Accentcare Hospice and Palliative Care of Tennessee LLC

“It is required that the documented comprehensive assessment includes 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 measures are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when 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 3 of 3 (100%) home visit observations, the agency did not ensure that the comprehensive assessment included a drug profile that contained the patient’s current medications to identify any potential adverse effects and actual or potential drug interactions. HOME VISIT 1/CLINICAL RECORD 1: The patient elected the hospice benefit on 04/09/2026 with a terminal diagnosis of senile degeneration of the brain. The patient resided in a group home. During the home visit with the Hospice Aide (HA) [Personnel Record 1] on 06/17/2026, the hospice medication profile, dated 06/16/2026, and the group home’s current medication administration record (MAR), dated 06/01/2026, were compared. The group home MAR included documentation of the following medications: vitamin C 1000 units tablet by mouth twice a day, acetaminophen ER 650 mg, one (1) tablet by mouth three times a day, calcium D3 600 mg by mouth twice a day, metoprolol 25 mg by mouth twice a day, probiotic 250 mg by mouth once a day, loratadine 10 mg by mouth daily as needed, and melatonin 5 mg by mouth once a day as needed. The hospice medication profile did not include documentation of vitamin C, acetaminophen ER, calcium D3, metoprolol, probiotic, loratadine, or melatonin. HOME VISIT 2/CLINICAL RECORD 2: The patient elected the hospice benefit on 05/26/2026 with a terminal diagnosis of senile degeneration of the brain. The patient resided in a group home. During the home visit with the Registered Nurse (RN) [Personnel Record 2] on 06/17/2026, the hospice medication profile, dated 06/16/2026, and the group home’s current MAR, dated 06/15/2026-07/14/2026, were compared. The group home MAR included documentation of the following medications: escitalopram 10 mg by mouth daily, folic acid 1 mg by mouth daily, gabapentin 100 mg two capsules at night, levothyroxine 100 mcg by mouth daily in the AM, metformin 500 mg one tablet by mouth daily in the AM, misoprolol 100 mg by mouth twice a day, simvastatin 20 mg one tablet by mouth daily at night, vitamin B12 500 mcg two tablets by mouth daily, and vitamin D3 5000 units soft gel, one (1) capsule daily. The hospice medication profile did not include documentation of escitalopram, folic acid, gabapentin, metformin, misoprolol, simvastatin, vitamin B12, and vitamin D3 HOME VISIT 3/CLINICAL RECORD 3: The patient elected the hospice benefit on 10/29/2025 with a terminal diagnosis of senile degeneration of the brain. The patient resided in an assisted living facility (ALF). During the home visit with the Chaplain [Personnel Record 3] on 06/17/2026, the hospice medication profile, dated 06/16/2026, and the ALF MAR dated 06/01/2026 were compared. The ALF MAR included documentation of the following medications: gabapentin 100 mg by mouth twice a day, acetaminophen 325 mg, two (2) tablets by mouth every 4 hours as needed for pain/fever, amlodipine 5 mg one tablet by mouth every AM, aspirin EC tablet delayed release 81 mg one tablet by mouth twice a day, calmoseptine ointment 0.44-20.625% apply to itchy areas every 6 hours as needed, cyclobenzaprine 10 mg, one (1) tablet by mouth in the AM, escitalopram 10 mg tablet, one (1) tablet by mouth every AM, ipratropium-albuterol inhalation solution 0.5-2.5 (3) mg/3 ml inhale, 3 ml inhaled orally every 6 hours as needed for wheezing, The hospice medication profile did not include documentation of gabapentin, acetaminophen, amlodipine, aspirin EC, calmoseptine ointment, cyclobenzaprine, escitalopram, and ipratropium-albuterol inhalation solution. During a joint visit and clinical record review on 06/17/2026, the Director of Clinical Services stated that the home medication administration records did not match the hospice’s medication profiles.”

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene; use of gloves, mask, eye protection, or face shield depending on anticipated exposure; [and] safe handling of soiled items in the patient’s care environment. This standard was not met as evidenced by clinical record review, document review, and observation. Agency policy #4003 Protocol “Hand Hygiene” (revised 06/09/2021) stated in part, “Decontaminate the hands using an alcohol-based hand rub, or wash hands with antimicrobial soap and water when the hands are not visibly soiled in the following circumstances...Before and after direct contact with patients... After removing gloves... When performing patient care and moving from a contaminated body site to a clean-body site (e.g., when moving from the perineal area to the face).” In 1 of 3 (33%) home visit observations, the agency did not ensure that staff followed accepted standards of practice to prevent the transmission of infections and communicable diseases, including hand hygiene. HOME VISIT 1/CLINICAL RECORD 1: The patient elected the hospice benefit on 04/09/2026 with a terminal diagnosis of senile degeneration of the brain. The patient resided in a group home. During the home visit with the Hospice Aide (HA) [Personnel Record 1] on 06/17/2026, the HA was observed giving a bed bath to the patient. The HA cleansed the patient’s face, upper body, and perineal area, then applied lotion to the patient’s face without decontaminating their hands. The patient was then turned, and the rectal area, back, and legs were cleaned. The HA then applied barrier cream to the patient’s sacral area and then changed gloves without decontaminating her hands. During the joint visit and clinical record review on 06/17/2026, the Director of Clinical Services, who was present for the home visit, confirmed the findings and stated that the Hospice Aide did not follow the agency’s hand hygiene policy.”

