Novus Lifecare

“Based on review of the MedlinePlus drug information, policy review, record review, and interview, the hospice provider failed to ensure the plan of care (POC) reflected patient and family goals and included patient-specific interventions sufficient to guide hospice staff in patient care in, four of five full records reviewed (Records/Patients #1, #2, #3, and #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the MedlinePlus drug information website, accessed 06/02/2026 at medlineplus.gov, showed that metformin:- Helped to control the amount of glucose (sugar) in the blood; - Decreased the amount of glucose absorbed from food and the amount of glucose made by the liver; - May cause changes in blood sugar levels; and - Stated that patients should know the symptoms of high and low blood sugar and the actions to take should the symptoms occur. Review of the provider’s undated policy titled, “Plan of Care Content,” showed in part that the hospice written interdisciplinary plan of care is developed and individualized for each patient and family, reflects patient/family goals based upon problems identified in the initial/updated assessments, and includes all services necessary for palliation and management of the terminal illness and related conditions, including the following:- Treatments, drugs, biologicals and interventions to manage pain and symptoms of the terminal illness: including dosage/frequency/route when applicable; - Safety measures to protect against abuse, injury, infection or communicable disease, as appropriate; - Functional limitations; and- Diet and nutritional needs.Review of the provider’s undated policy titled, “Oxygen Therapy Management,” showed in part that:- Oxygen orders shall include: * Delivery device (nasal cannula, mask, etc.); * Flow rate or titration parameters; * Frequency of use whether continuous or PRN (as needed); and- The clinical record shall include: * Flow rate adjustments; and * Education provided to patients and caregivers. RECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 03/31/2026 with a terminal diagnosis of colon cancer with metastasis (the spread of cancer cells from their original location to other parts of the body) to the liver. The patient had secondary diagnoses of prediabetes (a condition where blood sugar levels are higher than normal).Review of the updated POC, dated 06/01/2026, showed in part that:- The POC contained orders for the patient to take metformin daily; and- The POC failed to contain orders to monitor the patient for signs and symptoms of hyper/hypoglycemia (high or low blood sugar).During an interview on 06/03/2026 at 9:00 AM, the administrator stated that:- The patient did not check his/her blood sugars;- They would expect the POC to contain interventions to monitor a patient’s blood sugars when on medication to lower blood sugar; and- The POC failed to contain interventions for the nurse to check the patient’s blood sugar in the event he/she exhibited signs and symptoms of hyper/hypoglycemia.RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 02/11/2026 with a terminal diagnosis of cancer of the rectum. The patient had secondary diagnoses of Alzheimer’s disease (a disease marked by progressive loss of mental capacity). He/she required total care and resided in a long-term care facility and required 24-hour-per-day care.Review of the updated Plan of Care Order, dated 06/01/2026, showed that:- The nurse was to monitor the patient’s pain level and related vital signs;- On 05/04/2026, 05/13/2026, 05/20/2026, and 05/27/2026 the patient had no pain; and- The patient had a pain control goal of a PAIN-AD scale (Pain in Advanced Dementia (a loss of mental capacity), a pain scale for patient unable to verbally rate their pain) rating of no more than four (a moderate level of pain) on a 0-10 high scale. During an interview on 06/03/2026 at 9:20 AM, the administrator stated that they would expect a patient with no reported pain to have a goal for pain control to be lower than moderate rating of four. RECORD/PATIENT #1:Review of the clinical record showed that the patient was admitted for hospice services on 02/20/2026 with a terminal diagnosis of cerebral infarction (occurs when blood flow to a section of the brain is severely reduced or blocked). The patient resided in a long-term care facility (LTCF). Review of the POC, dated 05/21/2026 to 08/18/2026, showed:- The patient had a high nutritional risk;- Interventions for nutritional risk included to assess for signs and/or symptoms of dysphagia and modify consistency of liquids as ordered, assess current by mouth (PO) intake and monitor for changes, and educate patient and/or caregiver(s) on aspiration precautions;- Nutritional goal of optimal nutritional/hydration will be achieved based on patient conditions and/or desires and the patient will maintain optimal swallowing;- The POC failed to include patient-specific dietary needs;- The patient had shortness of breath at times;- Interventions for respiratory distress included To assess for presence of respiratory secretions, assess for dyspnea or respiratory changes, educate on measures to reduce respiratory distress, educate patient and/or caregiver(s) on aspiration precautions, supplemental oxygen (O2) 5-10 liters (lts) as needed (PRN) for respiratory distress, ensure oxygen nasal cannula (NC) is changed monthly, and administer supplemental oxygen as ordered;- Respiratory discomfort goal showed the patient/caregiver would receive optimal teaching and support as cardiac and pulmonary functions change during care;- The POC showed a different dosage range for oxygen in the medication section that included supplemental oxygen 6-10 liters to be administered continuously to keep saturations (sats) greater than 