Community Home Care & Hospice

“Upon patient record review, 2 of 27 (Patient #4,14) 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 4: During home visit medication reconciliation with the pt’s caregiver, hospice medication profiles did not match what was being given in the home. The hospice profile contained orders for Mucinex 2 times daily, Spiriva 1 puff daily, Symbicort 2 puffs twice daily, and Zyrtec daily. The caregiver reported that the patient does not take those medications on a daily basis, they are being given PRN daily. Patient 14: RN documentation indicated that the patient uses oxygen at 2LNC as needed. No evidence that an order was received for oxygen at 2L via NC PRN. No evidence of a titration order with parameters for titration. The current oxygen order on the medication profile is for 4L via NC as needed.”

“Upon patient record review, 1 of 27 (Patient #7) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 7: No evidence that the initial bereavement assessment was completed within 5 days of election of hospice. The patient was admitted on 03/26/2026. The bereavement risk assessment was completed on 04/01/2026.”

“Upon patient record review, 3 of 27 (Patient #1, 12,17) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family’s needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient 1: The medical record indicated that the agency preformed a UA on the patient for suspected UTI on 04/07/2026. No evidence that the RN completed a follow up or that those results were uploaded to the chart at the time that the chart was surveyed. Patient 12: MSW documentation on 04/02/2026 indicated that the caregiver informed her that the patient was more agitated at night and has hit the caregiver twice. The caregiver inquired about a way to give medications when the patient is agitated. The MSW documented that she told the RNCM on 04/02/2026. There was no indication that a follow up was completed by the RN. Patient 17: MSW documentation on 03/30/2026 indicated that the patient had complaints of new onset dizziness and trouble reading. The MSW documented that she told the RNCM on 03/30/2026. There was no indication that a follow up was completed by the RN.”

“Upon patient record review, 2 of 27 (Patient 11,12) 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. of care. Patient 11: The medical record contained nursing documentation upon admission identifying patient as having altered mobility. There was no evidence of problems, goals, and interventions related to altered mobility included in the plan of care. Patient 12: The medical record contained nursing documentation upon admission identifying patient as having altered mobility. There was no evidence of problems, goals, and interventions related to altered mobility included in the plan of care.”

“Upon patient record review, 4 of 27(Patient #4,5,8,14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 4: During home visit medication reconciliation with the pt’s caregiver, hospice medication profiles did not match what was being given in the home. The hospice profile contained orders for Mucinex 2 times daily, Spiriva 1 puff daily, Symbicort 2 puffs twice daily, and Zyrtec daily. The caregiver reported that the patient does not take those medications on a daily bases, they are being given PRN daily. No evidence that an order was received to change the frequency of those medications. Patient 5: RN documentation that the patient had an indwelling 16fr foley catheter. No evidence that an order was received for placement of the 16fr foley catheter. The current order is for 14fr foley catheter. Patient 8: RN documentation indicated that the patient has a suprapubic cath. No evidence that an order was received that included the catheter size, change frequency, or maintenance instructions. Patient 14: RN documentation indicated that the patient uses oxygen at 2LNC as needed. No evidence that an order was received for oxygen at 2L via NC. The current oxygen order is for 4L via NC as needed.”

“Upon client record review, 3 of 27 (Patient #6,17,20) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 6: Plan of care has SN visits ordered as 3 times weekly. No evidence that the patient received 3 visits for the week of 02/01/2026. No evidence that the visit was missed at the request of the patient or the caregiver. No evidence that a physician order was received to decrease the visit frequency for the week. Patient 17: Plan of care has SN visits ordered as 2 times weekly. No evidence that the patient received 2 visits for the week of 02/08/2026. No evidence that the visit was missed at the request of the patient or the caregiver. No evidence that a physician order was received to decrease the visit frequency for the week. Patient 20: Plan of care has SN visits ordered as 4 times for the week of 3/08/26. No evidence that the patient received 4 visits for the week of 03/08/2026. No evidence that the visit was missed at the request of the patient or the caregiver. No evidence that a physician order was received to decrease the visit frequency for the week.”

“Upon patient record review, 1 of 27(Patient #2) 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: Aide plan of care task included both bed bath and a shower, both ordered to given at every visit.”

“Upon patient record review 4 of 27 (Patient #4,6,19,20) 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 4: The plan of care had aide frequency ordered as twice a week. No evidence that 2 visits were completed for the week of 04/12/26. Only one visit documented, that visit occurred on 04/16/26. Patient 6: The aide plan of care has weekly linen changes, nail care, and hair shampooing. The medical record indicated that the aide performed nail care at every visit. For the week of 3/29 and 4/13 linen changes/ hair shampoos were completed at every visit. Patient 19: The aide plan of care has weekly linen changes. The medical record indicated that aide completed linen changes at every visit starting at 04/01/2026. Patient 20: The plan of care had aide frequency ordered as once for the week of 03/06/2026 and twice for the week 03/08/2026. No evidence that a visit was completed for the week of 03/06/26, nor did 2 visits occur for the week of 3/08/3026. Only one visit documented for the week of 03/08/2026, that visit occurred on 03/09/26.”

