Alternative Hospice, LLC

“Based on policy review, contract review, record review and interview, the hospice failed to ensure patients’ rights to effective pain and symptom management by failing to provide timely access to medications, failing to ensure timely nursing response after hours, and failing to coordinate services necessary to prevent unnecessary pain and distress. These failures resulted in unmanaged symptoms in, two of three patient records reviewed (RECORD/PATIENT #1 and #2). This deficient practice has the potential to affect all patients served by the provider. Findings Included: Review of the provider’s policy titled, “After Hours Accessibility,” revised June 2019, showed in part the following:- Nursing services, physician services and drug and biologicals are routinely available on 24-hour basis 7 days a week; and- Other covered services must be available on a 24-hour basis when reasonable and necessary to meet the needs of the patient and family.Review of the provider’s policy titled, “Coordination of Patient Care,” revised June 2019, showed in part the following:- Ensure that care and services are provided in accordance with the plan of care and are based on all assessments of the patient and family needs; and- Care will be coordinated with other involved external organizations such as pharmacy companies. Review of the provider’s policy titled, “Nursing Services,” revised February 2025, showed in part the following:- Patients receiving nursing services will have appropriate assessments and reassessments of the patient’s needs; and- Responsibilities include informing the physician, medical director, interdisciplinary group (IDG) and other staff of changes in the patient’s needs. Review of the provider’s policy titled, “Medication Dispensing,” revised June 2019, showed in part, the following:- Hospice staff will order medications from the contracted pharmacy in advance of patient’s need to assure timely delivery of medications; and- Hospice medications are to be available 24 hours per day, 7 days per week through contracted pharmacy providers. Review of the hospice’s contracted pharmacy agreements showed that the pharmacies’ hours of operation were limited to daytime and weekend hours. None of the agreements included provisions for 24-hour medication dispensing or delivery. The agreements included only 24-hour on-call pharmacist availability, which does not ensure 24-hour access to medications. RECORD/PATIENT #1:Review of the medical record showed the patient was admitted to hospice services on 02/26/2026 with a terminal diagnosis of heart failure (a decrease in the ability of the heart to pump blood). The patient resided in a long-term care facility (LTCF) and died on 03/01/2026.Review of the physician orders dated 02/26/2026 showed morphine sulfate (Roxanol) (used to treat moderate to severe pain) 5 milligrams (mg) sublingual every 2 (two) hours as needed for pain or dyspnea (shortness of breath) and lorazepam (Ativan) (antianxiety) 0.5 mg sublingual every 4 (four) hours as needed for anxiety/restlessness.Review of the on-call log dated 2/27/2026 at 9:34 AM, documented events from the night of 02/26/2026, showed the following:- The LTCF was locked out of the stat (for immediate use) drug machine (the LTCF medication supply that was not provided by hospice. The hospice provider had the orders for the medication but had not delivered the medication to the patient);- The hospice nurse obtained temporary orders;- The family became upset and considered sending the patient to the emergency room (ER);- The hospice nurse believed the patient was anxious and “did not need morphine”; and- The LTCF eventually accessed the stat drug machine. Review of the on-call report dated 3/2/2026 at 8:45 AM, showed:- The patient’s daughter called on 02/27/2026 requesting an increase in morphine due to the patient was crying and had discomfort;- The hospice nurse relied on LTCF nurse’s assessment; and- Ativan was given and the hospice staff failed to assess the patient. During an interview on 03/18/2026 at 11:25 AM, the reporter stated that:- The LTCF medication system locked up;- The patient was in excruciating pain for several hours and the family also reported the patient was having chest pain;- The daughter called hospice around 9:00 PM or 10:00 PM, hospice did not send a nurse;- The hospice indicated they were not contracted with a 24-hour pharmacy;- The hospice offered no advice or follow-up;- The reporter advised the daughter to call emergency medical system (EMS);- The LTCF eventually accessed the medication and the patient became comfortable; and- The hospice nurse visited the next day (02/28/2026). During interview on 03/23/2026 at 