Hospice of South Texas Inc.

“It is required that the written Patient Bill of Rights includes the right to: be involved in the development of his or her plan of care. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 1 (100%) clinical record reviewed of a patient discharged with an extended prognosis, the agency did not ensure the patient was involved in the development in his or her plan of care. Agency policy titled “Discharge Policy, AD.3”, last reviewed 01/20/2026, stated in relevant parts: “Case manager or social worker will complete discharge paperwork no later than 48 hours of notification of discharge/transfer. Case manager or social worker will ensure delivery of the written notification no later than five (5) days before the date on which the patient is to be discharged/transferred.” The state Admin. Code § 558.295 “Client Transfer or Discharge Notification Requirements” states in part, “An agency must ensure delivery of the written notification no later than five days before the date on which the client will be transferred or discharged.” The “Notice Instructions for the Notice of Medicare Non-Coverage” (NOMNC) Center for Medicare and Medicaid Services (CMS)-10123 stated in part, “A Medicare provider/plan (Medicare Advantage plans and cost plans, collectively referred to as “plans”) must deliver a completed copy of this notice to beneficiaries/enrollees receiving covered skilled nursing, home health, comprehensive outpatient rehabilitation facility, and hospice services. The NOMNC must be delivered at least two calendar days before Medicare-covered services end, or the second-to-last day of service if care is not being provided daily.” CLINICAL RECORD 15: The patient elected the hospice benefit on 08/05/2025 with a diagnosis of senile degeneration of the brain. The agency discharged the patient for extended prognosis on 01/30/2026. The NOMNC was signed by the legal representative on 01/29/2026, 1 day prior to discharge, instead of the required 48 hours in accordance the form instructions and agency policy. The state Form 3071 - Individual Election, Cancellation or Update was included in the chart and signed by the legal representative but not dated; it is required by the state to be signed five (5) days prior to discharge. On interview and joint clinical record review, conducted with the Chief Nursing Officer and Clinical Manager on 05/29/2026, it was stated that the Form 3071 “should have been dated” per the Clinical Manager and the NOMNC was signed “too close to discharge.””

“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; other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation, and interview. In 1 of 4 (25%) observed home visits, it was revealed that the agency did not ensure the drug profile contained the patient’s current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. HOME VISIT 2/CLINICAL RECORD 2: The patient elected the hospice benefit on 02/23/2025 with a diagnosis of cerebrovascular disease. The patient resided in a skilled nursing facility (SNF). During the observed home visit with the Spiritual Counselor (SC - Personnel Record 10) on 05/27/2026 the hospice medication profile (printed on 05/27/2026) was compared to the SNF medication profile (printed on 05/27/2026). The hospice medication profile listed the following medication not listed on the SNF medication profile: Lorazepam 2mg/ml. Give 0.5 ml every 4 hours as needed (ordered 02/23/2025). Additionally, the medication profile(s) demonstrated the following discrepancies: the hospice medication profile listed Hyoscyamine 0.125 ml every 4 hours as needed and the SNF medication profile listed Hyoscyamine 0125 ml every hour as needed. An interview and joint clinical record review was conducted with the Chief Nursing Officer and Clinical Manager on 05/29/2026. It was stated that the expectation that medications were to be reconciled “at least every other week but preferably with every nursing visit.””

“It is required that written patient care instructions for a hospice aide are prepared by a registered nurse who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 4 of 20 (20%) clinical records reviewed in which hospice aide services were accepted revealed the agency did not ensure the registered nurse (RN) provided specific written instructions for the hospice aide (HA). CLINICAL RECORD 1: The patient elected the hospice benefit on 05/01/2026. The HA care plan dated 05/01/2026 included the following assigned tasks: “Document bowel movements; change patient linens and make bed; assist with dressing; bed bath or shower; shampoo and comb hair; skin care to scalp; clean under finger nails; may trim or file long or uneven fingernails; may trim or file any long or uneven toenails; brush teeth; provide peri care; change brief and apply barrier cream to buttocks/peri area after each incontinent episode; apply deodorant; apply lotion to skin; report any changes in skin condition; if patient complains of pain report to RN.” All tasks were to be completed every visit unless otherwise noted with a HA visit frequency of twice weekly. A physician’s order dated 05/01/2026 documented: “Perform wound/dressing change to right buttocks wound. Cleanse with wound wash. Pat dry with gauze. Apply hydrogel. Cover with border gauze.” The HA care plan did not notify the aide of the wound(s) nor to notify the nurse if the dressing became soiled, dislodged or wet. CLINICAL RECORD 5: The hospice benefit election date was 05/14/2026. The HA care plan dated 05/14/2026 included the following assigned tasks: “Turn and reposition at each visit; document BM (bowel movement); change linen and make bed; clean area; bed bath; skin care to scalp; nail care; brush teeth; peri care; change brief and apply barrier cream to buttocks/peri area; apply deodorant; apply lotion to skin; assist with dressing; report any changes in skin condition.” All tasks were to be completed every visit unless otherwise noted with an aide visit frequency of three times weekly. A physician’s order dated 05/27/2026 documented the following: “Perform wound care/dressing change. Stage II sacral PU (pressure ulcer).” The Plan of Care on the same date documented: “Cleanse wound with wound cleanser, pat dry with 4x4 gauze, apply therahoney, cover with silcone foam dressing QOD (every other day) and PRN (as needed).” The aide care plan did not notify the aide of the wound(s) nor to notify the nurse if the dressing became soiled, dislodged or wet. CLINICAL RECORD 10: The hospice benefit election date was 03/11/2026. The HA care plan dated 03/12/2026, updated 04/08/2026 included the following assigned tasks: “May assist with feeding during mealtime; empty foley bag; document bowel movements; bed bath; shampoo and comb hair; clean foley catheter and the area around insertion site; provide oral care with oral swabs; apply deodorant; apply lotion to skin; report to RN any redness, discoloration, foul odor or dislodgment of foley; report any changes in skin condition; if patient complains of pain report to RN.” All tasks were to be completed every visit unless otherwise noted with an aide visit frequency of twice weekly. A physician’s order dated 05/12/2026 noted the patient to have “foam pressure reducer boots.” A physician’s order dated 03/19/2026 documented: “Wound/dressing change daily and prn (as needed) stage IV PU involving bilateral gluteral areas. (Facility wound nurse is involved with patient’s wound care.) Cleanse with wound cleanser, pat dry with gauze, paint pink with skin prep. Place large pieces of calcium alginate in undermining areas and wound surface. Place large foam surface dressings to cover wound surface. Cover with ABD to hold foam dressing in place. Cover with non-adherent foam dressing. Two 6x6 border dressing to cover wound surface.” The aide care plan did not notify the aide of the wound(s) nor to notify the nurse if the dressing became soiled, dislodged or wet. The aide care plan did not notify the aide of the heel protectors nor provide specific instructions for them during the aide tasks. CLINICAL RECORD 14: The hospice benefit election date was 02/17/2026. The HA care plan updated 04/28/2026 included the task of “shower or bed bath.” All tasks were to be completed every visit unless otherwise noted with an aide visit frequency of twice weekly. The aide care plan did not provide specific instructions for the bath type to be given. An interview and joint clinical record review was conducted with the Chief Nursing Officer and Clinical Manager on 05/29/2026 during which time they agreed the aides needed to be given “precise instructions and were not allowed to assess or make decisions, especially on bath types.””