“Based on agency policy, clinical record review, and staff interviews the agency failed to include a Do Not Resuscitate order in the hospice plan of care for 1 of 1 patient with a change in code status. (patient #2) Findings included: A policy, The Plan of Care (revised 08/30/23) received on 09/03/24 at approximately 2:50 PM from the agency area director of clinical operations stated, “;The written plan of care will contain, but not limited to, the following: ... End-of-life preferences.” Patient #2 was admitted for routine home care on 08/01/2024 with a diagnosis of Chronic Obstructive Pulmonary Disease (lung disease that blocks airflow). Review of the clinical record revealed that on 08/13/24 patient #2 was transported to an emergency room and admitted for hospice general inpatient care. On 08/14/2024 hospice registered nurse #3 stated, “;New order, DNR [Do Not Resuscitate]...” There was no evidence in the hospice plan of care of a DNR order. An interview with the area director of clinical operations on 09/03/24 at approximately 2:30 PM revealed that the expectation is for the hospice plan of care to be updated with a change in code status.”

“Based on agency policy, clinical record review, and staff interviews the agency failed to notify a patients family/power of attorney of a planned discharge for 1 of 3 patients with a planned discharge and a decline in mental status. (Patient #2) Finding included: A policy LIVE DISCHARGE AND DISCHARGE PLANNING PROCESS (revised 01/22/2024) was received on 06/03/2024 at approximately 12:00 P.M. from the agency director. The policy stated, “;As soon as the IGD [interdisciplinary group] determines the patient will be discharged because his/her condition has plateaued organization personnel will: ... Consult with the patient and family/caregiver regarding the need for discharge.” Patient #2 was admitted on 01/25/2022 with a diagnosis of hypertensive chronic kidney disease (high blood pressure causing damage to the kidneys). The plan of care (POC) for 03/15/2024-05/13/2024 included orders for skilled nurse (SN) visits 2 times a week for 9 weeks and 4 PRN (as needed). The POC for 05/14/2024-07/12/2024 included orders for SN visits 2 times a week for 9 weeks, 3 PRN, and effective 05/07/2024 SN TO INITIATE DISCHARGE PLANNING. For the following SN visits the SNs stated: On 03/18/2024 the registered nurse case manager (RNCM) #3 stated, “;Periods of confusion... cognitive impairment.” On 03/21/2024 the licensed practical nurse (LPN) #7 stated, “;Periods of confusion... has cognitive deficits.” On 03/26/2024 RNCM #3 stated, “;forgetful...cognitive impairment.” On 03/27/2024 LPN #7 stated, “;periods of confusion...forgetful...has cognitive impairment.” On 04/01/2024 RNCM #3 stated, “;periods of confusion... cog [cognitive] impairment.” On 04/03/2024 RNCM #3 stated, “;forgetful...cognitive impairment.” On 04/16/2024 RNCM stated, “;disorganized thinking...cognitive impairment.” On 04/23/2024 RNCM #3 stated, “;Abnormal new learning ability...inability to recall recent events... periods of confusion... cognitive impairment.” On 04/25/2024 RNCM #3 stated, “;forgetful... periods of confusion... cognitive impairment.” On 04/29/2024 RNCM #3 stated, “;disorganized thinking...forgetful... cognitive impairment.” On 05/01/2024 RNCM #3 stated, “;Explained that he [patient #2] did not meet the criteria to stay on hospice...periods of confusion.” On 05/06/2024 RNCM #3 stated, “;forgetful... cognitive impairment.” On 05/09/2024 LPN #7 stated, “;has cognitive deficits... Patient aware of discharge from hospice next week.” For the discharge visit of 05/25/2024 RNCM #3 stated, “;cognitive impairment.” There was no evidence in the clinical record of patient #2s family/power of attorney being notified of the discharge. An interview was conducted on 05/30/2024 with patient #2s son/power of attorney. The patients son stated, “;He was informed of the discharge by the assisted living facility on the day of discharge.” An interview was conducted on 06/03/20/24 at approximately 12:45 P.M. with RNCM #3. RNCM #3 stated, “;I did not [notify the patients son of the discharge], the facility said they did. If the patient is not alert and oriented, I would notify the family. Why would I call him [patients son] I never had any contact with him? I was never told that we had a power of attorney. Yes, I would tell the family of a pending discharge if they were cognitively impaired” An interview with the agency director on 06/03/2024 at approximately 12:50 P.M. revealed that the nurses have access to the power of attorney documents and the family should be included in the plan of care.”