Interim Healthcare Hospice of East Louisiana

“Based on interviews and record review, the Hospice agency failed to provide documented evidence a patient was informed and/or provided with the required written information regarding advance directive policies for 1 (#9) out of 14 live patients reviewed. This deficient practice had the potential to affect any of the 188 patients admitted to the agency during the past 12 months, a current census of 39 patients, and any future admissions to the agency. Review of Patient #9’s Clinical Record revealed she was admitted to the Hospice agency on 01/06/2026 and in a current Certification Period of 01/06/2026 through 04/05/2026. Review of Patient #9’s Admission Documents and Clinical Record, as of 01/22/2026, revealed no documented evidence the Hospice agency informed and/or provided her with the required written information regarding Advance Directives.An interview was conducted on 01/22/2026 at 1:30 p.m. with S1ADM. S1ADM reviewed Patient #9’s Admission Documents and Clinical Record then confirmed Patient #9’s signed documentation to indicate she was informed of and received a written copy of the required information on Advance Directives was not present and should have been.”

“Based on interview and record review, the Hospice agency failed to provide documented evidence via signature to indicate the patient/representative was provided with a copy of the Notice of Patient Rights and Responsibilities for 1 (#9) of 14 live patients reviewed. This deficient practice had the potential to affect any of the 188 patients admitted to the agency during the past 12 months, a current census of 39 patients, and any future admissions to the agency. Review of Patient #9’s Clinical Record revealed she was admitted to the Hospice agency on 01/06/2026 and in a current Certification Period of 01/06/2026 through 04/05/2026. Review of Patient #9’s Admission Documents and Clinical Record, as of 01/22/2026, revealed no documented evidence of a signature indicating the patient/representative was provided with a copy of the Notice of Patient Rights and Responsibilities.An interview was conducted on 01/22/2026 at 1:30 p.m. with S1ADM. S1ADM reviewed Patient #9’s Admission Documents and Clinical Record then confirmed Patient #9’s signed documentation to indicate they received copy of the Notice of Patient Rights”

“Based on interviews and record reviews, the Hospice agency failed to have a system in place to ensure nursing care and services were provided under the supervision of an RN in order to meet all of the patient’s needs. This deficient practice was evidenced by failure to ensure the RN assessed and documented wound measurements and wound descriptions every 7 days for 1 (#6) of 3 patients reviewed for wounds.This deficient practice had the potential to affect any of the 11 wounds currently being treated by the agency and any future wounds which would require treatment by the agency. Review of the state’s Board of Nursing Declaratory Statement Scope of Practice for a RN - Wound Care Management, adapted 02/1999, revealed, in part, the following: RNs render care that is directed towards the prevention and treatment of wounds. Wounds are a common health care challenge that often occur with or result from chronic disorders such as impaired circulation and malnutrition. RN care of skin/wound conditions involves the identification, assessment, management, and ongoing evaluation of patients with alterations in skin/tissue integrity that includes but is not limited to draining wounds, pressure ulcers, and vascular ulcers, and conditions resulting from incontinence, surgical procedures, and/or trauma.Scope of Practice - The state’s Board of Nursing recognizes that assessment, planning,intervention, teaching, evaluation, and supervision are the major responsibilities of the RN in the practice setting. The RN is responsible for performing a nursing assessment and physical examination for preventative and restorative nursing and for providing patient/family teaching. Recognizing that the physician must always prescribe wound care, the following roles are defined to delineate the scope of practice for each member of the nursing team members. The RN initiates appropriate wound preventative measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by an authorized prescriber. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following:Pressure Ulcer Assessment 1. Assess the pressure ulcer initially and re-assess it at least weekly.1.1. Document the results of all wound assessments. Assess and document physical characteristics including: location, Category/Stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor.Review of Patient #6’s Clinical Record revealed she was admitted to the Hospice agency on 04/10/2025 with a terminal diagnosis of Cerebrovascular Disease and currently in a Certification Period of 12/06/2025 through 02/03/2025. Further review revealed she was currently receiving treatment for a Stage 2 Pressure Ulcer to the Sacrum. Review of Patient #6’s POC for her current Certification Period revealed, in part, she was to receive a SNV frequency of twice weekly.Review of Patient #6’s Physician’s Orders for Wound Care for her current Certification Period revealed, in part, the following order for the treatment of Stage 2 Pressure Ulcer Wounds to be performed twice weekly and as needed: Monitor wound. Cleanse/irrigate wound with wound cleanser or soap and water. Pat dry. Apply barrier cream/zinc oxide to wound bed. Review of Patient #6’s SNVs conducted by an RN, dated 12/06/2025 through 01/27/2026, revealed, in part, 4 missed opportunities for wound measurements by the RN on the following dates: 12/16/2025 – No wound measurements or description documented by RN; 12/26/2025 – No wound measurements or description documented by RN; 01/02/2026 – No wound measurements or description documented by RN; and01/16/2026 – No wound measurements or description documented by RN.An interview was conducted on 01/28/2026 at 10:55 a.m. with S1ADM. S1ADM confirmed wound measurements and description should be documented by the RN every 7 days at a minimum. S1ADM reviewed Patient #6’s Clinical Record on the aforementioned dates and confirmed there was no documented evidence of wound measurements being performed by the RN every 7 days and should have been.”

“Based on interviews and record reviews, the Hospice agency failed to ensure a patient’s Clinical Record contained authenticated physician’s orders with the signature of the ordering physician obtained within the required timeframe for 1 (#1) of 2 patients reviewed for discharge. This deficient practice had the potential to affect any of the 188 patients admitted to the agency during the past 12 months, a current census of 39 patients, and any future admissions to the agency. Findings: Review of the agency’s undated Verbal Orders Policy and Procedure, revealed, in part, the following:Policy: A Physician, his/ her designated agent, or eligible practitioner may give verbal orders to the Hospice’s licensed nurses, as allowed by the nurses state licensure rules. Purpose: To delineate the procedure for receipt of verbal orders.Procedure: 1. Verbal orders must be dated, timed, and authenticated in a timely manner by the ordering practitioner. 2. Verbal orders are documented and signed with the name and credentials of the personnel receiving the order and signed by the physician within the time frame established in the hospice’s policies and procedures and/ or state requirements. Review of the aforementioned reference to the state’s requirements revealed, in part, 8221 B.1.b - Orders shall be signed and dated in a timely manner, not to exceed 14 days, unless the hospice has documentation that verifies attempts to get orders signed (in this situation up to 30 days will be allowed).Review of Patient #1’s Clinical Record revealed she was admitted to the Hospice agency on 07/15/2025 and was in a Certification Period of 10/12/2025 through 11/07/2025 when she was discharged due to transfer to another local Hospice agency on 11/07/2025. Review of Patient #1’s Physician Orders for the Certification Period of 10/12/2025 through 11/07/2025, revealed, in part, the following: Order date: 11/07/2025;Order entered by: S1ADM; and Order details: Discharge patient effective 11/07/2025 due to transfer to another local Hospice. Further review revealed, in part, as of 01/27/2026 at 1:53 p.m., no physician’s signature present to authenticate the aforementioned order. Review attempted on 01/27/2026 at 1:55 p.m. for documented evidence within Patient #1’s EHR to indicate the aforementioned order was authenticated via signature by the ordering provider within the required timeframe with no documented evidence available for review. An interview was conducted on 01/28/2026 at 9:30 a.m. with S1ADM. S1ADM confirmed physicians had no more than 30 days to authenticate their verbal orders via signature. S1ADM confirmed Patient #1’s aforementioned physician’s order was not authenticated with the signature of the ordering provider within the required timeframe and should have been.”

