Accentcare Hospice & Palliative Care of Texas

“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, observation, and interview. In 2 of 19 (11%) clinical records reviewed and home visits observed, the agency did not ensure that the comprehensive assessment included a drug profile that contained the patient’s current prescription and OTC drugs. CLINICAL RECORD 1/HOME VISIT 1: The patient elected hospice care on 06/16/2025 with a diagnosis of hypertensive heart disease and chronic kidney disease. The skilled nursing (SN) visit note dated 07/11/2025 documented, “This writer educated patient on need to use O2 prn due to dyspnea....” The hospice medication profile did not document the oxygen noted in the clinical note. During the home visit with the Licensed Vocational Nurse (LVN) on 08/05/2025, the patient’s son stated the oxygen has been in the home since admission and, “She uses the oxygen two to three times a day.” Oxygen was observed in the home. The patient’s son stated that the patient’s daughter was in charge of the medications. The hospice medication profile did not document the oxygen noted in the clinical note and observed during the home visit. CLINICAL RECORD 6: The patient elected hospice care on 04/16/2025 with a diagnosis of atherosclerotic heart disease. The SN visit note dated 06/30/2025 documented, “The patient is in the bathroom. He is in there for about 5-10 minutes. He later shares that he has been having a harder time having bowel movements. He has been taking Colace and MiraLAX.” The hospice medication profile did not document the Colace and MiraLAX noted in the SN visit note. During a joint record review and interview on 08/06/2025, the Executive Director confirmed that the medications were not documented on the medication profiles for clinical record 1 and clinical record 6.”

“It is required that each patient’s individualized written plan of care: reflects patient, and family goals; [and] identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the patient’s plan of care reflected patient and family goals and identified planned interventions based on problems identified in the comprehensive assessments. CLINICAL RECORD 7: The patient elected hospice care on 05/28/2025 with a diagnosis of alcoholic cirrhosis of the liver. On 07/7/2025, the physician ordered, “Keflex 500 mg po bid x 7 days for skin infection.” The skilled nursing (SN) visit dated 07/10/2025 documented, “Pt continues with antibiotic treatment for skin lesions on neck, pt frequently scratches them, SN cleansed skin applied bandage to prevent infection. Instructed on skin integrity measures and keeping skin clean and dry.” The Hospice IDG Comprehensive Assessment and Plan of Care Update Reports 07/15/2025 did not document patient and family goals, and planned interventions for the identified skin infection. CLINICAL RECORD 9: The patient elected hospice care on 04/23/2025 with a diagnosis of Alzheimer’s Disease. On 05/16/2025, the physician ordered, “Macrobid 100mg PO BID x 7 days for urinary tract infection (UTI).” The Hospice IDG Comprehensive Assessment and Plan of Care Update Reports 05/20/2025 did not document patient and family goals, and planned interventions for the identified urinary tract infection. During a joint record review and interview on 08/06/2025, the Executive Director [Personnel Record 7] confirmed that the Hospice IDG Comprehensive Assessment and Plan of Care Update Reports did not include updated goals and planned interventions for clinical record 7 and clinical record 9.”

“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. This standard was not met as evidenced by document review, interview, and observation. Agency policy/protocol #4003 “Hand Hygiene” (revised 06/09/2021) read 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: g. when performing patient care and moving from a contaminated body site to a clean-body site.” In 1 of 4 (25%) home visit observations, the agency did not ensure that hand hygiene was performed when indicated per the agency’s policy. HOME VISIT 4: The patient elected hospice care on 07/16/2024 with a diagnosis of hypertensive heart disease and chronic kidney disease. The Hospice Aide (HA) [Personnel Record 4] provided peri care during the home visit on 08/06/2025. During the patient’s shower, the HA provided peri care, rinsed the patient, toweled off the patient, and dressed the patient. Once all tasks were completed, the HA removed their gloves and washed their hands. The HA did not perform hand hygiene when moving from a contaminated to a clean body site during patient care, as per the policy. During an interview on 08/06/2025, the Executive Director confirmed the finding and the agency policy that hand hygiene should be performed during patient care when moving from a contaminated body site to a clean-body site”

“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 was equal to five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. A joint review of the agency’s “Hospice Volunteer Requirement Report” with the Administrator [Personnel Record 7] and Volunteer Coordinator [Personnel Record 5] on 08/05/2025 revealed that volunteer utilization was 2.29% for the calendar year 2024 and 2.57% from January 2025 through July 2025. During an interview and a joint review of the report on 08/05/2025, the Administrator confirmed that volunteer utilization was below the required 5% and stated, “We have a PIP [performance improvement plan] in place; it’s been challenging as we grow.” Review of volunteer documents revealed the agency did not ensure that volunteers provided day-to-day administrative or direct patient care services in an amount that was equal to five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.”

