #8 had a hospice admission date of 4/29/24 and received hospice services while residing in a nursing home. Review of the clinical record revealed the following: a. The Plan of Care (POC), dated 4/29/24 to 7/27/24, identified the patient had a diagnosis of Congestive Heart Failure and included IDG orders for skilled nursing, hospice aide, social worker, and chaplain services. b. The Home Care Aide Plan of Care, dated 4/29/24, included RN instructions to the hospice aide to complete the following tasks: vitals-weight, perineal care if soiled, change bed linens if soiled, apply lotion to back, arms, legs, torso, make bed, assist patient to chair, assist with dressing, and assist with repositioning. c. The hospice aide visit notes, dated 4/30/24, 5/3/24, 5/7/24, 5/10/24, 5/17/24, 5/21/24, 5/23/24, 5/30/24, 6/3/24, and 6/6/24 lacked documentation the hospice aide completed the assigned task of checking the patient’s weight. The visit notes lacked a reason why the hospice aide failed to complete the assigned task. The above findings were shared with the Administrator and Vice President of Clinical Services.”

“Based on clinical record review and hospice policy review, the hospice failed to document required hospice aide supervision every 14 days when the patient received skilled services in conjunction with the hospice aide services for 5 of 8 sampled patients (Patients #1, #4,#7, #8 and #9) with hospice aide services for 14 days or longer. Failure to ensure the supervision of hospice aide by registered nurses completed according to regulation increased the risk of agency staff not meeting the patients’ personal care needs. 4. Patient #7 had a hospice admission date of 8/25/23, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24 and 5/23/24, included orders for skilled nursing and hospice aide services. b. The skilled nursing visit notes, dated 4/11/24 and 4/26/24, included documentation the nurse supervised the hospice aide, 15 days later, 1 day late per regulations. c. The skilled nursing visit notes, dated 4/26/24 and 5/21/24, included documentation the nurse supervised the hospice aide, 25 days later, 11 days later per regulations. The hospice failed to document aide supervision every 14 days. The Administrator and Vice President of Clinical Services received the above findings. 4. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a LTC facility. a. The POC, printed 6/11/24 for benefit period 2, included orders for hospice aide and skilled nursing services. b. The skilled nursing visit note performed by Staff K, Registered Nurse (RN), dated 4/11/24, included documentation that the hospice nurse supervised the hospice aide. The hospice failed to document aide supervision every 14 days. 2. Patient #4 had a hospice admission date of 3/24/24 and received hospice services while residing in a nursing home. Review of the clinical record revealed: a. The POC, dated 3/24/24 to 6/21/24, included orders for skilled nursing services and hospice aide services. b. The skilled nurse visit notes, dated 5/7/24 and 6/4/24, included documentation aide supervision was completed, 28 days apart, 14 days late per regulation. The RN failed to supervise the hospice aide services every 14 days. 3. Patient #8 had a hospice admission date of 4/29/24 and received hospice services while residing in a private residence. Review of the clinical record revealed: a. The POC, dated 4/29/24 to 7/27/24, included orders for skilled nursing services and hospice aide services. b. The skilled nurse visit notes, dated 5/20/24 and 6/6/24, included documentation aide supervision was completed, 17 days apart, 3 days late per regulation. The RN failed to supervise the hospice aide services every 14 days. According to the hospice policy, titled Hospice Aide/Homemaker Services, dated 03/2022, the Registered Nurse (RN) makes a supervisory visit in the patient’s care setting at least every 14 days. 1.Patient #9 had a hospice admission date of 5/9/24 and received hospice services while residing in a skilled nursing facility. Clinical record review revealed: a. The Plan of Care, dated 5/9/24 - 8/6/24, included orders for hospice aide and skilled nursing services. b. The skilled nursing visit note, dated 5/22/24, included documentation the nurse supervised the hospice aide. c. The skilled nursing visit note, dated 5/29/24, failed to include documentation the nurse supervised the hospice aide. d. The skilled nursing visit note, dated 6/11/24 failed to include documentation the nurse supervised the hospice aide. The hospice failed to document aide supervision every 14 days.”

