Heart to Heart Hospice of Northwest Indiana, LLC

“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; other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview and observation. In 3 of 19 (16%) clinical records reviewed and home visits observed, the agency did not ensure that the patient’s current medications were included in the drug profile. CLINICAL RECORD 1/HOME VISIT 1: The patient elected the hospice benefit on 11/17/2025. During a home visit with the Registered Nurse (RN) [Personnel Record Review 7] on 02/18/2026, a review of the patient’s medication revealed a prescription bottle labeled “Metformin 1,000mg tablets, take half a tablet two times daily.” The patient produced over-the-counter medications labeled “Fish Oil 1,200mg capsules,” “Vitamin D3 25mcg capsules,” and “Immodium 2mg tablets.” In an interview, the patient stated, “I have been taking those medications for a long time.” The caregiver in the home stated, “I know he has been taking all of those medications for at least three years.” The agency’s medication profile dated 02/17/2026 did not include documentation of metformin, fish oil, vitamin D, or Immodium. There was no evidence that the comprehensive assessment included a review of metformin, fish oil, vitamin D, or Immodium with the patient’s current medication regimen. CLINICAL RECORD 3/HOME VISIT 3: The patient elected the hospice benefit on 07/17/2022. The patient resided in an assisted living facility (ALF). During a home visit with the Chaplain (Personnel Record Review #4) on 02/19/2026, the patient’s ALF medication list was reviewed with the facility’s RN. The ALF medication list documented “Date: 09/25/2024 nystatin cream 100,000 units per gram, apply topically daily as needed for redness to abdominal skin folds; Date: 09/26/2025 guaifenesin 10mg/5ml, give 10ml by mouth every 6 hours as needed for cough.” The agency’s medication profile dated 02/18/2026 did not document the use of nystatin cream or guaifenesin. There was no evidence that the comprehensive assessment included a review of nystatin cream or guaifenesin CLINICAL RECORD 11: The patient elected the hospice benefit on 09/22/2025. A physician’s order dated 09/22/2025 ordered “Oxygen 3 liters per nasal cannula continuously.” The medication profile dated 09/22/2025 did not document oxygen. During joint record reviews and interviews on 02/18/2026 and 02/19/2026, the Area Clinical Manager confirmed the above findings that oxygen, nystatin cream, guaifenesin, metformin, fish oil, vitamin D, and Imodium were not included in the patients’ medication profiles.”

“It is required that each patient’s individualized written plan of care: 1. Reflects patient and family goals; identifies planned interventions based on problems identified in the initial and updated comprehensive assessments; includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, observation, and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the plan of care included the drugs and treatments necessary to meet the patient’s needs. CLINICAL RECORD 1/HOME VISIT 1: The patient elected the hospice benefit on 11/17/2025. During a home visit with the Registered Nurse [Personnel Record 7] on 02/18/2026, the patient’s prescription bottle was labeled “Metformin 1,000mg tablets, take half a tablet two times daily” and the over-the-counter medications with the labels reading “Fish Oil 1,200mg capsules,” “Vitamin D3 25mcg capsules,” and “Imodium 2mg tablets” were provided. During an interview, the patient stated, “I have been taking those medications for a long time.” The caregiver in the home stated, “I know he has been taking those medications for at least three years.” The POC did not include documentation of metformin, fish oil, vitamin D, or Imodium. CLINICAL RECORD 15: The patient elected the hospice benefit on 09/03/2025. The Skilled Nursing note dated 11/11/2025 documented “18Fr coude foley catheter changed.” A review of the clinical record revealed that the plan of care did not include the size or maintenance of the Foley catheter. During joint record reviews and interviews on 02/18/2026 and 02/20/2026, the Area Clinical Manager confirmed the above findings that the plan of care did not include all orders for the Foley catheter, metformin, fish oil, vitamin D, or Imodium.”

