Mosaic Life Care Hospice

“Based on policy review, record review, observation, and interview, the hospice provider failed to ensure that all medications the patient was taking were current in, but not limited to, one of four home visit observation records reviewed (Record/Patient #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Medication Reconciliation,” dated: 02/27/2019, showed in part:- Purpose is to maintain and communicate accurate medication information;- Medication reconciliation is a process of comparing a patient’s current medications and previously prescribed medications with newly ordered medications;- When a patient is admitted from an outside facility (e.g. nursing home) and has a current facility medication list, this list is to be used to update the home medication list in the EMR (electronic medical record);- Through a good faith effort, the clinical caregiver reviews the electronic medication profile/medication list and verifies the current medication list with the patient/family member to include all prescriptions and over the counter (OTC) medications, noting compliance. A complete listing of the patient’s current medications includes the following for each medication: Drug name, dosage, route, frequency, compliance and date/time of last dose if available for inpatient;- The clinical caregiver updates the electronic medication list as appropriate using but not limited to the patient medication list;- Medication reconciliation: Admission Inpatient:* Once the patient’s current medication list is updated into the EMR, the attending/consulting provider completes the admission medication reconciliation process;* The attending/consulting provider reviews compliance information documented by caregiver. Medications may be discontinued or modified on the home medication list as necessary;* Each medication in the current medication list will have a corresponding order to either continue without modification, continue with modification, or do not continue; * The nurse obtains clarification regarding any deferred medications; - Home Services:* Upon admission, resumption of care and recertification to home services the organization will obtain, reconcile and document a complete list of the patient’s current medications. Medication profile will be initiated; * Document current regimen including medication name, dosage, route and frequency; including over the counter and non-prescription medications must be included; * Discrepancies found must be clarified with ordering provider; and* If hospice patient is in a facility, medication list should be obtained from the facility medication administration record. RECORD/PATIENT #2:Review of the clinical record showed the patient was admitted to hospice services on 12/23/2025 with a primary diagnosis of mass of right breast (most often benign (not cancer), commonly caused by fluid-filled cysts), dysphagia (difficulty swallowing), and developmental delay (child takes longer than expected to reach key life milestones). The patient lived with care givers in a long-term care facility. Observation and interview on 07/29/2026 at 2:00 PM showed the following discrepancies between the provider’s current medication profile and the patient’s facility medication administration record (MAR): - The provider’s current medication profile showed lorazepam (Ativan – treats anxiety) 2 milligram/milliliter (mg/ml), take 0.25 ml by mouth every four hours if needed for anxiety. The facility’s current medication profile failed to show lorazepam. During an interview on 07/31/2026 at 10:10 AM, the administrator stated that:- The medication profile should match the facility MAR, and - The staff did not have access to the facility EMR’s (electronic medical records), but meds were reconciled at admission, recertification and any change.”

“Based on policy review, record review, observation, and interview, the hospice provider failed to ensure that each patient had an individualized plan of care (POC) in one of five full records reviewed (Record/Patient #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s policy titled, “Scope of Assessment/Reassessment: Hospice,” dated 10/16/2023, showed in part:- The interdisciplinary group (IDG) develops a comprehensive POC individualized to the patient and caregivers;- The POC is based on team assessments of strengths, limitations, and needs and takes into account age specific needs, cultural, and spiritual needs and resources; and- The POC reflects patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessment and includes all service necessary for the palliation and management of the terminal illness and related conditions. RECORD/PATIENT #4:Review of the clinical record showed the patient was admitted to hospice services on 04/03/2026 with a terminal diagnosis of atherosclerosis of native coronary artery (an abnormal collection of calcium and cholesterol on the artery walls, also known as plaque buildup), and ischemic cardiomyopathy (painful heart muscle disorder caused by coronary artery disease (plaque buildup in the coronary artery), heart attacks, and reduced blood flow). The patient lived at home with a family caregiver. Review of, but not limited to, the skilled nurse (SN) visit dated 07/20/2026 showed: filled medication box times one week. Observation and interview on 07/28/2026 at 2:12 PM showed:- The patient had a freestyle libre (continuous blood glucose (sugar) monitoring system) sensor to his/her left upper posterior arm. He/she stated that the freestyle libre had been used for “some time”. - The patient kept their medications with a medication list all together in their bedroom. The patient stated that the nurse filled the medication box twice a week and that his/her grandchild, that lived in the home, prefilled all his/her insulin syringes. Review of the current POC dated 07/02/2026 to 09/29/2026 failed to show:- The freestyle libre;- Who was responsible for filling the medication box; and- Who was responsible for prefilling the insulin syringes. During an interview on 07/30/2026 at 3:57 PM, the registered nurse coordinator stated that he/she would expect the POC to include:- The freestyle libre;- Who was responsible for filling the medication box; and- The grandchild was prefilling the insulin syringes.”

