Well Care Hospice, Inc.

“Upon patient record review, 1 of 19 (Patient #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 #14: Patient admitted 6/21/24. SNF Resident’s facility current medication profile observed during visit included extensive list of facility standing orders for medications. The hospice med profile does not include any reference to standing orders. There is no indication on either medication profile of intent to coordinate between the two providers when or before initiating either of the standing orders.”

“Upon patient record review, 4 of 19 (Patient #8, 9, 13, 16) 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 #8: Patient admitted 11/19/25. Initial bereavement assessment documented by SC 11/25/25 Day 6 (Patient refused earlier visit). Patient #9: Patient admitted 12/15/25. Initial bereavement assessment documented by SC 12/29/25. (There is a 12/22/25 entry that says “Hospice Bereavement Visit” but there is no other documentation in coordination notes or in attachments.) Patient #13: Patient admitted 10/28/25. Initial bereavement assessment documented by RN documented 12/10/25 Patient #16: Patient admitted 10/31/25. Initial bereavement assessments 11/7/25.”

“Upon patient record review, 1 of 19 (Patient #8) 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 #8: 1/29/26 RN identified new skin breakdown elbow and hip described as stage 2. MD notified and awaiting response. No follow up documentation of treatment order. No documented visits since then. 1/22/26 note eschar left great toe. Notified MD directed just watch. No follow up documentation related to toe on 1/29/26 recert visit.”

“Upon patient record review, 1 of 19 (Patient #6) 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 #6: Patient admitted 12/04/25 with suprapubic catheter. There is no reference to problem, goals, interventions associated with catheter. Functional limitations lists bladder incontinence. Problem list includes general “need for SN to insert/maintain indwelling catheter - hospice” with no specific orders regarding catheter or site.”

“Upon patient record review, 2 of 19 (Patient #6, 15) 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 #6: Patient admitted 12/4/25 with initial wound care order for hospice nurse to perform wound care to stage 2 wound on lower right extremity utilizing clean technique: cleanse with wound cleanser, apply Vaseline gauze and cover with ABD pad and Coban wrap, change every other day and PRN. Instruct caregiver in wound care. PRN is not qualified for dressing changes. Patient admitted 12//25 with suprapubic catheter with no specific orders regarding catheter or site. Patient #15: 9/6/2025 Order for in and out cath. Order does not specify size.”

“Upon client record review, 2 of 19 (Patient #3, 6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #3: Patient admitted 12/4/25. 1/15 and 1/21/26 orders for volunteer coordinator to visit with PCG to assess for need and appropriateness of volunteer services- requested. No documented follow up at time of survey. Patient #6: Patient admitted 12/4/25 with initial wound care order for hospice nurse to perform wound care to stage 2 wound on lower right extremity. utilizing clean technique: cleanse with wound cleanser. Apply Vaseline gauze and cover with ABD pad and Coban wrap. Change every other day and PRN. Instruct caregiver in wound care. PRN is not qualified for dressing changes. 12/5/25 SN Visit documented wound care provided to include covering wound with ABD and wrapping with “fluff” rather than Coban.”

“Upon patient record review 1 of 19 (Patient #8) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #8: 1/29/26 RN identified new skin breakdown elbow and hip described as stage 2. MD notified and awaiting response. No follow up documentation of treatment order. No documented visits since then. 1/22/26 note eschar left great toe. Notified MD directed just watch. No follow up documentation related to toe on 1/29/26 recert visit. No evidence patient needs met.”

“Upon patient record review, 2 of 19 (Patient #4, 6) 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 #4: Patient had recent history of GI bleeding with no reference/alert included in Hospice Aide Care Plan. Patient #6: Patient admitted with suprapubic catheter. Hospice Aide Care Plan includes task related to output, but no reference/alert to suprapubic catheter.”

“Upon patient record review 2 of 19 (Patient #1,5) 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 #1: Hospice Aide Care plan assigns hair, nails, linen once/week. Hospice Aide performed every visit Jan 14, 16, 19, 21, 23, 2026 Patient #5: Hospice Aide Care Plan Shampoo and linens assigned weekly. Hospice Aide both tasks every visit: January 5, 7, 9; 14, 16,19, 23, of 2026 and linen change also on the 12th and 21st of January 2026.”

“Upon patient client record review, 2 of 19 (Patient #4, 15) 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 #4: 1/30/26 SN prn visit for in and out cath. SN failed to document details of procedure including implication, technique, catheter size, amount and appearance of urine return. Patient #15: 9/16/25 physician order for in and out catheter and c/s related to retention. SN documented SN performed in and out catheter per protocol. Obtained sample. Patient had dark yellow urine drained about 300cc. Patient tolerated procedure well. Interview with staff confirms there is no actual protocol in place for in and out catheterization procedure.”