“Based on clinical record review and hospice policy review, the hospice failed to document all required components of hospice aide supervision including following the patient plan of care, creating successful interpersonal relationships with the patient and family, demonstrating competency with assigned tasks, complying with infection control policies and procedures, and reporting changes in patient condition for 7 of 13 sampled patients (Patients #1, #3, #4, #5, #7, #8, and #14) with hospice aide services. Failure to ensure the supervision of hospices by registered nurses maintained documentation of a review of all required supervisory elements increased the risk of agency staff not meeting the patients’ personal care needs. Findings include: 5. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated, 4/12/24, 4/26/24, 5/6/24 and 5/23/24, included IDG orders for skilled nurse and hospice aide services. b. The skilled nurse visit notes, dated 4/25/24 and 5/22/24, included documentation the hospice nurse provided aide supervision: followed established plan of care, utilized universal precautions, established positive rapport with patient/family, coordinated care with facility/family; but lacked documentation of competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision. 6. Patient #7 had a hospice admission date of 8/25/23, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The IDG meeting notes, dated 4/12/24, 4/26/24, 5/6/24 and 5/23/24, included orders for skilled nursing and hospice aide services. b. The skilled nurse visit notes, dated 4/11/24, 4/26/24 and 5/21/24, included documentation the hospice nurse provided aide supervision: followed established plan of care, utilized universal precautions, established positive rapport with patient/family, coordinated care with facility/family; but lacked documentation of competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision. 7. Patient #14 had a hospice admission date of 8/31/23, a discharge date of 2/26/24, and received hospice services while residing in a private home. Clinical record review revealed: a. The IDG meeting notes, dated 1/5/24, 1/19/24, 2/2/24, and 2/16/24, lacked documentation of a completed DRR. b. The skilled nurse visit notes, dated 1/4/24, 1/17/24, 1/31/24 and 2/14/24, included documentation the hospice nurse provided aide supervision: followed established plan of care, utilized universal precautions, established positive rapport with patient/family, coordinated care with facility/family; but lacked documentation of competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision. The Administrator and Vice President of Clinical Services received the above findings. 4. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a long term care (LTC) facility. a. The POC, printed 6/11/24 for benefit period 2, included orders for hospice aide and skilled nursing services. b. The skilled nursing visit note by Staff K, Registered K, Registered Nurse )RN), dated 4/11/24, included documentation that the hospice nurse supervised the hospice aide. C. The supervision documentation failed to include demonstrating competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision. According to the hospice policy titled Hospice Aide/Homemaker services, dated March 2022, a registered nurse (RN) makes a supervisory visit at least every 14 days to assess the quality of care and services provided by the hospice aide to ensure services meet the patient’s needs. 1.Patient #3 had a hospice admission date of 5/7/24 and received hospice services while residing in a private residence. a. The Interdisciplinary Group (IDG) meeting note, dated 5/23/24, included orders for skilled nursing and hospice aide services. b. The skilled nurse visit notes, dated 5/21/24 and 6/3/24, included documentation the hospice nurse provided aide supervision. c. The supervision documentation failed to include demonstrating competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision. 2.Patient #4 had a hospice admission date of 3/24/24 and received hospice services while residing in a private residence. Clinical record review revealed: a. The Interdisciplinary Group (IDG) meeting note, dated 3/29/24, included orders for skilled nursing and hospice aide services. b. The skilled nurse visit notes, dated 4/23/24, 5/7/24, and 6/4/24, included documentation the hospice nurse provided aide supervision c. The supervision documentation failed to include demonstrating competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision. 3.Patient #8 had a hospice admission date of 4/29/24 and received hospice services while residing in a nursing home. a. The Interdisciplinary Group (IDG) meeting note, dated 5/6/24, included orders for skilled nursing and hospice aide services. b. The skilled nurse visit notes, dated 5/20/24 and 6/6/24, included documentation the hospice nurse provided aide supervision c. The supervision documentation failed to include demonstrating competency with assigned tasks. The hospice failed to document all required components of hospice aide supervision.”

