Absolute Hospice Inc.

“Upon contract review, 1 of 1 (DaVita Dialysis) 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 The agency did not have an executed contract as it was not yet signed therefore, unable to abate this deficiency.”

“Upon observation and patient record review, 1 of 19 (Patient #14) 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. • To exercise his or her rights as a patient of the hospice • Have one’s property and person treated with respect • To not be subjected to discrimination or reprisal for exercising his or her rights Patient #14 On 5/22 the skilled nurse documented, “Pt. hanging off side of bed. Repositioned. Floor nurse reports pt accusing staff of raping him. Pt. admits to feeling confused disoriented to place and time, staff reports foul smelling urine no nutritional intake today”. There is no evidence of IDG follow-up and that the patient rights were protected.”

“Upon observation, there was no evidence that all alleged violations involving mistreatment, neglect, or verbal, mental, sexual and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of the hospice, are reported immediately to the Administrator or appropriate designee. Patient #14 On 5/22 the skilled nurse documented, “Pt. hanging off side of bed. Repositioned. Floor nurse reports pt accusing staff of raping him. Pt. admits to feeling confused disoriented to place and time, staff reports foul smelling urine no nutritional intake today”. There is no evidence of reporting to the Administrator of alleged sexual abuse/rape.”

“Upon observation, there was no evidence the hospice immediately investigates all alleged violations involving anyone furnishing services on behalf of the hospice and immediately takes action to prevent further potential violations while the alleged violation is being verified. Investigations and/or documentation of all alleged violations are conducted in accordance with established policies and procedures. Patient #14 On 5/22 the skilled nurse documented, “Pt. hanging off side of bed. Repositioned. Floor nurse reports pt accusing staff of raping him. Pt. admits to feeling confused disoriented to place and time, staff reports foul smelling urine no nutritional intake today”. There is no evidence of an immediate investigation to prevent further potential violations while the alleged violation is being verified.”

“Upon patient record review 1 of 19 (Patient #14) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process. Patient 14: On 4/29/26 the MSW documented, “patient attends Dialysis T-TH-Sat”, there is not evidence that the RN initial comprehensive assessment identifies a complete physical assessment including the patient’s need for dialysis and assessment of the fistula needed for dialysis.”

“Upon patient record review, 2 of 19 (Patient #9,12) 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 9: On the medication profile there is an order for Acetaminophen 500mg 1 tablet every 4 hours as needed, hydrocodone 5/325mg 2 times daily and hydrocodone 5/325mg every 4 hours as needed, there is not an order for a limit for acetaminophen on the medication profile. Patient 12: On the initial medication profile there is an order for acetaminophen 650mg rectal suppository every 6 hours as needed, Tylenol 325mg every 6 hours as needed and Tylenol 325, 2 tabs 3 times daily for pain. There is not an order for a daily limit for these medications.”

“Upon patient record review, 1 of 19 (Patient #14) 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 14: On 4/29/26 the MSW documented, “patient attends Dialysis T-TH-Sat”, there is not evidence that the initial comprehensive assessment and each nursing assessment, identifies a complete physical assessment including the patient’s need for dialysis and assessment of the fistula needed for dialysis.”

“Upon patient record review, 5 of 19 (Patient #4,5,7,11,14) 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 4: On the medication profile there is an order for Xarelto 10mg daily there is not a risk for bleeding with goals and interventions on the plan of care. Patient 5:On the medication profile there is an order for Aspirin 81mg there is not a risk for bleeding with goals and interventions on the plan of care. On the plan of care there is a goal to verbalize/demonstrate understanding of how to use oxygen safely and effectively, there are no interventions for this goal on the plan of care. Patient 7: On the medication profile there is an order for Aspirin 81mg there is not a risk for bleeding with goals and interventions on the plan of care. On the RN initial assessment there is evidence of a PEG tube, there are not orders for the PEG tube on the plan of care with goals and interventions. Patient 11: On the plan of care there is an order for Eliquis 5mg daily, there is not a risk for bleeding on the plan of care with goals and interventions. Patient 14: On 4/29/26 the MSW documented, “patient attends Dialysis T-TH-Sat”, there is no evidence that the hospice has developed an individualized complete plan of care to include problems, goals and interventions.”

“Upon patient record review, 3 of 19 (Patient #9,12,14) 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 9: On the medication profile there is an order for Acetaminophen 500mg, 1 tablet every 4 hours as needed, hydrocodone 5/325mg, 2 times daily and hydrocodone 5/325mg every 4 hours as needed, there is not an order for a limit for acetaminophen on the medication profile. Patient 12: On the initial plan of care there is an order for acetaminophen 650mg rectal suppository every 6 hours as needed, Tylenol 325mg every 6 hours as needed and Tylenol 325 2 tabs 3 times daily for pain. There is not an order for a daily limit for these medications. Patient 14: On 4/29/26 the MSW documented, “patient attends dialysis T-TH-Sat”, the plan of care does not include dialysis as a related medical treatment.”

“Upon patient record review 1 of 19 (Patient #14) 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 14: On 4/29/26 the MSW documented, “patient attends Dialysis T-TH-Sat”, there is not evidence that the initial comprehensive assessment identifies a complete physical assessment including the patient’s need for dialysis and assessment of the fistula needed for dialysis. There was no evidence of follow up with the patient or an additional visit made by members of the IDG to assess.”

“Upon patient record review, 1 of 19 (Patient #14) did not have evidence that the IDG shares information on a on-going basis with non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions. Patient 14: On 4/29/26 the MSW documented , “patient attends Dialysis T-TH-Sat”, there is not evidence that IDG shares information on an on-going basis with non-hospice healthcare providers including the dialysis center where the patient is receiving treatment three times a week. On 5/22 the skilled nurse documented, “Pt. hanging off side of bed. Repositioned. Floor nurse reports pt accusing staff of raping him. Pt. admits to feeling confused disoriented to place and time, staff reports foul smelling urine no nutritional intake today”. There is no evidence that the skilled nurse or other members of the IDG followed up on the patient “accusing staff of raping him”.”

“Upon observation and patient record review, 1 of 19 (Patient #14) there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient #14: On 5/22, the skilled nurse documented, “Pt. hanging off side of bed. Repositioned. Floor nurse reports patient accusing staff of raping him. Pt. admits to feeling confused disoriented to place and time, staff reports foul smelling urine no nutritional intake today”. There is no evidence that the agency documented the incident and followed up.”

“Upon personnel record review, 1 of 19 (Personnel #6) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 6: On the aide initial competency the aide was not trained on shampoo on the Shampoo, sink, tub, and bed competency.”

“Upon patient record review, 2 of 19 (Patient #1, 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 1: On the aide plan of care there is an order for a shower 2x/week and an order for bed bath weekly, there is not an order for one or the other. Patient 2: On the aide plan of care there is an order for bathing, bed bath and bathing, shower weekly, there is not an order for one or the other.”

“Upon contract review, 1 of 5 (Dialysis Contract) 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 Dialysis Contract: There is no evidence that the hospice provided a written agreement with dialysis services who is providing dialysis services 3 times a week for a hospice patient.”