12:29 PM, the on-call nurse stated that:- The patient was admitted after 4:00 PM and the comfort kit was delivered the next morning;- The physician sent the patient’s medication orders to the hospice’s usual contracted (named) pharmacy; and- There was a separate pharmacy identified as a potential 24-hour option. Review of the hospice’s contracted pharmacy agreements provided by the hospice provider showed that none of the pharmacies provided 24-hour medication dispensing or delivery. During an interview on 03/23/2026 at 1:12 PM, hospice registered nurse (RN) A stated that:- The patient arrived after 4:00 PM and the LTCF was busy;- The comfort kit was not delivered that night;- The family called at 9:30 PM reporting the LTCF could not access the emergency kit;- The nurse did not visit and relied on the LTCF assessment;- The family reported chest pain, and the nurse did not assess;- The nurse acknowledged he/she should have made a visit; and- There was no 24-hour pharmacy available locally. During interview on 03/24/2026 beginning at 10:35 AM, the clinical director stated that:- There was a 24-hour (named) pharmacy;- He/she was not made aware of the facility’s inability to access the stat kit;- The pharmacy contract required a 90-minute delivery timeframe; and- He/she would expect a visit for uncontrolled pain. During an interview on 03/23/2026 at 12:29 PM, the administrator stated that:- After-hours nursing visits are often determined based on whether the facility or family requests a visit; and- The patient was admitted after 4:00 PM and the comfort kit was not delivered until the following morning. RECORD/PATIENT #2;Review of the patient’s medical record showed the patient was admitted to hospice on 1/19/2026 with a terminal diagnosis of unspecified severe protein-calorie malnutrition. Other diagnoses included heart disease and heart failure. The patient lived in a LTCF and died on 03/21/2026.Review of the on-call record dated 02/16/2026 at 8:30 AM, showed that:- On 02/15/2026 (evening) the patient complained of chest pain;- The LTCF did not have any as needed (PRN) medications available to control symptoms; and- The hospice nurse instructed the LTCF to lay the patient down (there was no further follow up by the hospice nurse until the next day). Review of the nurse note dated 02/16/2026 at 8:10 AM, showed that:- The patient reported left-sided chest pain over the weekend;- Pain noted upon touch under the left arm/rib area; and- A chest x-ray was ordered. Review of a chaplain note dated 02/16/2026 at 11:10 AM showed the patient reported slight chest pain. During interview on 03/26/2026 at 7:37 AM, the clinical director stated that he/she would have expected the nurse to have a made a visit.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that the comprehensive assessment included an assessment of all the physical needs of the patient in one of five full records reviewed (Record/Patient # 5). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s policy titled, “Initial Assessment / Comprehensive Assessment,” revised 02/2025, showed in part the following:- Each patient admitted will receive a comprehensive assessment; and- The comprehensive assessment will identify the patient’s physical care needs. RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 01/30/2026 with a terminal diagnosis of bladder cancer. The patient resided at home with family support.Review of the registered nurse (RN) initial assessment, dated 01/30/2026, showed the following:- Hospice pain assessment section failed to include the location of the patient’s pain;- Hospice gastrointestinal assessment section showed the patient had a colostomy (a surgical opening in the abdominal wall (stoma - typically a red and moist opening on the surface of the abdomen) used to expel waste from the large intestines). The assessment failed to identify the location of the colostomy, the appearance of the stoma, if the colostomy was covered with a collection bag, or the appearance / absence of waste excreted from the colostomy; and- Hospice genitourinary assessment section showed the patient had an ileostomy (a surgical opening in the abdominal wall (stoma) that brings the small intestine (ileum) to the surface and produces continuous, liquid, and acidic waste). The assessment failed to include a location of the ileostomy, the appearance of the stoma, if the ileostomy was covered with a collection bag, or the consistency and appearance of the drainage coming from the ileostomy.During an interview on 02/19/2026 at 2:15 PM, the hospice administrator designee stated that he/she would expect the location of pain and a full assessment of the colostomy and ileostomy to be documented.”

