Caris Healthcare

“Based on agency policy review, medical record review, and interview, the agency failed to complete a thorough comprehensive assessment to include the bowel elimination for 5 Patients (#3, #4, #6, #8, and #10) of 16 patients reviewed. The findings include: Review of the agency policy titled, “Comprehensive Assessment & Plan of Care,” reviewed 2024 revealed “...The registered nurse (RN) will conduct an...assessment to determine the patient’s immediate care needs...including identification of goals and interventions, will include the assessment of...bowel...elimination...” Review of the agency policy, “;Pain and Symptom Management,” reviewed 2024 revealed “;...The interdisciplinary team ensures that patients receive effective pain management and symptom control from the hospice...including constipation...The patients pain and other symptoms...are thoroughly assessed during the comprehensive assessment of the patient by the RN Case Manager...” Medical record review revealed Patient #3 was admitted to the agency on 10/29/2024 with diagnoses including Congestive Heart Failure Medical record review of a nursing clinical note dated 12/31/2024 and 1/8/2025 revealed no documentation of Patient #3’s bowel assessment. Medical record review revealed Patient #4 was admitted to the agency on 1/4/2025 with diagnoses including Coronary Artery Disease. Medical record review of nursing clinical note dated 1/7/2025 and 1/10/2025 revealed no documentation of Patient #4’s bowel assessment. Medical record review revealed Patient #6 was admitted to the agency on 6/27/2024 with diagnoses including Congestive Heart Failure. Medical record review of nursing clinical note dated 1/3/2025 and 1/8/2025 revealed no documentation of Patient #6s bowel assessment. Medical record review revealed Patient #8 was admitted to the agency on 1/4/2024 with diagnoses including Cognitive Impairment. Medical record review of nursing clinical note dated 1/2/2025 and 1/9/2025 revealed no documentation of Patient #8s bowel assessment. Medical record review revealed Patient #10 was admitted to the agency on 11/5/2024 with diagnoses including Senile Degeneration of Brain Medical record review of nursing clinical note dated 11/7/2024 revealed no documentation of Patient #10s bowel assessment. During an interview on 1/14/2025 at 11:07 AM, the Administrator confirmed a thorough comprehensive assessment to include the bowel assessment for Patient #3, #4, #6, #8, and #10 had not been completed and documented on all visits.”

“Based on agency policy review, medical record review and interview, the agency failed to furnish services indicated by the individualized written plan of care (POC) established by the physicians order for 1 patient (#5) of 16 patients reviewed. The findings include: Review of the agency policy, “;Scheduling SOP Local Office,” revised 11/2023 revealed “;...Order and Scheduling Process to ensure visits are following the plan of care...Orders are entered upon admission to indicate the amount, frequency and duration of visits made by each discipline of the team that the patient/family will require to meet their needs...” Review of the agency policy, “;Plan of Care,” reviewed 2024 revealed “;...The patients plan of care specifies the care and services necessary to meet the needs of the patient/caregiver...frequency of services necessary to meet the specific patient and family needs...” Review of the agency policy “;Physician Orders,” reviewed 2024 revealed “;...orders are obtained for the physician in order to provide...dressing changes/wound care...to meet the needs of the patient...” Medical record review revealed Patient #5 was admitted to the agency on 12/29/2024 with diagnoses including Parkinsons Disease. Medical record review of Patient #5’s POC for the certification period 12/29/2024-3/28/2025 revealed a Physician’s order effective 1/1/2025 for Hospice Nurses (SN) 2 time a week for 1 week and 1 time a week for 12 weeks. Medical record review of Physician Orders dated 12/29/2024 showed Wound Care to 1st great toe 3 times per week for 23 days, left lateral ankle 3 times per week for 23 days, and left posterior ankle 3 times per week for 30 days. Continued review showed the Skilled Nurse was ordered a visit frequency of 2 times a week for 1 week and 1 time a week for 12 weeks. There was no documentation the physician had ordered wound care to be provided by the facility or family for Patient #5. During an interview on 1/14/2025 at 10:28 AM, the Administrator confirmed the physician had not ordered a visit frequency as 3 times per week for wound care orders and had not ordered for the facility to provide care in the absence of a skilled nurse visit.”

