Elite Hospice

“Based on policy review, record review, and interview, the hospice provider failed to ensure that emergency preparedness training was provided to all staff in one of five employee files reviewed (Employee #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, “Emergency Preparedness/Operational Plan,” revised 08/01/2024, showed the administrator shall ensure that all staff are trained in their emergency roles and provisions of the plan.EMPLOYEE #4:Review of the employee file showed the employee was hired on 11/01/2025.The file showed the provider failed to ensure the employee received emergency preparedness training during orientation.During an interview on 06/03/2026 at 11:10 AM, the business office manager stated that the employee did not have emergency preparedness training on file with the provider.”

“Based on policy review, record review, observation, and interview, the hospice provider failed to ensure that the advance directive status was documented accurately in one of five full records reviewed (Record/Patient #1). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Advance Directives,” revised 09/01/2023, showed:- On admission, the patient/representative makes known the patient’s wishes regarding advance directives, and this is documented in the patient’s record; and- Changes to the advance directives would be documented in the patient’s medical record. RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 02/27/2026 with a terminal diagnosis of non-Hodgkin lymphoma (cancer of the blood). The patient resided at home alone on 02/27/2026 and then transferred to a skilled nursing facility (SNF) on 03/06/2026. The plan of care (POC) dated 02/27/2026 showed the patient’s advance directive wishes were to be a full code (patient would be resuscitated-lifesaving measures to restore heartbeat or breathing). Review of the Allow Natural Death (A.N.D.) Request/Do Not Resuscitate (DNR) form in the patient’s clinical record, dated 03/06/2026, showed:-The patient signed the DNR form on 03/06/2026 and changed the full code status to A.N.D./DNR status; and-The physician/hospice medical director signed the form 03/06/2026. Review of the Hospice Interdisciplinary Group (IDG) Comprehensive Assessment and POC Update Report, dated 06/02/2026, showed the patient’s advance directive status was still listed as full code. Observation of the SNF’s documentation during a home visit on 06/03/2026 at 2:30 PM, showed the patient’s advance directive status was a DNR effective 03/06/2026. During an interview on 06/04/2026 at 11:50 AM, the hospice administrator confirmed that the patient’s code status was DNR and that the patient’s documentation should show that. The administrator stated the code status would be fixed immediately.”

“Based on policy review, record review, 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 the patients served by the provider. Findings included: Review of the provider’s policy titled, “Medication Management,” revised 11/01/2017, showed that all nurses participating in the patient’s care are responsible to assist in maintenance of accurate patient medication information throughout the tenure of care. RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 02/27/2026 with a terminal diagnosis of non-Hodgkin lymphoma (cancer of the blood). The patient resided at home alone on 02/27/2026 and then transferred to a skilled nursing facility (SNF) on 03/06/2026. Observation of the facilities medication profile (FMP), printed 06/03/2026 at 2:30 PM during the home visit, showed the following medication discrepancies:- FMP showed an order, dated 05/27/2026, for albuterol sulfate nebulizer solution every four hours as needed for dyspnea (shortness of breath). The provider’s medication profile (PMP), dated 06/02/2026, failed to include this medication;- FMP showed an order, start date 05/12/2026 and discontinue date 05/19/2026, for polytrim ophthalmic solution (antibiotic eye drop). The PMP failed to include this medication on the list of current or discontinued medications; and- FMP showed an order, dated 05/25/2026, for barrier cream (skin protectant). The PMP failed to include this medication/treatment. During an interview on 06/04/2026 at 11:50 AM, the hospice administrator agreed that the medications should match and stated that he/she was unable to find the orders for those medications. He/she stated that there was documentation of the albuterol, and the eye drops in the nurse’s notes, but there were no orders.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure a bereavement assessment was completed 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, “Bereavement Assessment,” revised 03/01/2021, showed the social worker or designee would complete a bereavement risk assessment within five days of admission to hospice. RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 05/18/2026 with a terminal diagnosis of multiple sclerosis (MS-an autoimmune disease). The patient resided in a skilled nursing facility (SNF). Review of the registered nurse (RN) admission visit, dated 05/18/2026, showed the patient stated it would be ok for a social worker (SW) to contact him/her. Further review of the clinical record, date range 05/18/2026 through 06/03/2026, showed the SW never contacted the patient or patient’s family and there was no bereavement assessment completed by the SW or a designee. During an interview on 06/04/2026 at 09:15 AM, the hospice administrator stated that the patient had refused services from the SW and chaplain. The RN documented an incorrect response to the SW question, and the RN did not know he/she was responsible for completing the bereavement assessment.”

