Continuum Home Care & Hospice of Lenior County

“Based on agency policy, clinical record review, and staff interviews, the agency failed to provide effective pain management for 1 of 1 patient reporting unmanaged pain (patient #2).Findings included: A policy, Pain Assessment and Reassessment (revised 2/2020), received on 6/3/26 at 2:25 PM from the Director of Nursing stated, “When a patient’s pain is not relieved, the nurse will intervene appropriately. Such interventions may include: Notification of the patient’s attending physician and/or Medical Director. Change in pain and symptom management based on physician orders. Patient education regarding alternative pain relief measures… Referral for pain management…”Patient #2 was admitted on 12/24/25 with a diagnosis of hypertensive heart disease (long term unmanaged blood pressure). The plan of care for 3/24/26-6/21/26 included orders for skilled nurse visits 1 time a week for 13 weeks with 3 PRN (as needed) and, “Monitor for effectiveness of pharmacological [medication] and non-pharmacological interventions to achieve comfort.” Review of the clinical record revealed that on 5/20/26 licensed practical nurse (LPN) #12 documented a pain assessment that included; “Primary Location, arms/wrist, Joints, legs/feet. Effect on Quality of Life, Decline in Mood, Decline in physical function. Patient reports, I hurt all the time, voices pain with movement is typically 6-7/10 [pain level at 6-7 on a 1-10 scale]… 1/10 FLACC [non-verbal pain assessment used for non-verbal patients] with movement AEB [as evidenced by] moaning /complaint, reports sharp arthritis pain to joint and nerve pain to BLE [bilateral lower extremities…” Further review revealed that there was no documentation of; a physician being notified for new orders; the registered nurse case manager being notified; a request for the facility nurse to administer a PRN medication; or education of non-pharmacological interventions.During an interview conducted on 6/3/26 at 1:51 PM LPN #12 stated, “I didn’t do anything about the medications, my plan was to reevaluate medication as needed… I’m new…normally I usually try to e-mail or call the nurse case manager.”During an interview conducted on 6/3/26 at 2:39 PM the director of nursing stated, the expectation is for the LPN to, “Report pain to facility staff member, and request that a PRN dose be given, and notify the nurse case manager.””

“Based on agency policy, clinical record review, and staff interviews, the interdisciplinary group failed to develop an individualized plan of care for 1 of 1 patient with a documented significant history of urinary tract infections (patient #10).Findings included: A policy, Reassessments/Update to the Comprehensive Assessment (revised 2/2021), received on 6/1/26 at 1:55 PM from the Director of Nursing stated, “Staff will analyze the data from assessments and reassessments. Such analysis of data will assist staff in identifying and prioritizing patient needs and problems to direct care and services and update the IDG care plan.”A policy, IDG (Interdisciplinary Group) Care Planning Process (revised 2/20220, received on 6/1/26 at 1:55 PM from the Director of Nursing stated, “The care of plan specifies the care and services necessary to meet the patient and family-specific needs identified in the comprehensive assessment as such needs related to the terminal illness and related conditions… All care and services furnished to patients and their families follows an individualized written plan of care established by the IDG in collaboration with the attending physician (if any), the patient or representative and the primary caregiver in accordance with the patient’s needs…”Patient #10 was admitted on 10/15/25 with a diagnosis of unspecified sequelae of cerebral infarction (lingering effects of a stroke). The plan of care for 4/13/26-6/1/26 included orders for skilled nurse visits 1 time a week for 9 weeks with 3 PRN (as needed). Review of the clinical record revealed that on 5/19/26 nurse practitioner #12 documented, “Patient has a significant history of recurrent UTIs [urinary tract infections], including prior infections severe enough to require hospitalization and IV [intravenous] therapy… each episode results in further decline in cognition and functional status…” Further review revealed that there were no interventions if the plan of care for monitoring for symptoms or education on prevention of UTI’s.An interview conducted on 6/3/26 at 11:27 AM with register nurse case manager #8 revealed that patient #10 should have a plan of care related to recurrent UTIs.An interview conducted on 6/3/26 at 11:29 AM with the director of nursing revealed that the expectation if for an individualized care plan related to UTI’s be included in the plan of care.”

