Continuum Home Care & Hospice

“Based on agency policy, clinical record review, and staff interviews, the agency failed to provide effective management of uncontrolled symptoms for 2 of 2 patients with unmanaged anxiety. (patient #2 & #9)Findings included: A policy Patient Bill of Rights (revised 06/2019) received on 09/23/2025 at 1:22 PM from care team manager #16 stated, “Hospice protects and promotes the rights of each patient. In advance of furnishing care to the patient and during the initial assessment, the patient is informed both verbally and in writing of all rights.”The Patient & Caregiver Resource Guide (not dated) received on 09/23/2025 at 1:22 PM from the care team manager #16 stated, “The patient has the right to: … Receive effective pain management and symptom control from hospice for conditions related to the terminal illness.”1. Patient #2 was admitted on 08/11/2025 with diagnoses of hypertensive heart and chronic kidney disease, depression, and generalized anxiety disorder. The plan of care for 08/11/2025-10/09/2025 included orders for skilled nurse (SN) visits 3 time a week for 1 week, 2 times a week for 8 weeks with 6 PRN (as needed), “SN to recognize and intervene to minimize complications, provide comfort care, manage signs and symptoms and collaborate with the IDG [interdisciplinary group] and patient’s physician.”Review of the clinical record revealed the following documentation:During the RN (registered nurse) visit on 09/05/2025 RN #14 documented, “She’s had a change this week and that she is crying out that she wants to die, is combative and will not let the hospice nurse touch her to get vitals or blood pressure, [sic] and is refusing most of her medications per facility nurse [nurses name].” Further review revealed no documentation of interventions provided to reduce anxiety or physician notification.During an interview conducted on 09/24/2025 at approximately 10:45 AM RN #14 stated, “I reported it to the floor nurse [facility nurse] to administer medication. No [it’s not documented].”During the RN visits on 09/12/2025 RN #14 documented, “She’s had a change this week and that she is crying out that she wants to die, is combative and will not let the hospice nurse touch her to get vitals or blood pressure, [sic] and is refusing most of her medications per facility nurse [nurses name].” Further review revealed no documentation of interventions provided to reduce anxiety or physician notification.During an interview conducted on 09/24/2025 at approximately 10:45 AM RN #14 stated, “She was still having combative issues… I did not notify the doctor because the medication worked when they [facility staff] gave it.”During the RN visit on 09/15/2025 RN #14 documented, “She’s had a change this week and that she is crying out that she wants to die, is combative and will not let the hospice nurse touch her to get vitals or blood pressure, and is refusing most of her medications per facility nurse [nurses name].” Further review revealed no documentation of interventions provided to reduce anxiety or physician notification.During an interview conducted on 09/24/2025 at approximately 10:45 AM RN #14 stated, “She was still having combative issues.”During the RN visit on 09/17/2025 RN #14 documented, “She’s had a change this week and that she is crying out that she wants to die, is combative and will not let the hospice nurse touch her to get vitals or blood pressure, and is refusing most of her medications per facility nurse [nurses name].” Further review revealed no documentation of interventions provided to reduce anxiety or physician notification.During an interview conducted on 09/24/2025 RN #14 stated, “AGAIN, she does have these crying out episodes… she was refusing meds [medications] but not the anxiety and agitation meds.”During an interview with on 09/24/2025 at 11:03 AM care team manager #15 stated, “If we are seeing on-going symptoms we should contact the provider [physician], maybe get the medication scheduled.” 2. Patient #9 was admitted on 08/13/2025 with a diagnosis of diagnoses of hypertensive heart and chronic kidney disease and anxiety disorder. The plan of care for 08/13/2025-11/10/2025 included orders for skilled nurse visits 2 times a week for 13 weeks, 1 time a week for 1 week, 2 times a week for 12 weeks with 6 PRN. Review of the clinical record revealed that between 08/14/2025 and 09/22/2025 RN #11 documented that the patient was “anxious” on 14 of 14 visits. Further review revealed that there was no documentation of interventions performed to reduce anxiety or physician notification.During an interview conducted on 09/24/2025 on at approximately 10:15 AM RN #11 stated, “The anxiety comes from not knowing what’s going on. Yes [normally documents interventions].” The interview revealed that RN #11 utilized non-pharmacological interventions.During an interview conducted on 09/24/2025 at 10:20 AM care team manager #15 stated, “Our staff should document all of the interventions.””

