M & L Medical Services Hospice Inc.

“Based on record review and interview, the agency failed to include in the plan of care, all services necessary for the palliation and management of the terminal illness and related condition including drugs and treatment necessary to meet the need of the patient, in that wound care treatments were not included in the plan of care for 3 (Patient #8, Patient #9, Patient #13) of 3 patient records reviewed where the patients received wound care from hospice nursing staff. The failure placed the patients at risk of wound infection or worsening of wounds. Patient #8: Record review of Patient #8’s clinical record revealed a Plan of Care dated 4/29/2026. The Plan of Care listed Alzheimer’s Disease (progressive brain disorder that destroys memory and thinking skills) as the terminal diagnosis. The Plan of Care contained an order for Patient #8 to receive skilled nurse visit 1-2 times each week. The Plan of Care did not contain wound care orders. Patient #8’s clinical record contained an initial comprehensive assessment date 11/16/2025, indicating when Patient #8 started on the hospice’s services. Licensed Vocational Nurse C conducted a skilled nurse visit on 5/29/2026. Licensed Vocational Nurse C documented that Patient #8 had a traumatic wound to the right buttock that had drainage. Licensed Vocational Nurse C documented cleaning the wound with normal saline (cleansing agent that matches the body’s natural fluids which keeps the tissue moist without damaging cells or delaying the healing process) applying normal saline-soaked gauze to the wound bed and covering it with gauze and securing it with tape. Licensed Vocational Nurse C conducted skilled nurse visits on 5/31/2026, 6/2/2026, 6/4/2026, 6/5/2026, 6/7/2026, 6/8/2026, 6/9/2026, 6/10.2026, 6/12/2026, 6/13/2026, 6/14/2026, 6/16/2026, 6/19/2026, 6/20/2026, 6/21/2026, 6/22/2026, 6/23/2026 and 6/24/2026. Licensed Vocational Nurse C documented cleaning the wound to Patient #8’s right buttock with normal saline, applying normal saline-soaked, covering with gauze and securing with tape. Patient #8 died on 6/25/2026. Patient #8’s clinical record contained Plans of Care dated 6/10/2026 and 6/24/2026. The Plans of Care contained an order to “provide/educate on wound care as ordered.” Patient #8’s Plans of Care did not include the wound care treatment to be provided to Patient #8’s wound. Patient #9:Record review of Patient #9’s clinical record revealed a Plans of Care dated 3/12/2026 and 3/18/2026. The Plan of Care listed Alzheimer’s Disease as the terminal diagnosis. The Plan of Care listed Pressure Ulcer (an injury to the skin and underlying tissue caused by prolonged, sustained pressure) of Sacral Region (lower back) Stage 4 as a diagnosis. The Plans of Care contained an order to “provide/educate on wound care as ordered.” Licensed Vocational Nurse C conducted skilled nurse visits on 3/14/2026 and 3/25/2026. Licensed Vocational Nurse C documented cleaning Patient #9’s wound with a diluted bleach mixture (used to clean infected wounds and prevent infections), dried, applied diluted bleach mixturemoisten gauze, covered with an abdominal pad (highly absorbent dressing used to manage large, heavily draining wounds), and secured with tape. Patient #9’s Plans of Care did not include the wound care treatment to be provided for Patient #9’s wound. Patient #13:Record review of Patient #13’s clinical record revealed Plans of Care dated 10/26/2025 and 10/29/2025. The Plans of Care listed Alzheimer’s Disease as the terminal diagnosis. The Plans of Care did not have wound care orders. The Supervising Nurse conducted an Initial Comprehensive Assessment on 10/26/2025. The Supervising Nurse documented that Patient #13 had redness to the buttocks and blisters to the scrotum (external pouch of skin and muscle located directly below the penis-external male sex organ used for sexual reproduction and urination). No wound care was provided. Licensed Vocational Nurse C conducted skilled nurse visits on 11/4/2025 and 11/7/2025. Licensed Vocational Nurse C documented cleaning a Stage II Pressure sore to a wound on Patient #13’s coccyx (base of the spine, lower back) that measured 8.5 x 6 x 0.2 centimeters. Licensed Vocational Nurse documented cleaning the wound with normal saline, patted dry, applied gauze, covered with an abdominal pad, and secured with tape. Patient #13 died on 11/9/2025. Patient #13’s Plans of Care did not include the wound care treatment to be provided for Patient #13’s wound. During an interview on 7/13/2026 at 12:16 PM with the Administrator and Supervising Nurse, the Surveyor discussed the Plans of Care for Patient #8, Patient #9, and Patient #13, did not include wound care treatments. The Surveyor asked who was responsible to ensure that the Plans of Care included wound care. The Supervising Nurse stated, “(Physician X).” The Surveyor asked why there were no wound care orders in the Plans of Care. The Supervising Nurse stated, “I don’t know, I will have to find out.” The Supervising Nurse informed the Surveyor that orders would pull from the comprehensive assessments to the Plans of Care. The Administrator informed the Surveyor that the Administrator would contact the agency’s electronic medical record company about this issue. During an interview on 7/13/2026 at 4:42 PM with Licensed Vocational Nurse C, the Surveyor discussed the wound care treatments were not included in the Plans of Care. The Surveyor asked how Licensed Vocational Nurse C would know what wound care to provide to the patients. Licensed Vocational Nurse C stated, “The admission nurse would tell me, or I would be told in the IDGs (Interdisciplinary Group Meeting).” Review of the agency’s policy titled “Plan of Care Process PC.30” last reviewed on 3/16/2026, read in part; “Purpose To ensure that the care provided is in accordance with the written Plan of Care (POC), appropriately planned, and delivered in a timely manner to meet the patient’s and family’s specific needs. Policy I. All hospice care and services furnished to patients and their families will follow an individualized written POC established by the Hospice Interdisciplinary Group/Team (IDG/IDT) in collaboration with the Attending Physician (if any), the patient or representative, and the primary caregiver, if any of them so desire, and in accordance with the patient’s needs...Procedure...VI. The POC includes, but is not limited too...D. Drugs and treatments necessary to meet the needs of the patient...””