“Based on clinical record review and staff interviews, the agency failed to report signs of possible neglect in a timely manner for 1 of 1 patient with an APS [adult protective services] referral [#1]. The findings included: Patient # 1 had a Start of Care date of 5/21/25 with a terminal diagnosis of Hypertensive Heart Disease, Vascular Dementia and Alzheimer’s Disease. Review of the Plan of Care for the certification period 8/19/25-11/16/25 included orders for SN [Skilled nursing] 2 times a week 2 times a week for 13 weeks, hospice aide 2 times a week for 13 weeks, MSW [medical social worker] 1 time a month for 3 months, chaplain 1 time a month for 3 months. Review of the clinical record revealed the patient lived alone with her adult disabled child. The patient was the primary caregiver for her disabled adult child. Another one of the patient’s adult daughters was noted to be the contact person for the agency, this daughter lived out of town and visited with the patient when possible. Further review of the clinical record revealed the clinicians [SN, MSW, and chaplain] documented numerous times their concern the patient’s basic needs were not being met. An APS [adult protective services] report was not filed until 10/9/25. The documentation included: On 8/22/25, RN # 1 documented “residence unsuitable for hospice care-patient lives alone 90% of the time and is the PC [primary caregiver] for her disabled adult child...” Review of the clinical record revealed the physician had ordered the patient an antibiotic on 8/26/25 for possible cellulitis of right lower leg. During the visit on 8/28/25, it was revealed the caregiver had not picked the antibiotic up at the pharmacy and the patient had not received the medication as ordered. RN # 1 also expressed concern over the patient’s nutritional status and documented there were 5 unopened meals [meals on wheels] in the patient’s refrigerator.Review of the SN visit dated 9/10/25 revealed the following information, “...Patient states she eats 3 meals a day, 100% but on further assessments SN found multiple means on wheels trays unopened in the patient’s refrigerator for a total of 9...Patient is sleeping at night or wakes up frequently in the night and rummages through doors [sic]. Patient lives 90% alone with the exception of her disabled daughter. Patient’s caregiver comes in [sic] sees patient Thursday night and stays through Saturday nights several times a month. Upon assessment patient’s pill planner is full. Patient is unsure if she is [sic] taking her pills this week.”On 9/10/25 the MSW made a routine visit and documented, “ “...Pnt [patient] daughter calls and informs MSW that she visits weekly and spends the nights at times...Pnt daughers [sic] reports she provides care for her mom. Ptn daughter does report confusion, issues with recollections, and ptn being unable to do certain IADLS [instrumental Activities of Daily Living]...” RN # 1 documented the following information for the 9/19/25 visit, “...CG [caregiver] stated patient has not been sleeping at night but has been running through the house and rummaging through things. CG is only available Monday through Saturday night to be with the patient and not able to watch her during the day 2 [sic] work obligations. Per CG patient is still not taking her medications as ordered. Medications are commonly found left in the pill planner...SN and CG discussed patient’s safety and patient being left alone 70-90% of the time. CG head [sic] verbal understanding but had no way to have somebody in the home to help monitor patient’s [sic] when she is not available...” On 9/24/25 SN # 1 documented, ““...Patient continuing to have redness and irritation to bilateral lower extremities. Triamcinolone Cream could not be found during the visit...Call daughter...instructed her on helping mother with daily bathing keeping legs moisturized and elevating, applying cream at least twice a day...Daughter verbalized understanding but will be difficult as she is only in town for the weekends...” On 9/26/25 Chaplain # 3 documented the following information, “...Patient was alert and oriented x 1 [aware of self]. SN reported that patient was confused and could not find the bathroom in her own home...Patient is confused about many details...Patient requires assistance with most ADLs since last visit. Chaplain observes patient’s increased confusion and forgetfulness...”RN # 1 made a visit on 9/30/25 and documented, “...Upon environmental assessment patient’s male [sic] planner still had all the weeks pills in it and patient could not recall [sic] she taken any of her medication...SN expressed concern to patient about her not getting enough nutrition...Patient’s lower extremities are red and inflamed...”On 10/7/25 RN # 1 documented, “...SN told CG that her [patient] staying in the home and is [sic] confused state was a safety risk not just for her but also for her disabled daughter..” The RN also entered a note with the following documentation dated 10/7/25, “RN called MSW to discuss some concerns for pnt and residing alone. Pnt is not taking medication, there has been a decline in pnts mobility, pnt is not eating, pnt is exhibiting mor [sic] aggression, delusions and paranoid behaviors...”On 10/8/25 MSW # 2 documented the following information, “...Pnt denied seeing a RN or aide in a long time. She was unable to recall who MSW was as well. When MSW talked about her daughter [primary caregiver] she stated she also hadn’t seen her in a long time as well. Daughter and SN had just visited with pnt...Pnt is not taking any of her medication because patient reports she honestly forgets to...” Further review of the clinical record revealed MSW called APS [adult protective services] on 10/9/25 to file a report related to the patient. The MSW documented, “MSW informed ____ [name of daughter] she made report to be helpful. ...MSW explained..._____ [patient # 1] not being able to care of [sic] herself is self neglect and neglect for ______ [adult disabled daughter]...” On 10/14/25 a communication note was noted for the director which stated, “...On Friday, 10/10/25, patient’s daughter ______ [name] called...Director followed up with a meeting with patient’s care team on Monday morning...concerns about patient’s declining mental and physical capacity while being alone with her adult daughter with disabilities most of the time. She is not taking her medications correctly, wanders in the woods at night, and allows team members into the home despite not remembering who they are... Team plans to meet with daughter on Friday...”During an interview with the vice president of compliance on 12/10/25 at approximately 9:30 am, the vice president of compliance confirmed the staff should have filed an APS report sooner. The vice president stated, “I think the staff was on the fence about making a report to APS. The daughter had told my staff all these things that she would do and then didn’t follow through on any of the things.””