Heartland Hospice (St Louis)

“Upon patient record review 2 of 19 (Patient #5,6) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process. Patient 5: There was no evidence of a spiritual care assessment of the patient/caregiver. Chaplain services were declined at the time of admission. There is no evidence that the RN or the SW completed this part of the assessment. Completed during survey. Patient 6: There was no evidence of a spiritual care assessment of the patient/caregiver. Chaplain services were declined at the time of admission. There is no evidence that the RN or the SW completed this part of the assessment. Completed during survey.”

“Upon patient record review, 1 of 19 (Patient #14) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 14: The patient was admitted on 12/11/25. There was no evidence a bereavement risk assessment was completed within 5 days of admission. The assessment was completed on 12/18/2025.”

“Upon patient record review, 1 of 19 (Patient #9) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 9: No evidence that a RN comprehensive assessment was completed every 15 days between 10/31/2025 and 11/21/2025, 21 days between assessments.”

“Upon patient record review, 1 of 19 (Patient #3) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 3: The aide documented on 01/05/26 that the patient had 2 skin tears to the patients right arm. The aide documented that she informed the nurse. No evidence that the nurse assessed the skin tears at the time that the chart was surveyed. Late data entry occurred during survey.”

“Upon patient record review, 2 of 19 (Patient #3,14) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient 3: The medical record indicated that the patient has chronic UTI’s and takes a prophylactic antibiotic daily. No evidence that problems, goals, and interventions related to infections were added to the current plan of care. Corrected on site. Plan of care updated during the survey. Patient 14: The RN admission documentation indicated that the patient is at high risk for falls. No evidence that the problems, goals, and interventions related to fall safety was added to the current plan of care. Corrected on site. Plan of care updated during the survey.”

“Upon patient record review, 1 of 19 (Patient #3) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 3: SW and SC frequency was listed as PRN only without a standing order on the initial evaluation order. Order corrected once the disciplines completed their evaluations.”

“Upon patient record review, 2 of 19 (Patient #13,14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 13: RN narrative documentation indicated that the patient used a Hoyer lift for all transfers. No evidence that the Hoyer lift was added to current DME supply list. Corrected on site. Plan of care updated during the survey to include the Hoyer lift. Patient 14: Active plan of care has active orders for oxygen. No evidence that oxygen or oxygen supplies added to the current supply list. Corrected on site. Plan of care updated during the survey to include the oxygen and supplies.”

“Upon client record review, 3 of 19 (Patient #7,11,16) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 7: The plan of care has an order for massage therapy to eval and treat written on 11/18/2025. No evidence that an evaluation or treatment was completed at the time of survey. Patient 11: The plan of care has an order for music therapy eval on 11/24/2025. No evidence that an evaluation was completed at the time that the chart was surveyed. Patient 16: The patient was discharged on 12/16/25 with no documentation that the patient was notified of discharge prior to discharge visit. There were problems/goals/interventions for discharge planning but no evidence the plan of care was followed.”

“Upon patient record review, 1 of 19 (Patient #16) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient 16: The patient was discharged on 12/16/2025. No evidence that the members of the IDG team were notified of the discharge before the day of discharge. No mention of patients discharge in any RN or MSW IDG notes before the IDG that occurred on 12/17/25, which was one day after the patient was discharged.”

“Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient 9: RN documentation on 11/09/2025 indicated that the patient’s son had a complaint, stating that the staff was unreliable and unpredictable. RN documented that she notified office management of the complaint. No evidence that an investigation was completed at the time the chart was surveyed. Corrected on site with late data entry.”

“Upon patient record review 2 of 19 (Patient #11,12) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 11: The plan of care has orders for the aide to start on 11/23/2025 at twice a week. No evidence that aide services were provided to the patient until 12/04/2025. Corrected on site with late data entry. Also the aide plan of care had orders for the patients linens to be changed weekly. Aide documentation indicated that it was completed at all visits except the visit that occurred on 12/22/25 and 12/24/25. Patient 12: The plan of care has aide frequency ordered as 3 times a week. No evidence that 3 visits were completed for the week of 01/12/2025. The aide documented that the visit was missed due to “other”. No evidence that the visit was missed at the request of the patient/caregiver. Corrected on site with late data entry.”

“Upon patient record review 3 of 19 (Patient #1,2,11) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient 1: The medical record indicated that aide visits started on 11/05/2025. No evidence that aide supervisory visit was conducted until 12/12/2025 and not again until 12/30/2025. Patient 2: The medical record indicated that aide visits started at the time of admission. No evidence that aide supervisory visit was conducted between 12/05/2025 and not again until 12/24/2025, 19 days. Then again between 01/01/2026 and 01/16/2026, 15 days. Patient 11: The medical record indicated that aide visit was scheduled as once weekly. No evidence that aide supervisory visit was completed every 14 days between 10/31/2025 and 11/21/2025.”

“Upon patient client record review, 2 of 19 (Patient #6,14) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 6: The NP documented that the patient was a DNR on the face-to-face that occurred on 10/29/25 and 12/13/25. The signed advanced directives and RN documentation indicated that the patient was a full code. Patient 14: RN documented an aide supervisory visit on 01/01/2026 and documented that the patient was receiving aide visits once a week in the IDG note that occurred on 12/31/2025. The medical record indicated that the patient was not receiving aide services since admission. RN documented LVN supervisory visits on 01/22/25 and 01/29/25. No evidence that a LVN completed visits for the patient since admission.”

“Upon client record review, 1 of 19 (Patient #8) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 8: The plan of care had SN frequency ordered as twice a week starting 11/23/25 and the volunteer frequency ordered as twice a month starting in November 25. No evidence that 2 visits for the RN week of 12/14 or that volunteer 2 visits were completed for the month of Jan 2026 at the time that the chart was surveyed. RN documentation stated that the 2nd visit was missed due to SN illness and other staff out.”