90%;- The patient was a high fall risk;- Fall risk interventions included, identify safety issues and educate on safety precautions to prevent fall and/or injury and ensure bed is low and locked wheelchair (w/c) locked when out of bed and fall mats placed at bedside;- Durable medical equipment (DME): hospital bed, bedside table, Hoyer lift (A specialized patient transfer device designed to help caregivers move individuals with limited mobility between beds, wheelchairs, and bathroom safely and without physical strain) with sling, oxygen concentrator, and Broda chair (a specialized wheelchair that is highly adjustable and designed for complex positioning, fall prevention, and pressure relief); and- The POC failed to show the patient’s level of functional assistance needed. Review of the LTCF records, titled “Medication Review Report,” dated 06/02/2026, showed the following active orders:- A regular mechanical soft texture diet;- Boost oral liquid (nutritional supplement) give 30 milliliters (ml) by mouth three times a day for supplement with medication (med) pass;- Continuous supplemental oxygen at 10 liters via high flow NC; and- Change the oxygen tubing weekly on Sunday nights, date and bag the tubing, and place the tubing in the bag when not in use. Review of the hospice clinical record failed to show orders for a regular mechanical soft textured diet, boost oral liquid nutritional supplement three times a day, continuous supplemental oxygen at 10 liters via high flow NC, and weekly oxygen tubing changes. RECORD/PATIENT #2:Review of the clinical record showed that the patient was admitted for hospice services on 05/12/2026 with a terminal diagnosis of senile degeneration of the brain (a neurological disorder characterized by a progressive decline in cognitive function, memory impairment, and behavioral changes). The patient resided in an assisted living facility (ALF). Review of the POC, dated 05/12/2026 to 07/10/2026, showed:- Assess the need and encourage use of nutritional supplements as ordered;- The POC failed to include an order for nutritional supplements;- Educate on nutritional intake and needs as disease progresses;- The POC failed to include specific nutritional needs;- Administer Lactaid (a brand of lactase enzyme supplement that helps individuals with lactose intolerance comfortably digest dairy by breaking down lactose into easily absorbable sugars) as ordered due to dairy allergies;- Lactaid fast acting 9000-unit oral tablet, give one tablet by mouth every four hours as needed if eating dairy. May give an additional tablet if stomach upset occurs after consumption of dairy;- The POC failed to include show the patient’s diet and/or dietary needs;- Fall interventions showed, educate patient and/or caregiver(s) on ways to reduce falls risk, identify safety issues and educate on safety precautions to prevent fall and/or injury, assess for weakness and/or fatigue, assess for signs and/or symptoms of muscle atrophy or wasting (i.e measuring mid-arm circumference), and assess for injury from falls;- DME showed the patient had a walker and needed a hospital bed, foam mattress, and a walker;- The patient was worried that hygiene would not be adequate, and the goal was for optimal hygiene to be maintained during care;- Identify safety issues and educate on safety precautions to prevent fall and/or injury and a hospice aide to provide personal care needs twice a week for hygiene and bathing; and- The POC failed to show patient-specific safety precautions to prevent falls and failed the patient’s level of mobility and/or functional assistance needed. Review of the ALF records, titled “Medication Review Report,” dated 06/02/2026, showed the following active orders:- Diet: regular diet, no dairy; and- Tubi grips size E to bilateral lower extremities (BLE) from toes to knees, on in the morning and off at bedtime, elevate legs two times a day when resting (the hospice POC failed to include an order for tubi grips and failed to include interventions to elevate legs two times a day). During an interview on 06/03/2026 at 2:20 PM, the administrator stated that the hospice POC should always match with the facilities POC.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure the plan of care (POC) contained measurable outcomes in three of five full records reviewed (Records/Patients #3, #4, and #5). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Plan of Care,” showed that the interdisciplinary written plan of care is based on initial and updated patient-specific comprehensive assessments by members of the interdisciplinary group (IDG) and is developed with measurable goals and outcomes for planned interventions. RECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 03/31/2026 with a terminal diagnosis of colon cancer. The patient resided in his/her own home with the assistance of his/her spouse. Review of the updated POC/IDG note, last updated 05/20/2026, showed in part the following patient goals:- Optimal nutrition/hydration would be achieved based on patient conditions and/or desires during cares through end-of-life, the goal failed to identify what elements evidenced optimal nutrition/hydration; and- The patient and spouse would receive optimal teaching and support, the goal failed to identify what elements evidenced optimal teaching and support.RECORD/PATIENT #4:Review of the clinical record showed the patient was admitted to hospice services on 12/30/2025 with a terminal diagnosis of myeloblastic leukemia (a fast-growing cancer of the blood and bone marrow). The patient resided in his/her own home independently. Review of the updated POC/IDG note, last updated 05/20/2026, showed in part the following patient goals:- Care needs would be met safely and effectively by caregivers and