Heartland Hospice

“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: The medical record indicated that the patient has an active stage 4 wound to the coccyx. No evidence that the wound was measured for the week of 10/19/2025. Gentiva policy is for wound measurements to be completed weekly.”

“Upon patient record review, 2 of 5 (Patient #1,3) 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 1: The RN documentation indicated that the patient was using oxygen at PRN 2LNC. No evidence that an order was received for the oxygen at 2LNC. The current order is for oxygen continuously at 1LNC. COS - New oxygen order written to update during survey. Patient 3: The plan of care has duplicate orders for oxybutynin both written as 5mg 1 tablet 3 times a day. One written on 10/05/2025 and the other was written on 10/15/2025. COS - New clarification order rec’d during survey.”

“Upon observation, there was no evidence the patient has the right to voice grievances/complaints regarding treatment or care that is (or fails to be) furnished and lack of respect of property by anyone who is furnishing care/service on behalf of the hospice. Patient 3: The medical record contained social worker documentation 2/4/25 with attempt to schedule visit for discharge paperwork to be signed. During the phone call the daughter denied having any knowledge of plan to discharge and refused visit and signing of paperwork, with notes of concern for continuity of care. The social worker stated the executive director to be notified. There was no evidence of investigation of alleged violation of discharge notification.”

“Upon patient record review, 1 of 5 (Patient #3) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient 3: There was no evidence the patient/family received education and training regarding responsibilities included with plan to discharge. There was no documentation regarding education for need to follow up with a community physician for further medical treatment to assist with post discharge continuity of care. IDG nursing documentation 2/19/25 after discharge states patient agreed to a physician as primary care provider, however no evidence of documentation of the continuity of care prior to discharge.”

“Upon patient record review, 1 of 5 (Patient #4) 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 4: The medical record contained nursing documentation upon admission identifying patient has an ostomy. There was no evidence of problems, goals, and interventions related to ostomy included in the plan of care.”

“Upon client record review, 1 of 5 (Patient #3) did not have evidence that the plan of care included IDG’s documentation of the patient’s or families level of understanding, involvement and agreement with the plan of care. Patient 3: The medical record contained physician documentation during IDG 1/15/25 identifying need to investigate eligibility and discharge planning. There was no evidence communication with the patient/family regarding possibility of discharge until 2/4/25 social worker documentation regarding attempt to schedule appointment for signature of Notification of Medicare Non-Coverage. 2/4/25 social worker documentation stated the daughter denied having any knowledge regarding plan to discharge and refused the visit.”

“Upon patient record review, 1 of 5 (Patient #3) 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 3: There was no evidence of steps taken to determine eligibility or decision for discharge after physician IDG note 1/15/25 to reference decision tree to be done for extended prognosis. IDG nursing note 2/5 states decision tree in process. There was no evidence of a nursing visit after 1/29/25 and the documentation 1/29/25 does not address plan to discharge. Patient was discharged”

“Upon patient record review, 9 of 23 (Patients #3,#5,#6,#12,#13,#15,#16,#17,#18) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 3: Upon medication reconciliation during home visit, the facility and hospice medication profiles did not match. The facility profile did not contain a hydrocodone-acetaminophen PRN that was on the hospice profile. Corrected on site with order clarification and medication profile update. Patient 5: Upon medication reconciliation during home visit, the facility and hospice medication profiles did not match. The facility profile did not contain lorazepam and morphine PRNs, and had instructions for milk of magnesia PRN instead of hospice instructions for scheduled daily. Corrected on site with order clarification and medication profile update. Patient 6: Upon medication reconciliation during home visit, the facility and hospice medication profiles did not match. The facility profile did not contain lorazepam scheduled at bedtime that was on the hospice profile, did contain lorazepam PRN that was not on hospice profile, contained instructions for 15ml Mucinex instead of 20ml listed on hospice, and contained morphine scheduled twice daily that was not on hospice. Corrected on site with order clarification and medication profile update. Patient 12: The medication profile contained Miralax oral powder with no instructions to mix with a diluent. Corrected on site with order clarification and medication profile update. Patient 13: The medication profile contained diclofenac topical gel with no area defined for administration. Corrected on site with order clarification and medication profile update. Patient 15: The medication profile contained duplicative listings for Preparation H with differing concentrates. Corrected on site with order clarification and medication profile update. Patient 16: Upon medication reconciliation during home visit, the facility and hospice medication profiles did not match. The facility profile did not have lorazepam that was on hospice profile, facility had hyoscyamine every 24 hours PRN instead of hospice instructions every 2 hours PRN, facility had levetiracetam 250 mg twice daily instead of hospice instructions for once daily. Facility had oxycodone every 4 hours PRN instead of hospice instructions every 6 hours PRN, facility had oxygen 2LPM instead of hospice instructions for 2-4LPM, and hospice also had mucinex that was not on the facility profile. Corrected on site with order clarification and medication profile update. Patient 17: Upon medication reconciliation during home visit, the facility and hospice medication profiles did not match. The facility profile contained acetaminophen suppository every 24 hours PRN instead of hospice instructions every 6 hours PRN, facility profile had buspirone 1 tab instead of hospice 1.5 tabs, and facility had clonidine patch changes on Tuesday instead of hospice instructions for Monday. Corrected on site with order clarification and medication profile update. Patient 18: Upon medication reconciliation during home visit, the ALF had multiple medications not listed on the hospice profile including: haldol 0.5ml PRN, quetiapine daily, Miralax PRN, guaifenesin PRN, and furosemide daily. The ALF also had senna-s 2 tabs daily instead of senna 1 tab daily. Corrected on site with order clarification and medication profile update.”