“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. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review, interview and observation. In 3 of 19 (16%) clinical records reviewed, the agency did not ensure the patient’s clinical record contained physician orders for the care and services provided. CLINICAL RECORD 1/HOME VISIT 1: The patient elected hospice care on 06/16/2025 with a diagnosis of hypertensive heart disease and chronic kidney disease. The skilled nursing (SN) visit note dated 07/11/2025 documented, “This writer educated patient on need to use O2 prn due to dyspnea. This writer educated on Zofran use for NV.” During the home visit with the Licensed Vocational Nurse (LVN) on 08/05/2025, the patient’s son stated the oxygen has been in the home since admission and, “She uses the oxygen two to three times a day.” Oxygen was observed in the home. The patient’s son provided a medication bottle of Zofran that was his prescription, stating he gave it to the patient for nausea and vomiting. The patient’s son stated that the patient’s daughter was in charge of the medications. The patient’s Hospice IDG Comprehensive Assessment and Plan of Care Update Reports dated 07/16/2025 and 07/30/2025 did not document Zofran and oxygen. There was no evidence of a physician’s order for the patient for oxygen or Zofran. CLINICAL RECORD 6: The patient elected hospice care on 04/16/2025 with a diagnosis of atherosclerotic heart disease. The SN visit note dated 06/30/2025 documented, “The patient is in the bathroom. He is in there for about 5-10 minutes. He later shares that he has been having a harder time having bowel movements. He has been taking Colace and MiraLAX.” The hospice medication profile did not document the Colace and MiraLAX noted in the SN visit note. The patient’s Hospice IDG Comprehensive Assessment and Plan of Care Update Reports dated 07/09/2025 and 07/23/2025 did not document Colace and MiraLAX. A clinical record review revealed no evidence of a physician’s order for Colace or MiraLAX. CLINICAL RECORD 7: The patient elected hospice care on 05/28/2025 with a diagnosis of alcoholic cirrhosis of the liver. On 07/07/2025, the physician ordered, “Keflex 500 mg po bid x 7 days for skin infection.” The skilled nursing (SN) visit note dated 07/10/2025 documented, “Pt continues with antibiotic treatment for skin lesions on neck, pt frequently scratches them, SN cleansed skin, applied bandage to prevent infection. Instructed on skin integrity measures and keeping skin clean and dry.” The patient’s Hospice IDG Comprehensive Assessment and Plan of Care Update Report dated 07/15/2025 did not document the wound care (treatment) provided to the patient. A clinical record review revealed no evidence of a physician’s order for the wound care provided. During a joint record review and interview on 08/08/2028, the Executive Director confirmed the findings and stated in part, “We should have orders in the record for wound care and medications.””

