Morris Infinite Healthcare Services Incorporated

“Based on record review and interview, the agency failed in include all services necessary for the palliation and management of the terminal illness and related conditions that included drugs and treatments necessary to meet the needs of the patient in that the plans of care did not include the frequency that wound care treatments were to be performed, the wound care to be provided, or the secondary dressing to be applied for 2 (#10, #12) of 2 patient records reviewed where agency nursing staff were performing wound care.The failure placed the patients at risk that the wounds would worsen or become infected. Patient #10:Record review of Patient #10’s clinical record revealed an Initial Plan of Care dated 12/2/2024. The Plan of Care indicated that Patient #10 started on the agency’s services on 12/2/2024. The Plan of Care listed Cerebral Infarction (stroke) as the terminal diagnosis. The Plan of Care listed Pressure Ulcer (bed sore, damage to skin and underlying tissue caused by prolonged pressure) as a related condition. The initial Plan of Care did not contain wound care treatments. Patient #10’s record contained a Plan of Care dated 12/6/2024. The Plan of Care listed Pressure Ulcer of Sacral Regions (bedsore to the lower back), Unstageable as a diagnosis. The Plan of Care contained an order to clean the sacral wound with saline, apply Aquaphor (product used to soothe dry skin, minor cuts, and burns) if available or Calcium Silver alginate (dressing used to manage moderate to heavy draining wound with anti-infection properties). Apply Metronidazole (antibiotic used to treat infections of the skin) powder if wound had an odor. Patient #10’s record contain a Plan of Care dated 1/2/2025. The Plan of Care listed Pressure Ulcer of Sacral Regions, Unstageable as a diagnosis. The Plan of Care contained an order to clean the sacral wound with saline, apply Aquaphor, if available, or Calcium Silver alginate. Apply Metronidazole powder if wound had an odor. Licensed Vocational Nurse C performed skilled nurse visits on 12/5/2024, 12/9/2024, 12/12/2024 12/20/2024, 12/24/2024, and 1/2/2025. 12/5/2024- Licensed Vocational Nurse C documented that wound care was provided to the sacral wound, wound on left buttock, and the wound to left heel. Licensed Vocational Nurse C did not document the wound care that was performed. 12/9/2024 - Licensed Vocational Nurse C documented that Patient #10 had an open sacral wound, a Stage II wound to the left buttock, and a suspected deep tissue injury to the left heel. Licensed Vocational Nurse C documented that providing wound care to Patient #10/s sacral wound, left buttock wound, and the wound to the left heel. Licensed Vocational Nurse C did not document the wound care that was performed. 12/20/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #10’s sacral wound, left buttock wound, and left heel wound. Licensed Vocational Nurse D did not document the wound care that was performed. 12/24/2024 - Licensed Vocational Nurse C documented performing wound care “by this nurse” to Patient #10’s sacral wound, left buttock wound, and left heel wound. Licensed Vocational Nurse C did not document the wound care that was performed. 1/2/2025 - Licensed Vocational Nurse C documented performing wound care “by this nurse” to Patient #10’s sacral wound, left buttock wound, and left heel wound. Licensed Vocational Nurse C did not document the wound care that was performed. Manufacturer Z, manufacturer of calcium alginate with silver, listed in the instructions for use, that calcium alginate with silver would be covered and secured with a non-occlusive secondary dressing. The agency did not include in the Plans of Care the secondary dressing to be applied to Patient #10’s sacral wound. The agency did not include in the Plans of Care the wound care treatments for the wounds on Patient #10’s left buttock and left heel. Patient #12:Record review of Patient #12’s clinical record revealed a document titled “IDT (interdisciplinary team) Plan of Care” for the certification period from 4/8/2024 to 5/29/2024. The Plan of Care listed Chronic Obstructive Pulmonary Disease (progressive lung disease that causes difficulty breathing) as the terminal diagnosis. The Plan of Care contained an order to perform dressing change to the sacrum (lower back) every visit, “see wound care orders.” The Plan of Care did not include the wound care treatments. Patient #12’s clinical record contained a Plan of Care dated 5/1/2024. The Plan of Care contained an order for the hospice nurse to change sacral wound dressing twice a week. The Plan of Care did not include the wound care treatment. Patient #12’s clinical record contained a Plan of Care dated 5/15/2024. The Plan of Care indicated that Patient #12 had a sacral wound. The Plan of Care did not include wound care treatments. Patient #12’s clinical record contained a Plan of Care dated 5/29/2024. The Plan of Care indicated that Patient #12 had a sacral wound. The Plan of Care contained an order for the hospice nurse to perform a dressing change every visit and “see wound care order.” The Plan of Care did not include wound care treatments. Patient #12’s clinical record did not contain interim physician orders for wound care. Licensed Vocational Nurse C conducted skilled nurse visits on 4/15/2024, 4/18/2024, 4/22/2024, 5/13/2024, 5/15/2024, 5/22/2024, 5/24/2024, 6/3/2024, and 6/5/2024. 