“Based on agency policy, clinical record review, and staff interviews, the agency failed to provide volunteer visits as ordered in the plan of care for 2 of 2 patients with orders for volunteer visits (patient #5 & 6).Findings included: A policy, Professional Standards of Practice (revised 6/20/19), received on 6/1/26 at 1:55 PM from the director of nursing stated, “Hospice staff will provide care, treatment and services to each patient according to the IDG plan of care and physician orders.”1. Patient #5 was admitted on 7/15/25 with a diagnosis of end stage renal disease. The plan of care for 5/11/26-7/9/26 included orders for volunteer visits 3 times a month for 1 month starting 6/1/26 and “Hospice volunteer will provide: companionship, engagement/socialization, supportive listening…” Review of the clinical record revealed that no volunteer visits were conducted.2. Patient #6 was admitted on 1/13/26 with a diagnosis of chronic obstructive pulmonary disease (lung disease). The plan of care for 4/13/26-6/11/26 included order for volunteer visits 3 times a month for 3 months and “Hospice volunteer will provide: companionship, engagement/socialization, supportive listening…” Review of the clinical record revealed that no volunteer visits were conducted.An interview conducted on 6/1/26 at 2:53 PM with the volunteer coordinator revealed that the agency does not have any volunteers that conduct home visits. An interview conducted on 6/2/26 at approximately 2:55 PM with the director of nursing revealed that there may be some confusion related to adding volunteer visit to the plan of care.”

“Based on agency policy, observation, and staff interviews, the medical social worker (MSW) failed place a barrier under the clinical bag for 1 of 1 patient with a MSW home visit (patient #8) and the registered nurse (RN) failed to perform hand hygiene before removing items from the clinical bag for 1 of 2 patient with a RN home visits (patient #10).Findings included: A policy, Professional Standards of Practice (revised 6/2019), received on 6/1/26 at 12:01 PM from the director of nursing stated, “Indications for hand hygiene are: … Before re-entering nursing bag or patient’s clean supplies…”A policy, Exposure Control Plan: OSHA Regulations (revised 6/2019), received on 6/1/26 at 12:01 PM from the director of nursing stated, “Upon entering the home, place the bag on a clean surface. Paper towels or plastic bag may be used to create a clean area if indicated.”1. Patient #8 was admitted on 9/12/24 with a diagnosis of malignant neoplasm of the pancreas (pancreatic cancer). Patient #9 was a resident at a skilled nursing facility. The plan of care for 5/5/26-7/3/26 included orders for MSW visits 2 times a month for 2 months with 3 PRN (as needed). During a home visit conducted on 6/2/26 at 9:00 AM MSW #9 placed the clinical bag on a personal chair without the use of a protective barrier.During an interview conducted on 6/3/26 at 2:54 PM MSW #9 stated, “What I should have done was to put a barrier under the bag.”2. Patient #10 was admitted on 10/15/25 with a diagnosis of unspecified sequelae of cerebral infarction (lingering effects of a stroke). The plan of care for 4/13/26-6/1/26 included orders for skilled nurse visits 1 time a week for 9 weeks with 3 PRN (as needed). Patient #10 was a resident of a skilled nursing facility. During a home visit conducted on 6/2/26 at 9:50 AM RN #3 performed hand hygiene, assessed the patient’s temperature, heart rate, and oxygen saturation and failed to perform hand hygiene before reaching into the clinical bag for supplies.During an interview conducted on 6/3/26 at 2:09 PM RN #3 stated that they normally perform hand hygiene each time they enter the clinical bag.An interview conducted on 6/3/26 at 2:11 PM, with the director of nursing revealed that the expectation is for the clinicians to place a protective barrier under the bag and to sanitize their hands before reaching into the clinical bag.”

“Based on agency policy, volunteer cost savings review, and staff interviews the agency failed to provide volunteer services to equal 5 percent of patient care hours. Findings included: A policy, Volunteer Services (revised 8/25), received on 6/4/26 at 9:18 AM from the Director of Nursing stated, “Hospice will document and maintain a volunteer staff sufficient to provide administrative and/or direct patient care in an amount that, at a minimum, equals 5% of the total patient care hours of all paid hospice employees and contract staff.A review of the volunteer cost savings report revealed that the agency provided volunteer services to equal an average of 0.60% from 6/2025 through 5/2026.An interview conducted on 6/1/26 at 2:53 PM with the volunteer coordinator revealed that they strive to have 5% volunteer to patient care hours.”