“Based on policy review, record review, 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 #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,” Plan of Care,” dated 10/01/2024, showed the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions including measurable outcomes anticipated from implementing and coordinating the plan of care.RECORD/PATIENT #2:Review of the clinical record showed the patient was admitted to hospice services on 06/10/2025 with a terminal diagnosis of hypertensive heart and chronic kidney disease with heart failure (a dangerous cycle where high blood pressure strains the heart) and secondary diagnosis of type 2 diabetes mellitus (a chronic disease that affects how the body uses sugar for energy). The patient lived at home with a family caregiver.Review of the POC dated 04/06/2026-06/04/2026 showed a goal that patient’s capillary blood glucose (CBG) will be maintained within prescribed therapeutic range. The POC failed to specify a range for the CBG of the patient.During an interview on 06/04/2026 at 9:00 AM, the administrator stated that he/she would expect the POC to include a range for all vital signs for the patients.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that the skilled nurse followed the plan of care (POC) in one of five full 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, “Physician Orders,” revised 10/01/2024, showed services are provided according to the most recent orders updating the patient’s plan of care.Review of the clinical record showed the patient was admitted to hospice services on 06/10/2025 with a terminal diagnosis of hypertensive heart and chronic kidney disease with heart failure (a dangerous cycle where high blood pressure strains the heart) and secondary diagnosis of type 2 diabetes mellitus (a chronic disease that affects how the body uses sugar for energy). The patient lived at home with a family caregiver.Review of the POC dated 04/06/2026 - 06/04/2026 showed a skilled nursing intervention that the nurse will monitor the patient’s blood sugar at every visit.Review of skilled nurse visits dated 04/22/2026 – 06/01/2026, showed the nurse failed to document the patient’s blood sugar levels.During an interview on 06/04/2026 at 9:00 AM, the administrator stated that he/she would expect the nurse to follow the POC orders and the nurse should have documented the patient’s blood sugar levels.”

“Based on job description review, employee file review, and interview, the hospice provider failed to ensure that all hospice aides completed a competency evaluation program in one of five employee files reviewed (Employee #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s undated hospice aide job description, showed a job qualification that the employee would have a successful completion of a competency evaluation prior to patient care.EMPLOYEE #5:Review of the employee file showed:-Date of hire: 07/07/2025; and-Date of written competency exam: 04/19/2026 (286 days after the date of hire).During an interview on 06/04/2026 at 12:30 PM, the business office manager stated that the aide began seeing patients in the middle of July 2025.During an interview on 06/04/2026 at 12:30 PM, the administrator stated that the aide had completed the exam prior to April of 2026, but the provider moved office buildings in November of 2025, and the original competency exam could not be located. He/she also stated that they had discovered the missing exam after the move, and they had the aide take a new exam for the employee file.”

“Based on job description review, policy review, record review, observation, and interview, the hospice provider failed to ensure that the registered nurse (RN) updated the aide care plan when the needs of the patient changed in two of four records reviewed with aide services (Records/Patients #1 and #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s undated aide job description showed, (care provided) under the direction and ongoing supervision of an RN, personal direct patient care services provided as established and delegated in the plan of care on a daily basis.Review of the provider’s policy titled, “Physician Orders,” revised 10/01/2024, showed services were provided according to the most recent orders updating the patient’s plan of care. Review of the provider’s policy titled, “Hospice Aide Supervision,” revised 11/01/2022, showed aides were assigned to patients based on the assessment made by the staff RN. RECORD/PATIENT #4:Review of the clinical record showed the patient was admitted to hospice services on 10/13/2023 with a terminal diagnosis of Alzheimer’s Disease (a disease marked by progressive loss of mental capacity). The patient lived in a skilled nursing facility.Review of the aide care plan report, dated 10/13/2023, showed the aide was to assist the patient to the toilet every visit due to the patient’s risk of falling.Review of the aide visits dated 04/21/2026-05/26/2026, showed the aide did not complete the task of assisting the patient to the toilet due to the patient being incontinent. Aide also documented that the registered nurse case manager was aware of the task not being completed each visit.During an interview on 06/04/2026 at 9:00 AM, the administrator stated that he/she would have expected the aide care plan to be updated to reflect the care the patient was receiving. RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 02/27/2026 with a terminal diagnosis of Non-Hodgkin Lymphoma (cancer of the blood). The patient resided at home alone on 02/27/2026 and then transferred to a skilled nursing facility (SNF) on 03/06/2026. Review of the aide care plan report dated 02/27/2026 showed:-The patient was a full code (code status changed to DNR 03/06/2026); and-The patient was to ambulate with the use of a walker (wheelchair was not listed on the aide care plan). Review of the recertification plan of care (POC) dated 05/28/2026 showed the patient had the following durable medical equipment, a walker, wheelchair, and shower/tub equipment. The goals of care included that the patient and caregiver would verbalize and demonstrate understanding of fall precautions within 48 hours of identified potential fall risk. Observation of the patient on 06/03/2026 at 3:00 PM showed the patient was sitting in his/her wheelchair watching a movie with other residents in the common area. The patient propelled the wheelchair with his/her feet back to his/her room to visit with the chaplain. During an interview on 06/04/2026 at 11:50 AM, the hospice administrator stated that the aide care plan should be updated when the patient had changes. The only aide care plan in the clinical record was the one dated 02/27/2026, and the code status and addition of the wheelchair should be added to an updated aide care plan.”

