Crown Hospice

“It is required that the update of the comprehensive assessment is completed by the hospice Interdisciplinary Group, who, in collaboration with the individual’s attending physician, if any, consider the changes that have taken place since the initial assessment. The update of the comprehensive assessment includes reassessment of the patient’s response to care. The assessment update is completed as frequently as the condition of the patient requires and no less frequently than every 15 days. This standard was not met as evidenced by clinical record review and interview. In 3 of 19 (16%) clinical records reviewed it was revealed that the agency did not ensure that the comprehensive assessment was updated based on changes that had taken place since the initial assessment. CLINICAL RECORD 2: The patient elected the hospice benefit on 06/25/2025. At admission, the patient had an extensive right foot wound exposing tendons. Although the wound was photographed at admission, measurements were not obtained. Nursing documentation throughout care was vague, with entries such as ‘wound present’ and ‘wound improving.’ The wound was photographed during the healing process, and wound care treatment was discontinued on 11/23/2025 following complete healing. However, while the wound was assessed, required elements of a comprehensive wound assessment—such as measurements, evaluation of tissue characteristics, general appearance, drainage, and signs or symptoms of infection—were not documented. CLINICAL RECORD 5: The patient elected the benefit on 03/13/2025. On 06/19/2025, the patient developed a coccyx wound requiring daily wound care orders. At the time of onset, no wound measurements or photographs were documented. As of 12/01/2025, the wound remains present, though noted as improving. Documentation examples include: 07/07/2025 – ‘wound to coccyx remains present’; 09/02/2025 – ‘wound continues to show improvement’; and 12/01/2025 – ‘small open area on coccyx with continued improvement.’ While the wound was being assessed, required elements of a comprehensive wound assessment—such as measurements, general appearance, evaluation of tissue characteristics, signs and symptoms of infection, and photographic evidence have not been documented. CLINICAL RECORD 6: The patient elected the benefit on 06/04/2025. On 08/11/2025 the patient developed a wound on the right upper buttocks requiring daily wound care orders. The nursing documentation has only vague statements regarding the wound that it is improving and wound still present. While the wound was being assessed, required elements of a comprehensive wound assessment—such as measurements, evaluation of tissue characteristics, signs and symptoms of infection, and photographic evidence have not been documented. Following a joint record review and an interview with the Program Director and Director of Clinical Services on 12/11/2025, both confirmed that the agency’s expectation is for wound assessments to be completed weekly. These assessments must include measurements and evaluation of wound characteristics, such as drainage and signs or symptoms of infection, for all patients, including those in facilities. horrible right foot wound opens down to the tendons. Wound-healing treatment was discontinued on 11/23/2025. Not consistent wound assessments vague comments like wound continues to improve. few measurements noted.”

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following interventions to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed revealed the agency did not ensure that the patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness including planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 3: The patient elected the hospice benefit on 04/01/2025. A review of the clinical record revealed that the initial plan of care dated 04/02/2025 did not include specific interventions or instructions for managing the patient’s PleurX chest tube drain. On 04/02/2025, the registered nurse documented cleansing the drain site and applying a new border gauze; however, the plan of care lacked any guidance or interventions related to drain management. Although the assessment noted the patient was independent in draining the tube, this was not reflected in the plan of care. The drain was subsequently removed by the physician on 05/22/2025. During a joint record review and interview on 12/10/2025, the Program Director (Personnel Record 1) and Director of Clinical Services (Personnel Record 2) acknowledged that the plan of care lacked specific interventions addressing an identified and assessed problem.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient and must include physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed revealed the agency did not ensure that orders were obtained for all necessary services. CLINICAL RECORD 3: The patient elected the hospice benefit on 04/01/2025. At that time, standing orders included oxygen at 2 liters via nasal cannula as needed, with instructions to increase to 3 liters as needed. However, nursing documentation on 11/24/2025, 11/26/2025, and 12/08/2025 reflected the patient utilizing oxygen at 4–5 liters via nasal cannula as needed. These changes in oxygen usage were not reflected in the plan of care and were not supported by updated physician orders. During a joint record review and interview on 12/10/2025, both the Program Director (Personnel Record 1) and the Director of Clinical Services (Personnel Record 2) acknowledged that an updated physician order was required to reflect the increased oxygen usage documented in the clinical record.”

“It is required that the hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed of patients residing in a facility it was revealed that the agency did not identify which provider was responsible for performing the functions that were agreed upon and included in the plan of care. CLINICAL RECORD 6: The patient elected the benefit on 06/04/2025. On 08/11/2025 wound care orders were initiated for a coccyx wound: cleanse with wound cleanser, apply calcium alginate, and cover with Optifoam gentle/silicone border dressing daily. On 10/07/2025, new orders were issued: cleanse with wound cleanser, apply Medihoney and Flagyl, then pack with packing strip daily and as needed. On 10/22/2025, the order was revised to remove Medihoney, continuing Flagyl and packing. There was no documented evidence to delineate responsibility for dressing changes between facility staff and hospice staff. Following a joint record review and an interview with the Program Director (Personnel Record 1) and Director of Clinical Services (Personnel Record 2) on 12/11/2025, both confirmed that the physician’s order did not specify whether dressing changes were to be performed by hospice staff or facility staff.”