“Based on record review and interview, the agency failed to comply with the provisions of the Texas Human Resources Cod, Chapter102 for 1 of 3 active patients (Patient #3), whose records were reviewed in that the patient received services that was refused. This failure placed the agency’s patients at risk for their rights being violated when the patient refuse services from the agency. Findings include: Record Review of the State of Texas regulation titled, “;Texas Human Resource Code § 102.003 Section 102.003 - Rights of the Elderly,” revealed “;(b) An elderly individual has the right to be treated with dignity and respect for the personal integrity of the individual, without regard to race, religion, national origin, sex, age, disability, marital status, or source of payment. This means that the elderly individual: (1) has the right to make the individual’s own choices regarding the individual’s personal affairs, care, benefits, and services;” During a record review of Patient #3s clinical records revealed a start of care date of 1/17/2023 with a terminal diagnosis of chronic obstructive pulmonary disease (a condition that causes difficulty breathing). Further review of the Patient #3s clinical records further reveal Patient #3 lived in a skilled nursing facility and received hospice nurse visits once weekly, hospice aide visits twice weekly, and chaplain services once monthly. During a record review of Patient #3s clinical records from HHA A, the clinical records dated 11/21/2024 revealed, “;I saw [Patient #1] ...the facility wanted her cleaned up because they were going to get her up for their Thanksgiving Dinner. She was so mad and fighting but I did manage to complete my assignment. Just in case she tells her family...” During a record review of Patient #3s clinical records from HHA A, the clinical records dated 11/26/2024 revealed, “;I saw [Patient #3] ...today, and she was very agitated and mean. She told me she didnt like me. She deliberately held on to the rails when I am trying to turn her. She told me that in front of the nurse. She said she doesnt not like the baths. She got a small skin tear on her left arm from holding the rails while I was trying to turn her...she is only like that when its bath time. I also informed the nurse.” During an interview with Patient #3 on 2/6/2025 at 1:45 p.m., Patient #3 stated she never liked HHA A and she didnt like the way she bathed her. Patient #3 stated that the last time HHA A bathed her, she caused bruises on her arms. During an interview on 1/30/2025 at 3:00 p.m. with HHA A, HHA A stated,” When I went to bathe [Patient #3], she already stated that she didnt like me, and she didnt like my bathing, but I kept bathing her. She kept saying she doesnt like me. No, I never asked her why she didnt like me. Then I got the [nursing facility] nurse to assist me . The nurse tried to talk to her. She kept saying that she didnt like me, and I dont know why. It was my fourth time seeing her. She had refused me bathing her twice before. The other time, the nurse had to assist me.” HHA A further stated that HHA A was wearing a bracelet while bathing Patient #3 that cause bruises on Patient #3 arms. During an interview on 2/10/2025 at 5:00 p.m., with the Alternate Administrator, the Alternate Administrator was asked why HHA A was not reassigned due to Patient #3s consistent refusal of services from HHA A, the Alternate Administrator stated, “;No, I didnt know this. We usually try to accommodate the patient.” During an interview on 2/10/2025 at 5:00 p.m., with the Administrator, the Administrator was asked why HHA A was not reassigned due to Patient #3s consistent refusal of services from HHA A, the Administrator stated that the failure was a result of her not being aware of the previous refusals of services. Review of the agencys policy, no date, titled “;Consent and Education for Hospice Care,” revealed “;Sec 102.003 Rights of the Elderly...the elderly individual: has the right to make the individuals own choices regarding the individuals personal affairs, care, benefits, and services...2. Acknowledges that the individual clearly understands the consequences of refusing treatment...””

