Mclaren Hospice

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 7 of 23 (30%) clinical records reviewed it was revealed that the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the patient’s individualized written plan of care. CLINICAL RECORD 3: The patient elected the hospice benefit on 04/19/2024. The plan of care dated 02/13/2025-04/13/2025 included orders for “Oxygen 2.5 liters via nasal cannula as needed for dyspnea.” The plan of care did not include the patient’s oxygen concentrator and oxygen supplies. CLINICAL RECORD 6: The patient elected the hospice benefit on 05/31/2023. A physician’s order dated 06/04/2023 included orders for “Oxygen 2 liters via nasal cannula as needed for dyspnea.” The plans of care dated 08/29/2023-11/26/2023, 11/27/2023-01/25/2024, 01/26/2024-03/25/2024, 03/26/2024-05/24/2024, 05/25/2024-07/23/2024, 07/24/2024-09/21/2024, 09/22/2024-11/20/2024, 11/21/2024-01/19/2025, and 01/20/2025-03/20/2025 did not include the patient’s oxygen concentrator and oxygen supplies. CLINICAL RECORD 12: The patient elected the hospice benefit on 10/28/2024. The plan of care dated 10/28/2024-01/25/2025 included orders to “Train patient in pharmacological and non-pharmacological measures to manage/relieve respiratory symptoms including continuous oxygen.” The plan of care did not include the patient’s oxygen concentrator and oxygen supplies. CLINICAL RECORD 13: The patient elected the hospice benefit on 12/27/2024. The initial nursing assessment dated 12/27/2024 read in part “patient is on intermittent oxygen at 2 liters via nasal cannula.” The plan of care dated 12/27/2024-03/26/2025 did not include the patient’s oxygen concentrator and oxygen supplies. CLINICAL RECORD 15: The patient elected the hospice benefit on 01/02/2025. The plan of care dated 01/02/2025-04/01/2025 included orders to “Train patient in pharmacological and non-pharmacological measures to manage/relieve respiratory symptoms including oxygen.” The plan of care did not include the patient’s oxygen concentrator and oxygen supplies. CLINICAL RECORD 18: The patient elected the hospice benefit on 11/23/2024. The plan of care dated 02/21/2025-05/21/2025 included orders to “Train patient in pharmacological and non-pharmacological measures to manage/relieve respiratory symptoms including oxygen.” The plan of care did not include the patient’s oxygen concentrator or oxygen supplies. CLINICAL RECORD 19: The patient elected the hospice benefit on 01/26/2024. The plan of care dated 01/26/2024-03/03/2024 included orders for “Oxygen 1-6 liters via nasal cannula as needed for shortness of breath.” The plan of care did not include the patient’s oxygen concentrator or oxygen supplies. In an interview on 03/13/2025, the Hospice Clinical Manager reviewed the records, confirmed the above findings, and stated “The oxygen supplies are not listed on any of these plans of care.””

“It is required that hospice aides are assigned to a specific patient by a registered nurse (RN) 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 4 of 16 (25%) clinical records reviewed with hospice aide services provided it was revealed that the agency did not ensure that all patient care instructions were included in the aide care plan. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/21/2024. The nursing visit note dated 01/31/2025 read in part, “Patient has a foley catheter in place after hospitalization.” The plan of care dated 01/19/2025-04/18/2025 ordered “Aide 1x/week.” The aide care plan dated 10/21/2024 lacked updated patient care instructions for the foley catheter. CLINICAL RECORD 11: The patient elected the hospice benefit on 02/14/2025. A physician’s order dated 02/24/2025 ordered, “Oxygen 2-6 liters via nasal cannula as needed for dyspnea.” The plan of care dated 02/14/2025-05/14/2025 ordered “Aide 1x/week.” The aide care plan dated 02/15/2025 did not include instructions regarding the oxygen. CLINICAL RECORD 12: The patient elected the hospice benefit on 10/28/2024. A physician’s order dated 11/21/2024 ordered, “Place Foley catheter 18Fr, with 10ml balloon.” The plan of care dated 10/28/2024-01/25/2025 ordered “Aide 2x/week.” The aide care plan dated 11/22/2024 did not include instructions regarding foley catheter care. CLINICAL RECORD 23: The patient elected the hospice benefit on 10/16/2024. A physician’s order dated 10/16/2024 included orders for wound care with a wound dressing to a wound on the patient’s coccyx. The plan of care dated 10/16/2024-11/15/2024 ordered “Aide 2x/week.” The aide care plan dated 10/16/2024 included relevant instructions of “shower at every visit.” The aide care plan did not include instructions regarding the wound dressing should it become wet or dislodged during the shower. On 03/13/2025, the Hospice Clinical Manager reviewed the records and confirmed the findings that the aide care plans did not include foley catheter care, wound dressing or oxygen instructions.”

