Unified Care Hospice

“Upon observation, there was no evidence the hospice is in compliance with accepted professional standards and principles for all core services which includes nursing services, medical social services and counseling services. The agency is using a wound company to provide wound care to its patients and not providing core services. The wound care company is providing all wound care for patient #5, reviewed during survey. The wound care order in record reads, “Wound care to evaluate and treat wounds”. The patient had stage 2 pressure wounds on buttocks and wound care was ordered at admit. There was no documentation stating wound care was not related to hospice diagnosis and the documented wounds were not outside the scope of a hospice nurse. No subsequent debridement had been done and the wound care being provided is not highly specialized wound care.”

“Upon patient record review, 1 of 5 (Patient #3) 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 #3: On 10/31/25, patient complained of nausea vomiting and coughing. A nurse visited. It stated orders were obtained though no orders written. On 11/2/25, a call from a caregiver saying patient had been vomiting for 30 minutes and likely vomited her Zofran. RN advised to give Zofran again. No further follow up call or visit noted as of 5 days later.”

“Upon patient record review, 1 of 5 (Patient #1) 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 10/31/25. Patient is ordered to have Nicoderm CQ patches for smoking cessation. The patient is also on oxygen. There are no interventions or goals for smoking or oxygen safety with smoking on plan of care.”

“Upon patient record review, 2 of 20 (Patient #2, 4) 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 #2: Patient experienced unwitnessed fall 7/6/25, resulting in laceration to head. Next SN visit 7/9/25 with no specific documentation to status of wound, other than Integumentary assessed, no issues. 7/10/25 patient experienced another unwitnessed fall, resulting in another laceration to head. Next SN visit was 7/15/25, again with no specific documentation to status of head wounds other than Integumentary assessed, no issues. Patient #4: Patient experienced fall 7/13/25, resulting in skin tear left toe. Next nursing visit 7/16/25 with no specific documentation to status of wound, other than Integumentary assessed, no issues.”

“Upon patient record review, 3 of 20 (Patient #1, 2, 14) 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 has Eliquis prescribed with no related problems, goals, interventions specific to bleeding precautions. Patient #2: RN initial assessment documented that patient experienced fall in past month. No related safety/fall problems, goals interventions included in initial Plan of Care. Patient #14: Patient has medication prescribed for seizures, but no related problems, goals, interventions.”

“Upon patient record review, 1 of 20 (Patient #17) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient #17: 8/13/25: PRN order for End of Life Doula. The order is unclear if one time visit or a PRN frequency.”

“Upon patient record review, 2 of 20 (Patient #2, 7) 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 #2: 7/6 and 7/10/25 falls resulting in head lacerations and 2 different wounds. Orders received for each occurrence to cleanse with NS and leave OTA. Not clear if one time order or to repeat particular frequency or as needed for recurrent bleeding, etc. Patient #7: 8/1/25 HN (hospice nurse) to change 16 Fr. catheter monthly and PRN. PRN is not qualified.”

“Upon patient record review, 7 of 20 (Patient #1, 2, 3, 4, 6, 9, 20) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient #1: Initial Doula IDG Plan of Care opened 5/30/25 with goal set as “The goal will be to visit (patient name) next week again to see if he’s better. Then I can make a better assessment of how often visits should be and what we can focus on with him I will need to understand his emotional state and what type of support he may need along with end of life planning needs, if any.” (Patient visited 7/15/25. No documented updates to problems, goals, interventions at that time.) Patient #2: Patient continues with multiple falls (7/6 and 7/10/25) and no update to POC with related problems, goals, interventions such as environmental safety/fall precautions. Effective 8/26/25, Plan of Care goal for End of Life Doula was documented as “I saw this patient once for now as I feel the language barrier and the cognition issues will not allow for my extra conversations. I will be happy to revisit patient if family or our care team feels the benefits of a visit from me.” No documented evidence of IDG discussion and/or subsequent update to goal. Patient #3: Patient became homeless- temporarily living in car with sons. Problems goals and interventions updated 7/28/25 with referral for community housing; however psychosocial and safety implications related to being homeless were not included in updates. Patient #4: Patient experienced fall 7/13/25. There were no related updates to problems, goals, interventions. Volunteer visit notes for 7/25 and 8/18/25. No related problems, goals, interventions. Patient #6: Effective 8/19/25, Plan of Care for End of Life Doula included: Issue - From what I can see, (patient) needs companionship and support emotionally... My goal with (patient name) is to provide a safe place with me for him to communicate and let me know concerns or what he needs from me. I’m hopeful that my next visit, he can communicate more so we can discuss goals. Patient #9: Volunteer providing stretching “therapy” 6/13 and 8/25/25 visits. There were no related problems, goals, interventions. Patient #20 Patient exhibited sadness, anxiety, crying over change of environment, loss of independence and functional status as demonstrated in 8/12/25 Doula visit, 8/22/25 SC visit and 8/30/25 MSW visit. Only psychosocial problem/goal identified is funeral planning. End of Life Doula goals include 8/12/25 include “The goal is to be there emotionally for her. she does not have any family in Vegas at all. Her children live in Chicago. She seems a little lost and sad. She told me her goals and they are doing art and being more social. “”