4/15/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #12’s sacral wound per physician orders. Licensed Vocational Nurse C did not document the wound care that was performed. 4-18-2024- Licensed Vocational Nurse C documented performing wound care to Patient #12’s wound. Licensed Vocational Nurse C did not document the wound care that was performed. 4/22/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #12’s wound. Licensed Vocational Nurse C did not document the wound care that was performed. 5/13/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #12’s wound. Licensed Vocational Nurse C did not document the wound care that was performed. 5/15/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #12’s wound. Licensed Vocational Nurse C did not document the wound care that was performed. 5/22/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #12’s wound. Licensed Vocational Nurse C did not document the wound care that was performed. 5/24/2024 - Licensed Vocational Nurse C documented performing wound care to Patient #12 wound. Licensed Vocational Nurse C did not document the wound care that was performed. 5/27/2024- Licensed Vocational Nurse C documented performing wound care to Patient #12’s wound. Licensed Vocational Nurse C did not document the wound care that was performed. Registered Nurse D conducted a skilled nurse visit on 6/3/2024. Registered Nurse D documented changing the sacrum wound dressing. Registered Nurse D did not document the wound care that was performed. Registered Nurse D conducted a skilled nurse visit on 6/5/2024. Registered Nurse D documented changing the sacrum wound dressing. Registered Nurse D did not document the wound care that was performed. Registered Nurse D was no longer employed at the agency. During an interview on 5/19/2025 at 1:00 p.m. with the Administrator/Supervising Nurse, the Alternate Administrator/Alternate Supervising Nurse, and Quality Assurance Nurse, the surveyor discussed the Plans of Care did not include wound care treatments that staff were performing on Patient #10 and Patient #12. The surveyor asked how the nurses would know what the wound care was. The Alternate Administrator/Alternate Supervising Nurse informed the surveyor that wound care orders would come from Wound Agency Y and would be uploaded. The Alternate Administrator/Alternate Supervising Nurse stated, “It (wound care orders) were not uploaded into the clinical record.” The Administrator/Supervising Nurse, Alternate Administrator/Alternate Supervising Nurse, and Quality Assurance Nurse did not know why the wound care orders were not included in the plans of care. On 5/21/2025 at 10:13 a.m. with Alternate Administrator/Alternate Supervising Nurse brought the requested documents from record review to the surveyor which included documents sent to the Agency by Wound Agency Y. The Alternate Administrator/Supervising Nurse confirmed that the documents from Wound Agency Y were not in the clinical record and were not included in the Plans of Care. The Alternate Administrator/Supervising Nurse stated, “They were supposed to be uploaded.’ During an interview on 5/22/2025 at 1:10 p.m. with Licensed Vocational Nurse C, Licensed Vocational Nurse C informed the surveyor that wound care was performed for Patient #10 and Patient #12. The surveyor asked what the wound care was that was performed on the clients. Licensed Vocational Nurse C did not remember the wound care that was performed. The surveyor asked how Licensed Vocational Nurse C would know what wound care to perform. Licensed Vocational Nurse C informed the surveyor that Wound Agency Y or a wound care physician also provided wound care to the patients. The agency office would either receive an email or fax from Wound Agency Y. Licensed Vocational Nurse C informed the surveyor that Licensed Vocational Nurse C would get a message from the agency’s office if there were any changes to the wound care. Wound Agency Y usually saw the clients once a week and the hospice would provide the wound care for the other days of the week. The surveyor asked who would be responsible for including the wound care orders received into the plan of care. Licensed Vocational Nurse C stated, “It would be someone at the office.” Licensed Vocational Nurse C did not know why the Plans of Care did not include wound care treatments. Licensed Vocational Nurse C did not state how it could affect the agency’s patients. Review of the agency’s policy titled “Care Planning Process,” labeled TX.6, and dated 3/1/2015 read in part; “Purpose To ensure that care provided is appropriately planned in a timely manner to meet the patient/family’s specific needs and problems. Policy...Procedure...2.3 Content of the IDT (Interdisciplinary Team) Plan of Care will include...Medications and treatments to meet needs of patient...””