“Based on interview and record review, the Hospice agency failed to ensure a patient’s Discharge Summary was submitted to the receiving facility for 1 (#2) of 2 patients reviewed for discharge.This deficient practice had the potential to affect any of the agency’s patients who were discharged during the past 12 months and any future discharges from the agency. Findings: Review of the agency’s undated Transfer and Discharge Addendum Policy and Procedure, as of 01/28/2026, revealed, in part, the following: Revocation: 1. The agency provides adequate and appropriate information upon revocation. Review of Patient #2’s Clinical Record revealed she was admitted to the Hospice agency on 09/02/2025 and was in a Certification Period of 09/02/2025 through 09/17/2025 when she was discharged due to revocation for hospitalization on 09/17/2025. Review of the Patient #2’s Revocation of Benefits, signed 09/27/2025, revealed, in part, her family elected to send her to the hospital for more aggressive treatment. Review of Patient #2’s Unattended Discharge Note, dated 09/17/2025, revealed, in part, the nurse received a text message from Patient #2’s son indicating Patient #2 was revoking hospice services to be transported to the local emergency department for more aggressive treatment. Further review revealed no documented evidence to indicate a Discharge Summary, which included, in part, the patient’s current diagnoses and current medication list, was submitted to the receiving facility. Review attempted on 01/27/2026 at 2:15 p.m. for documented evidence within Patient #2’s Scanned Documents, Discharge Documents, and Clinical Record to indicate a Discharge Summary, which included, in part, the patient’s current diagnoses and current medication list, was submitted to the receiving facility with no documented evidence available for review. An interview was conducted on 01/27/2026 at 2:41 p.m. with S1ADM. S1ADM confirmed when Patient #2’s nurse became aware of her revocation on 09/17/2025, she should have immediately called the receiving facility to give report and provided the facility with a Discharge Summary; including Facesheet, current diagnoses, and current medication list; and she did not.”

“Based on record review and interview, the Hospice agency failed to implement a system for the safe use and management of controlled drugs in the patient’s home in accordance with accepted standards of practice. The Hospice agency failed to ensure current and accurate records were maintained for the disposition of all controlled substances provided by the Hospice agency to the patient for 14 (#6, #7, #8, #9, #10, #11, #12, #13 #14, #15, #16, #17, #18, and #19) of 14 live patients reviewed in the sample. This deficient practice had the potential to affect any of the 188 patients admitted to the agency during the past 12 months, a current census of 39 patients, and any future admissions to the agency. Findings: Review of the United States GAO’s Report titled Preventing Drug Diversion, published 04/2020, revealed, in part, the following: Misuse of controlled substances continues to be a serious public health problem in the United States.1 National survey data from the Substance Abuse and Mental Health Services Administration show that in 2017, 53 percent of people 12 years of age and older in the United States who misused prescription pain relievers in the past year, obtained the drugs from friends and family. The most commonly misused controlled substances include opioids (such as oxycodone), which are used to treat pain, and central nervous system depressants (such as diazepam), which are used to treat anxiety and sleep disorders. These types of drugs are prescribed for a large portion of patients in hospice care. Patients select hospice care when they no longer want treatment for their terminal illness, but rather choose a hospice team to provide symptom management and control. In 2017, approximately 1.5 million Medicare beneficiaries received hospice services, and 56 percent of those patients received care in the patient’s home. Medicare is the largest payer for hospice services.The Controlled Substances Act regulates the manufacture, distribution, use, and disposal of controlled substances.13 In general, the Controlled Substances Act was enacted to facilitate the use of controlled substances for legitimate medical, scientific, research, and industrial purposes while preventing them from being diverted for illegal uses.What GAO Found: Best Practices for Reducing the Risk of DiversionHospice officials identified best practices for preventing diversion of controlled substances. Best practices include routine prescription drug counts performed by hospice employees to determine if controlled substances are being used properly.Narcotic counts can also help ensure that unused or expired medications are properly disposed of, preventing potential misuse or accidental ingestion. Review of the agency’s undated Drugs and Biologicals Medical Supplies, and DME Policy and Procedure, as of 01/27/2026, revealed, in part, the following: V. Labeling, disposing, and storing of drugs and biologicals:C. The agency must have written policies and procedures for the management of controlled drugs in the patient’s home. Review attempted on 01/22/2026 at 1:46 p.m. and 01/27/2026 at 9:30 a.m. of the agency’s policy and procedure regarding the safe management of controlled drugs in the patient’s home which would require the nurse to count and document controlled substances during a SNV with no documented evidence available for review. Patient #6Review of Patient #6’s Clinical Record revealed she was admitted to the Hospice agency on 04/10/2025 and in a current Certification Period of 12/06/2025 through 02/03/2026. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #6’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 3 active medication orders for controlled substances:Lorazepam 0.5mg oral tablet by mouth every 4 hours PRN for anxiety; Lorazepam 2mg/mL Oral Concentrate. Give 0.5mL by mouth every 4 hours PRN for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 0.5ml by mouth every hour as needed for pain/dyspnea. Review of Patient #6’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances for a total of 25 missed opportunities during the following SNVs:01/02/2026; 01/06/2026;01/09/2026; 01/12/2026; 01/16/2026;01/19/2026; and01/21/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #6’s controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances with no documented evidence available for review. Patient #7Review of Patient #7’s Clinical Record revealed she was admitted to the Hospice agency on 09/19/2025 and in a current Certification Period of 12/18/2025 through 03/17/2026. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #7’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 3 active medication orders for controlled substances:Clonazepam 0.5mg tablet. Give 1 to 2 tablets by mouth every 4 hours PRN for anxiety/agitation;Lorazepam 2mg/mL Oral Concentrate. Give 0.25mL by mouth every 4 hours PRN for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 5mg by mouth every hour as needed for pain/dyspnea. Review of Patient #7’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/02/2026;01/06/2026;01/09/2026;01/12/2026;01/16/2026; 01/19/2026; and 01/21/2026. Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #7’s controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances with no documented evidence available for review. Patient #8Review of Patient #8’s Clinical Record revealed he was admitted to the Hospice agency on 10/24/2025 and in a current Certification Period of 1/22/2026 through 04/21/2026. Further review revealed he had an ordered SNV frequency of twice weekly and as needed.Review of Patient #8’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 3 active medication orders for controlled substances:Oxycodone Hcl 10 mg oral tablet every 4 hours as needed for painLorazepam 2mg/mL Oral Concentrate. Give 0.5mL by mouth every 4 hours PRN for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 0.5ml by mouth every hour as needed for pain/shortness of breath. Review of Patient #8’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/02/2026; 01/05/2026;01/07/2026; 01/15/2026; and01/26/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #8’s controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances with no documented evidence available for review. Patient #9Review of Patient #9’s Clinical Record revealed she was admitted to the Hospice agency on 01/06/2026 and in a current Certification Period of 01/06/2026 through 04/05/2026. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #9’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 2mg/mL Oral Concentrate. Give 0.25mL by mouth every 4 hours PRN for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 5mg by mouth every hour as needed for pain/dyspnea. Review of Patient #9’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/06/2026; 01/08/2026;01/12/2026; 01/15/2026; 01/19/2026;01/23/2026; and01/26/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #9’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #10Review of Patient #10’s Clinical Record revealed he was admitted to the Hospice agency on 05/29/2025 and in a current Certification Period of 01/24/2026 through 03/24/2026. Further review revealed he had an ordered SNV frequency of twice weekly and as needed.Review of Patient #10’s current Hospice Medication Profile, as of 01/27/2026, revealed, in part, the following 5 active medication orders for controlled substances:Fentanyl 50mcg/hr Transdermal Patch. Apply one patch transdermal every 72 hours for pain; Lorazepam 0.5mg Tablet. Give 0.25mg by mouth every 4 hours PRN for anxiety; Lorazepam 2mg/mL Oral Concentrate. Give 0.5ml by mouth every 4 hours PRN for anxiety; Morphine Sulfate 20mg/mL Oral Concentrate. Give 10mg by mouth every hour PRN for pain/dyspnea; and Oxycodone (immediate release) 5mg. Give 1 tablet by mouth every 4 hours PRN for pain. Review of Patient #10’s SNV Notes, dated 01/01/2026 through 01/27/2026, as of 01/27/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 5 aforementioned controlled substances for a total of 35 missed opportunities during the following SNVs:01/05/2026; 01/08/2026;01/12/2026; 01/13/2026; 01/18/2026;01/19/2026; and01/23/2026.Review attempted on 01/27/2026 at 1:40 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #10’s controlled substances was performed and/or documented by the nurse for the 5 aforementioned controlled substances with no documented evidence available for review. Patient #11Review of Patient #11’s Clinical Record revealed she was admitted to the Hospice agency on 11/13/2024 and in a current Certification Period of 01/07/2026 – 03/07/2026;. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #11’s current Hospice Medication Profile, as of 01/22/2026, revealed, in part, the following 6 active medication orders for controlled substances:Hydrocodone-Acetaminophen 7.5-325mg. Give 1 tablet by mouth 4 times daily for pain; Hydrocodone-Acetaminophen 7.5-325mg. Give 1 tablet by mouth every 4 hours PRN for pain; Hydromorphone 4mg Tablet. Give 1 tablet by mouth every 4 hours PRN for pain;Lorazepam 0.5mg tablet. Give 2 tablets by mouth 4 times daily for anxiety; Lorazepam 0.5mg tablet. Give 2 tablets by mouth every night at bedtime for anxiety; and Lorazepam 0.5mg tablet. Give 2 tablets by mouth every 4 hours PRN for anxiety. Review of Patient #11’s SNV Notes, dated 01/01/2026 through 01/26/2026, as of 01/27/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 6 aforementioned controlled substances for a total of 30 missed opportunities during the following SNVs:01/06/2026; 01/09/2026;01/12/202601/19/2026; and01/23/2026.Review attempted on 01/22/2026 at 11:46 a.m., 01/27/2026 at 9:15 a.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #11’s controlled substances was performed and/or documented by the nurse for the 6 aforementioned controlled substances with no documented evidence available for review. Patient #12Review of Patient #12’s Clinical Record revealed she was admitted to the Hospice agency on 12/17/2025 and in a current Certification Period of 12/17/2025 through 03/16/2026. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #12’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 0.5mg oral tablet by mouth every 6 hours as needed for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 5mg by mouth under the tongue every hour as needed for pain/shortness of breath. Review of Patient #12’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/06/2026; 01/07/2026;01/13/2026; 01/20/2026; and01/22/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #12’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #13Review of Patient #13’s Clinical Record revealed she was admitted to the Hospice agency on 01/08/2026 and in a current Certification Period of 01/08/2026 through 04/07/2026. Further review revealed she had an ordered SNV frequency of once weekly and as needed.Review of Patient #13’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 0.5mg oral tablet by mouth every 6 hours as needed for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 5mg by mouth under the tongue every 3 hours as needed for pain/shortness of breath. Review of Patient #13’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/08/2026; 01/13/2026; and01/21/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #13’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #14Review of Patient #14’s Clinical Record revealed she was admitted to the Hospice agency on 10/10/2025 and in a current Certification Period of 12/09/2025 through 02/06/2026. Further review revealed she had an ordered SNV frequency of three weekly and as needed.Review of Patient #14’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 0.5mg oral tablet by mouth every 4 hours as needed for anxiety; and Morphine Sulfate 20mg/mL Oral Solution. Give 10mg by mouth under the tongue every hour as needed for pain/dyspnea. Review of Patient #14’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/05/2026; 01/07/2026;01/12/2026;01/14/2026;01/19/2026; 01/21/2026; and01/26/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #14’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #15Review of Patient #15’s Clinical Record revealed she was admitted to the Hospice agency on 11/17/2025 and in a current Certification Period of 01/16/2026 through 03/16/2026. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #15’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 2mg/ml oral concentrate, give 0.5ml by mouth at bedtime and every 4 hours as needed for anxiety/ restlessness ; and Morphine Sulfate 100mg/5mL Oral Solution. Give 0.5ml by mouth every hour as needed for pain/dyspnea. Review of Patient #15’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 21 missed opportunities during the following SNVs:01/02/2026; 01/06/2026 completed by LPN;01/06/2026 completed by RN;01/09/2026; 01/13/2026;01/15/2026;01/19/2026; and01/27/2026.Review attempted on 01/22/2026 at 1:46 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #15’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #16Review of Patient #16’s Clinical Record revealed she was admitted to the Hospice agency on 12/29/2025 and in a current Certification Period of 12/29/2025 through 03/28/2026. Further review revealed she had an ordered SNV frequency of twice weekly and as needed.Review of Patient #16’s current Hospice Medication Profile, as of 01/27/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 0.5mg Tablet. Give 0.5mg by mouth every 6 hours PRN for anxiety; Morphine Sulfate 100mg/5mL Oral Concentrate. Give 5mg by mouth every 3 hours PRN for pain/dyspnea. Review of Patient #16’s SNV Notes, dated 01/01/2026 through 01/27/2026, as of 01/27/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 14 missed opportunities during the following SNVs:01/02/2026;01/06/2026; 01/09/2026;01/13/2026; 01/16/2026; 01/20/2026; and01/22/2026.Review attempted on 01/27/2026 at 1:15 p.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #16’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #17Review of Patient #17’s Clinical Record revealed she was admitted to the Hospice agency on 10/27/2025 and in a current Certification Period of 10/27/2025 through 01/24/2026. Further review revealed she had an ordered SNV frequency of once weekly and as needed.Review of Patient #17’s current Hospice Medication Profile, as of 01/20/2026, revealed, in part, the following 3 active medication orders for controlled substances:Dilaudid 1mg/mL Oral Liquid. Give 0.5mL by mouth every hour PRN for shortness of breath;Hydrocodone-Acetaminophen 5-325mg. Give 1 tablet by mouth every 6 hours PRN for pain; and Lorazepam 0.5mg tablet. Give 1 tablet by mouth every 4 hours PRN for anxiety.Review of Patient #17’s SNV Notes, dated 01/01/2026 through 01/22/2026, as of 01/22/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances for a total of 12 missed opportunities during the following SNVs:01/06/2026; 01/09/2026;01/13/2026; and 01/20/2026.Review attempted on 01/22/2026 at 11:46 a.m. and again on 01/28/2026 at 9:30 a.m. of documented evidence indicating a count of Patient #17’s controlled substances was performed and/or documented by the nurse for the 3 aforementioned controlled substances with no documented evidence available for review. Patient #18Review of Patient #18’s Clinical Record revealed she was admitted to the Hospice agency on 11/04/2024 and in a current Certification Period of 12/29/2025 through 02/26/2026. Further review revealed she had an ordered SNV frequency of once weekly and as needed.Review of Patient #18’s current Hospice Medication Profile, as of 01/28/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 0.5mg tablet. Give 1 tablet by mouth every 4 hours PRN for anxiety; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 0.5mL by mouth every hour PRN for pain. Review of Patient #18’s SNV Notes, dated 01/01/2026 through 01/28/2026, as of 01/28/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 8 missed opportunities during the following SNVs:01/06/2026; 01/15/2026;01/20/2026; and 01/26/2026. Review attempted on 01/28/2026 at 10:35 a.m. of documented evidence indicating a count of Patient #18’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. Patient #19Review of Patient #19’s Clinical Record revealed she was admitted to the Hospice agency on 01/15/2026 and in a current Certification Period of 01/15/2026 through 01/28/2026. Further review revealed she had an ordered SNV frequency of once weekly and as needed.Review of Patient #19’s current Hospice Medication Profile, as of 01/28/2026, revealed, in part, the following 2 active medication orders for controlled substances:Lorazepam 2mg/mL Oral Concentrate. Give 0.5mL by mouth every 4 hours PRN for agitation; and Morphine Sulfate 100mg/5mL Oral Concentrate. Give 0.5mL by mouth every 2 hours PRN for pain/dyspnea. Review of Patient #19’s SNV Notes, dated 01/15/2026 through 01/28/2026, as of 01/28/2026, revealed, in part, no documented evidence a count of controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances for a total of 8 missed opportunities during the following SNVs:01/15/2026;01/16/202601/21/2026; and 01/26/2026. Review attempted on 01/28/2026 at 10:45 a.m. of documented evidence indicating a count of Patient #19’s controlled substances was performed and/or documented by the nurse for the 2 aforementioned controlled substances with no documented evidence available for review. An interview was conducted on 01/21/2026 at 10:55 a.m. with S3RN. S3RN confirmed she did not document the current count of a patient’s controlled substances during her SNVs and was not required to. An interview was conducted on 01/28/2026 at 9:30 a.m. with S1ADM. S1ADM confirmed the agency’s policy and procedure did not require nurses to perform and/or document a current count of controlled substances present in the patient’s home during their SNVs. S1ADM confirmed Patients #6 through #19’s Clinical Records did not contain documented evidence to indicate the nurses performed a count of controlled substances during their SNVs and should. An interview was conducted on 01/28/2026 at 9:30 a.m. with S2RD. S2RD confirmed the agency’s policy and procedure did not require nurses to perform and/or document a current count of controlled substances present in the patient’s home during their SNVs. S2RD confirmed Patients #6 through #19’s Clinical Records did not contain documented evidence to indicate the nurses performed a count of controlled substances during their SNVs and should.”