“Based on agency policy review, medical record review and interview, the agency failed to implement a bowel regimen for 4 Patients (#1, #3, #4, and #6) of13 patients reviewed for opioid medications. The findings include: Review of the agency policy, “;Comprehensive Assessment,” reviewed 2024 revealed “;...An assessment of the need for a bowel regimen when the patient has been prescribed opioids...” Review of the agency policy, “;Pain and Symptom Management,” reviewed 2024 revealed “;...The interdisciplinary team ensures that patients receive effective pain management and symptom control from the hospice...including constipation...The patients pain and other symptoms...are thoroughly assessed during the comprehensive assessment of the patient by the RN Case Manager...” Medical record review revealed Patient #1 was admitted to the agency on 9/19/2024 with diagnoses including Senile Degeneration of Brain. Medical record review of a Physician Order dated 12/18/2024, showed Patient #1 had been ordered Morphine Concentrate (an opioid used to treat pain) 20 milligrams/5 milliliters (MG/ML) oral syringe every 4 hours as needed for pain. Medical record review of the medication profile summary showed Patient #1 had not been ordered medications for constipation. Medical record review revealed Patient #3 was admitted to the agency on 10/29/2024 with diagnoses including Congestive Heart Failure Medical record review of a Physician Order dated 12/18/2024, showed Patient #3 had been ordered Morphine Concentrate (an opioid used to treat pain) 20mg/5ml oral syringe every 4 hours as needed for pain and Hydrocodone 7.5 mg-Acetaminophen 325 mg tablet every 4 hours as needed for pain. Medical record review of the medication profile summary showed Patient #3 had not been ordered medications for constipation. Medical record review revealed Patient #4 was admitted to the agency on 1/4/2025 with diagnoses including Coronary Artery Disease. Medical record review of a Physician Order dated 1/5/2025, showed Patient #4 had been ordered Hydrocodone 5 mg-Acetaminophen 325 mg tablet every 6 hours as needed for pain. Medical record review of the medication profile summary showed Patient #4 had not been ordered medications for constipation. Medical record review revealed Patient #6 was admitted to the agency on 6/27/2024 with diagnoses including Congestive Heart Failure. Medical record review of a Physician Order dated 9/16/2024, showed Patient #6 had been ordered Hydrocodone 5 mg-Acetaminophen 325 mg tablet every 6 hours as needed for pain. Medical record review of the medication profile summary showed Patient #6 had not been ordered medications for constipation. During an interview on 1/14/2025 at 10:20 AM, the Administrator confirmed the agency failed implement a bowel regimen for Patients #1, #3, #4, and #6 who received opioids.”

“Based on agency policy, record review, and interview, the agency failed to follow the plan of care (POC) related to visit frequency for 2 of 13 sampled patients (Patient #10 and #12). The findings include: Review of the agency policy titled, “Plan of Care” reviewed 2/25/2020 showed “...The patient’s plan of care specifies the care and services necessary to meet the needs of the patient/caregiver as identified in the initial, comprehensive and updated assessment of the patient. Medical record review revealed Patient #10 was admitted to the agency on 11/5/2024 with a diagnosis of Senile Degeneration of Brain. Medical record review showed Patient #10’s Plan of Care for recertification period 11/5/2024-2/2/2025 showed orders for visit frequency for “HHA [Hospice Aide] 2 WK [week] 13...” Medical record review showed Patient #10s visit calendar (calendar that documents all disciplines scheduled to provide services) showed 1 completed Hospice Aide visit for the week of 11/5/2024 for Patient #10. Medical record review revealed Patient #12 was admitted to the agency on 4/3/2024 with a diagnosis of Coronary Artery Disease Medical record review showed Patient #12’s Plan of Care for recertification period 12/29/2024-2/26/2025 showed orders for visit frequency for “HHA [Hospice Aide] 3 Week 8...” Medical record review showed Patient #12’s visit calendar showed 2 completed Hospice Aide visits for the week of 12/29/2024 and 1/5/2024 for Patient #12. During an interview 1/14/2025 at 11:07 AM, the Administrator confirmed the agency had not followed the plan of care related to visit frequency for Patients #10 and #12.”