Meridian Palliative & Hospice Care Services LLC

“Upon patient record review 2 of 14 (Patient #8,10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #8 - Patient was admitted on 12/12/25. The psychosocial comprehensive assessment was not completed until 12/19/25. Patient #10 - Patient was admitted on 12/23/25. The psychosocial comprehensive assessment was not completed until 12/29/25. There was no evidence of an attempt to complete prior to that assessment. The spiritual comprehensive assessment was not completed until 12/30/25.”

“Upon patient record review 1 of 14 (Patient #2) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process. Patient #2 - The patient was admitted on 12/04/25. The MSW documented a note dated for 12/08/25, “LCSW made several attempts and LVM to schedule initial psychosocial visit within 5 days of admission and no response. LCSW will continue to monitor and be available to address psychosocial needs. IDG aware.” There was no evidence that the psychosocial or emotional needs have been assessed.”

“Upon patient record review, 7 of 14 (Patient #1,3,4,6,7,8,10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1 - The medication profile contained MiraLAX 17 gm daily. There was no evidence of a diluent added. Patient has Bisacodyl 5 mg po daily prn and bisacodyl 10 mg suppository daily prn with no indication of which prn medication to use first. Patient #3 - The medication profile contained Tylenol 500 mg tabs take 2 tabs every 4 hours prn. The profile also contained Tylenol 650 mg suppository q 4 hrs prn. There was no evidence of a maximum daily dose of acetaminophen listed. Patient #4 - The medication profile contained MiraLAX 17 gm daily. There was no evidence of a diluent added. Patient #6 - The medication profile contained MiraLAX 17 gm daily. There was no evidence of a diluent added. The profile also contained Tylenol 500 mg take 2 tabs three times daily and Tylenol suppository 650 mg every 4 hrs prn. There was no evidence of a maximum daily dose of acetaminophen listed. Patient #7 - The medication profile contained MiraLAX 17 gm daily. There was no evidence of a diluent added. Patient #8 - The medication profile contained MiraLAX 17 gm daily. There was no evidence of a diluent added. Patient #10 - The medication profile contained MiraLAX 17 gm daily. There was no evidence of a diluent added.”

“Upon patient record review, 6 of 14 (Patient #3,4,5,7,8,10) 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 #3 - The medical record contained a missed visit note dated 09/26/25 for the bereavement risk assessment. There was no evidence that a risk assessment was completed Patient #4 - Patient was admitted on 12/24/25. There was no evidence that an initial bereavement risk assessment was completed. Patient #5 - Patient was admitted on 01/16/25. There was no evidence that an initial bereavement risk assessment was completed. Patient #7 - Patient was admitted on 11/12/25. There was no evidence that an initial bereavement risk assessment was completed. Patient #8 - Patient was admitted on 12/12/25. There was no evidence that an initial bereavement risk assessment was completed. Patient #10 - Patient was admitted on 12/23/25. There was no evidence that an initial bereavement risk assessment was completed.”

“Upon patient record review, 9 of 14 (Patient #1,2,3,4,5,6,8,10,13) 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 #1 - The recertification nursing assessment and subsequent assessments, documented patient was on a mechanical soft diet. There was no evidence of problems, goals or interventions for that diet listed. Patient #2 - The medication profile contained coumadin and ASA daily as blood thinners. There was no evidence of problems, goals, or interventions related to bleeding risk. Patient #3 - The medication profile contained Eliquis and ASA daily as blood thinners. There was no evidence of problems, goals, or interventions related to bleeding risk. Patient #4 - The medical record contained advanced directives which outlined patient wishes to remain a full code. There was no evidence of problems, goals, or interventions related to that full code status. Patient #5 - The medication profile contained Eliquis as a blood thinner. There was no evidence of problems, goals, or interventions related to bleeding risk. The medical record also contained advanced directives which outlined patient wishes to remain a full code. There was no evidence of problems, goals, or interventions related to that full code status. Patient #6 - The medication profile contained several bowel medications to include MiraLAX daily, bisacodyl suppository prn, and Colace twice a day. There was no evidence of problems, goals, or interventions related to constipation listed. Patient #8 - The medical record contained advanced directives which outlined patient wishes to remain a full code. There was no evidence of problems, goals, or interventions related to that full code status. Patient #10 - The medical record contained advanced directives which outlined patient wishes to remain a full code. There was no evidence of problems, goals, or interventions related to that full code status. The initial plan of care contained an order for a mechanical soft diet. There were no problems, goals or interventions related to that diet. The medication profile contained several bowel medications to include MiraLAX daily, bisacodyl suppository prn, and Senna Plus twice a day. There was no evidence of problems, goals, or interventions related to constipation listed. Patient #13 - The medication profile contained the medication Jardiance for diabetes management. There was no evidence of problems, goals, or interventions related to the endocrine system.”