“Based on hospice staff interview, clinical record review, and hospice policy review the hospice failed to ensure staff all required components of physician certification of the patients terminal illness (CTI) for 3 of 14 sampled patients (Patient #10, #11, and #14). Failure to obtain the physicians certification of terminal illness puts the patient at risk of receiving hospice care inappropriately and/or without a funding source. Findings include: 3.Patient #10 had a hospice admission date of 1/25/24, a death date of 2/7/24 and received hospice services while residing in a private home. Clinical record review revealed documentation of Certification of Terminal Illness (CTI) form, dated 1/25/24 to 4/23/24, electronically signed by the Medical Director, included narrative statement “;Please see CTI in Documents”. The documents section of the electronic medical record lacked a narrative statement form for the 1/25/24 CTI. During an interview on 6/12/24 at 4:15PM, Administrator reported no CTI narrative statement forms were located. 4. Patient #14 had a hospice admission date of 8/31/23, a discharge date of 2/26/24, and received hospice services while residing in a private home. Clinical record review revealed documentation of verbal Certification of Terminal Illness form, dated 11/29/23 to 2/26/24, signed by the Medical Director, lacked a narrative statement. The electronic medical record lacked a narrative statement form for the 11/29/23 CTI. During an interview on 6/12/24 at 4:15PM, Administrator reported no CTI narrative statement forms were located. The Administrator and Vice President of Clinical Services received the above findings and hospice staff provided no further information prior to the end of the survey. According to the hospice policy titled, Contents of Clinical Record dated April 2017, in pertinent part, documentation will include certification and recertification(S) of terminal illness. Each entry will be dated and signed, including title and credentials, by the person providing the care/service. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The Election of Hospice Care form signed by the patient for services to begin on 4/4/24 included the name of the patients attending physician along with the name of the hospice medical director with meds in parenthesis behind the hospice medical directors name. Both physicians names were listed on the same line on the form. The CTI for benefit period 1 from 4/4/24 to 7/2/24 included the medical directors electronic signature. The CTI for benefit period 1 from 4/4/24 to 7/2/24 failed to include the patients attending physicians signature.”

“Based on staff interviews, clinical record reviews, and agency policy reviews, the hospice failed to ensure clinical records contained pertinent, up-to-date and complete information in a time manner for 3 of 3 sampled patients (Patients #3, #4, and #8) with hospice services. Failure to maintain accurate clinical records with current patient information increased the risk for hospice staff to provide services without up-to-date information related to the patient’s condition, and decreased the ability of hospice staff to communicate effectively in order to coordinate patient care. Findings include: Review of the undated hospice policy, titled Contents of Clinical Record, identified a clinical record will be maintained for each patient receiving care. The clinical record will contain sufficient information to identify the patient, describe the patient’s problems and needs, justify care, accurately document care provided and facilitate continuity of care among hospice Interdisciplinary Group (IDG) members and contract personnel. The documentation includes IDG meetings and individual patient/family caregiver case conferences, physician review of medications and plan of care oversight, including justification for recertification, and certification and recertification(s) of terminal illness. On 6/12/24 at 3:16 PM, during an interview, the Administrator reported the missing IDG notes and drug regimen reviews (DRR) were uploaded on 6/11/24 as there had been a staffing change and this task was neglected. 1. Patient #3 had a hospice admission date of 5/7/24 and received hospice services while residing in a private residence. Review of the clinical record revealed the following: a. On 6/10/24, during a clinical record review, the clinical record lacked documentation of any IDG notes and any drug regime reviews (DRRs). b. On 6/11/24, the hospice agency uploaded the completed IDG notes and DRRs for patient #3. The hospice failed to maintain accurate clinical records with current patient information. 2.Patient #4 had a hospice admission date of 3/4/24 and received hospice services while residing in a private residence. Review of the clinical record revealed the following: a. On 6/10/24, during a clinical record review, the clinical record lacked documentation of any IDG notes and DRRs. b. On 6/11/24, the hospice agency uploaded the completed IDG notes and DRRs for patient #4. The hospice failed to maintain accurate clinical records with current patient information. 3.Patient #8 had a hospice admission date of 4/29/24 and received hospice services while residing in a nursing home. Review of the clinical record revealed the following: a. On 6/11/24, during a clinical record review, the clinical record lacked documentation of any IDG notes and DRRs. b. On 6/11/24, the hospice agency uploaded the completed IDG notes and DRRs for patient #8. The hospice failed to maintain accurate clinical records with current patient information. The above findings were presented to the Administrator and Vice President of Clinical Services.”