“Based on record review and interviews, the agency failed to ensure the effective exchange of information, reporting, and coordination of patient services of 1 of 1 discharged patient (Patient #1), who live in an assisted living facility and whose records were reviewed. This failure could place the agency’s patients at risk of inadequate care and a delay in care due to ineffective communication among providers and staff. The findings included: Record Review of Patient #1 clinical records reveal a start of care date of 7/6/2024, with Patient #1 receiving the following hospice services: skilled nursing services three times weekly, Chaplain services one visit monthly, Social Worker services one visit monthly, and home health aide services twice weekly. Patient#1 was living in an assisted living facility and had a terminal diagnosis of Parkinsons Disease (A disorder of the brain that affects movement and causes tremors.) Further record review revealed that on 11/08/2024 at 1:45 a.m., Patient #1 fell off the bed on the floor. RN A (on call nurse) visited Patient #1 to assess for injury at approximately 2:30 a.m. RN A gave Patient #1 pain medication for pain and discussed with staff regarding ordering a right and left hip x-ray. RN A did not write an order for a x-ray. LVN A visited Patient #1 to perform a follow up reassessment 11/8/2024 at approx. 10:00 a.m. During the visit, LVN A asked the assisted living staff about a right and left hip x-ray to which the assisted living staff stated a right and left hip x-ray was ordered. Further record review revealed that on 11/10/2024, the family member of Patient #1 inquired why the right and left hip x-ray to Patient #1s hips were not done, and the agency call center informed the family member of Patient #1 that RN B will visit Patient #1. On 11/11/2025 RN B assessed Patient #1 and to order the right and left hip x-ray. Record review revealed Patient #1 RN A had hip fracture because of the fall on 11/8/2024. During an interview on 2/6/2025 at 7:00 p.m., with RN A, it was revealed that RN A was assigned to Patient #1s home on 11/8/2024 at 2:30 a.m for the assessment after Patient #1s fall. RN A stated, “;I dont know I would assume the day shift staff at the assisted living facility notified the doctor. I notified the doctor after my visit a little before 8 am. I texted the Doctor, but the family member of Patient #1 stated she didnt want [Patient #1] to go to the hospital. I informed the family member of the fall after my visit. I assumed that the the family member was aware of the option of the mobile x-ray.” During an interview on 2/6/2025 at 7:45 p.m., with LVN A, LVN A stated that she was assigned to Patient #1s home on 11/8/2024 at 10:00 a.m., for the an additional assessment after Patient #1s fall. LVN A stated, “;the assisted living facility staff medicated Patient #1 before I arrived. He was grimacing and the facility medicated him. The Facility representative stated that the mobile x- ray was ordered. I relayed the information about the mobile x-ray to the hospice office staff.” During an interview on 2/7/2025 at 3:00 p.m., with the family member of Patient #1, the family member stated the delay in the ordering of the x-ray was a result of a, “;miscommunication between the facility and the hospice agency.” During an interview on 2/6/2025 at 7:45 p.m., with RN B, RN B stated he was assigned to visit Patient #1s home on 11/11/2024 for a follow up on the family members phone call. RN B stated, “;I went there that Monday and realized that the x-ray was not done so I arranged for the x-ray to be done after receiving an order. I spoke with the family member of Patient #1 about it.” During an interview on 2/6/2025 at 5:00 p.m., with the Administrator, the Administrator, stated that the failure was a result from the lack of follow up of the x-ray being ordered by RN A or LVN A was due to miscommunication from the assisted living facility. The Administrator also revealed that RN A was the on-call nurse at the time of Patient #1s fall and should have assured that the x-ray was completed. Record review of an agency policy titled, “Triage,” dated 11/21/2024, read in part, “;The call center receives a call from patient...or facility regarding situations...request for new, non-routine diagnostic studies/tests etc...”When a fall is reported by a family, patient or facility, it is considered a significant event and requires an in-person hospice assessment including evaluation of patient status....any need for diagnostic x-rays...” Record review of an agency policy titled, “Interdisciplinary group Coordination of Care,” dated 10/31/2024, read in part, “;The interdisciplinary group...is responsible for...i. Monitor continually of care and implement plans across all settings, including residence and inpatient facilities...” Record review of an agency policy titled, “Adverse Event Reports,” dated 5/22/2023, read in part, “;...Event Management: The process for multidisciplinary, coordinated response to sentinel events and significant patient quality outcomes. The process includes points of escalation, coordination, reporting, and planning by the site level, region team members and national roles. The process is applied to a significant event that require oversight...””

“Based on observation, record review and interview, the agency failed enforce written policies addressing infection control including the prevention of the spread of infectious and communicable disease, that: No handwashing was observed before and after patient care to Patient #4 by 1 of 2 employees (RN D) observed. This failure placed the agency’s clients at risk for an infection. Findings include: During an observation on 2/7/2025 at 1:30 pm, the surveyor was observing the bathing of Patient #4 with HHA A and RN D. Further observation revealed that RN D, prior to touching Patient #4, walked to her medical bag, and proceeded to obtain and don rubber gloves. Further observation revealed RN D, assisted HHA A with patient care of Patient #4, removed her gloves and disposed the gloves in the trash. Further observation revealed no hand sanitizer was used or handwashing performed prior to or after care was provided. During an interview on 2/7/2025 at 2:00 p.m. with RN D, RN D was informed of the observation findings. When asked the reason of the lack of hand washing before and after patient care, RN D responded, “;I forgot.” During an interview on 2/7/2025 at 5:00 p.m. with the Administrator, the Administrator was informed of the above findings. The Alternate Administrator stated that RN was a new nurse that may require education. Record review of an agency policy titled, “Hand Hygiene,” dated 6/9/2021, read in part, “;To prevent cross-contamination and the transmission of healthcare-associated infections...guidelines for hand hygiene...2. 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: a. Before having direct contact with patients. b. After removing gloves...””