“Based on observations, interviews and record reviews, the Hospice agency failed to ensure all care provided by the local ALF where a patient resided was provided in accordance with their Hospice POC. This deficient practice was evidenced by failure to ensure the ALF’s medication orders matched the medication orders present in the Hospice POC for 3 (#6, #7, and #9) of 3 home visits conducted in an ALF. This deficient practice had the potential to affect any of the patients who resided in an ALF during the past 12 months, any of the 25 patients currently residing in an ALF and any future admissions to the agency who resided in an ALF. Findings: Patient #6Review of Patient #6’s Clinical Record revealed she was admitted to the Hospice agency on 04/10/2025 and in a current Certification Period of 12/06/2025 through 02/03/2026. Further review revealed she resided at a local ALF. Review of Patient #6’s Hospice POC and Hospice Medication Profile for her current Certification Period, as of 01/20/2026 at 3:00 p.m., revealed, in part, the following: Ipratropium Bromide 0.03%, 1 spray four times daily as needed for allergies;Magnesium 100 mg oral tablet daily;Methocarbamol 500 mg oral tablet four times daily as needed for muscle spasms;Miralax 17 GM oral daily;Oxygen 2 liters per minute daily as needed for shortness of breath;Seroquel 100 mg oral tablet daily for depression;Triple Antibiotic Ointment, small amount daily as needed for wound care; andZofran 8 mg one tablet every 8 hours as needed for Nausea/ Vomiting. An observation of Patient #6’s Clinical Record for the local ALF where she resided was conducted during Home Visit on 1/21/2026 at 10:22 a.m. Patient #6’s ALF medication Pass-MAR revealed in part the following medication did not match the Hospice order frequency: Zofran 8mg by mouth every 6 hours PRN for nausea/ vomiting.Further review revealed the following Hospice orders were not present on the ALF’s MAR:Ipratropium Bromide;Magnesium;Methocarbamol; Miralax;Oxygen; Seroquel 100 mg oral tablet daily for depression;Triple Antibiotic Ointment; andZofran 8 mg one tablet every 8 hours as needed for Nausea/ Vomiting.Patient #7Review of Patient #7’s Clinical Record revealed she was admitted to the Hospice agency on 09/19/2025 and in a current Certification Period of 12/18/2025 through 03/17/2026. Further review revealed she resided at a local ALF. Review of Patient #7’s Hospice POC and Hospice Medication Profile for her current Certification Period, as of 01/20/2026 at 3:00 p.m., revealed, in part, the following: Acetaminophen 500mg. Give 1 tablet by mouth PRN every 6 hours for pain;Macrobid 100mg. Give 1 capsule by mouth at bedtime;Nauzene 968-175-230mg. Give 1 tablet by mouth PRN daily for nausea/vomiting; Zofran 8mg. Give 1 tablet by mouth every 8 hours PRN for nausea;Zoloft 25mg. Give 1 tablet by mouth daily for depression; and Haldol 2mg/mL. – No active order present.An observation of Patient #7’s Clinical Record for the local ALF where she resided was conducted during Home Visit on 01/21/2026 at 10:00 a.m. Patient #7’s ALF Medication Pass-MAR revealed, in part, the following medications did not match the Hospice order frequency:Zofran 8mg. Give 1 tablet by mouth PRN every 6 hours for nausea/vomiting.Further review revealed, in part, the following Hospice orders were not present on the ALF’s MAR: Acetaminophen 500mg;Macrobid 100mg; Nauzene 968-175-230mg; and Zoloft 25mg.Further review revealed, in part, the following medication present on the ALF’s MAR with no Hospice order:Haldol 2mg/mL. Give 0.5mL sublingual PRN every 4 hours for anxiety;Patient #9Review of Patient #9’s Clinical Record revealed she was admitted to the Hospice agency on 01/06/2026 and in a current Certification Period of 01/06/2026 through 04/05/2026. Further review revealed she resided at a local ALF. Review of Patient #9’s Hospice POC and Hospice Medication Profile for her current Certification Period, as of 01/20/2026 at 3:00 p.m., revealed, in part, the following: Hycoscycamine Sulfate 0.125 mg sublingual tablet every 4 hours PRN for terminal secretions;Lorazepam 2mg/ml, 0.25ml oral every 4 hours PRN for anxiety;Morphine Sulfate 100 mg/5 ml, 5 mg oral every hour PRN for pain or dyspnea;Ondansetron 8mg oral tablet every 8 hours PRN for nausea/vomiting; andOxygen 2-5 Liters daily PRN for dyspnea.An observation of Patient #9’s Clinical Record for the local ALF where she resided was conducted during Home Visit on 01/21/2026 at 11:23 a.m. Patient #9’s ALF Medication Pass-MAR revealed in part, the following Hospice orders were not present on the ALF’s MAR:Hycoscycamine Sulfate 0.125 mg sublingual tablet every 4 hours PRN for terminal secretions;Lorazepam 2mg/ml, 0.25ml oral every 4 hours PRN for anxiety;Morphine Sulfate 100 mg/5 ml, 5 mg oral every hour PRN for pain or dyspnea;Ondansetron 8mg oral tablet every 8 hours PRN for nausea/vomiting7; andOxygen 2-5 Liters daily PRN for dyspnea.An interview was conducted on 01/21/2026 at 10:55 a.m. with S3RN. S3RN confirmed a patient’s Hospice Medication Orders should match their ALF’s MAR at all times to ensure no medication errors occurred. S3RN confirmed she tried to perform a reconciliation of Hospice Orders against an ALF’s MAR once a month, however she did not always get a chance to. S3RN reviewed Patient #6, #7, and #9’s ALF MARs against their current Hospice Medication Orders and confirmed they did not match and should have. An interview was conducted on 01/28/2026 at 9:30 a.m. with S1ADM. S1ADM confirmed a patient’s Hospice Medication Orders should match their ALF’s MAR at all times to ensure no medication errors occurred. S1ADM confirmed nurses should perform a reconciliation of Hospice Orders against an ALF’s MAR as needed and no less frequently than once a month. S1ADM confirmed an as needed reconciliation should be performed any time a new medication order was received and/or a medication order was changed. S1ADM reviewed Patient #6, #7, and #9’s ALF MARs against their current Hospice Medication Orders and confirmed they did not match and should have. An interview was conducted on 01/28/2026 at 9:30 a.m. with S2RD. S2RD confirmed a patient’s Hospice Medication Orders should match their ALF’s MAR at all times to ensure no medication errors occurred. S2RD confirmed nurses should perform a reconciliation of Hospice Orders against an ALF’s MAR as needed and no less frequently than once a month. S2RD confirmed an as needed reconciliation should be performed any time a new medication order was received and/or a medication order was changed. S2RD confirmed Patient #6, #7, and #9’s ALF MARs did not match their current Hospice Medication Orders and should have.”

“Based on observations, interviews and record reviews, the Hospice agency failed to meet the Condition of Participation for Organization and Administration of Services as evidenced by failure to have a system in place to ensure each patient’s medications were administered in a safe and effective manner. The Hospice agency failed to have a system in place to ensure the contracted inpatient unit (IPU):1. Administered routine and as needed (PRN) medications by a licensed nurse as evidenced by the administration of medications, including narcotics and non-narcotics, by an unlicensed CNA/sitter (caregiver), without the supervision of an onsite licensed nurse for 2 of 2 (#1 and #2) patients in the sample (See Findings in L660); 2. Performed proper patient assessments by a licensed nurse prior to the administration of PRN narcotic medications as evidenced by the administration of PRN Morphine, Ativan and/or Oxycodone based on an assessment of need performed by an unlicensed caregiver without the supervision of an onsite licensed nurse for 2 of 2 (#1 and #2) patients in the sample (See Findings in L660); and3. Provided secure storage of patient medications, including Morphine, Ativan and/or Oxycodone, as evidenced by the unlicensed caregiver maintaining sole possession of the key to the locked medication closet where all patient medications were stored (See Findings in L660).This deficient practice had the potential to cause harm to any of the Hospice agency’s 2 patients who resided at the contracted IPU during the past 12 months, a current census of 65 patients and any future admissions to the Hospice agency.See Findings in L660. See Findings in L660.”