“Based on clinical record review and policy review, the hospice failed to ensure patient clinical records included a physician order for all medications and treatments for 6 of 14 sampled patients (Patients, #2, #3, #4, #5, #9, and #11) Failure to have a physician order for all medications and treatments increased the potential for patients to receive incorrect or ineffective treatment to meet assessed needs. Findings include: 6. Patient #5 had a hospice admission date of 8/31/22, and received hospice services while residing in a nursing home. Clinical record review revealed: a. The plan of care, printed 6/11/24, identified as Benefit Period 10, included physician orders for bisacodyl rectal suppository 10 milligrams (mg), insert 1 suppository rectally daily as needed; and Milk of Magnesia suspension 1200 mg/15 ml (milliliters), frequency of stools. b. The undated medication profile included physician orders for bisacodyl rectal suppository 10 mg, insert 1 suppository rectally daily as needed; and Milk of Magnesia suspension 1200 mg/15 ml, 30 ml per G-tube (gastrostomy tube – tube inserted through belly to the stomach for nutrition) as above, frequency of stools. The documents failed to identify a reason for the hospice to administer the bisacodyl suppository and the frequency to administer the Milk of Magnesia. The hospice failed to document complete medication orders. The Administrator and Vice President of Clinical Services received the above findings and hospice staff provided no further information prior to the end of the survey. 5. Patient #9 had a hospice admission date of 5/9/24, and received hospice services while residing in a private home. Clinical record review revealed: a. The plan of care (POC) dated 5/9/24 - 8/6/24 included physicians orders for patient medications. b. The comprehensive assessment dated 5/22/24 indicated the patient had oxygen for comfort. c. The Interdisciplinary Group (IDG) updates to the plan of care, indicated the patient was using oxygen at 2 Liters, however lacked specific physicians orders for the oxygen therapy including route, dose and how often. d. The updated medication profile printed on 6-11-24 failed to list oxygen as a medication. The hospice failed to document complete medication orders. 3. Patient #2 had a hospice admission date of 6/7/24 and received hospice services while residing in a nursing home. Clinical record revealed: a. The plan of care, printed 6/11/24, identified as Benefit Period 1, included physician orders for ABH (lorazepam, diphenhydramine, and haloperidol medications) PLO(a type of topical dosage form) 1 mL three times a day as needed, artificial tears 1 drop q4h prn (every 4 hours as needed), Fleet enema rectal 1 dose q24h prn (every 24 hours as needed) and Milk of Magnesia suspension 30 mL q24h prn. b. The undated medication profile included physician orders for ABH PLO Gel 1 mL transdermal three times a day as needed, artificial tears 1 drop ophthalmic q4h, Fleet enema 1 dose, 19-7 gram/118 mL rectally q24h prn, and Milk of Magnesia 30 mL, 400 mg/5 mL by mouth q24h. The documents failed to identify a reason for the hospice to administer the ABH PLO, artificial tears, Fleet enema, and Milk of Magnesia. The hospice failed to document complete medication orders. 4. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: a. The plan of care, printed 6/11/24, identified as Benefit Period 1, included physician orders for Ambien oral tablet (5 mg) q hs prn (every bedtime as (needed) and Fioricet oral tablet four times a day prn. b. The undated medication profile included physician orders for Ambien 5 mg po (oral) q hs prn and Fioricet 1 tablet 50-300-40 mg po four times a day prn. The documents failed to identify a reason for the hospice to administer the bisacodyl suppository and the frequency to administer the Milk of Magnesia. The hospice failed to document complete medication orders. Review of the undated policy, titled Plan of Care, identified a written individualized patient and family/caregiver plan of care will be established and maintained for each individual admitted to the hospice program. The plan of care will meet the documentation requirements of the physician-directed medical orders and the care planning process. 