Alamo Hospice

“Upon patient record review, 1 of 5 (Patient #3) 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 3: The medical record contains evidence of an order for the foley to be changed every other week. The SN has not changed the foley since 3/9/26. The patient continues to have symptoms of leakage, UTI symptoms, and weekly flushes required.”

“Upon client record review, 1 of 5 (Patient #3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 3: The SN documented on 3/9/26 inserted a 20fr coude catheter inserted. There is no order for a 20fr coude catheter to be inserted. The current POC contains an order for foley irrigation once per week. On 3/13/26 the SN documented educated caregiver that foley can be flushed 2-3 times per week. The SN flushed the foley on 3/13 and 3/16/26 without an order to increase flushes. The SN did not irrigate the foley the week of 3/22-3/28/26 there was no evidence of refusal. On 3/20/26 the SN documented flushed foley with 30ml NS the order is for 60ml flush. The order on 2/27/26 is for changing the foley every other week the foley was changed on 3/9/26 and there is no evidence of the foley being changed up until current.”

“Upon patient client record review, 2 of 5 (Patient #3,4) 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 3: The SN documents on her biweekly visits that the order for the foley to be changed is every 30 days or as needed for blockage. The order on the POC 2/27/26 has foley to be changed every other week. Patient 4: The SN documented on 4/1/26 the patient does not have a feeding tube. The medical record contains evidence the patient does have a Peg tube and no evidence the feeding tube/Peg tube was discontinued.”

“Upon patient record review, 1 of 5 (Patient #3) did not have evidence that if a drug order is verbal or given via an electronic transmission, it is given to a Registered Nurse, Nurse Practitioner, pharmacist, physician or other licensed individuals as designated by state regulations. The person receiving the order records and signs it immediately and has the prescribing person sign it in accordance with state and federal regulations. Patient 3: The SN documented receiving an order from the MD for Oxybutynin 3/9/26. The nurse did not transcribe the verbal order.”

“Upon patient record review, 8 of 19 (Patients #2,#5,#6,#8,#10,#11,#12,#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 2: The medication profile contained active instructions for cephalexin that was ordered on 7/22/25, and dorzolamide-timolol eyedrops with no instructions for administration in one or both eyes. Patient 5: The medication profile contained instructions for oxygen to be delivered via nasal cannula in error. The order 2/10/26 identified administration of oxygen via a face mask. Patient 6: During home visit medication reconciliation the facility and hospice medication profiles did not match. The facility profile contained an additional acetaminophen PRN, calcium carbonate tablets, lidocaine patches, nitroglycerin, and protein oral liquid that were all missing from the hospice profile. The facility profile also contained instructions for lactulose 30 ml, differing from the hospice dose of 15 ml. Patient 8: The medication profile contained active instructions for cipro that was ordered for 7 days on 4/15/25. Patient 10: During home visit medication reconciliation the facility and hospice medication profiles did not match. The facility profile contained a guaifenesin PRN, morphine 0.5ml every 4 hours PRN instead of 0.25-1ml every 2 hours PRN, and the facility did not have hydrocortisone cream for feet on hospice profile, duoneb on hospice profile, and lorazepam on hospice profile. Patient 11: The plan of care identified patient use of oxygen. There was no evidence of oxygen included on the medication profile. The profile also contained conflicting instructions for senna lax administration. Patient 12: During home visit medication reconciliation the caregiver stated patient has not used the albuterol inhaler since November and there was no zofran or hyoscyamine present for administration if needed. The medication profile contained the inhaler as active. Patient 14: The plan of care identified oxygen use. There was no evidence of oxygen included on the medication profile.”