“Based on record reviews and interviews, the Hospice agency failed to ensure licensed professionals actively participated in all aspects of the patient’s Hospice care in accordance with current professional standards. The Hospice agency failed to ensure a patient’s medical pronouncement of death was performed by a coroner based on personal observation or information and statements obtained from a qualified professional for 2 of 2 (#1 and #2) patients reviewed in the sample. This deficient practice had the potential to affect a current census of 65 patients and any future admissions to the Hospice agency. Review of Louisiana Revised Statute 9.111 (LA RS 9.11) revealed, in part, the following: A. A person will be considered dead if in the announced opinion of a physician, duly licensed in the state of Louisiana based on ordinary standards of approved medical practice, the person has experienced an irreversible cessation of spontaneous respiratory and circulatory functions….B. The medical pronouncement of death by a coroner may also be based on personal observation, information, or statements obtained from coroner investigators, Registered Nurse (RN)s, physician assistants, or emergency medical technicians at the scene who are reporting from firsthand observation of the physical condition of the deceased. …Review of the Hospice agency’s “Responding to a Patient’s Death at Home: Policy and Procedure, dated 12/02/2008, revealed, in part, the following: Policy: The Hospice agency responds to the suspected death or confirmed death of the patient in the home in accordance with law and regulation. Responsibility: The Hospice agency knows the applicable law or regulation regarding the pronouncement of a patient’s death in his/her residence.Procedure: 3. a. The Hospice employee notifies: ii. The proper authority to pronounce death in the event the employee is not permitted to pronounce death per law or regulation.5. Once the patient has been pronounced dead per law or regulation, the nurse may perform appropriate post mortem care per standards of practice. Patient #1Review of Patient #1’s Clinical Record revealed he was admitted to the Hospice agency on 10/03/2024 with a Certification Period of 10/03/2024 through 10/06/2024. Further review revealed he expired on 10/06/2024.Review of Patient #1’s Death Visit, as of 04/15/2025 at 12:00 p.m. revealed, in part, the following: Date/Time of Death: 10/06/2024 at 6:36 p.m.Person Who Pronounced Death: S2RNFurther review revealed the local coroner’s office was contacted following S2RN’s pronouncement of death to receive a release of authorization for the body. Patient #2Review of Patient #2’s Clinical Record revealed she was admitted to the Hospice agency on 12/10/2024 with a Certification Period of 12/10/2024 through 12/11/2024. Further review revealed she expired on 12/11/2024.Review of Patient #2’s Death Visit, as of 04/15/2025 at 12:20 p.m. revealed, in part, the following: Date/Time of Death: 12/11/2024 at 7:19 a.m.Person Who Pronounced Death: S2RNNarrative: Pronounced patient and performed post mortem care. Further review revealed the local coroner’s office was contacted following S2RN’s pronouncement of death to receive a release of authorization for the body. An interview was conducted on 04/15/2025 at 12:50 p.m. with S2RN. S2RN confirmed she pronounced the death of Patient #1 and #2. S2RN confirmed for a death visit she reported to the patient’s location to assess and pronounce the patient’s death. S2RN stated after pronouncement, she performed post mortem care, counted and wasted narcotics and just before leaving the home, she contacted the coroner to let them know she had pronounced the patient as deceased and request an authorization number to release the body to the funeral home. S2RN confirmed she performed pronouncement of death and her call to the coroner was only to obtain an authorization number to release the body. S2RN stated Hospice nurses were able to perform pronouncement of death because the Hospice agency had a physician on staff to sign off on it. S2RN stated pronouncement of death could be performed by either a registered nurse (RN) or a licensed practical nurse (LPN) depending on the parish the patient was located. An interview was conducted on 04/15/2025 at 3:35 p.m. with S3RN. S3RN confirmed the Hospice agency’s RN performed pronouncement of death during their death visit. S3RN confirmed after the pronouncement of death, the RN contacted the local coroner to request a release authorization number for their body. S3RN confirmed a Hospice RN was allowed to perform pronouncement of a patient’s death in the State of Louisiana. An interview was conducted on 04/15/2025 at 3:30 p.m. with S1ADM. S1ADM confirmed the Hospice agency’s nurses performed pronouncement of death for their patients then contacted the local coroner to obtain an authorization number for release of the body. S1ADM confirmed a Hospice RN could perform pronouncement of death independently and a Hospice LPN could perform the death assessment if they contacted the Hospice physician to sign off on the pronouncement based on the LPN’s assessment findings. S1ADM confirmed she was not aware of LA RS 9.111 and the Hospice agency had not implemented it into their procedure upon the death of the Hospice agency’s patients.”

“Based on observations, interviews and record reviews, the Hospice agency failed to meet the Condition of Participation for Organization and Administration of Services as evidenced by failure to have a system in place to ensure each patient’s medications were administered in a safe and effective manner. The Hospice agency failed to have a system in place to ensure the contracted inpatient unit (IPU): 1. Administered routine and as needed (PRN) medications by a licensed nurse as evidenced by the administration of medications, including narcotics and non-narcotics, by an unlicensed CNA/sitter (caregiver), without the supervision of an onsite licensed nurse for 2 of 2 (#1 and #2) patients in the sample; 2. Performed proper patient assessments by a licensed nurse prior to the administration of PRN narcotic medications as evidenced by the administration of PRN Morphine, Ativan and/or Oxycodone based on an assessment of need performed by an unlicensed caregiver without the supervision of an onsite licensed nurse for 2 of 2 (#1 and #2) patients in the sample; and3. Provided secure storage of patient medications, including Morphine, Ativan and/or Oxycodone, as evidenced by the unlicensed caregiver maintaining sole possession of the key to the locked medication closet where all patient medications were stored.This deficient practice had the potential to cause harm to any of the Hospice agency’s 2 patients who resided at the contracted IPU during the past 12 months, a current census of 65 patients and any future admissions to the Hospice agency.Cross Reference: L648. Review of the IPU’s webpage, https://thehospicehouse.org/about-us-1, revealed, in part, the following: Physical Address: 141 Pleasant Drive; Slidell, LA 70460; and Currently Contracted Partners: the Hospice agency.Review of the Hospice agency’s signed contract with the IPU revealed the contract was signed on 12/20/2024 by S1ADM. Further review revealed, in part, the following: This agreement provides the terms required of Hospice agency (provider) who desire to have patients placed into the IPU. This agreement provides the terms required of providers who desire to have patients placed into the IPU. Inconsideration of the mutual covenants hereinafter, set forth, it is hereby agreed that this Agreement shall cover a collaboration between the IPU and provider, beginning upon due execution by both parties, to provide Hospice