Parrish Palliative and Hospice Care, LLC

“Based on observations, interviews, record review, and agency policy review, the agency failed to provide the patient and/or representative with written notice of the patient’s rights and responsibilities for three patients (Patients (P) 6, P8, and P9) of three patient home binders reviewed during home visits. This failure had the potential to affect the patients and/or their representatives ability to be aware of and understand their rights under the hospice benefit.Findings included: 1. Review of P6’s “Face Sheet” located in the “Intake” tab of the electronic medical record (EMR) revealed a “Start of Care” (SOC) date of 08/22/23 and a diagnosis of Crohn’s disease (a digestive disorder).During a home visit observation at a Skilled Nursing Facility (SNF) on 04/16/26 at 9:00 AM, the hospice agency binder was reviewed. The binder did not contain information regarding the patient’s rights and responsibilities under the hospice benefit.During an interview on 04/16/26 at 10:15 AM, the Director of Nursing (DON) stated, “I have only been here for two weeks and was not aware that the patient’s rights and responsibilities were not included in the hospice binder.”During an interview on 04/16/26 at 2:24 PM, the Hospice Administrator stated, “I don’t know why that information was not there, we have all the signed documents at the office.”2. Review of P8’s “Face Sheet” located in the “Intake” tab of the EMR revealed a SOC date of 10/08/20 and a diagnosis of Alzheimer’s diseaseOn 04/16/26 at 10:45 AM, a visit was made to P8’s home. The hospice binder was reviewed with[TP1] [SH2] [SH3] Caregiver 1. There was no documentation to show that P8 or his/her representative was provided with a written copy of the rights and responsibilities under the hospice benefit.During an interview on 04/16/26 at 11:00 AM, Caregiver 1 stated, “That book has not been updated in six years.”During an interview on 04/16/26 at 2:59 PM, the Administrator stated, “I don’t know why that information was not included in the binder.”3. Review of P9’s “Face Sheet” located in the “Intake” tab of the EMR revealed a SOC date of 12/05/25 and a diagnosis of Alzheimer’s disease.On 04/16/26 at 12:00 PM, a visit was made to P9’s group home. A hospice binder could not be located in the group home. The owner of the group home was contacted on the telephone and confirmed no binder was ever received and the home did not have information regarding P9’s rights and responsibilities under the hospice benefit.During an interview on 04/16/26 at 2:52 PM, the Administrator stated, “I don’t know why she does not have a binder with this information in it.”Review of an undated agency policy titled, “Hospice Policy and Procedures” revealed, “Rights Policy... Hospice protects and promotes patient rights...Provide written notice of rights...Ensure confidentiality, dignity, and right to refuse care... Maintain grievance process documentation...””

