Onesource Hospice

“It is required that the written Patient Bill of Rights includes the right to: be informed about the scope of services the hospice provides and any specific limitations on those services. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the patient was informed about the scope of services the hospice provided and any specific limitations on those services. Clinical Record 4: The patient elected the hospice benefit on 04/06/2025 and requested the non-covered items addendum. A clinical record review on 07/02/2025 revealed that the electronic medical record (EMR) did not contain documentation indicating that this had been completed or given to the patient. This should have been issued within five (5) days of the election of benefits, making it almost three (3) months outstanding. During a joint clinical record review and interview on 07/02/2025, the Quality Nurse stated, “It should have been uploaded in this area (of the EMR). All uploaded documents were checked to ensure they had not been mislabeled.” During a joint clinical record review and interview conducted on 07/03/2025, the Administrator confirmed that the addendum could not be located.”

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current: prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation, and interview. In 1 of 3 (33%) home visits observed, the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. Home Visit 2/Clinical Record 2: The patient elected the hospice benefit on 01/31/2025 with a diagnosis of chronic obstructive pulmonary disease (COPD). The patient resided in an assisted living facility (ALF). During the home visit with the Hospice Aide [Personnel Record 7] on 07/02/2025, the hospice medication profile (printed on 07/01/2025) was compared to the ALF medication profile (printed on 07/02/2025). The following medications were listed on the hospice medication profile and were not listed on the ALF medication profile: triple antibiotic 3.5 mg-400 units, apply to minor skin tears and wounds as needed (ordered 06/24/2025); Iodosorb gel 5.9%, apply weekly (ordered 02/03/2025); healthy eyes 4.296 mcg, twice daily (ordered 01/31/2025); docusate 100 mg, take daily (ordered 01/31/2025). The ALF medication profile contained the following medication not listed on the hospice medication profile: Albuterol inhaler, inhale two (2) puffs every 6 hours as needed (ordered 11/19/2021). A joint clinical record review and interview were conducted with the Administrator on 07/03/2025, in which the medication differences were confirmed.”

“It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review, document review, interview, and observation. In 1 of 13 (8%) clinical records reviewed and home visits observed of patients receiving Hospice Aide (HA) services, the agency did not ensure that the HA provided services included in the patient’s plan of care. Document 2: The state Administrative Code revealed the following: “Oxygen adjustment can be performed with clear direction from a licensed nurse.” Home Visit 2/Clinical Record 2: The HA care plan dated 01/31/2025 and revised 05/01/2025 assigned the Hospice Aide the relevant tasks: “Shower; assist to bath chair; shampoo hair; comb hair; mouth care; assist with dressing; clean nails; file nails; wheelchair.” All tasks were to be completed on every visit. The HA visit frequency was twice weekly. During the home visit with the HA [Personnel Record 7] on 07/02/2025, the HA assisted the patient with most of the tasks assigned in the HA care plan, as the patient “wanted to do it herself.” The HA and the patient did not complete the cleaning or filing of the patient’s nails. The HA was observed to blow-dry the patient’s hair and change the patient’s oxygen from the concentrator to a portable tank, which was not assigned in the care plan by the Registered Nurse (RN). During a joint clinical record review and interview on 07/02/2025, the Administrator stated that they ‘thought the HA was allowed to do this.””

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed of patients who required a discharge summary, the agency did not ensure that the patient’s discharge summary included at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. Clinical Record 12: The patient elected to revoke the hospice benefit on 07/21/2024. The discharge summary dated 07/21/2024 included the following note: “Patient revoked hospice to seek treatment.” It did not include at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. During a joint clinical record review and interview on 07/02/2025, the Quality Nurse advised that the “IDG (interdisciplinary group) note contained the medications and notifications, but did not have the summary of the stay. There does not appear to be a summary added.””