care and residential care for terminally ill persons mutually accepted by both parties pursuant to the following terms and conditions: Provider understands the costs of operating the House are substantial to the IPU and provider agrees to work with the IPU in conjunction with its fundraising efforts. Criteria for admission to the house includes: The patient’s provider has executed the contract with the IPU; and Provider’s agreement to follow the IPU’s House Rules.The IPU shall provide residential services to IPU residents. Provider shall provide Hospice services to IPU residents. Residential services shall include the following: assistance with the administration of medication. Hospice services shall provide: pharmacy, oxygen, medical supplies related to the care of the terminal illness. Hospice services must follow State of Louisiana, Medicare and/or Medicaid regulations regarding Hospice care. Each party to this Agreement shall be responsible for the direct employment and supervision of its employees performing services pursuant to this Agreement. Notwithstanding any other provision in this Agreement, the Hospice agency remains solely responsible for: Ensuring any Hospice services provided comply with all pertinent provisions of any federal, state and local statutes, rules and regulations; Planning and coordinating and ensuring the quality of all Hospice services provided; and Ensuring adherence to the Plan of Care (POC) established for patients. Review of the IPU’s “House Rules” referenced in the aforementioned Contract revealed, in part, the following: 3. Family members are not allowed to administer any type of medications. All medicines must be ordered by the Hospice nurse and given by IPU caregivers. Review of the Hospice agency’s Policy and Procedure for the IPU, as of 04/15/2025 at 11:02 a.m., revealed, in part, the following: Admissions process: Medications: Medications are stored in locked closet for the IPU caregiver to administer. Medications must be in pre-filled syringes. Caregiver will only provide what is ordered, no changes will be made to dosage administered without an order. Review of the Hospice agency’s list of patients who resided at the IPU during the past 12 month period, as of 04/15/2025, revealed, in part, a total of 2 patients; Patient #1 and #2. Patient #1Review of Patient #1’s Clinical Record revealed he was admitted to the Hospice agency on 10/03/2024 for a Certification Period of 10/03/2024 through 10/06/2024 with a terminal diagnosis of Malignant Neoplasm of the Liver. Further review revealed he moved into the IPU on 10/03/2024 until he expired on 10/06/2024 and his physical address at the time of his death was 141 Pleasant Drive; Slidell, LA 70460.Review of Patient #1’s Initial Registered Nurse (RN) Visit revealed, in part, the following: Visit Date: 10/03/2025RN Performing Initial Visit: S4RNSkilled Nurse Visit (SNV) Narrative: Patient arrived to IPU via ambulance. Reviewed symptom management and comfort medications with IPU caregiver. Review of Patient #1’s POC for the Certification Period of 10/03/2024 through 10/06/2024, revealed, in part, the following: Problem: Alteration in comfort related to pain. Problem: At risk for undertreated pain secondary to inability to verbalize pain. Goal: Patient’s pain will be managed at or below their self-identified pain goal of 0-3. Intervention: Conduct and document a comprehensive pain assessment using a standardized assessment tool, including location, quality, intensity, aggravating/alleviating factors, and associated symptoms. Monitor for effectiveness of pharmacological and non-pharmacological interventions to achieve patient’s self-determined pain goal. Administer medications per physician’s orders. Interventions Assigned to: Skilled Nurse.Review of Patient #1’s Physician’s Orders for the Certification Period of 10/03/2024 through 10/06/2024, revealed, in part, the following: 10/03/2024: Haloperidol Lactate 2mg.mL Oral Concentrate – 1mg by mouth every 4 hours as needed for anxiety and agitation; 10/03/2024: Hyoscyamine Sulfate: 0.125mg sublingual tablet – 1 tablet every 4 hours as needed for terminal secretions; 10/03/2024: Ipratropium-Albuterol 0.5-2.5(3)mg/3mL Inhalation Solution – 3mL inhalation per nebulizer every 4 hours as needed for dyspnea; 10/03/2024: Ondansetron 8mg disintegrating tablet – Give 1 tablet by mouth every 8 hours as needed for nausea/vomiting;10/03/2024: Senna S 8.6-50mg tablet – 1 tablet by mouth daily as needed for constipation;10/03/2024: Temazepam 15 mg Capsule – Give 1 capsule at bedtime as needed for insomnia;10/03/2024: Lorazepam 2mg/mL Oral Concentrate – 0.5mL by mouth every 4 hours as needed for anxiety; and10/03/2024: Morphine Concentrate 20mg/mL – 10mg by mouth every hour as needed for dyspnea or pain. Review of Patient #1’s Visit Calendar for the Certification Period of 10/03/2024 through 10/06/2024, revealed, in part, the following SNVs while in the IPU:10/03/2024 and 10/04/2024: S4RN; and 10/05/2024 and 10/06/2024: S2RN.An interview was conducted on 04/15/2025 at 3:30 p.m. with S1ADM. S1ADM confirmed Patient #1 resided at the IPU from 10/03/2024 through 10/06/2024 and received all medications, both narcotic and non-narcotic, from the IPU’s unlicensed caregiver.Patient #2Review of Patient #2’s Clinical Record revealed she was admitted to the Hospice agency on 12/10/2024 for a Certification Period of 12/10/2024 through 12/11/2024 with a terminal diagnosis of Non-Hodgkin Lymphoma. Further review revealed she moved into the IPU on 12/10/2024 until she expired on 12/11/2024 and her physical address at the time of her death was 141 Pleasant Drive; Slidell, LA 70460.Review of Patient #2’s Initial RN Visit, dated 12/10/2024, revealed, in part, the following: Visit Date: 12/10/2024RN Performing Visit: S3RNSNV Narrative: Patient arrived to IPU via ambulance. Patient noted to be actively dying with terminal agitation, pain 8/10, and agonal breathing with a respiration rate of 28. Review of Patient #2’s POC for the Certification Period of 12/10/2024 through 12/11/2024, revealed, in part, the following: Problem: Alteration in comfort related to pain. Problem: At risk for undertreated pain secondary to inability to verbalize pain. Goal: Patient’s pain will be managed at or below their self-identified pain goal of 0-3. Intervention: Conduct and document a comprehensive pain assessment using a standardized assessment tool, including location, quality, intensity, aggravating/alleviating factors, and associated symptoms. Monitor for effectiveness of pharmacological and non-pharmacological interventions to achieve patient’s self-determined pain goal. Administer medications per physician’s orders. Interventions Assigned to: Skilled Nurse.Review of Patient #2’s Physician’s Orders for the Certification Period of 12/10/2024 through 12/11/2024, revealed, in part, the following: 12/10/2024: Ondansetron 8mg disintegrating tablet – Give 1 tablet by mouth every 8 hours as needed for nausea/vomiting;12/10/2024: Lorazepam 1mg tablet – 1 tablet by mouth every 4 hours as needed for anxiety;12/10/2024: Morphine Concentrate 100mg/5mL – 10mg by mouth every hour as needed for dyspnea or pain; and 12/10/2024: Oxycodone 5mg tablet – 1 tablet by mouth every 4 hours as needed for pain. Review of Patient #2’s Visit Calendar for the Certification Period of 12/10/2024 through 12/11/2024, revealed, in part, the following SNVs while in the IPU:12/10/2024: S3RN; and 12/11/2024: S2RN.An interview was conducted on 04/15/2025 at 3:30 p.m. with S1ADM. S1ADM confirmed Patient #2 resided at the IPU from 12/10/2024 through 12/11/2024 and received all medications, both narcotic and non-narcotic, from the IPU’s unlicensed caregiver.An interview was