1.Patient #3 had a hospice admission date of 5/7/24 and received hospice services while residing in a private residence. Clinical record review revealed: The undated medication profile included physician orders for adult low dose aspirin 81 milligrams (mg) 1 every day via pop; Zyrtec 10 mg by mouth every day; Singulair 10 mg by mouth every day; Sertraline 50 mg by mouth daily; Metoprolol Succinate 25 mg by mouth twice a day; Metamucil 3.4 grams (g)/5.4 g by mouth daily; Melatonin 10 mg by mouth every night; Levothyroxine 150 micrograms (mcg) by mouth every day; Lasix 20 mg by mouth daily; Albuterol Sulfate inhalation 2 puffs 90 mcg/actuation every 2 hours as needed; Ipratropium-Albuterol inhalation 1 vial .5 mg-3mg (2.5 mg base)/3 milliliters (ml); Calcitrol .25 mcg by mouth every day; Clonazepam 1 mg by mouth every night. The document failed to identify a reason for the hospice to administer the medications listed above. 2.Patient #4 had a hospice admission date of 3/24/24 and received hospice services while residing in a private residence. The undated medication profile included physician orders for haloperidol lactate .5 ml by mouth every 6 hours as needed; lorazepam .5 mg by mouth every 6 hours as needed; and prochlorperazine maleate 1 tablet by mouth every 6 hours as needed. The document failed to identify a reason for the hospice to administer the haloperidol lactate, lorazepam, and prochlorperazine maleate.”

“Based on clinical record review, hospice policy review and staff interview, the hospice failed to ensure all electronic signatures included staff credentials and locked date for 14 of 14 sampled patients. During an interview on 6/11/24 at 9:05 AM, Administrator reported all the staff visit notes electronic signature was located at the top of the visit note and included the verbiage performed by, staff name, started, completed, date and time. Administrator reported the dates and times reflected the start and end of the visits and would indicate the electronic signatures when the visit note was completed. When questioned about entry dates and times on the discipline visit notes, Administrator reported that would indicate the date and time the staff entered the specific data entries on the visit notes, these dates may be after the start and completed dates and times at the top of the visit notes. Administrator is unsure of how to see when the visit notes were locked when completed. Administrator was unaware the staff credentials were missing from the electronic medical record for several staff members. During an interview on 6/12/24 at 8:53 AM, Staff B, Vice President of Clinical Services, reported the hospice has entered the required credentials for Staff C, RN (registered nurse); Staff D, RN; Staff E, hospice aide; and Staff G, spiritual advisor, the credentials should now show up in the electronic medical record for these staff members. The hospice is unable to enter credentials in the electronic medical record for Staff F, social worker/bereavement coordinator, due to the staff member not having a license. Failure to ensure all clinical record documentation, and each patient’s clinical record was complete, timely and appropriately authenticated, decreased the ability of hospice staff to communicate and coordinate patient care effectively, and to provide safe, effective hospice services to its patients. Findings include: Review of the hospice policy, titled Contents of Clinical Record, dated April 2017, identified each entry will be dated and signed, including title and credentials, by the person providing the care/service. Patient #5 had a hospice admission date of 8/31/22 and received services while residing in a nursing home. Clinical record review revealed: a. Plan of Care, printed date 6/11/24, included orders for skilled nursing, social worker, hospice aide and spiritual advisor services with effective dates of 9/1/22. b. Skilled nurse visit note, dated 5/16/24, included performed by Staff D, Registered Nurse, but lacked staff credentials/discipline title and locked date. c. Skilled nurse visit notes, dated 5/29/24 and 6/6/24, included performed by Staff C, Registered Nurse, but lacked staff credentials and locked date. d. Social Worker visit note, dated 6/4/24, included performed by Staff F, Social Worker/Bereavement Coordinator, but lacked staff credentials and locked date. e. Hospice aide visit notes, dated 5/6/24, 5/8/24, 5/13/24, 5/15/24, 5/20/24, 5/22/24, 5/31/24, 6/3/24 and 6/7/24, included performed by Staff E, Hospice Aide, but lacked staff credentials and locked date. f. Spiritual advisor visit note, dated 5/29/24, included performed by Staff G, Spiritual Advisor, but lacked staff credentials and locked date. Discipline visit notes failed to include an electronic signature that included staff name, discipline title and locked date for all sampled patients. The Administrator and Vice President of Clinical Services received the above findings.”