“It is required that Hospice Aides are assigned to a specific patient by a Registered Nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a Hospice Aide are prepared by a RN who is responsible for the supervision of the Hospice Aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 15 (13%) clinical records reviewed, in which Hospice Aide (HA) services were provided, the agency did not ensure that all written patient care instructions were included in the Hospice Aide care plan. CLINICAL RECORD 2: The patient elected the hospice benefit on 01/11/2026. A physician’s order dated 02/04/2026 included orders for wound care with a wound dressing to a wound on the patient’s right buttock. The plan of care dated 01/11/2026 through 03/11/2026 ordered “HA 2 times weekly.” The Hospice Aide care plan dated 01/26/2026 assigned the HA the relevant task of “Bed bath every visit.” The HA care plan was not updated to include instructions regarding the wound dressing on the right buttock if it became wet or dislodged during the bed bath. CLINICAL RECORD 11: The patient elected the hospice benefit on 09/22/2025. A physician’s order dated 09/22/2025 included orders for “Oxygen 3 liters via nasal cannula continuously.” The plans of care dated 09/22/2025 through 12/20/2025 and 12/21/2025 through 03/20/2026 ordered “HA 2 times weekly”. The Hospice Aide care plan dated 09/22/2025 assigned the HA the relevant task of “Shower every visit.” The Hospice Aide care plan did not include instructions on how the Hospice Aide should use the oxygen during the shower. During joint record reviews and interviews on 02/18/2026 and 02/19/2026, the Area Clinical Manager confirmed the above findings, stating, “There are no wound dressing or oxygen instructions included in the care plans for the aide.””

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to: assess the quality of care and services provided by the hospice aide; and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 7 of 15 (47%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that HA supervisory visits were completed by a Registered Nurse at least every 14 days. CLINICAL RECORD 1: The patient elected the hospice benefit on 11/17/2025. The plan of care dated 11/17/2025 through 02/14/2026 ordered “HA 2 times weekly.” The first Hospice Aide visit was dated 11/21/2025. Hospice Aide supervisory visits were dated 12/03/2025, 12/11/2025, and 12/19/2025. The next Hospice Aide supervisory visit was dated 01/16/2026, with 28 days outstanding. CLINICAL RECORD 2: The patient elected the hospice benefit on 01/11/2026. The plan of care dated 01/11/2026 through 03/11/2026 ordered “HA 2 times weekly.” The first Hospice Aide visit was dated 01/13/2026. Hospice Aide supervisory visits were documented as completed on 01/22/2026 and 02/06/2026, with 15 days outstanding. CLINICAL RECORD 6: The patient elected the hospice benefit on 11/12/2025. The plan of care dated 11/12/2025 through 02/09/2026 ordered “HA 2 times weekly starting week of 11/17/2025.” The first Hospice Aide visit was dated 11/21/2025. Hospice Aide supervisory visits were documented as completed on 12/02/2025, 12/10/2025, 12/20/2025, and 12/31/2025. The next Hospice Aide supervisory visit was dated 01/19/2026, with 19 days outstanding. CLINICAL RECORD 8: The patient elected the hospice benefit on 10/30/2025. The plans of care dated 10/30/2025 through 01/27/2026 and 01/28/2026 through 04/27/2026 ordered “HA 2 times weekly starting week of 11/06/2025.” The first Hospice Aide visit was dated 11/07/2025. The first Hospice Aide supervisory visit was dated 01/29/2026, with 83 days outstanding. CLINICAL RECORD 9: The patient elected the hospice benefit on 08/22/2025. The plans of care dated 08/22/2025 through 10/20/2025, 10/21/2025 through 12/19/2025, and 12/20/2025 through 02/17/2026 ordered “HA 2 times weekly.” The first HA visit was dated 08/25/2025. Hospice Aide supervisory visits were documented as completed on 08/26/2025, 08/30/2025, 09/02/2025, 09/10/2025, and 09/23/2025. The next HA supervisory visit was dated 10/15/2025, with 22 days outstanding. HA supervisory visits were documented on 10/28/2025 and 11/04/2025. Hospice Aide supervisory visits were documented as completed on 11/23/2025 (19 days outstanding), 12/09/2025 (12 days outstanding), 12/30/2025 (21 days outstanding), and 01/21/2026 (22 days outstanding). CLINICAL RECORD 11: The patient elected the hospice benefit on 09/22/2025. The plans of care dated 09/22/2025 through 12/20/2025 and 12/21/2025 through 03/20/2026 ordered “HA 2 times weekly.” The first Hospice Aide visit was dated 09/25/2025. Hospice Aide supervisory visits were dated 09/30/2025 (5 days outstanding, 10/10/2025 (10 days outstanding), and 12/22/2025 (73 days outstanding). CLINICAL RECORD 18: The patient elected the hospice benefit on 09/01/2025. The plan of care dated 09/01/2025 through 11/29/2025 ordered “HA 4 times weekly.” The first Hospice Aide visit was dated 09/03/2025. Hospice Aide supervisory visits were dated 09/09/2025 (6 days outstanding), 09/17/2025 (8 days outstanding), and 10/02/2025 (15 days outstanding). During joint record reviews and interviews on 02/17/2026, 02/18/2026, 02/19/2026, and 02/20/2026, the Area Clinical Manager confirmed the above findings, stating, “We will be completing re-education with all nursing staff regarding completing and documenting aide supervisory visits every 14 days.””