the hospice team; the goal failed to identify what elements evidenced care being provided safely and effectively; - Patient and caregiver would receive optimal teaching and support as cardiac and pulmonary functions change during care, the goal failed to identify what elements evidenced optimal teaching and support; and- Optimal nutrition/hydration would be achieved based on client conditions and/or desires; the goal failed to identify what elements evidenced optimal nutrition/hydration. RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 02/11/2026 with a terminal diagnosis of cancer of the rectum. The patient resided in a long-term care facility. Review of the updated POC/IDG note, last updated 05/20/2026, showed in part the following patient goals:- The patient would receive optimal treatment and support as cardiac and pulmonary functions change during care, the goal failed to identify what elements evidenced optimal treatment and support; and- The patient’s needs would be identified by assessment and symptoms treated; the goal failed to identify what elements evidenced how the identified needs would be met. During an interview on 06/03/2026 at 9:20 AM, the administrator stated that they:- Would expect patient goals to be measurable; and- The identified goal statements failed to contain measurable elements to show the patient’s progress toward his/her identified goals.”

“Based on Missouri statute, policy review, and interview, the hospice provider failed to ensure that Alzheimer’s training for direct care staff included the topic of understanding and dealing with family issues. This deficient practice has the potential to affect the care of all patients served by the provider. Findings included: Review of 19 CSR 30-35.010 (2) (M) 1. B. (xiii) requires: “Alzheimer’s disease and related dementias. Hospice agencies shall provide dementia-specific training about Alzheimer’s disease and related dementias to their employees and those persons working as independent contractors who provide direct care to or may have daily contact with residents, patients, clients or consumers with Alzheimer’s disease or related dementias. (a) At a minimum, the training required shall address the following areas: A. An overview of Alzheimer’s disease and related dementias;B. Communicating with persons with dementia;C. Behavior management;D. Promoting independence in activities of daily living; andE. Understanding and dealing with family issues.(b) Employees or independent contractors who do not provide direct care for, but may have daily contact with, persons with Alzheimer’s disease or related dementias shall receive dementia-specific training that includes, at a minimum:A. An overview of Alzheimer’s disease and related dementias; andB. Communicating with persons with dementia.(c) Dementia-specific training about Alzheimer’s disease and related dementias shall be incorporated into orientation for new employees with direct patient contact and independent contractors with direct patient contact. The training shall be provided annually and updated as needed.”Review of the provider’s undated policy titled, “Development and Continuing Education Including In-services,” showed in part that: - Alzheimer’s training for direct care staff would include: * An overview of Alzheimer’s and related dementias; * Communicating with persons with dementia; * Behavior management; * Promoting independence in activities of daily living; and * Understanding and dealing with family issues; - Alzheimer’s training for non-direct care staff would include: * An overview of the dementias; and * Communicating with persons with dementia.Review of the Alzheimer’s training content provided to all direct care employees failed to contain information on understanding and dealing with family issues. During an interview on 06/02/2026 at 1:55 PM, the administrator stated that: - They were unable to find information on understanding and dealing with family issues in the Alzheimer’s module used for training new hires and annual education for those employees providing direct patient care; and- They have used the same training module for years.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that the inpatient facility provided hospice with a copy of the discharge summary at the time of discharge from respite care in, two of two respite records reviewed (Records/Patients #6 and #7). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated policy titled, “Facility Contracts-Inpatient Care Short Term Care,” showed that the hospice patient’s inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge and that a copy of the inpatient clinical record is available to the hospice at the time of discharge. RECORD/PATIENT #6:Review of the clinical record showed that the patient was admitted for hospice services on 12/16/2025 with a terminal diagnosis of malignant neoplasm of lung (lung cancer). The patient resided at home with his/her spouse. The patient was admitted to respite on 01/26/2026 and was discharged from respite on 01/30/2026. The clinical record failed to show a discharge summary from the inpatient facility provided to the hospice at discharge. RECORD/PATIENT #7:Review of the clinical record showed that the patient was admitted for hospice services on 09/30/2025 with a terminal diagnosis of cerebrovascular accident (CVA; stroke). The patient resided at home with his/her family. The patient was admitted to respite on 05/21/2026 and was discharged from respite on 05/26/2026. The clinical record failed to show a discharge summary from the inpatient facility provided to the hospice at discharge. During an interview on 06/02/2026 at 2:15 PM, the administrator stated that the inpatient facilities did not provide hospice with the discharge summary.”