“Based on observations, interviews, record reviews, and policy review, the Hospice agency failed to ensure three patient (Patients (P) 6, P8, P9) hospice binders reviewed during home visit observations had received information about all hospice services and non-covered services. In addition, the binders did not include documentation of the Hospice Election of Benefits or physician signed “Do Not Resuscitate” (DNR) order. This failure placed the residents and caregivers at risk of not fully knowing information about hospice services.Findings included: 1. Review of P6’s “Face Sheet” located in the “Intake” tab of the electronic medical record (EMR) revealed a “Start of Care (SOC)” date of 08/22/23, and a diagnosis of Crohn’s disease (a digestive disorder).Review of P6’s hospice binder during a home visit on 04/16/26 at 9:00 AM, at a Skilled Nursing Facility (SNF), revealed the binder did not include the following signed documents: Election of Hospice Benefit, a physician signed copy of the DNR, or the non-covered hospice services form.During an interview on 04/16/26 at 2:24 PM, the Hospice Administrator stated, “They[TP1] [SH2] [nursing home staff] have a binder and after the forms are signed, they are to put them into that binder. All forms are turned over to the nursing home administrator after signing. I don’t know why the information is not there, we have the signed documents at the office.”2. Review of P8’s “Face Sheet” located in the “Intake” tab of the EMR revealed, a SOC date of 10/08/20, and a diagnosis of Alzheimer’s disease.Review of P8’s hospice binder during a home visit on 04/16/26 at 10:45 AM, revealed no front cover which contained the hospice’s 24-hour phone number or the name and phone number of the Registered Nurse Case Manager (RN/CM). In addition, the following items were not located in the binder: Certification of Terminal Illness, Signed copy of the DNR.During an interview on 04/16/26 at 2:59 PM, the Administrator was asked why the signed documents had not been placed in P8’s home binder. The Administrator stated, “I don’t know why they are not in there; they were signed a while ago.”3. Review of P9’s “Face Sheet” located in the “Intake” tab of the EMR revealed a SOC date of 12/02/25, and a diagnosis of Alzheimer’s disease.During a home visit on 04/16/26 at 12:00 PM, no hospice binder was located at the group home where P9 resides.The group home staff confirmed there was no documentation regarding P9’s Election of Benefits, Certification of Terminal Illness, non-covered hospice services, or a DNR/Code Status at the group home.During an interview on 04/16/26 at 2:52 PM, the Administrator stated, “[P9] moved to this new house and those are standard forms that should have been in the binder. I don’t know why the group home does not have a binder.”Review of the agency policy titled, “Care to Residents in a SNF/NF [skilled nursing facility/nursing facility] and ICF/MR [intermediate care facility/mentally retarded]” dated 2016, revealed, “...Hospice will provide to the SNF/NF or ICF/MR the following information...Hospice election form and any advanced directives specific to each patient...Physician certification and recertification of the terminal illness specific to each patient...Names and contact information for Hospice personnel involved in Hospice care of each patient...””

“Based on interviews, record review, and policy review, the Hospice agency failed to ensure that the “Spiritual Counselor” and “Social Services” comprehensive assessments were completed within five days of the Hospice Election of Benefits (EOB) for four of 14 patients (Patient (P)1, P2, P3, P4). Failure to complete a spiritual assessment and/or social services assessment had the potential to miss the identification of the patient or their caregivers’ needs.Findings included: 1. Review of P1’s “Face Sheet” located in the “Intake” tab of the electronic medical record (EMR) revealed a “Start of Care” (SOC) date and an EOB date of 03/25/26, with a diagnosis of bone cancer.Review of the P1’s “Social Service” assessment in the “Assessments” tab in the EMR revealed the assessment was completed on 04/04/26, which was not within the required timeframe.2. Review of P2’s “Face Sheet” located in the “Intake” tab of the EMR revealed a SOC date and an EOB date of 08/08/25, with a diagnosis of colon cancer.Review of P2’s “Social Services” assessment located in the “Assessments” tab in the EMR revealed the assessment was completed on 08/29/25, which was not within the required timeframe.3. Review of P3’s “Face Sheet” located in the “Intake” tab of the EMR revealed a SOC date and an EOB date of 01/27/26 for a diagnosis of Alzheimer’s disease.Review of P3’s “Assessments” tab in the EMR revealed that no evidence of a comprehensive social services assessment was completed for P3 within five days, as required.4. Review of P4’s “Face Sheet” located in the “Intake” tab of the EMR revealed a SOC date and an EOB date of 03/10/26, for a diagnosis of a cerebral vascular accident (CVA-stroke).Review of P4’s “Spiritual Counselor” assessment located in the “Assessments” tab in the EMR revealed the assessment was completed on 04/01/26, which was not within the required timeframe.Review of P4’s “Social Services” assessment located in the “Assessments” tab in the EMR revealed the assessment was completed on 03/27/26, which was not within the required timeframe.During an interview on 04/17/26 at 1:52 PM, the Administrator stated, “It is my expectation that assessments are to be completed within five days, as required.”Review of the agency policy titled, “Coordination of Patient Care,” dated 2013, revealed, “...Ensure that all care and services are provided in accordance with the plan of care and are based on all assessments of the patient and family needs...””