“Upon client record review, 9 of 20 (Patient #1, 4, 7, 8, 9, 11, 15, 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 #1: SOC 5/23/25. Volunteer visits 8/6 and 8/22/25. There are no orders. 7/15/25 End of Life Doula visit made with no order. Patient #4: SOC 5/30/25. Volunteer visit notes for 7/25 and 8/18/25. No orders. Patient #7: SOC 8/8/25 End of Life Doula ordered 2/month and provided 1/month in Aug 8/19/25. Patient #8: SOC 5/17/25. Volunteer visits 5/31, 6/7, 6/21, 7/1, 8/15/25 with no orders. Patient #9: SOC 6/4/25. Volunteer visits 6/10, 6/13, 6/20, 7/11, 8/6, 8/20, 8/27/25 with no orders. MSW ordered frequency monthly. Visits made 6/6 and 7/27/25. There was no documented visit for August, 2025 and no documentation visit was offered/declined. Patient #11: SN Visit 9/4/25 documents patient sustained fall on 9/1/25. Upon rising, he scraped his arm on the corner of dresser and got a skin tear. Wound care provided. No documented order for wound care. No order written until 9/9/25 to be effective 9/16/25 (for 2/week wound care). Patient #15. 6/1/25 order for wound care referral but no follow up documented by time of discharge 7/10/25. Interview with staff unable to clarify. Patient #17: SOC 12/7/24. 8/13/25 PRN order for End of Life Doula. The order is unclear if one time visit or a PRN frequency, but visits were made 6/2/25 and 8/13/25, with no additional orders. Patient #20: Patient received volunteer visits 7/28, 8/2, 8/6, 8/15, 8/20, 8/28, 8/29/25 with no physician ordered frequency.”

“Upon patient record review, 6 of 20 (Patient #1, 3, 4, 7, 14, 15) 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 #1: Patient has Eliquis prescribed with no reference to bleeding precautions for Aide Assignment. Patient #3: Patient has Oxygen 2-4 lpm via NC prescribe with no reference to Oxygen precautions for Aide Assignment. Patient #4: 8/11/25 Aide assignment includes: Encourage fluids if not contraindicated. Patient is on oxygen 2lpm however, no oxygen precautions. Patient #7: Aide assignment includes: Encourage fluids if not contraindicated. Patient is on oxygen 2 lpm continuously however, no oxygen precautions. Patient #14: Patient has documented seizure disorder (CTI) and seizure med prescribed however, no seizure precautions for Aide Assignment. The prompt for seizure precautions is blank. Patient #15 - Patient is on oxygen 2 lpm however, no oxygen precautions”

“Upon observation, there was no evidence the hospice is directed by a Board of Directors/governing body which assumes full legal authority and responsibility for the operation of the hospice as evidenced by agency using contract staff for MSW and NP role which are required to be employees of the agency, this was corrected on day 2 as both signed W4 to become employees. In addition, agency did not have SLP contract at start of survey however, was able to secure one on day 2 of survey. Agency must be able to provide all core, non-core services along with levels of care for all patients at all times. Last, agency was unable to show evidence of patient plan of care is followed and updated per patient needs.”

“Upon contract review, 7 of 10 (Contracts for Aspen PT, CH-OT, CL-MSW, MD-Doula, No ST Contract on day 1, No Wound Care Contracts for JD and Dubin Medical Consultants) did not have evidence the agreement to furnish any services under arrangement included that the hospice must retain administrative and financial management, and oversight of staff and services for all arranged services, to ensure the provision of quality care. Arranged care/services are supported by written contract/agreement that requires all care/services are: • Authorized by the hospice • Furnished in a safe and effective manner by qualified personnel • Delivered in accordance with the patient’s plan of care All individuals/agencies requiring contracts listed above did not have an actual contract with the above bullet points.”

“Upon patient client record review, 20 of 20 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20: Patient Notice of Election Form includes SOC date, but does not specify as effective date of the election. Form was revised prior to end of survey. Patient #14: Hospice Notice of Election form (Election) section allocated to choose or not to choose physician - both options are blank.”

“Upon patient client record review, 2 of 20 (Patient #2, 11) 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 #2: Patient experienced fall 7/6/25, resulting in approximately 1” laceration of head with significant bleeding. SN documented wound cleansed, but solution not specified. Patient #11: SN Visit 9/4/25 documents patient sustained fall on 9/1/25. Upon rising, he scraped his arm on the corner of dresser and got a skin tear. Wound care provided. Wound care not specified.”

“Upon observation, there was no evidence the hospice discussed the policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. Patient #1, 2, 3, 4, 6, 9, 10, 11 13, 15, 16, 17: Upon observation, agency policy is to provide policy and discussion of procedures for managing controlled drugs education at time controlled drugs are prescribed. These patients had controlled medications ordered at start of care, but no documented evidence of policy provided and discussion occurred.”

“Upon client record review, 12 of 20 (Patient #1, 2, 3, 4, 6, 9, 10, 11 13, 15, 16, 17) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #1, 2, 3, 4, 6, 9, 10, 11 13, 15, 16, 17: Upon observation, agency policy is to provide policy and discussion of procedures for managing controlled drugs education at time controlled drugs are prescribed. These patients had controlled medications ordered at start of care, but no documented evidence of policy provided and discussion occurred.”