“Upon patient record review, 8 of 14 (Patient #1,2,3,4,6,7,8,10) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #1 - The plan of care contained an order MiraLAX 17 gm daily. There was no evidence of a diluent added to the order. Patient has Bisacodyl 5 mg po ordered daily prn and bisacodyl 10 mg suppository daily prn with no indication of which prn medication to use first in the order. Patient #2 - The nursing comprehensive assessment dated 12/04/25, noted patient had an indwelling catheter. There was no evidence of an order for the maintenance of that catheter. Patient #3 - The plan of care contained Tylenol 500 mg tabs take 2 tabs every 4 hours prn. The order also contained Tylenol 650 mg suppository q 4 hrs prn. There was no evidence of a maximum daily dose of acetaminophen listed. Patient #4 - The plan of care contained an order for MiraLAX 17 gm daily. There was no evidence of a diluent added to that order. Patient #6 - The plan of care contained an order for MiraLAX 17 gm daily. There was no evidence of a diluent added to that order. The record also contained an order for Tylenol 500 mg take 2 tabs three times daily and Tylenol suppository 650 mg every 4 hrs prn. There was no evidence of a maximum daily dose of acetaminophen listed. Patient #7 - The plan of care contained an order for MiraLAX 17 gm daily. There was no evidence of a diluent added to that order. Patient #8 - The plan of care contained MiraLAX 17 gm daily. There was no evidence of a diluent added to that order. Patient #10 - The plan of care contained MiraLAX 17 gm daily. There was no evidence of a diluent added to that order.”

“Upon patient record review, 2 of 14 (Patient #9,10) 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 #9 - The medication profile contained the medication DuoNeb nebulized every 6 hours prn. The plan of care did not contain a nebulizer machine on the DME list. Patient #10 - The nursing comprehensive dated 12/23/25 and subsequent nursing assessments, documented that patient is incontinent of bowel and bladder. The plan of care orders did not include incontinent supplies.”

“Upon observation, there was no evidence the QAPI program uses quality indicator data, including patient care and other relevant data in the design of its program. The hospice must use the data collected to: • Monitor the effectiveness and safety of services and quality of care • Identify opportunities and priorities for improvement The agency QAPI program only contains data collected related to infections, incidents, wounds, revocations, HIS submission tracking, live discharges, ADC, and ALOS and a review of this data by the QAPI committee quarterly for 2024 and 2025. There is no evidence of the committees assessment, identification, and or review of any opportunities for improvement in these areas. There was no evidence of any process improvement projects listed.”

“Upon observation, there was no evidence in the QAPI reports that the hospice maintains a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases. The agency QAPI program only contains data collected related to infections, incidents, wounds, revocations, HIS submission tracking, live discharges, ADC, and ALOS and a review of this data by the QAPI committee quarterly for 2024 and 2025. There is no evidence of the committees assessment, identification, and or review of any opportunities for improvement in these areas. There was no evidence of any process improvement projects listed.”

“Upon patient record review, 2 of 14 (Patient #11,12) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #11 and #12 did not have evidence that a bereavement plan of care was initiated.”

“Upon patient record review 6 of 14 (Patient #2,3,4,5,6,7) 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 #2 - The plan of care dated 12/04/25 noted aide frequency for 2 visits per week. The medical record showed for the weeks of 01/13/26, 01/20/26 and 01/27/26, there was only 1 visit completed with no documentation of a missed or refused visit. There is also no evidence of aide visits since 01/27/26. Patient #3 - The plan of care dated 09/23/25, noted aide frequency for 2 visits per week. There is no evidence of any visits completed since 01/20/26. Patient #4 - The plan of care dated 12/24/25, noted aide frequency for 2 visits per week. There is no evidence of any visits completed since 01/29/26. Patient #5 - The plan of care dated 01/16/26, noted aide frequency for 2 visits per week. There is no evidence of any visits competed since 01/30/26. Patient #6 - The plan of care dated 07/22/25, noted aide frequency for 2 visits per week. There is evidence that only 1 visit was completed the week of 01/12/26 and no evidence of any aide visits the week of 02/02/26-02/06/26. Patient #7 - The recertification plan of care dated 12/29/25, noted aide frequency for 2 visits per week. The week of 01/12/26 had only 1 visit dated 01/16/26 and no evidence of missed visit or patient refusal documentation.”

“Upon client record review, 2 of 14 (Patient #13,14) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient’s attending physician: • A copy of the hospice discharge summary • The patient’s clinical record, if requested Patient #13 - Patient decided to revoke hospice service effective 04/21/25. There was no evidence that a discharge summary was forwarded to attending physician. Patient #14 - Patient transferred hospice service to another agency. There was no evidence that a discharge summary was forwarded to attending physician.”