Hospice of Chattanooga Holdings, LLC

“Upon patient record review, 1 of 31 (Patient #3) 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 #3: During home visit and medication reconciliation, noted that patient/ALF medication profile listed Atenolol 25 mg (1/2) tab daily and hospice medication profile listed Atenolol 25 mg (1) tab daily. RN informed and will reconcile.”

“Upon patient record review, 1 of 31 (Patient #2) 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 is IDDM. Initial assessment RN documented plan to decrease insulin, based on patient blood sugars. Patient had 2 prior hospitalizations for hypo-hyper glycemic episodes and has documented weight loss 8-9 lbs in past 4 months (per CTI). There was no documented evidence blood sugar is being monitored. Example visit notes November 22, Dec 1, 8, 19, 26 29 of 2025.”

“Upon client record review, 4 of 31 (Patient #4, 6, 21, 26) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: 12/18/25 SN note: Patient has an unstageable wound on left heel, dressing peeling off. Area cleaned and redressed per MD order. Patient tolerated well. There are no documented orders for dressing change. Patient #6: Plan of Care includes order for wound measurements weekly. No documented evidence of measurements including, but not limited to 12/9, 12/16. 12/23, 12/30/25 SN visits. Patient #21: 7/2/25 written order for PT consult and up to 3 visits. Record only included documentation of Physical Therapist’s evaluation visit, including plan for follow up visit; however, record did not include documentation of subsequent visits. Patient #26: Travel patient admitted into GIP in hospice care center. Volunteer visit documented 12/18/25. No ordered volunteer frequency. POC states provide volunteer as ordered.”

“Upon observation 1 of 6 visits, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #8 (Visit 6): Upon observation during home visit with RN, observed that clean and dirty was not clearly defined for barrier used. RN cleaned equipment and placed equipment back on dirty space where equipment had been placed after use on patient. Nurse also entered bag after contact with patient and without sanitizing first. Nurse retrieved used nasal cannula for patient from portable tank, and touched used cannula without sanitizing afterwards.”

“Upon patient record review, 1 of 31 (Patient #7) 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 #7: Patient has continuous oxygen prescribed with oxygen precautions not specified in Aide care plan.”

“Upon patient client record review, 4 of 31 (Patient #4, 5, 11, 12) 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 #4: 12/18/25 SN note: Patient has an unstageable wound on left heel, dressing peeling off. Area cleaned and redressed per MD order. Patient tolerated well. SN did not document specifics of treatment provided. Patient #5: CTI signed 12/24/25 (for 12/23--2/20/25) includes documentation that patient she has a growth on her left neck with an eschar. She has a stage two pressure wound on her sacral area and bilateral buttock wounds as well. SN notes dated 12/10, 12/19, 12/31 say skin intact with no documented wounds. Interview with staff confirm patient has no wounds. Patient #11: Patient readmitted status post hospitalization for fall and hip fracture. 11/21/25 SN visit narrative references 3 surgical incisions. One of the three wound was described in wound care section as type: “Burn” with 4 staples intact. Interview with staff confirm all 3 wounds to be surgical incisions and “burn” is error. SC IDG note effective 11/26/25, says simply that patient revoked to seek aggressive treatment. At that point, should have included that patient had been readmitted 11/21/25, as most accurate status. Patient #12: SN initial eval and listing of multiple wounds failed to specify right or left for “lower calf” and “pinky toe” wounds.”

“Upon observation, there is no evidence the corridor walls and doors of a facility is provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. Hospices are exempt from chapter 19.3.6.3.5 “exception number 1 and 2 and 19.3.6.3.6 number 2”. If recommended by state survey agency, CMS may waive for periods deemed appropriate, specific provisions of the LSC which, if rigidly applied, would result in unreasonable hardship to the hospice, but only if the waiver would not adversely affect the health and safety of patients. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. Existing Construction During building tour the following was observed: 1. Self closing fire doors (11327) had greater than 1/8” gap at the meeting edges, which exceeds maximum allowable clearance (NFPA 101, 7.2.1.4.3). Corrected on site-Intumescent edge seal installed. 2. Missing corner in ceiling tile in smoke compartment corridor area. Corrected on site- Ceiling tile repaired.”

“Upon observation, there is no evidence the smoke compartmentation and control of a facility is provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. Existing Construction During building tour, the following was observed: 1. Ceiling tile were was discolored in the Janitor Closet (19.3.7.3). Corrected on site (COS)-tile replaced 2. Wooden wedge door stops were identified propping open Nutrition and Staff Break rooms (19.3.7.8 ). Corrected on Site-door stops removed”

“Upon observation, there was no evidence the building service equipment of a facility is provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. Existing Construction During the building tour, it was observed: 1. The ceiling supply air register in the Supply-2 room showed evidence of a past or active water leak. The surrounding gypsum board exhibited water discoloration, indicating possible moisture intrusion or damage. 2. The exhaust vent hose serving the portable air conditioning (spot cooling) unit in the server room was observed disconnected due to the UL 181–listed aluminum foil HVAC tape coming loose. (NFPA 75-4.2.3 &6.1.3)”

“Upon observation, there was no evidence the electrical of a facility is provided consistent with the 2012 editions of the LSC of the National Fire Protection Association and NFPA 99. The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. New and existing Construction During the building tour, it was observed that three power strips at the nursing station were located directly on the floor. This placement makes them susceptible to water exposure during cleaning or mopping, creating a potential electrical shock and fire hazard. (Electrical wiring and equipment shall be in accordance with NFPA 70, National Electrical Code. 9.1.2”