Homestead Home Health & Hospice LLC

“Upon observation, there was no evidence the hospice designates a physician to serve as Medical Director which includes: • The Medical Director must be a doctor of medicine or osteopathy who is an employee or is under contract. • When the Medical Director is not available, a physician designated by the hospice assumes the same responsibilities and obligations as the Medical Director. • All other hospice physicians function under the supervision of the medical director. Upon chart review both Medical providers have a Medical Director contract. Each provider has their own patients and IDT team that they manage. In addition, there is not an assigned Alternate Medical Director.”

“Upon patient record review, 3 of 15 (Patients #1, 2, 9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. Patient #1, The patient’s daughter identified patient takes garlique, magnesium, calcium, Vit C, Multi vitamin and eye vitamin. No evidence of any vitamins were added to the medication profile. Daughter also states patient no longer takes celecoxib, furosemide, KCL, which remains on the medication profile. Patient also is wearing oxygen at 3 l/NC which is not noted on the medication profile. Patient #2, Lantus Solostar remains active on the medication list. This medication was discontinued and confirmed with assisted living RN. Patient #9, No evidence of medication reconciliation was completed and MD was notified of severe interactions. The EMR system identified patient was taking medications that contained three medication interactions.”

“Upon patient record review, 9 of 15 (Patient #1,2,3,4,5,6,7,8,15) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #1,2,3,4,5,6,7,8,15, No evidence of bereavement assessment completed within the first 5 days.”

“Upon patient record review, 1 of 15 (Patient #7) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #7, The RN delegated the LPN to make comprehensive assessment visits which is outside the scope of practice for an LVN. Nursing Practice Act, Idaho Code IDAPA 24.34.01, licensed practical nurses function in dependent roles. The nurse delegating functions is to supervise the persons to whom the functions have been assigned or delegated. There is no evidence in the medical record that the RN visited the patient from 6/10/26 to 7/8/26.”

“Upon patient record review, 1 of 15 (Patient #7) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #7, The patient lives in an ALF and there was not a visit by the RN for coordination and implementation of the plan of care. The RN provided aide supervisory visit on 6/24 with LVN completing routine visit on the same day. According to the Idaho Code IDAPA 24.34.01, Nursing Practice Act, licensed practical nurses function in dependent roles. The nurse delegating functions is to supervise the persons to whom the functions have been assigned or delegated. The LPN was the only nurse making visits from 6/10/26 to 7/8/26 and no evidence of documentation that the RN was collaborating with and supervising the LPN.”

“Upon patient record review, 9 of 15 (Patient #1,2,3,4,5,7,8,9,10) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #2, No evidence of goals and interventions documented for diabetes safety precautions upon start of care. Patient #3, No evidence on goals and interventions for neurological disorder upon start of care. Patient #4, No evidence of goals and interventions for neurological disorder or funeral home planning upon start of care. Patient #8, No evidence of goals and interventions for fall prevention. Patient #2,7,8,9, No evidence of goals and interventions for volunteer services. Patient #1,2,3,5,7,8,9,10, No evidence of goals and interventions for personal care needs.”

“Upon patient record review, 2 of 15 (Patient #1,3) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient #1, Upon home visit it was noted patient has a wheelchair, walker and over the bed table. No evidence of these items documented on plan of care under DME. Plan of care did document Hoyer lift. No evidence of Hoyer lift in home. Observed patient standing and walking with a walker. Patient #3, Upon home visit it was noted patient has a hospital bed. No evidence of documentation of hospital bed under DME on the plan of care.”

“Upon patient record review, 3 of 15 (Patient #1,3,10) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #1, Bactrim ordered on 5/27 and remain on the plan of care. No evidence goals and interventions were updated. Patient #3, Order for patient to use Unna boot or tubigrip. On SN visit 5/7 patient refused tubigrip. No evidence of goals and interventions updated. Patient #10, SN visit on 5/22 documents patient has depression. No evidence of goals and interventions updated on the plan of care.”

“Upon client record review, 1 of 15 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, Order for foley catheter 16F 30cc. Plan of care states to change every 4 weeks. No evidence of foley catheter changed every 4 weeks. Catheter inserted on 2/20/26, changed 3/6 then 6/3. In addition, there is a standing order for calmoseptine for skin care due to diarrhea. Upon surveyor home visit, LVN stated she heard from the aide patient had a wound. No evidence of wound care order documented in the chart days after the home visit of LVN providing wound care of cleansing with wound cleanser and applying border foam dressing.”

“Upon patient record review, 10 of 15 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #5, Swallow study ordered on 7/6 and completed on 7/6. No evidence of discussion in IDT meeting. Patient #1,2,3,4,5,6,7,8,9,10 No evidence of sharing of information between all disciplines due to lack of documentation within the IDT meeting, most IDT meeting notes contained no IDT updates. If there was an update the IDT documentation only included a copy and paste of the SN note and/or bereavement risk noting patient as low risk.”

“Upon patient record review, 2 of 15 (Patient #2,5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2, Aide care plan states to shampoo of patient choice. Patient has dementia and unable to make a choice of which shampoo is her choice. Patient #5, Aide care plan states to give shower with comment stating “if patient refuses bed bath”. Patients KPS 30, PPS 30, FAST 7C. No evidence the patient is cognitively and functionally able to choose and perform this task.”

“Upon patient record review 3 of 15 (Patient #1,5,10) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1, Aide care plan states to wash patients hair with a product of her liking and to lather hair and rinse. Aide used shower cap to wash hair. No evidence of direction to use shower cap noted on aide plan of care. Patient #5, Aide visit on 6/1 applied lotion to legs and feet. No evidence of directive on aide care plan by RN to complete this task. Patient #10, Aide applied lotion to lower legs and feet on 5/1 and 5/4. No evidence of directive on aide care plan by RN to complete this task.”

“Upon observation, there was no evidence the hospice is directed by a Board of Directors/governing body which assumes full legal authority and responsibility for the operation of the hospice. The hospice agency failed to ensure compliance by not maintaining the required organizational and clinical oversight. The agency identified two medical directors; however, there was no documentation designating an alternate medical director as required when coverage is necessary. There was no evidence of supervision of the physician services by the Medical Director. In addition, the agency did not employ a nurse practitioner to perform hospice face-to-face encounters. Instead, face-to-face visits were conducted by a contracted nurse practitioner, and the agency failed to demonstrate compliance with the regulatory requirements governing qualified hospice personnel performing these encounters. The agency failed to obtain signed hospice consents/election document at the time of admission, resulting in patients being admitted to hospice services without documented evidence that consents and the election of the hospice benefit had been properly executed in accordance with Medicare hospice regulations. Furthermore, the agency did not provide evidence that its QAPI program addressed high-risk, high-volume, or problem-prone areas documenting the rationale for performance improvement projects, and detail of QAPI data collection and analysis.”

“Upon patient client record review, 3 of 15 (Patient #1,2,10) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #1, Upon initial assessment by RN, the consent states patient has a living will. Upon review of the MSW assessment, documentation states no living will. Consent states copies obtained left empty. Patient #2, Aide visit on 7/14, aide documents redness in folds of skin and within same paragraph documents did not see any redness in folds of skin. Patient #10, Consent document under Advance Directive documents patient has a POLST, POA, Living Will, DNR, CPR/Full Code. The facility documentation DNR, Advanced Directive. No evidence of clear documentation of advance directive.”