“Based on policy review, record review, home visit observation, and interview the hospice provider failed to ensure an accurate/updated medication profile was maintained in one of five full records reviewed (Record/Patient #1). This deficient practice has the potential to affect all patients served by the provider.Findings included: During an interview on 02/18/2026 at 2:30 pm the registered nurse coordinator (RNC) stated that skilled nursing staff are responsible to follow the hospice provider’s policy regarding medication reconciliation. The staff are directed to compare the patient’s medication bottle(s) to the most current medication list to ensure accuracy once each week. This process is completed in the patient’s home or nursing facility. If discrepancies are discovered, staff are directed to contact the patient’s physician for resolution of the discrepancy. Review of the provider’s policy titled, “Medication Reconciliation,” revised June 2019, showed in part:- Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication; and- When a patient is transferred to another organization, Hospice will fax a copy of the patient’s current medication list/profile to the organization and inform the organization how to obtain clarification regarding the reconciled list of medications. Such communication is documented. Review of the provider’s policy titled, “Care to Residents of SNF/NF or ICF/IID,” (skilled nursing facility/nursing facility or intermediate care facility for individuals with intellectual disabilities) revised February 2025, showed in part, the named hospice will provide to the SNF/NF the following information:- The most recent hospice plan of care specific to each patient; and- The hospice medication information specific to each patient. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice services on 12/19/2025, with a terminal diagnosis of unspecified severe protein-calorie malnutrition. The patient lived in a skilled nursing facility (SNF). Review of the current hospice medication profile showed in part the following:- Atropine ophthalmic solution 1% 2 (two) drops SL (sublingual) every 4 (four) hours as needed for excess secretions;- Magnesium hydroxide (Milk of Magnesia Suspension) 400 mg/5mL 30 mls PO (by mouth) once per day;- Acetaminophen 325 mg (milligrams) 2 (two) tables PO (by mouth) every 6 (six) hours, do not exceed 3 grams/24 hours;- Barrier cream apply topically PRN (as needed) after peri-care for redness/irritation every 8 (eight) hours; and- Lotion apply topically prn for dry skin once a day. Review of the current SNF’s medication orders and Medication Administration Record (MAR) showed in part the following:- Atropine 1% eye drops (Atropine Sulfate) 1-2 (one to two) drops sublingually (medication placed under the tongue) every 4 (four) hours as needed for secretions (the facility list had 1-2 drop range instead of the 2-drop dose on the hospice list);- Milk of Magnesia 400 mg/5 milliliters (ml) oral suspension (Magnesium Hydroxide) 30 ml by mouth as needed constipation (the facility list failed to include the timeframe of once per day); and- Tylenol 325mg tablet (acetaminophen) 2 tablets by mouth as needed pain (the facility list failed to include timeframe of every 6 (six) hours). The provider failed to reconcile the medications, which showed three medications failed to have a time frame for administering prn medications on the SNF’s record, and failed to include two treatments listed on the providers record but not listed on the SNF’s record.”

“Based on policy review, record review, and interview, the provider failed to ensure that each patient received an individualized initial or revised plan of care (POC) in four of five full records reviewed (Records/Patients #2, #3, #4, and #5). This deficient practice has the potential to affect all patients served by the provider. RECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 08/12/2025 with a terminal diagnosis of protein-calorie malnutrition, and additional diagnoses of diabetes mellitus type 2 (a chronic disease that affects how the body uses sugar for energy), and depression. The patient resided with an adult sibling caregiver.Review of five skilled nurse visit notes with a date range of 01/19/2026 through 02/03/2026 showed the nurse documented that the patient’s blood glucose was obtained.Review of the updated POC dated 01/20/2026 showed the care need (care plan) section failed to include an endocrine care need with goals and interventions related to the patient’s diagnosis of diabetes; included a depression care need that failed to include a goal or intervention, and included an anticipatory grief care need that failed to include a goal or intervention. No additional orders were noted on the POC and no interim orders related to checking the patient’s blood glucose were provided. RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 01/30/2026 with a terminal diagnosis of bladder cancer. The patient resided at home with family support.Review of the Registered Nurse (RN) Initial Assessment, dated 01/30/2026, showed the