Alamo Hospice of Waco

“Upon patient record review, 3 of 14 (Patient #2,3,10) 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: Patient 2: Upon home visit finding the hospice medication profile contains an order for Oxygen, the facility MAR does not have this order. This was not new since last SN visit. Patient 3: The medication profile contains Nitroglycerin PRN with no frequency, max dose or what steps to follow if ineffective. Upon home visit finding the facility MAR had the following medications that were not included on the Hospice medication profile: Multivitamins, Acetaminophen 500mg po. These were not new since last SN visit. Patient 10: The medication profile contains Hydrocodone/acetaminophen 10/325 1 tab prn pain with no frequency or directive for safe maximum dose in 24 hours and Lactulose 30G as directed, no frequency. The medication profile has acetaminophen 500mg as 1 tab 4 times daily prn and acetaminophen 500mg 1 tab every 6 hours prn both for pain. There was no directive for safe maximum dose of acetaminophen in 24 hours.”

“Upon patient record review, 2 of 14 (Patient #7,8) 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 7: The POC contains an order for Facility nursing to complete wound care weekly. The RN assessed the wound on 4/23/26 when it was discovered and has not again assessed or measured the wound until 5/19/26. Agency policy 4-120 is to assess and measure wounds weekly. Patient 8: The medical record contains orders for the facility nurse or hospice to change the wound dressing twice weekly. The RN is ordered to see patient once weekly and did not assess or measure the wound at visits 4/14/26, 4/21/26, 5/5/26 or 5/12/26. Agency policy 4-120 is to assess and measure wounds weekly.”

“Upon patient record review, 3 of 14 (Patient #2,3,10) 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 contains an order on 3/13/26 for wound care though does not state where the wound is. Upon home visit finding the hospice POC contains an order for Oxygen, the facility MAR does not have this order. This was not new since last SN visit. Patient 3: The POC 4/7/26 contains Nitroglycerin PRN with no frequency, max dose or what steps to follow if ineffective. Upon home visit finding the facility MAR had the following medications that were not included on the Hospice POC: Multivitamins, Acetaminophen 500mg po these were not new since last SN visit. Patient 10: The POC 03/27/26 has Acetaminophen 500mg twice, ordered as 1 tab 4 times daily prn pain and acetaminophen 500mg 1 tab every 6 hours prn for pain. On 4/24/26 there is an order to add Hydrocodone/acetaminophen 10/325 1 tab every 4 hours prn pain with no directive for safe maximum acetaminophen dose in 24 hours.”

“Upon patient record review 3 of 14 (Patient #7,8,10) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 7: The aide POC 4/16/26 contains orders to shower, shampoo, change linens every visit. The aide did not completed these tasks on 4/7/26, 4/15/26, 4/22/26. There was no evidence of refusal. The aide documented 4/24/26 giving a bed bath, a shower is ordered on aide POC 4/16/26. There was no evidence the RN was notified for approval of change in POC. The aide did not shower or shampoo patient on 5/5/26 with no evidence of refusal. Patient 8: The aide did not shave the patient as ordered every visit on 4/7/26. There was no evidence of refusal. The updated aide POC 4/16/26 contains shower and shampoo every visit. The aide did not complete these tasks on 4/17/26, 4/24/26 with no evidence of refusal. On 5/8/26 the aide did not change linens as ordered every visit there was no evidence of refusal. Patient 10: The POC 4/11/26 contains an order for aide visits 5 days a week. The week of 4/26-5/2/26 there were 4 visits made with no missed visit documentation or evidence of refusal. The aide POC contains an order to check vital signs each visit. The aide did not assess BP on 4/15/26, there was no evidence of refusal. Aide POC has orders to shave daily, the aide did not shave the patient 4/16/26 with no evidence of refusal. On 5/4/26 the aide did not shave the patient, documented it was not needed and did not shampoo the patient and documented “patient was sort of out of it today”. There was no evidence of refusal.”

“Upon patient record review 1 of 14 (Patient 10) did not have evidence in the patient record that the hospice aides report: Patient 10: The aide POC 4/9/26 contains a directive to notify RN if BP less than 80/50. On 4/7/26 the aide recorded the patient’s BP as 79/49. There is no evidence the RN was notified. On 5/4/26 the aide did not shave the patient, documented it was not needed and did not shampoo the patient and documented “patient was sort of out of it today”. There was no evidence that the RN was notified of this change in condition.”

“Upon patient client record review, 3 of 14 (Patient #2,10,14) 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 2: The SN documented on 4/14/26 in the narrative note “Hydrocolloid dressings apply to bilateral knee skin tears”. It is unclear if this was performed or if the POC was followed. SN documented on 5/11/26 and 5/5/26 wound care by restating the order, not in past tense, and then documented “wound care done.” It is unclear the SN followed the POC. Patient 10: The SN documented changing a foley catheter on 5/15/26 though did not document using sterile technique. It is unclear that sterile technique was performed. Patient 14: The SN documented on 6/25/25 “antibiotics given per order-Peg tube”. It is unclear the POC was followed.”