Remembrance Hospice Medina

“It is required that the documented comprehensive assessment include a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following: the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but at a minimum, at the time of each comprehensive assessment and/or when a new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 3 (33%) home visit observations, the agency did not ensure an accurate review of medications the patient was currently using to identify any potential adverse effects and drug reactions was documented. HOME VISIT 1 / CLINICAL RECORD 1: The patient elected the hospice benefit on 01/15/2026 with a terminal diagnosis of combined systolic and diastolic heart failure. During the home visit observation on 03/04/2026, with the Hospice Aide (HA) (Personnel Record 1) and the Clinical Director (Personnel Record 7) present, the hospice drug profile was reconciled with the assisted living facility medication administration record. The following medications were on the ALF medication administration record but were not on the hospice drug profile: ascorbic acid oral wafer 500mg one tablet daily, cholecalciferol tablet 1000-unit one tablet daily by mouth, and Ferrett’s oral tablet 325 mg one tablet daily by mouth. In an interview with the Clinical Manager on 03/05/2026, she stated that the ALF medication administration record did not match the hospice drug profile.”

“It is required that the hospice follow accepted standards of practice to prevent the transmission of infections and communicable diseases, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by clinical record review, document review, interview, and observation. In 1 of 3 (33%) home visit observations, the agency did not ensure staff performed hand hygiene as required by agency policy. DOCUMENT 1: Agency Policy No. 7-009 titled, Hand Hygiene stated, in part: “ 3. Hand decontamination using an alcohol-based rub should be performed...after contact with a patient’s intact skin.” HOME VISIT 1/CLINICAL RECORD1: This patient elected the hospice benefit on 01/15/2026 with a terminal diagnosis of combined systolic and diastolic heart failure. During the home visit observation on 03/04/2026 with the Hospice Aide (HA) (Personnel Record 1) and the Clinical Director (Personnel Record 7) present, the HA was observed to assist the patient to the toilet, go to the patient’s bedroom, and pull out clean clothes without removing gloves and sanitizing hands. The Clinical Manager was interviewed on 03/4/2026 and stated that the Hospice Aide did not follow the agency policy for hand hygiene.”

“It is required that hospice aides be assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by an RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 14 (7%) clinical records reviewed of patients who received Hospice Aide Services (HA), the agency did not ensure that all written patient care instructions were included in the hospice aide care plan. CLINICAL RECORD 2/HOME VISIT 2: This patient elected the hospice benefit on 09/25/2024 with a terminal diagnosis of hypertensive heart disease with congestive heart failure. The plan of care dated 09/25/2024-12/24/2024 ordered: “Insert indwelling urinary catheter per physician order 22 French (FR) with 10ml balloon” and “Aide 2x/week.” The HA care plan dated 09/25/2024 did not include instructions addressing the care and maintenance of the Foley catheter during personal care. The hospice plan of care for the dates of 01/18/2026-03/18/2026 included orders for the use of a Hoyer lift, oxygen prn, and Aide 2x/week. The hospice aide care plan was reviewed for the dates of 01/18/2026-03/04/2026. The hospice aide care plan did not include instructions for the use of the Hoyer lift and Oxygen. During the home visit observation on 03/04/2026, with the Registered Nurse (RN) (Personnel Record 2) and the Clinical Director (Personnel Record 7) present, a Hoyer lift and an oxygen concentrator were present in the patient’s room. The RN stated that the staff utilized the Hoyer lift daily. During an interview and joint review of records on 03/04/2025, the Clinical Director stated that the hospice aide care plan was not complete and that there would be continued education for the case managers to ensure the care plans included all the necessary instructions.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met, as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed in which hospice aide services were provided, the agency did not ensure the Hospice Aide reported a change in the patient’s needs to the Registered Nurse. CLINICAL RECORD 6: This patient elected the hospice benefit on 12/04/2025 with a terminal diagnosis of Alzheimer’s Disease. The hospice plan of care reviewed for the dates of 12/04/2025-03/04/2026 included orders for hospice aide visits 1XW. The hospice aide’s visit note dated 12/11/2025 documented that the patient refused the bed bath. The clinical record was reviewed with no evidence that the RN was notified of the change. During an interview and joint review of records on 03/04/2025, the Clinical Director stated that there was no documentation present in the clinical record that the Hospice Aide had notified the RN that the patient refused a bed bath.”

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. Volunteer services are noted in the plan of care and documented in the patient record, including the time spent. This standard was not met, as evidenced by document review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that volunteer services were offered to the patient. CLINICAL RECORD 3: This patient elected the hospice benefit on 08/19/2025 with a terminal diagnosis of Alzheimer’s Disease. A review of the clinical record, admission forms, and the IDG notes for the dates of 08/19/2025-03/042026 did not include documentation that volunteer services were offered. During an interview and joint clinical record review on 03/04/2026, the Clinical Director stated that the admitting Registered Nurse was the person responsible for assessing the patient’s request for volunteer services and there was no documentation in the clinical records that the volunteer services were offered to the patient.”