“Based on interviews, record review, and agency policy review, the hospice agency failed to ensure the interdisciplinary group (IDG) developed a plan of care (POC) for spiritual needs and/or social service needs for four of 14 patients (Patients (P)1, P3, P4, P5). This failure had the potential to affect the planning of anticipated needs for the 12 patients who are currently receiving hospice services.Findings included: 1. Review of P1’s “Face Sheet” located in the “Intake” tab of the electronic medical record (EMR) revealed a “Start of Care (SOC)” date of 03/25/26 with a diagnosis of bone cancer.Review of P1’s POC located in the “Care Plan” tab in the EMR did not show the Licensed Medical Social Worker (LMSW) had developed a “Social Services” POC despite having completed an assessment and made visits.2. Review of P3’s “Face Sheet” located in the “Intake” tab of the EMR revealed a “SOC” of 01/27/26 with a diagnosis of Alzheimer’s disease.Review of P3’s POC located in the “Care Plan” tab in the EMR did not show the LMSW had developed a “Social Services” POC despite having completed an assessment and made visits.3. Review of P4’s “Face Sheet” located in the “Intake” tab of the EMR revealed a “SOC” date of 03/10/26 with a diagnosis of cerebral vascular accident (CVA-stroke).Review of P4’s POC located in the “Care Plan” tab in the EMR did not show the Spiritual Advisor had developed a “Spiritual Services” POC despite having completed an assessment and made visits.4. Review of P5’s “Face Sheet” located in the “Intake” tab of the EMR revealed a “SOC” date of 07/07/23 with a diagnosis of CVA.Review of P5’s POC in the “Care Plan” tab in the EMR did not show documentation that a “Spiritual Counselor” and “Social Services” had developed a POC despite having completed an assessment and made visits.During an interview on 04/17/26 at 1:47 PM, the Administrator stated, “I don’t know why they did not develop a care plan, we discuss it in IDG [interdisciplinary group].” The Administrator further stated, “My expectation is the care plan is developed when the assessment is completed.””

“Based on interview, record review, and policy review, the Hospice agency failed to obtain a signed “Certification of Terminal Illness (CTI)” which included a physician narrative indicating a life expectancy of six months or less for one patient (Patient (P) 11) in a total sample of 14. This failure had the potential for fraud.Findings include: Review of P11’s “Face Sheet” located in the “Intake” tab of the electronic medical record revealed a “Start of Care (SOC)” date on 01/15/26 with a diagnosis of end-stage heart failure.Review of the “Certifications” tab in the EMR revealed a verbal order dated 01/15/26, to admit to hospice was received from an on-call physician and was documented in the EMR by Registered Nurse (RN) 2. There was no signed CTI which included a narrative by the Medical Director (MD) to indicate P11 had a life-expectancy of six months or less since admission to hospice.During an interview on 04/17/26 at 12:37 PM, the Administrator stated, “I don’t know why it [CTI] wasn’t done. It was missed.”Review of an undated agency policy titled, “Patient Eligibility & Admission Policy” revealed, “...Patients must meet CMS [Center for Medicare and Medicaid] hospice eligibility criteria...Physician certification of terminal illness...Document diagnosis and related conditions...””

“Based on interview, record review, and policy review, the Hospice agency failed to send a discharge summary to the attending physician who assumed the patient’s care for one patient (Patient (P) 11) in a total sample of 14 patients’ who had revoked hospice services The failure to provide the current provider information regarding the services the patient received while on hospice had the potential to affect the patient’s continuity of care.Findings include: Review of P11’s “Face Sheet” located in the “Intake” tab of the electronic medical record (EMR) revealed a “start of care (SOC)” date of 01/15/26 and a diagnosis of end-stage heart failure.Review of information in the “Discharge” tab in the EMR revealed that on 03/06/26, P11 and his/her family had revoked hospice services. A discharge summary was completed, however, there was no indication that the discharge summary was provided to the attending physician.During an interview on 04/17/26 at 12:09 PM, the Administrator was asked if a copy of the discharge summary was provided to the attending physician. The Administrator stated, “No, I was not aware that I needed to do this.”Review of the agency policy titled, “Coordination of Patient Care,” dated 2013 revealed, “... Provide for an ongoing sharing of information with other non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions.””