Hospice of North Carolina

“Upon observation, there was no evidence the hospice designates a physician to serve as Medical Director which includes: • The Medical Director must be a doctor of medicine or osteopathy who is an employee or is under contract. • When the Medical Director is not available, a physician designated by the hospice assumes the same responsibilities and obligations as the Medical Director. There is currently no physician designated to assume responsibility in absence of medical director. A candidate has been identified, but the contract is not duly executed at time of survey.”

“Upon observation, there was no evidence the hospice designates a physician to serve as Medical Director which includes: • The Medical Director must be a doctor of medicine or osteopathy who is an employee or is under contract. • When the Medical Director is not available, a physician designated by the hospice assumes the same responsibilities and obligations as the Medical Director. There is currently no physician designated to assume responsibility in absence of medical director. A candidate has been identified, but the contract is not duly executed at time of survey.”

“Upon patient record review, 1 of 14 (Patient #2) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: Patient admitted 3/7/25. During home visit and medication review, patient has Morphine Concentrate in home, but it is not on hospice medication profile. Prescription bottle dated 4/15/25. Patient caregiver states she has not needed dose thus far.”

“Upon patient record review, 5 of 14 (Patient #1, 2, 3, 10, 11) 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 #1: Patient admitted 3/21/25 with Huntington’s disease and dysphagia. No related problems, goals, interventions related to dysphagia. Patient #2: Patient has order for oxygen, but no related problems, goals interventions related to oxygen safety precautions. Patient #3: Patient admitted 3/19/25 with cirrhosis, pleural effusion, ascites, and DM. There are no problems, goals, interventions related to primary diagnoses of bleeding precautions. Patient #10: Patient admitted 4/2/25 with orders for Oxygen 4LPM NC continuous, but there are no problems, goals, interventions related to oxygen precautions. Patient #11: Patient admitted 6/8/24 with port-a-cath on admission, but no related problems, goals, interventions.”

“Upon patient record review, 3 of 14 (Patient #3,6,7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: 3/19/25 order for MSW 1x/week for 2 weeks. The next order started on 5/4/25 order for MSW 4x/week for 4 weeks. For the weeks of April 11, 19, 21, 23, the patient was seen weekly with no orders. Staff interview with administrator identifies interim frequency order inadvertently discontinued during update. Patient #6: 4/15/25 order for SC 1/wkx13. There was is no documented visit week of 4/21/25. Patient #7: 2/1/25 order for MSW 1/mox2. There is no visit for March”

“Upon patient record review, 3 of 14 (Patient #2, 3, 8) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: Patient admitted 3/7/25. Hospice aide care plan includes assigned task to change linens each visit prn and ensure oxygen in place every visit after bathing prn. PRN is not qualified with specific circumstances and/or with statement of patient’s cognitive ability to decide task. Patient #3: Patient admitted 3/19/25 with orders for oxygen therapy. Hospice aide care plan does not include oxygen related safety precautions. Patient #8: Patient admitted 4/19/25 with Eliquis prescribed and no related bleeding precautions included on the hospice aide care plan.”

“Upon patient record review 1 of 14 (Patient #10) 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 #10: Tasks assigned include provide ROM each visit and to notify RN after each visit for refused interventions. 4/23/25 ROM was not noted and various tasks including bath, shampoo, shave were documented as patient refused. There was no documented evidence RN was notified of refusal.”

“Upon patient record review, 1 of 14 (Patient #1) 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 #1: Hospice Aide supervisory visit documented in initial RN visit 3/21/25, with details including aide following care plan and family satisfied with aide. The aide had not yet provided services at that time.”