“Based on agency policy, clinical record review, and staff interviews, the agency failed to notify a patients legal guardian of services covered under the hospice benefit. (patient #5)Findings included: A policy Patient Record Content received on 09/24/2025 at 11:40 AM from care team manager #5 stated, “Hospice will initiate and maintain an individual and accurate patient record…”Patient #5 was admitted on 08/01/2025 with a diagnosis of Alzheimer’s disease (progressive mental function disease). The plan of care for 08/01/2025-10/29/2025 included orders for skilled nurse visits 1 time a week for 1 week, 2 times a week for 12 weeks with 6 PRN (as needed). Review of the clinical record revealed that during the admission registered nurse (RN) visits on 08/01/2025 RN #12 documented, “Unable to reach legal guardian…Patient/Representative provided with information about financial responsibility for certain hospice services… Review the right to request in writing…”RN #12 was not available for an interview.During an interview conducted on 09/24/2025 at 10:05 AM care team manager #17 stated, “The education was provided by [name of central intake coordinator]. [nurse #12’s name] did not provide training to the guardian, looks like a careless mistake.” The expectation is “On the visits, make attempts to reach out to the guardian, be accurate about who she talked to.””

“Based on agency policy, clinical record review, and staff interviews, the agency failed to document wound assessments, measurements, and treatment for 1 of 6 patients with orders for wound care (patient #2).Findings included: A policy, Pressure Ulcer Wound Dressing Change (no date), received on 09/23/2025 at 4:19 PM from care team manager #16 stated, “Document in the clinical record, specific treatment, location, size of ulcer. Color and appearance of wound bed…”Patient #2 was admitted on 08/11/2025 with diagnoses of hypertensive heart and chronic kidney disease, depression, and generalized anxiety disorder. The plan of care for 08/11/2025-10/09/2025 included orders for skilled nurse (SN) visits 3 times a week for 1 week, 2 times a week for 8 weeks with 6 PRN (as needed), and “Monitor the site of impaired tissue integrity at least weekly for size measurements…” A review of the clinical record revealed that on 08/11/2025 the Initial Plan of Care stated, “Impaired skin integrity related to suspected DTI [deep tissue injury] to tip of R [right] great toe and stage II pressure injury [partial-thickness skin injury] to L [left] buttocks area along with redness to under L breast and moderate-severe excoriation [abrasion] to R/L buttocks and gluteal folds.” Further review revealed that from 08/12/2025-09/19/2025 12 of 12 skilled nurse visits did not have documentation of wound assessments or measurements.During an interview conducted on 09/24/2025 at approximately 10:45 AM registered nurse #14 stated, “I always measure them [wounds] at least weekly and document it.”An interview conducted on 09/24/2025 at approximately 12:30 with care team manager #5 revealed that the expectation is for the nurses to assess and measure wounds weekly and document the measurements.”

“Based on agency policy, clinical record review, and staff interviews, the agency failed to include orders for an indwelling urinary catheter for 1 of 3 patients with an indwelling urinary catheter. (patient #9)Findings included: A policy Patient Record Content, (revised 06/2019) received on 09/24/2025 at 11:40 AM from care team manager #5 stated, “Each patient record will contain the following as applicable: … Physician’s orders that include medications, diet, treatment and activity orders…”Patient #9 was admitted on 08/13/2025 with a diagnosis of hypertensive heart and chronic kidney disease. The plan of care for 08/13/2025-11/10/2025 included orders for skilled nurse visits 2 times a week for 13 weeks, 1 time a week for 1 week, 2 times a week for 12 weeks with 6 PRN (as needed). Review of the clinical record revealed that during the registered nurse (RN) visits on 09/02/2025 RN #11 documented, “Suprapubic catheter in place.” Further review revealed that there were no orders for a suprapubic catheter.On 09/23/2025 at approximately 2:30 PM care team manager #5 confirmed that there were no orders related to an indwelling urinary catheter.”