following:- Patient had a colostomy (a surgical opening in the abdominal wall (stoma - typically a red and moist opening on the surface of the abdomen) used to expel waste from the large intestines), an ileostomy (a surgical opening in the abdominal wall (stoma) that brings the small intestine (ileum) to the surface and produces continuous, liquid, and acidic waste), three pressure ulcers (one stage 1 and two stage 2), and had pain; and- The RN assessed the patient’s pain, but failed to assess/document the location of pain; and - The RN documented that wound care was provided to the three pressure ulcers.Review of the initial POC dated 01/30/2026 through 04/29/2026 showed the document included a colostomy/ileostomy care need that failed to include a goal or intervention, a pain care need that failed to include goals or interventions, and the document failed to include an integumentary care need with goals and interventions for the pressure ulcers. No additional orders were noted on the POC, and no interim orders were provided, for colostomy/ileostomy, pain, or wound care.Review of the updated plan of care dated 02/05/2026 failed to include any new orders or care needs with goals or interventions for the colostomy/ileostomy, pain, or integumentary/wounds.During an interview on 02/19/2026 at 2:15 PM, the hospice administrator designee stated that he/she would expect orders to be in the record. Findings included: Review of the provider’s policy titled, “Physician Orders” revised 02/2025, showed, in part:The plan of care (POC) may include:Types of services required;Specific procedures deemed essential;Medications and treatments;Equipment and supplies required (including flow rate, delivery device, hours of use etc.;Expected goals or outcomes to be achieved;Care and services provided will be provided according to physician orders; andOrders are current and updated. RECORD/PATIENT #2:Review of the clinical record showed the patient was admitted to hospice services on 08/15/2024 with a terminal diagnosis of Alzheimer’s disease (a disease marked by progressive loss of mental capacity). The patient lived in a specialized memory care unit of a Skilled Nursing Facility (SNF).Review of the Medication Administration Record dated 02/2026 showed hospice and facility staff shared the responsibility of wound care of the patient’s wound located on the right cheek of the face. The treatment order dated 2/11/2026, showed staff were directed to clean the wound with wound cleanser, apply Mupirocin (an anti-bacterial ointment) to the wound bed, apply zinc oxide (an antiseptic ointment) to the peri-wound, then cover with a gauze dressing, and affix with adhesive tape once each day.Review of the patient’s Plan of Care (POC) dated 02/06/2026 to 04/06/2026 failed to show the wound care treatment as an intervention as part of the POC for the problem of impaired skin integrity identified by the provider on 05/27/2025.During an interview on 02/18/2026 at 2:30 pm the registered nurse coordinator (RNC) stated that all interventions including the wound care treatment should be included in the patient’s impaired skin integrity POC. The RN supervisory nurse stated the omission was probably hospice staff failing to save the order / intervention when updating the POC. RECORD/PATIENT #4:Review of the clinical record showed the patient was admitted to hospice services on 12/18/2025 with a terminal diagnosis of vascular dementia (a decline in mental capacity). The patient lived at home with daughters as primary caregivers.Review of the Physician’s Order Sheet (POS) dated 02/09/2026 showed an order for a urinary catheter to be placed for urinary incontinence. The order read as follows: May place foley (a brand of urinary catheter) 18 French for comfort. Change PRN (as needed) leaking or clogged. May flush PRN with 60 ml (milliliters) of normal saline if needed or clogged.Review of the patient’s Plan of Care (POC) dated 12/18/2026 to 03/17/2026 showed the hospice staff identified the patient’s problem of genitourinary / catheter. The intervention read as follows: SN (Skilled Nursing) will replace 18 French foley if clogged, flush with 60 cc (cubic centimeters) of sterile water PRN. The POC failed to show the intervention as the physician order as written.During an interview on 02/18/2026 at 2:30 pm the registered nurse coordinator (RNC) stated that all interventions and physician orders should match on the patient’s POC. Findings included:Review of the provider’s policy titled, “Physician Orders” revised 02/2025, showed in part the plan of care (POC) may include:- Types of services required;- Specific procedures deemed essential;- Medications and treatments;- Equipment and supplies required (including flow rate, delivery device, hours of use etc.);- Expected goals or outcomes to be achieved;- Care and services provided will be provided according to physician orders; and- Orders are current and updated.RECORD/PATIENT #2:Review of the clinical record showed the patient was admitted to hospice services on 08/15/2024 with a terminal diagnosis of Alzheimer’s