“It is required that all hospice aide services must be provided by an individual who has successfully completed one (1) of the four (4) training and competency evaluations programs described below. The individual furnishes hospice aide services on behalf of a hospice only after successfully completing a competency evaluation program. The competency evaluation addresses each of the following subject areas: they are evaluated by observation of an aide’s performance with a patient or pseudo-patient, including: 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; appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist:bed bath; sponge, tub, and shower bath; hair shampoo (sink, tub, and bed); nail and skin care; oral hygiene; toileting and elimination; safe transfer techniques and ambulation; [and] normal range of motion and positioning. The competency evaluation is performed by a registered nurse in consultation with other skilled professionals, as appropriate. This standard was not met as evidenced by personnel record review and interview. In 1 of 1 (100%) personnel records reviewed for a Hospice Aide (HA), the agency did not ensure that all aide tasks were observed by the Registered Nurse (RN) before the aide performed them independently. PERSONNEL RECORD 1: This Hospice Aide was hired on 01/05/2026. The personnel record was reviewed and revealed that the hospice aide initial skills competency conducted on 01/07/2026 did not document the Hospice Aide’s ability to demonstrate initial satisfactory performance in the following tasks: sponge bath, shower, safe transfer techniques, and ambulation. There was no other documentation of the HA’s skills or competencies. A joint review of personnel records and interviews was conducted on 06/18/2026; the Director of Clinical Operations stated that not all tasks were observed and that they should have been.”

“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 and interview. In 1 of 13 (8%) clinical records reviewed of patients who received Hospice Aide services, the agency did not ensure that the Hospice Aide received written patient care instructions to meet the patient’s needs. CLINICAL RECORD 7: The patient elected the hospice benefit on 06/10/2026 with a terminal diagnosis of cirrhosis of the liver. The hospice plan of care for the dates of 06/11/2026-09/08/2026 ordered: wound #1: stage: unstageable location: anterior LLE wash with wound cleanser, dry: pat dry with sterile gauze, apply: Xeroform to wound bed, cover: ABD pad and secure with rolled gauze, change every 3-4 days and PRN soiled. Wound #2 Stage: unstageable location: RLE anterior wash with wound cleanser, dry: pat dry with sterile gauze, apply Xeroform, cover: ABD pad, and secure with rolled gauze, change every 3-4 days, and PRN soiled. Wound #3 stage: unstageable location: LLE lateral ankle wash with wound cleanser, dry: pat dry with sterile gauze, and apply Xeroform; cover: ABD pad, and secure with rolled gauze; change every 3-4 days, and PRN soiled. DME supplies included dressings: specialty impregnated petroleum gauze. Additionally, the plan of care ordered Hospice Aide services 2XW, starting on 06/14/2026. The Hospice Aide care plan reviewed for the dates of 06/11/2026-09/08/2026 did not include instructions for the care and management of the dressings for the wounds should they become soiled, wet, or dislodged during personal care. During a joint review of clinical records and an interview on 06/17/2026, the Director of Clinical Operations stated that the Hospice Aide care plan needed to be more specific so the Hospice Aide would know how to care for wound dressings during personal care.”

“It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. 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 that Hospice Aide services were provided as ordered by the Interdisciplinary Group (IDG) and included in the plan of care. CLINICAL RECORD 1: The patient elected the hospice benefit on 04/09/2026 with a terminal diagnosis of senile degeneration of the brain. The initial Registered Nurse comprehensive assessment dated 04/09/2026 documented that patient’s skin was intact, but the patient had a history of skin tears due to having very thin skin. During a home visit observation on 06/17/2026 with the Hospice Aide (HA) [Personnel Record 1], the HA was applied barrier cream to the patient’s sacral area following the bed bath. The hospice plan of care for the dates of 04/09/2026-07/07/2026 ordered Hospice Aide visits 2XW. The Hospice Aide care plan reviewed for the dates of 04/09/2026-07/07/2026 did not assign the Hospice Aide the task: apply barrier cream to the sacrum. During an interview on 06/17/2026, the Director of Clinical Operations stated that the Hospice Aide care plan did not include instructions for the Hospice Aide to apply barrier cream to the patient’s sacral area.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. The agency did not ensure that hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. An interview and a joint review of the Cost Savings report for 2024 and 2025 on 06/17/2026 with the Volunteer Coordinator and the Administrator revealed that the volunteer utilization for 2024, 01/01/2024 through 12/31/2024 was 0% and 2025, 01/01/2025 through 12/31/2025 was 0.69%. The Volunteer Coordinator confirmed the findings and stated that there was an action plan in place to recruit additional volunteers. An interview was conducted with the Volunteer Coordinator and the Administrator on 06/17/2026 The cost savings report for 2024 and 2025 were reviewed revealed that the volunteer utilization fo 2024 was 0% and 2025 was 0.69%. This did not meet the requirement of five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The Volunteer Coordinator stated that there was an action plan in place to recruit additional volunteers.”