“Upon patient record review, 9 of 19 (Patients #3,#4,#5,#6,#7,#8,#9,#11,#13) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patients 3,6: The plan of care contained problems, goals, and interventions related to oxygen use that were inaccurate for patients and added in error. Patient 4: The plan of care contained identification of the patient code status as both full code and DNR in error. Patient 5: The plan of care contained problems, goals, and interventions for care needs to be met by a hospice aide. The patient was not receiving aide services. Patient 7: The medical record contained nursing documentation upon admission identifying patient issues with dysphagia requiring a pureed diet. There was no evidence of problems, goals, and interventions related to dysphagia included in the plan of care. Patient 8: The medical record contained a prescription for Eliquis since admission. There was no evidence of problems, goals, and interventions related to risk for bleeding included in the plan of care. Patient 9: The medical record contained nursing documentation upon admission identifying patient history of CVA and seizures, and use of oxygen. There was no evidence of problems, goals, and interventions related to neurological dysfunction and oxygen use included in the plan of care. Patient 11: The medical record contained a prescription for Eliquis since admission. There was no evidence of problems, goals, and interventions related to risk for bleeding included in the plan of care. Patient 13: The medical record contained nursing documentation upon admission identifying patient diagnosis of Alzheimer’s dementia. There was no evidence of problems, goals, and interventions related to neurological dysfunction included in the plan of care.”

“Upon patient record review, 3 of 19 (Patients #3,#5,#9) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patient 3: The recertification frequency order did not contain a frequency for nurse visits. Patient 5: The medical record contained an order 1/6/26 for two visits that week with no identification of discipline to deliver visits. Patient 9: The medical record contained an order 12/30/25 for two visits that week with no identification of discipline to deliver visits.”

“Upon patient record review, 7 of 19 (Patients #2,#6,#7,#8,#10,#11,#14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 2: The medical record contained an order for dorzolamide-timolol eyedrops with no instructions for administration in one or both eyes. Patient 6: During home visit medication reconciliation the facility and hospice medication orders did not match. The facility record contained additional orders for an extra acetaminophen PRN, calcium carbonate tablets, lidocaine patches, nitroglycerin, and protein oral liquid that were all missing from the hospice record. The facility orders also contained instructions for lactulose 30 ml, differing from the hospice order for dose of 15 ml. Patient 7: The medical record contained nursing documentation 2/10/26 identifying patient had an indwelling catheter. There was no evidence of an order for catheter type, size, change frequency, and maintenance. Patient 8: The medical record contained nursing documentation 12/10/25 identifying patient requires a suprapubic catheter. There was no evidence of an order for catheter type, size, change frequency, and maintenance. Patient 10: During home visit medication reconciliation the facility and hospice medication orders did not match. The facility had an order for guaifenesin not on hospice, the order for morphine was for 0.5ml every 4 hours PRN instead of 0.25-1ml every 2 hours PRN, and the facility did not have hydrocortisone cream for feet in hospice orders, duoneb in hospice orders, and lorazepam in hospice orders. The hospice also had an order for oxygen with no delivery method and orders for catheters 1/15/26 and 1/20/26 with no identification of type, size, change frequency, and maintenance. Patient 11: The plan of care identified patient use of oxygen. There was no evidence of an order for oxygen rate, frequency, and delivery method. Patient 14: The plan of care identified oxygen use. There was no evidence of an order for oxygen rate, frequency, and delivery method.”

“Upon patient record review, 11 of 19 (Patients #1,#2,#3,#5,#6,#7,#8,#10,#12,#13,#14) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 1: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair, 1/13/26 identifying use of a commode, and 1/26/26 identifying use of a trapeze. During home visit, the patient was also observed to have a hospital bed, half rails, overbed table, transport wheelchair, and shower chair. There was no evidence of orders for the DME included in the plan of care. Patient 2,3: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair. There was no evidence of an order for the DME included in the plan of care. Patient 5: The medical record contained nursing documentation 2/10/25 identifying patient use of oxygen. There was no evidence of an order for the DME included in the plan of care. Patient 6: The medical record contained nursing documentation 1/8/26 identifying patient use of a hospital bed, light touch call bell, fall mat, and wheelchair. There was no evidence of orders for the DME included in the plan of care. Patient 7: The medical record contained nursing documentation 2/10/26 identifying patient use of oxygen, a mechanical lift, pressure relief boots, and catheter supplies. There was no evidence of orders for the DME included in the plan of care. Patient 8: The medical record contained nursing documentation upon admission and 12/10/25 identifying patient use of a shower chair and catheter supplies. There was no evidence of orders for the DME included in the plan of care. Patient 10:The medical record contained nursing documentation upon admission identifying patient use of a walker, wheelchair, nebulizer, catheter supplies, hospital bed, and overbed table. There was no evidence of orders for the DME included in the plan of care. Patient 12: The medical record contained nursing documentation 1/20/26 identifying patient use of a wheelchair and an order for duoneb to be administered via a nebulizer. There was no evidence of orders for the DME included in the plan of care. Patient 13: The medical record contained nursing documentation 12/16/25 identifying patient use of a Hoyer lift and scoop mattress. There was no evidence of orders for the DME included in the plan of care. Patient 14: The plan of care identified oxygen use. There was no evidence of an order for the oxygen DME included in the plan of care.”