disease (a disease marked by progressive loss of mental capacity). The patient lived in a specialized memory care unit of a skilled nursing facility (SNF).Review of the medication administration record dated 02/2026, showed hospice and facility staff shared the responsibility of wound care of the patient’s wound located on the right cheek of the face. The treatment order dated 2/11/2026, showed staff were directed to clean the wound with wound cleanser, apply mupirocin (an anti-bacterial ointment) to the wound bed, apply zinc oxide (an antiseptic ointment) to the peri-wound, then cover with a gauze dressing, and affix with adhesive tape once each day.Review of the patient’s POC, dated 02/06/2026 to 04/06/2026, failed to show the wound care treatment as an intervention as part of the POC for the problem of impaired skin integrity identified by the provider on 05/27/2025.During an interview on 02/18/2026 at 2:30 PM, the registered nurse coordinator (RNC) stated that all interventions, including the wound care treatment, should have been included in the patient’s impaired skin integrity POC. The RNC stated that the omission was probably hospice staff failing to save the order / intervention when updating the POC.RECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 08/12/2025 with a terminal diagnosis of protein-calorie malnutrition and additional diagnoses of diabetes mellitus type 2 (a chronic disease that affects how the body uses sugar for energy), and depression. The patient resided with an adult sibling caregiver.Review of five skilled nurse visit notes, with a date range of 01/19/2026 through 02/03/2026, showed the nurse documented that the patient’s blood glucose was obtained.Review of the updated POC dated 01/20/2026, showed the care need (care plan) section failed to include an endocrine care need with goals and interventions related to the patient’s diagnosis of diabetes; included a depression care need that failed to include a goal or intervention, and included an anticipatory grief care need that failed to include a goal or intervention. No additional orders were noted on the POC and no interim orders related to checking the patient’s blood glucose were provided.RECORD/PATIENT #4:Review of the clinical record showed the patient was admitted to hospice services on 12/18/2025 with a terminal diagnosis of vascular dementia (a decline in mental capacity). The patient lived at home with daughters as primary caregivers.Review of the physician’s order sheet (POS), dated 02/09/2026, showed an order for a urinary catheter (a sterile tube placed in the bladder to drain urine) to be placed for urinary incontinence. The order read as follows: May place Foley (a brand of urinary catheter) 18 french for comfort. Change PRN (as needed) leaking or clogged. May flush PRN with 60 milliliters (ml) of normal saline if needed or clogged.Review of the patient’s plan of care (POC) dated 12/18/2026 to 03/17/2026 showed the hospice staff identified the patient’s problem of genitourinary / catheter. The intervention read as follows: SN (Skilled Nursing) will replace 18 French foley if clogged, flush with 60 cc (cubic centimeters) of sterile water PRN. The POC failed to show the intervention as the physician order was written.RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 01/30/2026 with a terminal diagnosis of bladder cancer. The patient resided at home with family support.Review of the Registered Nurse (RN) Initial Assessment, dated 01/30/2026, showed the following:- Patient had a colostomy (a surgical opening in the abdominal wall (stoma - typically a red and moist opening on the surface of the abdomen) used to expel waste from the large intestines), an ileostomy (a surgical opening in the abdominal wall (stoma) that brings the small intestine (ileum) to the surface and produces continuous, liquid, and acidic waste), three pressure ulcers (one stage 1 and two stage 2), and had pain; and- The RN assessed the patient’s pain, but failed to assess/document the location of pain; and - The RN documented that wound care was provided to the three pressure ulcers.Review of the initial POC dated 01/30/2026 through 04/29/2026 showed the document included a colostomy/ileostomy care need that failed to include a goal or intervention, a pain care need that failed to include goals or interventions, and the document failed to include an integumentary care need with goals and interventions for the pressure ulcers. No additional orders were noted on the POC, and no interim orders were provided, for colostomy/ileostomy, pain, or wound care.Review of the updated plan of care dated 02/05/2026 failed to include any new orders or care needs with goals or interventions for the colostomy/ileostomy, pain, or integumentary/wounds.During an interview on 02/18/2026 at 2:30 PM the registered nurse coordinator (RNC) stated that all interventions and physician orders should match on the patient’s POC.During an interview on 02/19/2026 at 2:15 PM, the hospice administrator designee stated that he/she would expect orders to be in the record.”

