Infinity Hospice, LLC DBA Acg Hospice - Carthage

“It is required that the documented comprehensive assessment include 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. This standard was not met as evidenced by observation, clinical record review, and interview. In 2 of 3 (67%) home visits observed, it was revealed that the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. Home Visit 2/Clinical Record 2: The patient elected the hospice benefit on 07/28/2025 for a diagnosis of protein-calorie malnutrition. The patient resided in a skilled nursing facility (SNF). During Home Visit 2 with Personnel Record 7 (Hospice Aide) on 09/30/2025, the hospice medication profile (printed on 09/30/2025) was compared to the SNF medication profile (printed on 09/30/2025). The following medications were listed on the hospice profile and were not listed on the SNF profile: “Lorazepam 0.5 mg, take 1 every 12 hours as needed (ordered 08/15/2025); Nystatin topical powder, apply 2 times daily (ordered 07/28/2025).” The following medications were listed on the SNF medication profile and were not listed on the hospice medication profile: “Guaifenesin 100 mg/5 ml, take 10 ml every 4 hours as needed (ordered 02/28/2023); Ventolin inhaler, 2 puffs every 6 hours as needed (ordered 03/15/2023).” The last comprehensive nursing visit was dated 09/26/2025. Home Visit 3/Clinical Record 3: The patient elected the hospice benefit on 09/01/2025 for a diagnosis of Alcoholic cirrhosis of the liver. The patient resided in a skilled nursing facility (SNF). During Home Visit 3 with Personnel Record 4 (Registered Nurse) on 09/30/2025, the hospice medication profile (printed on 09/30/2025) was compared to the SNF medication profile (printed on 09/30/2025). The following medication discrepancy was noted: Hospice profile had Potassium 10 meq, take 1 daily (ordered 09/01/2025) vs SNF profile had Potassium 20 meq, take 1 daily (ordered 08/12/2025). The last comprehensive nursing visit was dated 09/26/2025. An interview and joint clinical record review were conducted with the Director of Clinical Operations on 10/01/2025, during which she confirmed the discrepancies and advised, “She would get them fixed right away.””

“It is required that 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 3 of 12 (25%) clinical records reviewed, where hospice aide services were accepted, it was revealed that the agency did not ensure the Registered Nurse provided specific written instructions for the hospice aide. CLINICAL RECORD 7: The hospice aide care plan dated 07/30/2025 included the following relevant tasks: “bedbound, fall precautions, apply barrier cream, bathing (bed), shampoo, skin care, routine catheter care, perineal care, shaving, oral care, dressing, turn and position in bed, empty drainage bag (if facility allows), change linens, notify RN (registered nurse) of any skin changes, safety (patient has dysphagia and G-Tube, aspiration precautions).” All tasks were to be completed on every visit. The Aide visit frequency is scheduled as three times a week. A physician’s order dated 08/07/2025 noted the following: “Cleanse Stage IV ventral penis wound with normal saline, pat dry, and apply triad daily. Cleanse Stage III left ischium wound with normal saline, pat dry, apply triad, and cover with mepilex daily.” The hospice aide care plan did not notify the aide of the wounds, nor provide specific instructions to notify the nurse if the wound dressing became soiled, dislodged, or wet. CLINICAL RECORD 10: The hospice aide care plan dated 06/20/2025 included the following relevant tasks: “apply barrier cream, shaving, skin care, bathing (bed), dressing, shampoo, hair care, skin care, perineal care, shaving, oral care, skin care, notify RN (registered nurse) of any skin changes.” The hospice aide care plan revision dated 08/05/2025 included the following relevant tasks: “bathing (bed), shampoo, hair care, skin care, perineal care, shaving, oral care.” All tasks were to be completed on every visit. The Aide visit frequency is scheduled as three times a week. A physician’s order dated 08/01/2025 noted the following: “Shearing to buttocks. Cleanse with wound cleanser, pat dry with 4x4 gauze, apply a thin layer of medi honey to the wound, then cover with bordered dressing 3 times weekly and PRN (as needed).” The hospice aide care plan did not notify the aide of the wounds, nor provide specific instructions to notify the nurse if the wound dressing became soiled, dislodged, or wet. CLINICAL RECORD 13: The hospice aide care plan dated 04/28/2025 included the following relevant tasks: “bedbound, nail care, incontinence care, shaving, turn and position in bed, bathing (bed), shampoo, skin care, perineal care, shaving, oral care, dressing, apply barrier cream, change linens, oxygen safety.” The hospice aide care plan revision dated 07/30/2025 included the following relevant tasks: “bedbound, apply barrier cream, bathing (bed), dressing, nail care, oral care, perineal care, provide incontinence care, shaving, skin care, turn and position in bed, change linens, date of last bowel movement, notify RN (registered nurse) of any skin changes, oxygen safety.” All tasks were to be completed on every visit. The Aide visit frequency is scheduled as three times a week. A physician’s order dated 07/24/2025 noted the following: “cleanse wounds to left heel, left lateral foot, right distal foot, and right ischium with NS (normal saline) or wound cleanser, pat dry with 4x4 gauze, apply calcium alginate with silver, and cover with bordered dressing daily.” The hospice aide care plan did not notify the aide of the wounds, nor provide specific instructions to notify the nurse if the wound dressing became soiled, dislodged, or wet. An interview and joint clinical record review were conducted with the Director of Clinical Operations on 10/01/2025, in which she agreed the aides “needed to know exactly what to do with the wounds during tasks.””

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 12 (8%) clinical records reviewed, where hospice aide services were accepted, it was revealed that the agency did not ensure the hospice aide provided the services included in the plan of care. Home Visit 2/Clinical Record 2: The hospice aide care plan dated 07/29/2025 included the following relevant tasks: “Assist to toilet, hair care, skin care, oral care, nail care, dressing, bathing (shower), apply barrier cream, empty trash, change linens, report pain to nurse, notify nurse of any skin change, bowel/bladder concerns or safety issues, oxygen safety, date of last bowel movement, notify nurse of any tasks not completed.” All tasks were to be completed on every visit, except for changing linens, which was to be completed weekly. Aide visit frequency was three times weekly. Home Visit 2/Clinical Record 2 was conducted on 09/30/2025 with the Hospice Aide (Personnel Record 7). The aide was observed performing a bed bath on the patient instead of a shower. The bed bath was not included in the plan of care. An interview and joint clinical record review were conducted with the Director of Clinical Operations on 10/01/2025, during which she advised that she “had spoken with the aide after the visit,” and the aide said, “I messed up. I gave a bed bath and not a shower, but she was weak and I didn’t want her to fall.” The Director advised the “aide should’ve called the nurse to have the care plan adjusted.””