“Based on clinical record review and hospice policy review, the hospice failed to ensure the hospice staff completed a discharge summary for 2 of 2 patients sampled (live) that were discharged (Patients #11 and #14). Failure to ensure the hospice completed discharged summaries and forwarded them to the patients attending physician placed the patient at risk for not receiving ongoing medical care and services to meet the needs of the patients. Findings include: 2. Patient #14 was admitted to hospice on 8/31/23, had a discharge date of 2/26/24 and received services while residing in a private home. Review of the clinical record lacked documentation a discharge summary was completed and forwarded to the attending physician. The Administrator and Vice President of Clinical Services received the above findings. Review of the hospice policy, Contents of Clinical Record dated April 2017, in pertinent part, documentation will include: copies of summary reports sent to the physician, as appropriate, and discharge summary, if applicable. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The Revocation of Medicaid Hospice Benefit was signed by the patient on 4/16/24. The clinical record failed to include a discharge summary.”

“Based on admission packet review, clinical record review and policy review, the hospice failed to maintain documented evidence the hospice staff educated patients/caregivers on the policy for the disposal of controlled substances with 6 of 6 sampled patients residing in a private home receiving controlled substances. (narcotic medications) (Patient #3, #4, #10, #11, #12 and #13) Failure to provide written and verbal instruction on agency protocol of disposal of controlled substances increased the risk that the patient/caregiver discarded controlled substances in a way which might be hazardous for others. 7. Patient #3 had a hospice admission date of 1/25/24, a death date of 2/7/24, and received hospice services while residing in a private home. Clinical record review revealed: a. Skilled nurse visit note, dated 2/3/24, included documentation the nurse contacted the physician and received order for morphine sulfate and lorazepam. Nurse documented education to family on how to draw up and administer medications. b. The undated medication profile identified orders for morphine sulfate and lorazepam, with a start date of 2/4/24. The profile included documentation in a note section: how to store and process for destroying medications. The clinical record lacked documentation the nurse provided written and verbal instruction on the hospices policy, titled Home Use and Disposal of Controlled Substances, when the controlled substance was ordered. The Administrator and Vice President of Clinical Services received the above findings and hospice staff provided no further information prior to the end of the survey. 4. Patient #11 had a hospice admission date of 4/4/24 and received hospice services while residing in a private home. Clinical record revealed: The POC, printed 6/11/24 for benefit period 1, included controlled medication orders dated 4/4/24 for alprazolam 2 mg qid (four times per day), oxycodone 5 mg every 6 hours, prn (as needed), and fentanyl transdermal 75 mcg (microgram) patch every 3 days. The initial nursing visit performed by Staff K, Registered Nurse (RN) on 4/4/24 lacked documentation of education to the patient or his caregiver on controlled medication disposal. The clinical record lacked documentation the nurse provided written and verbal instruction on the hospices policy, titled Home Use and Disposal of Controlled Substances, when the controlled substance was ordered. 5. Patient #13 had a hospice admission date of 1/10/24, a death date of 1/15/24, and received hospice services while residing in a private residence. Clinical record revealed: The POC, printed 6/11/24 for benefit period 1, included controlled medication orders dated 1/10/24 for lorazepam 0.5 mg BID twice daily, oxycodone liquid 0.25 mL every 1 hour as needed, and oxycontin ER (extended release) 10 mg (BID) twice daily. The initial nursing visit performed by Staff K on 1/10/24 lacked documentation of education to the patient or his caregiver on controlled medication disposal. The clinical record lacked documentation the nurse provided written and verbal instruction on the hospices policy, titled Home Use and Disposal of Controlled Substances, when the controlled substance was ordered. According to the undated hospice policy, titled Home Use and Disposal of Controlled Substances, the admitting nurse/case manager will provide a copy of the written policies and procedures on the management and disposal of controlled drugs to the patient/representative and family. The admitting nurse/case manager will verbally discuss the policy in a language and manner the patient/caregiver understands and will also document the written policies and procedures were given to the patient and discussion occurred regarding the disposal of medications. 