“Based on policy review, record review, and interview, the hospice provider failed to revise the hospice plan of care to reflect changes that occurred in the facility where respite care was provided in one of two respite records reviewed (Record/Patient #7). This deficient practice has the potential to affect all patients served by the provider. Findings included:Review of the provider’s policy titled, “Physician Orders,” revised 02/2025, showed in part that orders would be current and updated. RECORD/PATIENT #7:Review of the clinical record showed the following:- A skilled nurse (SN) visit note, dated 11/17/2025, that showed the patient was transferring to a long-term care facility (LTCF) for respite care related to increased care needs and caregiver strain; - A SN visit note dated 11/18/2025, that showed the patient had a productive cough with green phlegm and the SN obtained an order for Levaquin (an antibiotic) 500 milligrams (mg) daily for five days; - A LTCF summary report that showed an order, dated 11/18/2025, for levofloxacin (another name for Levaquin) 500 mg daily for seven days; an order dated 11/20/2025 to increase Roxanol (narcotic pain medication) 20 mg/milliliter (ml) from 0.25 ml to 0.5 ml every two hours as needed for pain; and an order dated 11/20/2025 to increase lorazepam (antianxiety medication) 2 mg/ml from 0.25 ml to 0.5 ml every three hours as needed for restlessness or agitation; and- The hospice updated plan of care/IDG (interdisciplinary group known by the provider as interdisciplinary team, IDT) note dated 11/25/2025 failed to include the orders for Levaquin, the increased dose of Roxanol, or the increased dose of lorazepam.During an interview on 02/20/2026 at 10:00 AM, the hospice administrator designee stated that he/she agreed that the information was missing from the IDG note and he/she was unable to find additional clarifying information.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that care and services were provided in accordance with the plan of care in two of five full records reviewed (Records/Patients #3 and #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s policy titled, “Nursing Services,” revised 02/2025, showed in part, nursing care will be provided in accordance with the patient’s IDG (interdisciplinary group) plan of care.RECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 08/12/2025 with a terminal diagnosis of protein-calorie malnutrition, and additional diagnoses of diabetes mellitus type 2 (a chronic disease that affects how the body uses sugar for energy), and depression. The patient resided with an adult sibling caregiver.Review of five (5) skilled nurse (SN) visit notes, with a date range of 01/19/2026 through 02/03/2026, showed the nurse obtained a blood glucose level at each visit.Review of the plan of care dated 11/10/2025 through 02/07/2025, the updated plan of care/ IDG (known by the provider as IDT-interdisciplinary team) note dated 01/20/2026, and the updated plan of care/IDG note dated 02/03/2026 showed the plan of care and updated plan of care/IDG notes failed to include an order for the SN to obtain a blood glucose level. RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 01/30/2026 with a terminal diagnosis of bladder cancer. The patient resided at home with family support.Review of the registered nurse (RN) initial assessment, dated 01/30/2026, showed the following:- Patient had: * A colostomy (a surgical opening in the abdominal wall used to expel waste from the large intestines) * An ileostomy (a surgical opening in the abdominal wall that brings the small intestine (ileum) to the surface and produces continuous, liquid, and acidic waste) * One stage 1 pressure ulcer (skin injury caused by unrelieved pressure that presented as a persistent area of skin redness without a break in the skin and does not disappear when pressure is relieved * Two stage 2 (a partial thickness loss of skin) pressure ulcers * Pain - The RN assessed the patient’s pain, but failed to assess/document the location of pain; and - The RN documented that wound care was provided to the three pressure ulcers.Review of the initial POC dated 01/30/2026 through 04/29/2026, showed the document failed to include orders related the care of the colostomy, ileostomy, or the pressure ulcers. Review of the updated plan of care dated 02/05/2026 showed the document failed to include any orders for the colostomy, ileostomy, or wound care for pressure ulcers. No interim orders were provided for the colostomy, ileostomy, or wound care for pressure ulcers.During an interview on 02/19/2026 at 2:15 PM, the hospice administrator designee stated that he/she would expect orders to be in the record.”

“Based on policy review, record review, and interview, the hospice provider failed to show evidence/documentation that the hospice plan of care (POC) was provided to the long-term care facility (LTCF) in one of two respite records reviewed (Record/Patient #7). This deficient practice has the potential to affect all the patient’s served by the provider. Findings included:Review of the provider’s policy titled, “Inpatient Care and Respite,” revised 02/2025, showed in part that the hospice provider would provide a copy of the patient’s POC to the facility providing respite care to ensure care is furnished in accordance with the plan. RECORD/PATIENT #7:Review of the clinical record showed the patient was admitted to the LTCF for a respite stay on 11/17/2025 due to increased care needs and caregiver strain. The clinical record failed to contain documentation to show that the hospice provided the patient’s current POC to the LTCF.During an interview on 02/20/2026 at 10:00 AM, the hospice administrator designee agreed that the information was missing from the record, and the registered nurse coordinator stated that he/she called the LTCF, and they were unable to find a copy.”

