Advisacare Solutions of Northern Michigan, 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, and 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, and 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 1 of 3 (33%) home visit observations, the agency did not ensure a review of medications the patient was currently using was completed to identify any potential adverse effects and drug reactions. CLINICAL RECORD 1/HOME VISIT 1: This patient elected the hospice benefit on 02/09/2026 with a terminal diagnosis of hypertensive heart disease with heart failure. The registered nurse (RN) initial assessment dated 02/09/2026 stated that patient had oxygen in the room to be used prn. This was not listed on the drug profile which was reviewed for the dates of 02/09/2026-05/04/2026. During the home visit observation on 05/04/2026 with the Registered Nurse (Personnel Record 1), a medication review was completed by comparing the hospice drug profile to the medication list in the home. The home medication list included barrier cream N/A Oral (by mouth) apply barrier cream twice a day to affected area. The home medication list included documentation that this barrier cream was last administered on 05/04/2026 at 7:47am. The hospice drug profile dated 05/04/2026 did not include the barrier cream. The RN stated that this barrier cream should be on the hospice drug profile and that the incorrect route of the medication would be corrected. During a joint review and interview conducted on 05/04/2026, the Administrator (Personnel Record 6) stated that the hospice drug profile would be updated to include the barrier cream and oxygen.”

“It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 14 (14%) clinical records reviewed, and in 1 of 3 home visit observations, the agency did not ensure that the plan of care included interventions based on problems identified in the initial and updated comprehensive assessments CLINICAL RECORD 1: This patient elected the hospice benefit on 02/09/2026 with a terminal diagnosis of hypertensive heart disease with heart failure. The initial registered nurse (RN) comprehensive assessment dated 02/09/2026 stated the patient experienced nausea, vomiting, agitation and diarrhea. The drug profile included Zofran 1 tablet every 6 hours as needed for nausea/vomiting and Zofran 2 tablets (4mg tablets) 1 time a day routine. The patient also experienced anxiety/agitation/hallucinations and was administered haloperidol lactate 0.5 ml oral every 6 hours (2mg/ml) as needed for agitation and nausea/vomiting, and lorazepam for 0.25 ml oral every 4 hours (2mg/ml) as needed for anxiety/agitation and restlessness. The plan of care was reviewed for the dates of 02/09/2026-05/04/2026 and did not include interventions for nausea, vomiting, agitation, or diarrhea. CLINICAL RECORD 3/HOME VISIT 3: This patient elected the hospice benefit on 12/18/2024 with a diagnosis of Parkinson’s Disease. Review of the clinical record revealed an RN visit note dated 04/24/2026 documented a red area to the patient’s mid-back. The hospice plan of care was reviewed for the dates of 04/26/2026-05/06/2026 and did not include interventions for the red area. During a home visit conducted with the hospice aide (Personnel Record 3), the hospice aide was observed to remove a bandage from the patient’s back which revealed an open area on the upper mid-section of the back. In joint review and interview with the Administrator (Personnel Record 6) conducted on 05/06/2026, the registered nurse case manager (RNCM)(Personnel Record 10) was contacted and stated that she made a visit to the patient to check the open area on Clinical Record 3. She stated that new orders had been received from the physician and the plan of care was updated to include interventions for the open area. The Administrator (Personnel Record 6) also stated that the plan of care for Clinical Record 1 would be updated to include interventions for nausea, vomiting, agitation, or diarrhea.”

