Three Oaks Hospice

“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 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 19 (5%) clinical records reviewed and home visits observed, the agency did not ensure that the medications were reviewed and updated to the drug profile. Clinical Record 6/ Home Visit 1: The patient elected hospice care on 08/26/2024 with a diagnosis of unspecified severe protein-calorie malnutrition. The patient resided in a skilled nursing facility (SNF). During the home visit with the Hospice Aide (HA) on 07/23/2025, the hospice medication profile was compared to the medication list provided by the SNF nurse. The hospice medication profile dated 07/23/2025 documented milk of magnesium, morphine sulfate, omeprazole, hyoscyamine, lorazepam, and Losartan as current medications. The SNF medication list included discontinuation for the milk of magnesium (discontinued 12/19/2024), morphine sulfate (discontinued 04/29/2025), omeprazole (discontinued 12/19/2024), hyoscyamine (discontinued 01/09/2025), lorazepam (discontinued 09/23/2024), and Losartan (discontinued 09/09/2024). There was no documented evidence that the patient’s medication profile was updated to include the patient’s current medication regimen. During a joint record review and interview on 07/23/2025, the Regional Vice President of Quality and Compliance agreed there was no documented evidence that the medications were reviewed and updated to the drug profile.”

“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 17 (6%) clinical records reviewed of patients who received Hospice Aide services, the hospice did not ensure that the Hospice Aide (HA) received written patient care instructions to meet the patient’s needs. CLINICAL RECORD 6: The patient elected hospice care on 08/26/2024 and resided in a skilled nursing facility (SNF). The hospice plan of care dated 05/28/2025 ordered HA services three times a week. The HA care plan documented in the electronic medical record (EMR), completed by the Registered Nurse (RN) dated 06/04/2025 through 06/28/2025, assigned the HA the relevant tasks every visit: bed bath, denture care, oral care, foot care, nail care, perineal care, shampoo, shave, and skin care. However, the contract HA was not able to access the written patient care instructions in the EMR. There was no documented evidence that the RN provided the contracted HA [Personnel Record 12] with the patient’s written care plan or assigned tasks for the HA visits dated 06/04/2025, 06/06/2025, 06/09/2025, 06/11/2025, 06/13/2025, 06/16/2025, 06/18/2025, 06/20/2025, 06/23/2025, 06/25/2025, and 06/26/2025. During a joint record review and interview on 07/24/2025, the Patient Care Manager agreed there was no documented evidence that an RN provided the contracted HA with written patient-specific care instructions. The Patient Care Manager stated, “We usually go over it with them on the phone, but nothing is documented. The contracted aides do not have access to our records (EMR).””

“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: the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes including the care and services provided. This standard was not met as evidenced by clinical record review and interview. In 1 of 17 (6%) clinical records reviewed of patients who received Hospice Aide services, the hospice did not ensure that the patient’s record included completed visit notes for Hospice Aide (HA) services. CLINICAL RECORD 6: The patient elected hospice care on 08/26/2024 and resided in a skilled nursing facility (SNF). The hospice plan of care dated 05/28/2025 ordered HA services three times a week. The HA care plan dated 06/04/2025 through 06/28/2025 assigned the HA the relevant tasks every visit: bed bath, denture care, oral care, foot care, nail care, perineal care, shampoo, shave, and skin care. During a review of the clinical record, HA visit notes located in the uploaded documents folder revealed HA visit notes dated 06/04/2025, 06/06/2025, 06/09/2025, 06/11/2025, 06/13/2025, 06/16/2025, 06/18/2025, 06/20/2025, 06/23/2025, 06/25/2025, and 06/26/2025. The visit notes documented that an HA visit was performed; however, they did not specify whether the HA provided services or completed the assigned tasks. During a joint record review and interview on 07/24/2025, the Patient Care Manager agreed there was no documented evidence that hospice aide services were provided as ordered on the plan of care. Additionally, the Patient Care Manager stated, “We identified this problem recently. We added a new checklist for the aides to document which tasks were completed. Unfortunately, this was not added until the beginning of July, and we have no evidence to show the services were provided for these dates.””