“Based on review of the medical director contract, review of the medical director job description, record review and interview, the provider failed to ensure the medical director assumed overall responsibility for the medical component of the provider’s patient care program, including all multiple locations. This deficient practice has the potential to affect all patients the provider serves in all locations. Findings included: Review of the medical director contract with the provider titled, “Associate Medical Directorship Agreement,” effective 05/01/2017, and signed by the designated medical director, showed that the named hospice contracts with the physician to assume responsibility for the medical component of hospice’s patient care program in accordance with the requisite of State law and the Medicare and Medicaid conditions of participation for hospice agencies. Review of the medical director job description, dated 2009, showed in part the duties and responsibilities of the medical director included:- To oversee the implementation of the entire physician, nursing, social work, therapy and counseling areas within the named hospice to ensure that these areas consistently meet patient and family needs;- Assumes overall responsibility for the medical component of the named hospice patient care program;- Provides medical consultation and direction when the attending physician or their designee cannot be reached and there is a change in the patient’s condition requiring medical attention; and- When the medical director is not available, a physician designated by the named hospice assumes the same responsibilities and obligations as the medical director. Review of the three patient lists for the provider’s three locations, dated 02/17/2026, showed the medical director was not listed as a patient physician at two of the three hospice locations. During an interview on 02/19/2026 at 2:50 PM, the administrator designee and the registered nurse coordinator stated that:- The medical director was not involved in the hospice multiple location-1 area or hospice multiple location-2 area, he/she was the physician for the patients served out of the main (parent) hospice location;- Physicians A and B were contracted by the provider that served the patients in hospice multiple location-1, and physician C was contracted by the provider to serve the patients in the hospice multiple location-2; and- The medical director did not supervise the other contracted physicians, they operated autonomously.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that staff submitted complete documentation timely in two of five full records reviewed (Records/Patients #3 and #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s policy titled, “Timely Submission of Patient Documentation,” revised 06/2019, showed in part, that all visit reports must be submitted the next scheduled work day, not exceeding three business days.RECORD/PATIENT #3:Review of the clinical record showed the following late documentation:- Licensed practical nurse (LPN) conducted a visit on 01/19/2026. The documentation was completed 01/24/2026;- Chaplain conducted a visit on 01/19/2026. The documentation was completed 01/25/2026;- LPN conducted a visit on 01/20/2026. The documentation was completed on 01/25/2026;- LPN conducted a visit on 01/22/2026. The documentation was completed on 01/31/2026;- LPN conducted a visit on 01/27/2026. The documentation was completed on 02/03/2026;- LPN conducted a visit on 01/29/2026. The documentation was completed on 02/03/2026; and - LPN conducted a visit on 02/03/2026. The documentation was completed on 02/11/2026.RECORD/PATIENT #5:Review of the clinical record showed the following late documentation:- An aide visit was conducted 02/09/2026. The documentation was completed 02/16/2026.- There were three skilled nurse visits missing from the record. One during the week of 02/02/2026 and two during the week of 02/08/2026.During an interview on 02/20/2026 at 9:40 AM, the hospice registered nurse (RN) coordinator stated that the visits have been conducted by the RN but the documentation was late.”

“Based on policy review, home visit observation, and interview, the provider failed to ensure the skilled nursing facility (SNF) patient record contained a copy of all required hospice documents in one of two home visits of patients that resided in a SNF (Record/Patient #1). This deficient practice has the potential to affect all the provider’s patients who reside in a SNF. Findings included: Review of the provider’s policy titled, “Care to Residents of a SNF/NF or ICF/IID,” (SNF/nursing facility or intermediate care facility for individuals with intellectual disabilities) revised 02/2025, showed in part the (named hospice) will provide the SNF/NF with the most recent hospice plan of care specific to each patient. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to hospice services on 12/19/2025, with a terminal diagnosis of unspecified severe protein-calorie malnutrition. The patient lived in a SNF. Observation on 02/19/2026, at 11:30 AM, when reviewing the hospice’s facility binder, showed the binder failed to contain the current hospice updated plan of care, but contained only the original plan of care dated 12/19/2025. During an interview on 02/20/2026, at 11:03 AM, the registered nurse coordinator stated that he/she would expect the updated plan of care to be in the facility binder, as the updated plan of care was sent to the facility every two weeks.”