“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 5 of 16 (31%) clinical records reviewed with hospice aide services provided it was revealed that the agency did not ensure that hospice aide supervisory visits were completed no less frequently than every 14 days. CLINICAL RECORD 2: The patient elected the hospice benefit on 04/18/2024. The plans of care dated 10/15/2024-12/13/2024 and 12/14/2024-02/11/2025 ordered, “Aide 1 time per week.” A hospice aide supervisory visit was dated 12/06/2024 and the next hospice aide supervisory visit was dated 12/27/2024, 21 days later and 7 days outstanding. CLINICAL RECORD 3: The patient elected the hospice benefit on 04/19/2024. The plans of care dated 07/18/2024-10/15/2024, 10/16/2024-12/14/2024, and 12/15/2024-02/12/2025 ordered, “Aide 1 time per week.” A hospice aide supervisory visit was dated 09/19/2024 and the next hospice aide supervisory visit was dated 01/02/2025, 105 days later and 91 days outstanding. The next hospice aide supervisory visit was dated 02/04/2025, 33 days later and 19 days outstanding. CLINICAL RECORD 4: The patient elected the hospice benefit on 07/09/2024. The plans of care dated 10/07/2024-01/04/2025 and 01/05/2025-03/05/2025 ordered, “Aide 1 time per week.” A hospice aide supervisory visit was dated 10/09/2024 and the next hospice aide supervisory visit was dated 10/30/2024, 21 days later and 7 days outstanding. A hospice aide supervisory visit was dated 11/27/2024 and the next hospice aide supervisory visit was dated 01/17/2025, 50 days later and 36 days outstanding. CLINICAL RECORD 14: The patient elected the hospice benefit on 11/20/2024. The plan of care dated 11/20/2024-02/17/2025 ordered, “Aide 1 time per week starting 11/27/2024.” The first hospice aide visit was dated 11/27/2024. The first hospice aide supervisory visit was dated 02/05/2025, 70 days later and 56 days outstanding. CLINICAL RECORD 22: The patient elected the hospice benefit on 05/03/2024. The plan of care dated 05/03/2024-07/31/2024 ordered, “Aide 2 times per week.” A hospice aide supervisory visit was dated 05/22/2024. The next hospice aide supervisory visit was dated 06/12/2024, 21 days later and 7 days outstanding. In an interview on 03/13/2025, the Hospice Clinical Manager reviewed the records, confirmed the above findings, and stated “There are no other supervisory visits in these patient charts.””

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes physician orders. This standard was not met as evidenced by clinical record review and interview. In 6 of 23 (26%) clinical records reviewed it was revealed that the agency did not ensure that the patient’s clinical record included all physician orders. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/21/2024. The nursing visit note dated 01/31/2025 read in part “Patient has a foley catheter in place after hospitalization.” The record lacked documentation of physician orders for the size, care and maintenance of the foley catheter. CLINICAL RECORD 7: The patient elected the hospice benefit on 01/24/2025. The nursing visit note dated 01/27/2025 read in part “RN placed an 18 Fr, 10ml balloon foley catheter.” The record lacked documentation of physician orders for the size, care and maintenance of the foley catheter. CLINICAL RECORD 12: The patient elected the hospice benefit on 10/28/2024. The initial nursing assessment dated 10/28/2024 read in part “Patient is utilizing continuous oxygen.” The plan of care dated 10/28/2024-01/25/2025 included orders to, “Train patient in pharmacological and non-pharmacological measures to manage/relieve respiratory symptoms including continuous oxygen.” The clinical record did not include a physician order for the dose and route of the oxygen. CLINICAL RECORD 13: The patient elected the hospice benefit on 12/27/2024. The initial nursing assessment dated 12/27/2024 read in part “Patient is on intermittent oxygen at 2 liters via nasal cannula.” The clinical record did not include physician orders for the dosage, route and frequency of the oxygen. CLINICAL RECORD 15: The patient elected the hospice benefit on 01/02/2025. The initial nursing assessment dated 01/02/2025 read in part “Patient is on continuous oxygen.” The plan of care dated 01/02/2025-04/01/2025 included orders to “Train patient in pharmacological and non-pharmacological measures to manage/relieve respiratory symptoms including oxygen.” The plan of care did not include a physician order for the dose, route, and frequency of the oxygen. CLINICAL RECORD 18: The patient elected the hospice benefit on 11/23/2024. The plan of care dated 02/21/2025-05/21/2025 included orders to “Train patient in pharmacological and non-pharmacological measures to manage/relieve respiratory symptoms including oxygen.” The clinical record did not include a physician order for the dose, route, and frequency of the oxygen. On 03/12/2025, the Hospice Clinical Manager reviewed the records and confirmed the finding that the records did not contain physician’s orders for the size, care and maintenance of the foley catheter nor physician’s orders for the dosage, route and frequency of oxygen.”

“It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) live discharge clinical records reviewed it was revealed that the agency did not ensure that a hospice discharge summary was sent to the receiving Medicare/Medicaid certified facility. CLINICAL RECORD 22: The patient elected the hospice benefit on 05/03/2024. A hospice discharge visit was dated 08/02/2024 and read in part “Patient transferred to another hospice.” The record lacked documentation of a hospice discharge summary being sent to the receiving hospice. On 3/14/2025 the Hospice Clinical Manager reviewed the record and confirmed the finding, stating “We do not have any documentation of a summary being sent. Our computer system was down at that time and a discharge summary was hand delivered to the receiving hospice.””