“Upon patient record review, 1 of 23 (Patient #18) 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 18: There was no evidence of a bereavement assessment. Assessment completed during survey on 9/17/25.”

“Upon patient record review, 1 of 23 (Patient #7) 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 7: The medical record contained nursing documentation 9/3/25 identifying patient wound to left great toe. There was no evidence of weekly measurements per agency policy. First wound measurement was completed 9/15/25.”

“Upon patient record review, 3 of 23 (Patients #11,#13,#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 11: The medical record contained nursing documentation identifying patient use of oxygen. There was no evidence of problems, goals, and interventions related to the need for oxygen included in the plan of care. Corrected on site with update to plan of care. Patient 13: The medical record contained nursing documentation since admission identifying patient issues with nausea and vomiting. There was no evidence of problems, goals, and interventions related to gastrointestinal dysfunction included in the plan of care. Corrected on site with update to plan of care. Patient 14: The medical record contained nursing documentation since admission identifying blood pressure cannot be taken on the patient’s right arm. There was no evidence of problems, goals, and interventions to outline limiting factors included in the plan of care. Corrected on site with update to plan of care.”

“Upon patient record review, 2 of 23 (Patients #3,#13) 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 3: The medical record contained an order for social work visits 4 PRN. There was no evidence of an anticipated need for visits. Corrected on site with order clarification. Patient 13: The medical record contained an order for spiritual care 2 PRN. There was no evidence of an anticipated need for visits. Corrected on site with order clarification.”

“Upon patient record review, 4 of 23 (Patients #3,#12,#13,#18) 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 3: Upon medication reconciliation during home visit, the facility and hospice medication orders did not match. The hospice did not have an order for hydrocodone-acetaminophen PRN. Corrected on site with order clarification. Patient 12: The medical record contained an order for Miralax oral powder with no instructions to mix with a diluent. Corrected on site with order clarification. Patient 13: The medical record contained an order for diclofenac topical gel with no area defined for administration. Corrected on site with order clarification. Patient 18: Upon medication reconciliation during home visit, the ALF had multiple medications that hospice did not have orders for including: haldol 0.5ml PRN, quetiapine daily, Miralax PRN, guaifenesin PRN, and furosemide daily. The ALF also had an order for senna-s 2 tabs daily instead of hospice order for senna 1 tab daily. Corrected on site with order clarification.”

“Upon patient record review, 4 of 23 (Patients #4,#13,#15,#16) 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 equipment and supply needs. Patient 4: The medical record contained nursing documentation since admission identifying patient use of a walker. There was no evidence of an order for the walker included in the plan of care. Corrected on site with receipt of order. Patient 13: The medical record contained nursing documentation 9/9/25 identifying patient use of a walker. There was no evidence of an order for the walker included in the plan of care. Corrected on site with receipt of order. Patient 15: The medical record contained nursing documentation since admission identifying patient use of bedrails. There was no evidence of an order for the rails included in the plan of care. Corrected on site with receipt of order. Patient 16: The medical record contained nursing documentation since admission identifying patient use of a wheelchair. There was no evidence of an order for the wheelchair included in the plan of care. Corrected on site with receipt of order.”

“Upon patient record review, 2 of 23 (Patient #11,13) 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 11: The medical record contained physician documentation 7/23/25 identifying plan for patient discharge and decision to recertify patient 8/20/25. The plan of care was not updated to remove problems, goals, and interventions related to discharge planning. Corrected on site with update to plan of care. Patient 13: The medical record contained an order to discontinue spiritual care visits 8/29/25. The plan of care was not updated to remove problems, goals, and interventions to be addressed by the chaplain. Corrected on site with update to plan of care.”

“Upon patient record review, 5 of 23 (Patient #5,6,15,16,17) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient 5: Upon medication reconciliation during home visit, the facility and hospice medication orders did not match. The hospice did not have orders to discontinue lorazepam and morphine PRNs, and did not have an updated order for milk of magnesia PRN instead of scheduled daily. Corrected on site with order clarification. Patient 6: Upon medication reconciliation during home visit, the facility and hospice medication orders did not match. The facility had an order for lorazepam PRN that hospice did not have, and hospice had an order for lorazepam scheduled at bedtime that the facility did not have. Also the facility had an order for scheduled morphine twice daily that hospice did not have, and facility order for Mucinex was 15ml whereas hospice dose on order was 20ml. Corrected on site with order clarification. Patient 15: The medication profile contained duplicative orders for Preparation H with differing concentrates. Corrected on site with order clarification. Patient 16: Upon medication reconciliation during home visit, the facility and hospice medication orders did not match. The facility orders did not have lorazepam that was on hospice profile, facility had hyoscyamine every 24 hours PRN instead of hospice instructions every 2 hours PRN, facility had levetiracetam 250 mg twice daily instead of hospice instructions for once daily. Facility had oxycodone every 4 hours PRN instead of hospice instructions every 6 hours PRN, facility had oxygen 2LPM instead of hospice instructions for 2-4LPM, and hospice profile contained mucinex that was not on the facility profile. Corrected on site with order clarification. Patient 17: Upon medication reconciliation during home visit, the facility and hospice medication orders did not match. The facility orders contained acetaminophen suppository every 24 hours PRN instead of hospice instructions every 6 hours PRN, facility had buspirone 1 tab instead of hospice 1.5 tabs, and facility had clonidine patch changes on Tuesdays instead of hospice instructions for Mondays. Corrected on site with order clarification.”