“Based on Missouri law review, policy review, employee file review, and interview, the hospice provider failed to ensure criminal background checks were performed in, two of five employee files reviewed (Employees #1 and #3). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of Section 192.2495.3, RSMo: Prior to allowing any person who has been hired as a full-time, part-time or temporary position to have contact with any patient or resident the provider shall, or in the case of temporary employees hired through or contracted for an employment agency, the employment agency shall prior to sending a temporary employee to a provider: (1) Request a criminal background check as provided in section 43.540. Completion of an inquiry to the highway patrol for criminal records that are available for disclosure to a provider for the purpose conducting an employee criminal records background check shall be deemed to fulfill the provider’s duty to conduct employee criminal background checks pursuant to this section; except that, completing the inquiries pursuant to this subsection shall not be construed to exempt a provider from further inquiry pursuant to common law requirements governing due diligence. If an applicant has not resided in this state for five consecutive years prior to the date of his or her application for employment, the provider shall request a nationwide check for the purpose of determining if the applicant has a prior criminal history in other states.Review of Section 192.2495.6, RSMo: A provider is guilty of a class A misdemeanor if the provider knowingly hires or retains a person to have contact with patients or residents and the person has been found guilty in this state or any other state or has been found guilty of a crime, which if committed in Missouri would be a class A or B felony violation of chapter 565, RSMo (Offenses Against Persons), chapter 566, RSMo (Sexual Offenses), or chapter 569 (Robbery, Arson, Burglary and Related Offenses), or any violation of subsection 3 of section 198.070, RSMo (required reporter that knowingly fails to report abuse or neglect of a resident of a residential care, intermediate care or skilled nursing facility), or section 568.020, RSMo (Incest).Review of the provider’s undated policy titled, “Criminal Background Checks,” showed that criminal background checks are required for all employees (including volunteers) and contracted staff who provide direct patient care or who have access to patient records. Prior to an offer of employment to personnel and volunteers, the agency will conduct a state criminal history check. EMPLOYEE #1:Review of the registered nurse (RN) employee file showed the following:- Date of hire was 06/23/2025;- First patient contact was 06/23/2025; and- Criminal background check was completed 06/24/2025. EMPLOYEE #3:Review of the medical social worker (MSW) employee file showed the following:- Date of hire was 06/23/2025;- First patient contact was 06/23/2025; and- Criminal background check was completed 06/24/2025. During an interview on 06/02/2026 at 2:15 PM, the administrator stated that criminal background checks should be done prior to the first patient contact. The RN and MSW did not have criminal background checks performed prior to first patient contact due to (the provider) being under the impression that staff were grandfathered in as employees under the previous hospice (prior to the change of ownership that was effective on 06/23/2025).”

“Observed in Record Review. In 1 of 14 patient records reviewed, the organization had not implemented its criteria to assess pain. In the chart for RRNHV#9, the pain assessed at the admission did not include an evaluation of how bad the patient’s pain gets, the patient’s pain goal, etc. Rather simply that the patient had no pain at the visit. The patient/family identified goals of hospice care were documented as pain control and hospitalization avoidance. The patient was satisfied with Hydrocodone to manage her pain which apparently related to pain with bending/moving. This was confirmed with the LPN assisting with record review.”