“Based on agency policy, clinical record review, and staff interviews, the agency failed to include discharge summaries for 2 of 2 patients with a live discharge (patients #14 & 15).Findings included: A policy, Patient Record Content (revised 06/2019), received on 09/24/2025 at 11:40 AM from care team manager #5 stated, “Each patient record will contain the following… A discharge summary when a patient is discharged from Hospice…”A policy, Discharge Summary (revised 02/2022), received on 09/24/2025 at 12:39 PM from care team manager #5 stated, “The Hospice discharge summary will include: A summary of the patient’s stay including treatments, symptoms and pain management… A brief description of services provided and ongoing needs that cannot be met… Status of patient at time of discharge.”1.Patient #14 was admitted on 06/11/2024 with a diagnosis of unspecified sequelae of cerebral infarction (tissue damage to the brain with a block of blood flow). The plan of care for 02/06/2025-04/06/2025 included orders for skilled nurse visits 2 times a week for 6 weeks with 5 PRN (as needed) and discharge for extended prognosis. Review of the clinical record revealed that the patient was discharged on 04/06/2025. Further review revealed that there was no documentation of a discharge summary.2. Patient #15 was admitted on 07/01/2025 with a diagnosis of cerebral atherosderosis (sic) (obstruction of blood flow). The plan of care included orders for skilled nurse visits 4 times a week for 1 week, 7 times a week for 12 weeks with 3 PRN (as needed). Review of the clinical record revealed that the patient revoked (self-discharged) hospice on 07/11/2025. Further review revealed that there was no documentation of a discharge summary.During an interview conducted on 09/24/2025 at 12:45 PM when asked what the expectations were for a discharge summary the executive clinical director stated, “DIDN’T YOU GET THE POLICY?” After a second request for a statement of the agency’s expectations for a discharge summary the executive clinical director stated, “WE DON’T DEVIATE FROM THE POLICY!””

“Based on agency policy, clinical record review, and staff interviews, the agency failed to include a treatment for an acquired wound in the plan of care for 1 of 1 patient with a new wound. (patient #3) Findings included: A policy, Patient Record Content (revised 06/2019) received on 03/11/2025 at approximately 1:30 PM from the clinical director stated, “;Each patient record will contain the following as applicable: ...Updates to the comprehensive assessment... Care/services provided by Hospice... (evaluations, treatments, and progress notes) ... Physicians orders that include... treatments...” Patient #3 was admitted on 01/24/2025 with a diagnosis of neurocognitive disorder with Lewy bodies (a condition interfering with brain function). The plan of care for 01/24/2025-03/24/2025 included orders for skilled nurse visits 2 times a week for 7 weeks with 3 PRN (as needed). Clinical record review revealed that during a PRN registered nurse (RN) visit on 02/09/2025 RN# 6 documented a Skin tear/trauma to the patients right elbow. Further review revealed that there was no documented treatment of the wound and that the plan of care was not updated to include a new wound. RN #6 was not available for an interview. An interview conducted on 03/11/2025 at approximately 1:30 PM with the clinical director revealed that the expectation would be for the nurse to provide care to a new wound and document a treatment in the clinical record.”

“Based on agency policy, observation, and staff interviews, the agency failed to perform hand hygiene after removing contaminated gloves for 1 of 2 patients with a home visit conducted. (patient #2) Findings included: A policy, HAND HYGIENE – CDC GUIDELINES (not dated) received on 03/10/2025 at approximately 4:00 PM from the clinical director stated, “;All staff shall use the hand-hygiene techniques, as set forth in the following procedure... Always after removing gloves...” Patient #2 was admitted on 04/21/2022 with a diagnosis of senile degeneration of the brain (condition with a progressive decline in mental status). The plan of care for 02/04/2025-04/04/2025 included orders for skilled nurse visits 1 time a week for 9 weeks with 3 PRN (as needed). A home visit was conducted on 03/10/2025 at approximately 1:30 PM with registered nurse (RN) #5. RN #5 failed to perform hand hygiene after removing gloves and handling the documentation tablet. During an interview conducted on 03/10/2025 at approximately 4:26 PM RN #5 stated that hand hygiene should be performed after removing gloves. An interview conducted on 03/10/2025 at approximately 4:28 PM with the care team manager revealed that hand hygiene should be performed when gloves are removed.”