“Based on policy review, record review, and interview, the hospice provider failed to provide education to the patient and family on the hospice’s policies and procedures for managing controlled drugs following the termination of hospice services in two of 12 records reviewed (Records/Patients #8 and #10). This deficient practice has the potential to affect all the patients on service by the provider. Findings included: Review of the provider’s policy titled, “Medication Administration, Disposition, Including the Delivery of Medication and Medical Provider Order for Home Health and Hospice,” dated 03/08/2024, showed in part:-The ongoing monitoring of medication and education is documented in the nurse visit notes;-A hospice nurse will direct the family to destroy medications according to the recommendations of Missouri Department of Natural Resources regarding the proper disposal of pharmaceutical waste. The nurse must document witnessing the destruction of medications in the electronic medical record; and -If the family chooses not to destroy medications at this time, the nurse, with authorization from the director or the administrator on call, may dispose of the medications according to the recommendations of Missouri Department of Natural Recourses regarding the proper disposal of pharmaceutical waste (Brochure #2291). The nurse must document which medications were destroyed at the time of the visit as well as what family member witnessed the destruction. RECORD/PATIENT #8:Review of the clinical record showed that the patient was admitted for hospice services on 05/11/2026 with a terminal diagnosis of congestive heart failure (CHF; a decrease in the ability of the heart to pump blood) and aortic dissection with an 8.3 cm (centimeter) ascending aortic aneurysm (aortic dissection with aneurysm; a tear in the inner layer of an artery wall). The patient resided in a private residence.Review of the discharge summary dated 06/29/2026 showed patient #8 terminated services to seek treatment at the emergency department for pain after a fall. The medication list indicated the patient had a prescription for lorazepam (a controlled narcotic used for relaxation and air hunger) 2 milligrams (mg) per milliliter (ml) (2 mg/ml) of concentrated solution and morphine (an opioid pain medication used to treat severe pain) 100 mg/5 ml of concentrated solution. The discharge summary failed to indicate if the patient kept the controlled medications, or if the medications were disposed of. The provider failed to show that destruction education had been given to the patient and family. RECORD/PATIENT #10:Review of the clinical record showed that the patient was admitted for hospice services on 05/14/2026 with a terminal diagnosis of malignant neoplasm of female breast, unspecified estrogen receptor status (an abnormal and uncontrolled growth of cancerous cells in breast tissue). The patient resided in a private residence.Review of the discharge summary dated 07/08/2026 showed patient #10 was transferring to another hospice with 24-hour caregivers. The clinical record failed to show what happened to the comfort pack (a small supply of prescribed medications for pain relief delivered to a patient’s home when hospice care begins) prescribed by the hospice. The lorazepam 2 ml/ ml and the morphine 100 mg/ 5 ml, were listed on the discharge pharmacy list. The provider failed to show that destruction education had been given to the patient and family. During an interview on 07/30/2026 at 3:15 PM, the registered nurse coordinator (RN) stated that there were some documentation issues. The nurse had told the RN that he/she did not know to do the controlled substance education with patients at discharge or transfer.”