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. 6 of 20 (30%) clinical records reviewed revealed the agency did not ensure patients’ clinical records contained correct clinical information that is available to the patient’s attending physician and hospice staff, including physician orders. CLINICAL RECORD 1: The patient elected the hospice benefit on 05/01/2026. A physician’s order dated 05/01/2026 documented the following: “Perform wound/dressing change to right buttocks wound. Cleanse with wound wash. Pat dry with gauze. Apply hydrogel. Cover with border gauze.” This order did not include all relevant clinical information, including the frequency of wound care, the person(s) to provide wound care, or any as-needed visit orders. CLINICAL RECORD 2: The hospice benefit election date was 02/23/2025. A physician’s order dated 11/17/2025 documented the following: “Perform wound care/dressing change to buttock. Clean with soap and water, pat dry, apply zinc cream.” This order did not include relevant clinical information, including the frequency of wound care, the person(s) to provide wound care, or any as-needed visit orders. CLINICAL RECORD 5: The hospice benefit election date was. 05/14/2026. A physician’s order dated 05/27/2026 documented the following: “Perform wound care/dressing change. Cleanse wound with wound cleanser, pat dry with 4x4 gauze, apply therahoney, cover with silcone foam dressing QOD (every other day) and PRN (as needed).” This order did not include relevant clinical information, including the person(s) to provide wound care, or the reason for the as-needed visit orders. CLINICAL RECORD 10: The hospice benefit election date was 03/11/2026. A physician’s order dated 03/19/2026 documented the following: “Wound/dressing change daily and prn stage IV PU (pressure ulcer) involving bilateral gluteral areas. (Facility wound nurse is involved with patient’s wound care.) Cleanse with wound cleanser, pat dry with gauze, paint pink with skin prep. Place large pieces of calcium alginate in undermining areas and wound surface. Place large foam surface dressings to cover wound surface. Cover with ABD to hold foam dressing in place. Cover with non-adherent foam dressing. Two 6x6 border dressing to cover wound surface.” This order did not include relevant clinical information, including the person(s) to provide wound care, or the reason for the as-needed visit orders. CLINICAL RECORD 13: The hospice benefit election date was 04/04/2026. A physician’s order dated 04/04/2026 documented the following: “Perform wound care/dressing change: Stage 4 to coccyx. Cleanse with wound cleanser and pat dry. Apply calcium alginate to wound bed and cover with foam bordering dressing. Complete q (every) 3 days and PRN. Skin tear to right lower calf; cleanse with wound cleanser and pat dry. Apply hydrogel, and calcium alginate to wound bed, cover with 4x4 foam border dressing. Change q3 days and PRN.” This order did not include relevant clinical information, including the person(s) to provide wound care, or the reason for the as-needed visit orders. CLINICAL RECORD 15: The hospice benefit election date was 08/05/2025. The patient was a “live” discharge on 01/30/2026 due to “extended prognosis”. A physician’s order dated 09/10/2025 documented the following: “Perform wound care/dressing change: cleanse with wound cleanser, pat dry, apply calcium alginate to open areas on left and right buttock, cover with foam bordered dressing daily.” This order did not include relevant clinical information, including the person(s) to provide wound care, or any as-needed visit orders. An interview and joint clinical record review was conducted with the Chief Nursing Officer and Clinical Manager on 05/29/2026 during which time it was discussed that the wound care orders needed to contain precise information.”