All Seasons Healthcare, Inc.

“It is required that hospice aides are 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 a 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 2 of 14 (14%) clinical records reviewed in which hospice aide services were provided, the agency did not ensure that written patient care instructions for the hospice aide were clear and complete. CLINICAL RECORD 1/HOME VISIT 1: This patient elected the hospice benefit on 02/13/2025 with a terminal diagnosis of myoneural disorder. The initial comprehensive assessment dated 02/13/2025 documented that the patient ambulated with a walker. The initial plan of care dated 02/13/2025 included orders for hospice aide visits 5XW. The hospice aide care plan was reviewed for the dates 02/13/2025-04/15/2026. The care plan stated that the patient was independent with ambulation and did not include instructions for use of the walker for safe ambulation. During a home visit conducted on 04/15/2026 to observe the hospice aide (Personnel Record 1) with the Director of Nursing in attendance, the patient was observed to ambulate with a walker while walking from the living room to the bathroom for personal care. CLINICAL RECORD 2: This patient elected the hospice benefit on 06/07/2024 with a terminal diagnosis of heart failure. The initial comprehensive assessment completed on 06/07/2024 documented that oxygen was ordered at 2L/NC for “shortness of breath”. The physician order written on 06/08/2024 included oxygen at 2L/min via nasal cannula for shortness of breath and/or oxygen saturation under 90%. The plan of care was reviewed for the dates of 06/07/2024-02/16/2026 and included orders for hospice aide visits 5XW. The aide care plans from 06/07/2024-02/16/2026 were reviewed and did not include instructions for safe use of oxygen during personal care. The Oxygen was discontinued by the physician on 02/16/2026. During an interview conducted on 04/15/2026, the Director of Nursing (DON) stated that the hospice plans were not complete, and she could not find the necessary instructions within the electronic medical record (EMR) to ensure the hospice aide care plans were complete.”

“It is required that drugs and biologicals are labeled and stored in accordance with state law and regulation, as well as accepted standards of practice. At a minimum, labels include: the patient’s full name, generic, trade, or brand name of the medication, as well as amount dispensed, directions for use, including route, rate, frequency, and method of administration, prescriber’s name, expiration date, and cautionary instructions. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 3 (33%) home visits conducted, the agency did not ensure medications were properly labeled and not available for patient use after expiration, in accordance with accepted standards of practice. CLINICAL RECORD 1/HOME VISIT 1: This patient elected the hospice benefit on 06/07/2024 with a terminal diagnosis of heart failure. The review of the patient’s clinical documentation did not provide evidence of ongoing monitoring of medication dates regarding removal and disposal of expired medications. During a home visit with the hospice aide (Personnel Record 1) on 04/15/2026 accompanied by the Director of Nursing (DON) (Personnel Record 3), the patient’s medications were reviewed which revealed a medication bottle located in the patient’s bag attached to her rollator. The medication label was worn and illegible, preventing verification of medication name, dosage, expiration date, and instructions. The patient identified the medication as Meclizine, which was listed on the hospice drug profile. The DON examined the bottle and confirmed that the only legible information on the label indicated a year of “2024”. The DON stated that the drug was expired and removed the bottle from the patient’s possession, informing the patient that a new prescription would be obtained. All other medications listed on the drug profile were reviewed and were reconciled accurately. In an interview with the DON on 04/15/2026, it was stated that the medication had expired and the case manager must have missed it during the weekly reconciliation of medications. The DON removed the medication from the home at the time of the home visit and contacted the physician to provide a refill of the meclizine to prevent the patient using an expired medication and a medication that could not be properly identified.”