conducted on 04/15/2025 at 1:45 p.m. with the IPU’s Executive Director. She confirmed the IPU had a current contract with the Hospice agency to house and provide care for their patient’s. She confirmed the IPU contracted “caregivers” to perform basic ADL tasks for the patient’s in the facility through a local sitter agency. She stated some caregivers were CNAs and some were untrained sitters. She confirmed the IPU did not have a nurse on staff or on-site in the home 24/7 and all nursing care was provided by the contracted Hospice agency nurse(s) while they were present for their visit. She confirmed the Hospice agency did not provide a nurse to be present in the IPU at all times. She confirmed the IPU caregivers administered all medications for all of the Hospice patients while in the IPU. She confirmed the Hospice agency nurse came at least once a week to fill weekly pill organizers with patient medications in tablet/capsule form. She confirmed those pill organizers could contain narcotic and/or non-narcotic medications based on what was ordered for the patient. She stated if a patient’s medication was a liquid, the Hospice agency nurse pre-filled syringes with the appropriate dose of medication then placed the syringes into plastic sandwich bags labeled with the patient’s name and the medication name. She stated the syringes were typically filled by the Hospice nurse twice weekly but if the caregiver noticed they were running low, they would contact the Hospice nurse to come pre-fill additional syringes so they would not run out. She confirmed the Hospice agency nurse typically pre-filled at least 10 syringes with each narcotic medication. She confirmed the Hospice agency provided the IPU with a current medication list and a Medication Administration Record (MAR) for the caregivers to administer medications from. She confirmed the IPU caregivers documented what medication they administered and when in each patient’s binder on their MAR. She confirmed the Hospice agency nurse instructed the IPU caregivers on what medications should be administered when and why they should be administered. She confirmed all medications were stored in patient bins and kept inside of a locked medication closet located off of the home’s kitchen. She confirmed the only key for the closet was kept by the IPU’s caregiver throughout their shift then handed over to the next caregiver at shift change after they performed and documented a medication count. She confirmed the IPU caregiver’s were the only one who administered scheduled and PRN medications to patients in the IPU, both narcotic and non-narcotic. She confirmed the IPU caregivers administered PRN medications based off of their assessment to determine the need for the medication to be administered. An observation was conducted on 04/15/2025 at 1:55 p.m. of the IPU’s medication closet located off of the kitchen. The closet door contained a deadbolt lock on the outside accessible by key. Inside of the closet were shelves of binders and bins. The IPU’s Executive Directors stated each patient received their own bin which would be marked with their name and their medications would be kept inside of it. She stated each patient received a binder which contained their individual medication orders and MAR. The binders were labeled with the name of the patient it belonged to. A mini-refrigerator was located inside of the medication closet for medications which required cooling. An interview was conducted on 04/15/2025 at 12:50 p.m. with S2RN. S2RN confirmed she performed SNVs for Patient #1 and #2 while in the IPU. S2RN confirmed she received the Hospice agency’s in-service in January 2025 from S1ADM and the IPU’s Executive Director. S2RN confirmed the in-service was to review the policy and procedure for the IPU’s medication preparation process to ensure the IPU caregivers were able to administer patient medications. S2RN confirmed all Hospice patients would have a physician’s order to receive at least one narcotic medication during end of life, typically more than one. S2RN confirmed Hospice patients received routinely scheduled medications and medications to be given as needed based on the presence of signs/symptoms. S2RN confirmed she filled pill organizers and pre-filled syringes to be administered by the IPU’s caregivers both routinely scheduled and as needed. S2RN confirmed if a patient were running low on the pre-dosed medications, she would go pre-dose more immediately. S2RN confirmed the IPU’s caregiver maintained sole possession of the key to secure the closet where patient medications were stored in the IPU. S2RN confirmed the IPU did not have a nurse on-staff or present in the home at any time, except for when a Hospice nurse was present. S2RN confirmed all patient medications were administered by the IPU’s caregiver. S2RN confirmed she and other Hospice agency nurses informed the IPU’s caregivers of what signs/symptoms to administer as needed medications for and what timing the medications could be given. S2RN confirmed some of the IPU’s caregivers contacted her by phone to inform her of a patient’s current signs/symptoms then she would tell them what medications to give and when. An interview was conducted on 04/15/2025 at 3:35 p.m. with S3RN. S3RN confirmed she performed SNVs for Patient #2 while in the IPU. S3RN confirmed all Hospice patients would have a physician’s order to receive at least one narcotic medication during end of life, typically more than one. S3RN confirmed Hospice patients received routinely scheduled medications and medications to be given as needed based on the presence of signs/symptoms. S3RN confirmed she filled pill organizers and pre-filled syringes to be administered by the IPU’s caregivers both routinely scheduled and as needed. S3RN confirmed if a patient were running low on the pre-dosed medications, she, or another Hospice nurse, would go pre-dose more immediately. S3RN confirmed the IPU’s caregiver maintained sole possession of the key to secure the closet where patient medications were stored in the IPU. S3RN confirmed the IPU did not have a nurse on-staff or present in the home at any time, except for when a Hospice nurse was present. S3RN confirmed all patient medications were administered by the IPU’s caregiver. S3RN confirmed she and other Hospice agency nurses informed the IPU’s caregivers of what signs/symptoms to administer as needed medications for and what timing the medications could be given. An interview was conducted on 04/15/2025 at 3:30 p.m. with S1ADM. S1ADM confirmed the Hospice agency had a current contract in place to send patients to the IPU and the IPU required all patient medications to only be administered by the IPU’s caregivers. S1ADM confirmed the IPU’s caregivers were unlicensed and could be CNAs or untrained sitters. S1ADM confirmed the IPU did not have a nurse onsite and all nursing services were provided by the Hospice agency’s nurses during their SNVs. S1ADM confirmed when a patient was admitted to the IPU, the Hospice agency provided the IPU with a copy of the patient’s current medication orders, MARs for the caregiver to document medication administration, and all of the patient’s medications. S1ADM confirmed the Hospice agency nurses pre-filled all medications for all patients in the IPU. S1ADM confirmed nurses filled pill organizers at least once a week and pre-filled syringes with liquid medications at least twice weekly, sooner if necessary. S1ADM confirmed the medications a Hospice patient received consisted of both narcotic and non-narcotic medications. S1ADM confirmed those medications may be scheduled for routine administration or for as needed administration based on the current signs/symptoms.”