“Observed in Record Review. In the chart for RRNHV#8, the patient was admitted one day post-suicide attempt, yet the goal on the plan of care related to depression and suicide risk was not individualized to the level of safety risk ...will be provided with education and support to manage patient depression within 1 week of hospice admission or onset of signs and symptoms of depression. This was discussed with the Director. Observed in Record Review. In the chart for RRNHV#10, the patient was at risk for pressure ulcer development, yet the plan of care did not include any goals related to reduction of risk or pressure ulcer prevention. Observed in Record Review. In 3 of 14 patient records reviewed, the written plan of care was not based on the patient’s goals and the time frames, settings, and services required to meet those goals. In the chart for RRHV#2, goals were not time based. Example Patient/family/caregiver will report that patient’s pain as at or below 4 on 1-10 scale or were not measurable Patient/family/caregiver will receive adequate support through the last 7 days of patient life.. This was discussed with the Assistant Director for Hospice.”

“Observed in Record Review. In 1 of 14 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the following: Interventions to manage pain and symptoms. In the chart for RRHV#2, the medication order on the plan of care was incomplete and included Patient will use Voltaren jel/Morphine concentrate and Tylenol as ordered.... The Voltaren was not included on the medication profile; there was no dosage/amount, frequency, location nor indication for use in the order for Voltaren. This was discussed with the Assistant Director for Hospice.
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“Observed in Record Review. In the chart for RRNHV#8, the patient was referred to hospice from the emergency department after a suicide attempt related to disease process and uncontrolled symptoms. The contract developed by the ED and the patient related to an agreement not to self-harm was included in a scanned document in the EMR, however the interventions were not included on the hospice plan of care. Those interventions included the caregiver to handle and dispense all medications; lock box for all narcotics; firearms secured and/or removed from the home; education/reinforcement to the patient/caregiver about coping/distraction techniques, etc. 
Additionally, the patient’s oxygen flow was recorded at 12-14 lpm with no order to increase from the admission order of 10 lpm. This was discussed with the Director. Observed in Record Review. In the chart for RRHV#3, during the most recent recertification assessment, approximately 2 weeks prior to the date of this survey, wound care was provided to a mid chest mass. There was no current order for wound care. The most recent wound care order was written two months prior to the survey for daily x 7 days. This was confirmed with the LPN assisting with record review. Observed in Record Review. In the chart for RRNHV#10, the patient was assessed to be at high risk for pressure ulcer development upon admission. The hospice plan of care did not include any interventions related to risk reduction. This was discussed with the LPN assisting with record review. Observed in Record Review. In the chart for RRHV#2, the plan of care orders were incomplete and included Change suprapubic catheter monthly with no catheter size; no specific order regarding suprapubic site care. There was documentation by the RN about specific cleansing to the suprapubic site. This was discussed with the LPN assisting with record review. Observed in Record Review. In 5 of 14 patient records reviewed, the plan of care did not include all medications and treatments necessary to meet the needs of the patient. In the chart for RRHV#1, the RN administered a Fleets enema based on a prn order. That order was not included on the patient’s plan of care and medication list. This was confirmed with the Assistant Director for Hospice.”

“Observed in Record Review. In the chart for RRNHV#8, the patient with a history of suicide attempt, the organization had not notified the Attending nor Hospice physician when the patient reported that he had made a suicide attempt. The RN made a prn visit, assessed the patient, initiated medications from the comfort pack to manage the patient’s symptoms, yet there was no documentation that either physician was made aware of the change in patient status, assessment and changed treatment needs. This was discussed with the Director. Observed in Record Review. In 2 of 14 patient records reviewed, the organization had not collaborated care amongst all disciplines. In the chart for RRHV#1, the initial depression screening scored an 8 on the tool. The instructions included on the clinical form indicated that a score above 3 was to be reported to the physician and social worker. There was no documentation this was reported to either discipline. This was discussed with the Assistant Director of Hospice Services.”

“Observed in Record Review. In the chart for RRHV#3, the aide care plan stated n/a to any safety measures. The patient has oxygen, uses a walker and has dressings which are to be kept dry. Observed in Record Review. In the chart for RRHV#2, the Aide assignment did not include any directive about the oxygen - whether prn/continuous, etc. This was discussed with the LPN assisting with record review. Observed in Record Review. In the chart for RRNHV#6, the patient was diabetic yet the aide assignment included trimming nails at each visit. Per the Assistant Director, Aides are not allowed per organizational policy to trim nails for diabetic patients. There were no diabetic or oxygen precautions on the aide plan of care. Observed in Record Review. In 4 of 14 patient records reviewed, the hospice registered nurse had not prepared complete written patient care instructions. In the chart for RRHV#1, the aide plan of care did not include bleeding precautions for this patient on Eliquis. This was discussed with the Assistant Director of Hospice Services.”