“Based on policy review, volunteer hour review, and interview, the hospice provider failed to ensure that volunteers provided care services that equaled 5% of the total patient care hours. This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s policy titled, “Volunteer Program Reporting Process,” revised 03/17/2010 showed an action plan will be developed if volunteer hours are less than 5% of all total direct patient care hours of all paid employees and contract staff.Review of the provider’s volunteer hours for the past year showed volunteers hours equaled 4.2675% of all direct patient care hours for the provider.During an interview on 06/02/2026 at 2:30 PM, the administrator stated that he/she was working on building up the volunteer program and recruiting/training more volunteers.”

“Based on policy review, record review, and interview, the hospice provider failed to ensure that a discharge summary that included treatments, symptoms, and pain management was sent to the attending physician in three of six discharge records reviewed (Records/Patients #6, #9 and #10). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider’s policy titled, “Live Discharge/Transfer of the Hospice Patient,” revised 05/01/2026, showed when a patient is discharged, transferred or referred to another agency, relevant information for discharge is documented in the medical record, typically in the form of a discharge summary and sent to the patient’s physician and receiving agency.RECORD/PATIENT #6:Review of the clinical record showed the patient was discharged from the provider on 01/16/2026.The record failed to show a discharge summary for the patient.RECORD/PATIENT #9:Review of the clinical record showed the patient was discharged from the provider on 03/28/2025.The record failed to show a discharge summary for the patient.RECORD/PATIENT #10:Review of the clinical record showed the patient was discharged from the provider on 08/14/2025.The record failed to show a discharge summary for the patient.During an interview on 06/04/2026 at 9:30 AM, the administrator stated that he/she was not aware that sending discharge summaries was a requirement and there were no discharge summaries for those records.”

“Based on policy review, record review, observation, and interview, the hospice provider failed to ensure that the document used to coordinate care with the facility, the Hospice/Nursing Home Coordinated Task Plan of Care, was accurate and updated in one of one facility visit record reviewed (Record/Patient #1). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Hospice Care in the Nursing Home/Skilled Nursing Facility Setting,” revised 06/01/2018, showed that the hospice provider and the facility must define the manner in which the facility and the hospice would communicate and document communications to ensure that the needs of (the) patient were addressed and met. RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 02/27/2026 with a terminal diagnosis of non-Hodgkin lymphoma (cancer of the blood). The patient resided at home alone on 02/27/2026 and then transferred to a skilled nursing facility (SNF) on 03/06/2026. Review of the document titled, “Hospice/Nursing Home Coordinated Task Plan of Care,” dated 03/06/2026, provided with the patient’s clinical record showed the document failed to include the hospice chaplain or the hospice social worker visit frequency. During the home observation at the SNF on 06/03/2026 at 2:30 PM, the facility charge nurse (FCN) provided a hospice binder and stated that all of the paperwork that hospice provided was in that binder, including the coordinated task plan. Review of the Hospice/Nursing Home Coordinated Task Plan of Care form, dated 03/06/2026, in the hospice binder failed to include the hospice chaplain or the hospice social worker visit frequency. The coordination form showed the aide visits were on Monday and Thursday. The clinical record showed the aide visited Wednesday and Friday and the FCN stated that the aide usually visited on Wednesday and Friday. During an interview on 06/04/2026 at 11:50 AM, the hospice administrator stated that the coordination form should have been updated and signed off by the hospice and facility staff.”

“Based on policy review, record review, observation, and interview, the hospice provider failed to provide the skilled nursing facility (SNF) all the required information in one of one facility visit record reviewed (Record/Patient #1). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Hospice Care in the Nursing Home/Skilled Nursing Facility Setting,” revised 06/01/2018, showed that the hospice provider would provide the SNF with the hospice election form and the physician certification/recertification of the terminal illness forms. RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 02/27/2026 with a terminal diagnosis of non-Hodgkin lymphoma (cancer of the blood). The patient resided at home alone on 02/27/2026 and then transferred to a SNF on 03/06/2026. During the home observation at the SNF on 06/03/2026 at 2:30 PM, the facility charge nurse (FCN) provided a hospice binder and stated that all of the paperwork that hospice provided was in that binder. Review of the binder showed that the binder failed to contain the hospice election form and the physician certification/recertification of the terminal illness form. The FCN stated that the information was thinned and scanned into the facility electronic medical record (EMR) when the binder was too full. The FCN searched the EMR and was unable to find the documents. During an interview on 06/04/2026 at 11:50 AM, the hospice administrator stated that the hospice election form and the physician certification and recertification forms should have been in the binder.”

“Based on review of Missouri Statutes, policy review, employee file review, and interview, the hospice provider failed to ensure that a criminal background check (CBC) was performed on all staff prior to first patient contact in one of five employee files reviewed (Employee #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of Section 192.2495.3, RSMo stated: “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 policy titled, “Background Checks,” revised 10/01/2025, showed all applicants who are offered employment with [named company] must have a criminal background check successfully completed in order to remain with the company.EMPLOYEE #4:Review of the employee file showed the employee was hired on 11/01/2025.The file showed the provider failed to obtain a criminal background check on the employee.During an interview on 06/04/2026 at 10:00 AM, the administrator stated that the corporate office performed all other CBC checks and he/she was unaware that they did not do the CBC check on the employee.”