Beyond Hospice

“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 and interview. In 1 of 26 (4%) clinical records reviewed, it was revealed that the agency did not ensure that all interventions for problems identified in the initial and updated comprehensive assessments were included in the plan of care. CLINICAL RECORD 9: The hospice election of benefit (EOVB) was 04/15/2026 with a primary diagnosis of Anal Cancer. The plan of care (POC) was dated 04/15/2026 - 07/13/2026. The history and physical stated that the patient had considered a colostomy to manage the fecal incontinence but was not a surgical candidate due to the cardiovascular status. The patient reported daily leakage from the rectum and needed to wear pads, stating she had not been using stool softeners related the leakage and fear of making it worse as documented on the nursing visit dated 04/15/2026. She also noted that she had a port in the right chest that was flushed 04/10/2026 but would require monthly flushing. There were no documented problems or interventions for the problems of incontinence and port management on the POC dated 04/15/2026 - 07/13/2026. During interview with the administrator and clinical director on 04/30/2026, who reviewed the record, it was stated that all the interventions were not documented.”

“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 following: Measurable outcomes anticipated from implementing and coordinating the plan of care. This standard was not met as evidenced by clinical record review and interview. In 5 of 23 (22%) clinical records reviewed, the agency did not ensure that all outcomes included in the plan of care were measurable. CLINICAL RECORD 5: The hospice election of benefit (EOB) was 03/23/2026 for a primary diagnosis of Parkinson’s. The goal dated 03/23/2026 for DME Management and supplies documented “Safe use of medical equipment” this was not measurable. The patient had a hospital bed, mattress, wheelchair, and a Hoyer Lift were all equipment that the patient had. The goal was not specific to “safe” for this equipment. A Problem Falls/Safety goal dated 03/23/2026, read in part, “minimize unavoidable dementia-induced fall risks for nursing facility residents “minimize was not measurable.” CLINICAL RECORD 7: The hospice election of benefit (EOB) was 02/16/2026 for a primary diagnosis of rectal cancer. The problem dated 02/16/2026 documented “Patient quality of life will be at an optimal level. “optimal” was not measurable. CLINICAL RECORD 11: The hospice election of benefit (EOB) was 01/14/2026 for a primary diagnosis of Lung Cancer. A pain goal was documented 01/14/2026 read in part, “patients’ quality of life will be at an optimal level.” “optimal” was not measurable. Also, a problem for pain documented the goal “patient will report that pain is reduced to the level personally desired: -_____ on a scale of 1-10, the desired amount was blank as of review 04/29/2026. Nursing note clinical documentation described tolerable pain verbalized by patient was a 3 and that was a patient preferred score. CLINICAL RECORD 14: The hospice election of benefit (EOB) was 03/08/2026 for a primary diagnosis of Alzheimer’s. A problem of pain documented first on 03/08/2026 with updated interventions every 2 weeks, the goal was documented as “Patient will report that pain is reduced to the level personally desired: _____ on a scale of 1-10. (the desire was blank). Also, Patient quality of life will be at an optimal level, “no definition of optimal” as of review 04/29/2026. CLINICAL RECORD 19: The hospice election of benefit (EOB) was 03/28/2026 with a primary diagnosis of chronic kidney disease and congestive heart failure. A problem for pain was documented first on 03/28/2026 with goal documented for pain as “Patient will report that pain is reduced to the level personally desired: ____ on a scale of 1-10”. (the desired amount was blank) “Patients quality of life will be at an optimal level” Optimal was not defined as of 04/30/2026. During interview on 04/30/2026 with the administrator (Personnel Record 12) and clinical director (Personnel Record 13) who stated that they will be doing follow up as the goals were not measurable.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed, in which a hospice aide services were provided, it was revealed that the agency did not ensure that the registered nurse prepared a hospice aide plan of care that contained clear and specific instructions for the patient’s required care. CLINICAL RECORD 12: The hospice aide plan of care was documented on 01/04/2026 with an assigned task of bad bath 2 times a week. The aide documented on 01/07/2026, 01/09/2026, 01/14/2026, 02/11/2026, -2/16/2026 , 02/18/2026, 03/09/2026, 02/25/2026, 04/08/2026, and 04/15/2026, no bath as the patient only wanted a bed bath or shower on Fridays. The aide plan of care was not updated for this as of 04/29/2026. The aide visits were 2 times a week. The aide did document notifying the nurse of the patient request for bathing only once a week. During interview of the administrator and clinical director on 04/29/2026 who reviewed the record stated that the aide plan should have been updated.”

“It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group; Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 23 (4%) clinical records reviewed, in which a hospice aide provided care, the agency did not ensure that the hospice aide provided services as ordered by the Interdisciplinary Group (IDG). CLINICAL RECORD 15: The hospice aide care plan assigned task on 01/22/2026 and updated 02/27/2026 included the task of shower weekly. The ordered aide frequency was one (1) time a week. On the aide visit notes dated 02/04/2026, the aide documented that a bed bath was provided instead of a shower and again on 03/25/2026 a bed bath instead of a shower, there was no documented evidence that the nurse was notified. During interview on 04/29/2026 with the administrator and clinical director who reviewed the record and stated that the hospice aide did not document to the ordered plan of care.”

“It is required that the hospice inpatient facility provides meals to each patient that are obtained, stored, prepared, distributed, and served under sanitary conditions. This standard was not met as evidenced by interview and observation. A tour of the agency’s inpatient unit (IPU) revealed that the agency did not ensure that the food that was made available for patient use was not expired. IPU TOUR: During a tour of the agency’s IPU on 04/29/2026, the following items were found in a beverage preparation area for beverages that were made available to patients and families: Lipton Iced Tea Lemon instant mix, 47.2 oz container partially full, with an expiration date of 11/27/2025; Folgers Classic Decaf instant coffee crystals packets, box of 6 unopened, with an expiration date of 10/31/2021; Ferrara instant expresso coffee, 2 oz jar partially full, with an expiration date of 12/18/2022; Folgers coffee singles coffee bags, box of 19 unopened, with an expiration date of 01/04/2014; Archer Farms coconut macaroon coffee, 12 oz bag partially full, with an expiration date of 09/02/2020; and Lipton iced tea bags, box of 24 bags partially full, with an expiration date of 06/14/2018. During an interview on 04/29/2026, the agency’s IPU Household Coordinator, who was present for the IPU tour, confirmed that the listed items were expired and had been available for patient use. A tour of the agency’s inpatient unit (IPU) revealed that the agency did not ensure that food that was made available for patient use was not expired.”