“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, interview, and observation. In 3 of 10 (30%) clinical records reviewed in which hospice aide services were provided, the agency did not ensure that written patient care instructions for the hospice aide were clear and complete. CLINICAL RECORD 1: This patient elected the hospice benefit on 02/09/2026 with a terminal diagnosis of hypertensive heart disease with heart failure. The hospice plan of care dated 02/09/2026-05/04/2026 included orders for hospice aide visits two times a week (2XW). The hospice aide care plan prepared on 02/09/2026 and last reviewed by the registered nurse case manager (RNCM on 05/01/2026 instructed the hospice aide to provide a shower or bath every visit. In review of the HOSPICE AIDE visit note dated 05/01/2026, the hospice aide marked “acknowledged and completed shower or bed bath every visit”. The HOSPICE AIDE care plan did not clearly instruct the hospice aide to give the patient a shower or bed bath. The RN comprehensive assessment dated 02/09/2026 stated the patient was diagnosed with dysphagia. The hospice aide care plan dated 02/09/2026-05/04/2026 instructed the hospice aide to encourage fluids but did not provide instructions for aspiration precautions related to dysphagia. CLINICAL RECORD 2: This patient was admitted 12/31/2025 with a terminal diagnosis of cerebrovascular disease. The RN initial comprehensive assessment dated 12/31/2025 documented that the patient “requires CGA with gait belt and pivot transfers only. She is no longer ambulating or propelling her wheelchair.” The hospice plan of care dated 12/31/2025-03/31/2026 included orders for hospice aide visits three times a week (3XW). The hospice aide care plan dated 12/31/2025-03/31/2026 instructed the hospice aide to ambulate with caregiver assistance (CGA) and gait belt. This did not provide clear instructions for CGA and gait belt use were to be utilized for pivot transfers only. CLINICAL RECORD 3/HOME VISIT 3: This patient elected the hospice benefit on 12/18/2024 with a terminal diagnosis of Parkinson’s Disease. The hospice plan of care was reviewed for the dates of 02/11/2026-08/20/2026 and included orders for hospice aide visits two times a week (2XW). The hospice aide care plan, which was last updated at 05/03/2026, assigned the hospice aide the task of “Shower at every visit.” Review of the clinical record revealed an RN visit note dated 04/24/2026 documented a red area to the patient’s mid-back. The hospice plan of care was reviewed for the dates of 04/26/2026-05/06/2026 and did not include interventions for the red area. During a home visit conducted with the hospice aide (Personnel Record 3) on 05/05/2026, the hospice aide was observed to remove a bandage from the patient’s back which revealed an open area on the upper mid-section of the back. The hospice aide assisted the patient with her shower and applied a new bandage (plain gauze) to the open area on the patient’s back after the shower. The hospice aide care plan last updated 05/03/2026 did not include instructions addressing the wound dressing on the back should it become dislodged or wet during the shower. During a joint review and interview conducted on 05/06/2026, the Administrator (Personnel Record 6) stated that the hospice aide care plans needed to include more specific instructions for the hospice aide.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. Review of the Volunteer Activity Report dated 01/01/2026 revealed that the volunteer utilization for the year of 2025 was 0.1%. This did not meet the requirement of five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The Volunteer Coordinator (VC) stated that 4 new volunteers had just been onboarded and there was a performance improvement plan to increase the volunteer hours provided to patients. During the interview with the Administrator (Personnel Record 6) and the VC on 05/04/2026 the volunteer utilization was confirmed. An interview was conducted with the Administrator and the Volunteer Coordinator (VC) on 05/04/2026 and the Volunteer Activity Report dated 01/01/2026 was reviewed and revealed that the volunteer utilization for the year of 2025 was 0.1%. This did not meet the requirement of five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The VC stated that 4 new volunteers had just been onboarded and there was a performance improvement plan to increase the volunteer hours provided to patients.”

“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, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical record reviews, the agency did not ensure that the patient’s clinical record contained the physician orders. CLINICAL RECORD 1: This patient elected the hospice benefit on 02/09/2026 with a terminal diagnosis of hypertensive heart disease with heart failure. The RN initial assessment dated 02/09/2026 stated that the patient had oxygen in the room to be used prn. A review of the clinical record revealed that there was no order for oxygen. During a joint review and interview conducted on 05/06/2026, the Administrator (Personnel Record 6) stated that the physician would be contacted to obtain orders for oxygen.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: A summary of the patient’s hospice stay, including treatments, symptoms, and pain management; includes at least the following the patient’s current plan of care; and the patient’s latest physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for a patient discharged from service, the agency did not ensure the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; patient’s current plan of care; and the patient’s latest physician orders. CLINICAL RECORD 11: This patient elected the hospice benefit on 12/15/2025 with a terminal diagnosis of malignant neoplasm of the bladder and revocated on 04/24/2026. The clinical record did not include evidence that the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, current plan of care and the latest physician orders. During a joint review and interview conducted on 05/06/2026, the Administrator (Personnel Record 6) stated that the clinical record was thoroughly reviewed and there was no evidence that the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, current plan of care or the latest physician’s orders.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: A summary of the patient’s hospice stay, including treatments, symptoms, and pain management; includes at least the following the patient’s current plan of care; and the patient’s latest physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for a patient discharged from service, the agency did not ensure the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; patient’s current plan of care; and the patient’s latest physician orders. CLINICAL RECORD 11: This patient elected the hospice benefit on 12/15/2025 with a terminal diagnosis of malignant neoplasm of the bladder and revocated on 04/24/2026. The clinical record did not include evidence that the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, current plan of care and the latest physician orders. During a joint review and interview conducted on 05/06/2026, the Administrator (Personnel Record 6) stated that the clinical record was thoroughly reviewed and there was no evidence that the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, current plan of care or the latest physician’s orders.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: A summary of the patient’s hospice stay, including treatments, symptoms, and pain management; includes at least the following the patient’s current plan of care; and the patient’s latest physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for a patient discharged from service, the agency did not ensure the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; patient’s current plan of care; and the patient’s latest physician orders. CLINICAL RECORD 11: This patient elected the hospice benefit on 12/15/2025 with a terminal diagnosis of malignant neoplasm of the bladder and revocated on 04/24/2026. The clinical record did not include evidence that the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, current plan of care and the latest physician orders. During a joint review and interview conducted on 05/06/2026, the Administrator (Personnel Record 6) stated that the clinical record was thoroughly reviewed and there was no evidence that the attending physician received a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, current plan of care or the latest physician’s orders.”