“Upon patient record review, 3 of 19 (Patients #5,#8,#14) did not have evidence that a revised plan of care includes information from the patient’s updated comprehensive assessment and must note the patient’s progress towards outcome/goals from the plan of care. Patient 5: The medical record contained nursing documentation identifying patient issues with nausea 1/5/26. There was no evidence the plan of care was updated to include problems, goals, and interventions related to nausea. Patient 8: The medical record contained nursing documentation 12/10/25 identifying patient requires a suprapubic catheter. There was no evidence the plan of care was updated to included problems, goals, and interventions related to the suprapubic catheter. Patient 14: The medical record contained nursing documentation 1/16/26 identifying patient use of oxygen. There was no evidence the plan of care was updated to include problems, goals, and interventions related to oxygen use and safety.”

“Upon patient record review, 5 of 19 (Patients #2,#4,#7,#12,#13) did not have evidence in the patient record that hospice aide assignments and duties are specific to the patient needs. Patient 2: The medical record contained nursing documentation identifying patient wounds requiring bandages. There was no evidence of instructions for the aide to manage the wounds during showers on the aide care plan. Patient 4: The medical record contained nursing documentation 2/4/26 identifying patient need for max assist with transfers and wheelchair for ambulation. There was no evidence of instructions for use of chair and assistance with transfers on the aide care plan. Patient 7: The medical record contained wound care orders containing need for wound dressings. There was no evidence of instructions for wound management on the aide care plan. Patient 12: The medical record contained nursing documentation 1/20/26 identifying patient need for use of a wheelchair and max assist transfers. There was no evidence of instructions for use of a wheelchair and transfer instructions on the aide care plan. Patient 13: The medical record contained nursing documentation 12/16/25 identifying patient need for use of Hoyer for transfers. There was no evidence of instructions for use of a Hoyer on the aide care plan.”

“Upon patient record review 7 of 19 (Patients #1,#2,#3,#6,#7,#8,#9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group Patient 1: The medical record contained an order for aide visits twice weekly. There was no evidence of a second visit completed the week of 12/7/25. Patient 2: The medical record contained an order for aide visits three times weekly. There was no evidence of third visit completed the weeks of 1/4/26, 1/26/26, and 2/8/26. There was also one visit completed the week of 2/1/26. Patient 3: The medical record contained an order for aide visits five times weekly. There was no evidence of a fifth visit completed the week of 1/25/26. Patient 6: The medical record contained an order for aide visits three times weekly. There was no evidence of a third visit completed the weeks of 1/19/26, 1/26/26, and 2/1/26. Patient 7: The medical record contained an order for aide visits twice weekly. There was no evidence of a second visit completed the weeks of 12/21/25 and 12/28/25. Patient 8: The medical record contained an order for aide visits five times weekly. There was no evidence of a fifth visit completed the week of 1/25/26. Patient 9: The medical record contained an order for aide visits three times weekly. There was no evidence of a third visit completed the weeks of 12/21/25 and 12/28/25.”

“Upon patient record review, 2 of 19 (Patients #6,#10) did not have evidence that the hospice provided the following information: • The most recent hospice plan of care specific to each patient • Hospice election form and any Advance Directives specific to each patient • Physician certification and recertification of the terminal illness specific to each patient • Names and contact information for hospice personnel involved in hospice care of each patient • Instructions on how to access the hospice’s 24-hour on-call system • Hospice medication information specific to each patient • Hospice physician and attending physician (if any) orders specific to each patient Patient 6: There was no evidence the hospice provided the facility with the hospice election form, advance directives, and CTIs. Patient 10: There was no evidence the hospice provided the facility with CTIs.”