1.Patient #3 had a hospice admission date of 5/7/24, and received hospice services while residing in a private residence. Review of the clinical record revealed the following: a. The skilled nurse initial assessment, dated 5/7/24, identified the patient was on an Opiod as needed on admission and that medication was continued. b. The medication profile, dated 5/9/24, identified the patient was on hydrocodone-acetaminophen (pain medication) 5-325 milligrams by mouth every 4 hours as needed. The clinical record lacked documentation the nurse provided written and verbal instruction on the hospice’s policy, titled Home Use and Disposal of Controlled Substances, when the controlled substance was ordered. 2. Patient #4 had a hospice admission date of 3/24/24, and received hospice services while residing in a private residence. Review of the clinical record revealed the following: a. The skilled nurse visit note, dated 3/25/24, identified an Opiod was initiated on 3/25/24. b. The undated medication profile identified an order for Buprenorphine Transdermal patch, with a start date of 3/25/24. The clinical record lacked documentation the nurse provided written and verbal instruction on the hospice’s policy, titled Home Use and Disposal of Controlled Substances, when the controlled substance was ordered. 3.Patient #12 had a hospice admission date of 1/1724, a death date of 1/20/24, and received hospice services while residing in a private residence. Clinical record review revealed: a. The skilled nurse initial assessment, dated 1/17/24, identified the patient’s physician was contacted and morphine sulfate was ordered. b. The drug regiment review, dated 1/17/24, identified orders for lorazepam and morphine. The clinical record lacked documentation the nurse provided written and verbal instruction on the hospice’s policy, titled Home Use and Disposal of Controlled Substances, when the controlled substance was ordered.”

“Based on clinical record review,long term care (LTC) facility medication records, hospice policy review, the hospice failed to ensure hospice staff provided overall coordination of the hospice care with the nursing home for 2 of 2 sampled patients with visits observed who resided at nursing homes (Patients #1 and #2) including a review of the patients nursing home residence medication records. Failure to ensure the hospice staff provided overall coordination of patient care with the nursing home placed the patient at risk for receiving inadequate care and/or treatments needed to meet the individual needs of the patient. Findings include: According to the hospice policy titled, Patient Care-Nursing Facility dated January 2022, in pertinent part, Coordination of care of a patient’s hospice care in a SNF/NF (skilled nursing facility/nursing facility) is the responsibility of hospice. Hospice designates a RN (Registered Nurse) member of each interdisciplinary group to be responsible for this overall coordination of care. Hospice provides the facility with the following information for each hospice patient: hospice medication information specific to each patient. 1. Patient #1 had a hospice admission date of 3/5/24 and received hospice services while residing in a LTC facility. Clinical record revealed: The nursing homes order summary report, dated 6/10/24, included the following order discrepancies when reconciled against the medications listed on the hospice Plan of Care (POC), printed on 6/11/24 labeled as benefit period number 2 and undated hospice medication profile: The following medications were on the nursing home medication list and not on the hospice POC: Barrier cream to both buttocks bid (twice daily) every shift preventative with an active order date of 3/20/24. Apply medihoney (a medical-grade honey dressing used in wound treatment) to left knee wound and cover with border gauze every day shift every other day for wound healing with an active order date of 3/1/24. The hospice RN failed to ensure coordination of medications with the nursing home staff. 2. Patient #2 had a hospice admission date of 6/7/24 and received hospice services while residing in a nursing home. Clinical record revealed: The following medications were on the nursing home medication list and not on the hospice POC: Apply oxygen to keep O2 (oxygen) sat (saturation) greater than or equal to 90% as needed with an active order date of 4/8/24. Cough drops lozenge as needed for cough/sore throat with an active order date of 4/8/24. The hospice RN failed to ensure coordination of medications with the nursing home staff. The Administrator and Vice President of Clinical Services received the above findings.”