“Based on record review and interview, the agency failed to include in the patient discharge summaries; a summary of the patients’ stay that included treatments, symptoms and pain management, the current plan of care, and the latest physician orders in 4 (#3, #11, #12, #13) of 4 discharged records review where the patients were discharged in accordance with the Code of Federal Regulations 418.26 (no longer terminally ill), or revoked hospice services. The failure placed the patients at risk for a negative outcome when post agency discharge continuity of care did not include up-to-date patient care information. FindingsThe Code of Federal Regulations 418.26 read in part; “Reasons for Discharge. A hospice may discharge a patient if (1) The patient moves out of the hospice’s service area or transfers to another hospice; (2) The hospice determines that the patient is no longer terminally ill...” Patient #3:Record review of Patient #3’s clinical record contained a document titled “IDT (Interdisciplinary Team) Plan of Care” dated for certification period 11/20/2024 to 2/16/2025. The Plan of Care listed Parkinson’s Disease with Dyskinesia (progressive disorder resulting in the death of nerve cells affecting movement with involuntary jerking or twitching movements) as the terminal diagnosis. Patient #3’s clinical record contained a document titled “Discharge-Live” dated 2/16/2025 which listed the reason that Patient #3’s was discharged from the agency’s services on 2/16/2025 was due to no longer being terminally ill. Patient #3’s discharge summary did not contain a summary of the Patient #3’s hospice stay that included treatments, symptoms and pain management, the current plan of care, and the latest physician orders. Patient #11:Record review of Patient #11’s clinical record revealed a documented titled “IDT (Interdisciplinary Team) Plan of Care for benefit period 5/28/2024 to 7/7/2024. The Plan of Care listed End-Stage Heart Failure (heart unable to pump enough blood for the body’s needs) as the terminal diagnosis. Patient #11’s clinical record contained a document titled “Discharge-Live” dated 7/9/2024 which listed the reason that Patient #11 was discharged on 7/9/2024 was due to revocation of services. Patient #11’s discharge summary did not contain a summary of the Patient #11’s hospice stay that included treatments, symptoms and pain management, the current plan of care, and the latest physician orders. Patient #12:Record review of Patient #12’s clinical record revealed a document titled “IDT (interdisciplinary team) Plan of Care” for the certification period from 4/8/2024 to 5/29/2024. The Plan of Care listed Chronic Obstructive Pulmonary Disease (progressive lung disease that causes difficulty breathing) as the terminal diagnosis. Patient #12’s clinical record contained a document titled “Discharge-Live” dated 7/11/2024 which listed the reason that Patient #12 was discharged on 7/11/2024 was due to no longer being terminally ill. Patient #12’s discharge summary did not contain a summary of the Patient #12’s hospice stay that included treatments, symptoms and pain management, the current plan of care, and the latest physician orders. Patient #13:Record review of Patient #13’s clinical record an Initial Plan of Care/Physician’s orders that was signed on 5/10/2024. The Plan of care listed Occlusion and Stenosis of Cerebral Artery (blockage or narrowing of a blood that restricts blood flow to the brain) as the terminal diagnosis. Patient #13’s clinical record contained a document titled “Discharge-Live” dated 7/12/2024 which listed the reason that Patient #13 was discharged on 7/12/2024 was due to no longer being terminally ill. Patient #13’s discharge summary did not contain a summary of the Patient #13’s hospice stay that included treatments, symptoms and pain management, the current plan of care, and the latest physician orders. During an interview on 5/19/2025 at 1:00 p.m. with the Administrator/Supervising Nurse, the Alternate Administrator/Alternate Supervising Nurse, and the Quality Assurance Nurse, the surveyor discussed that the discharged summaries, for patients that revoked services or were discharged due to no longer being terminally ill, did not include treatments, symptoms and pain management, the current plan of care, and the latest physician orders. The staff were going to review the records for discharge summaries. During an interview on 5/21/2025 at 3:42 p.m. with the Administrator/Supervising Nurse, the Alternate Administrator/Supervising Nurse, and the Personal Assistance Services Supervisor, the survey reviewed the preliminary finding that the discharge summaries did not include the regulatory requirement information. The agency did not present further documentation that the discharge summaries contained the regulatory require information. The staff did not dispute the finding. The staff did not state why the summaries did not include the information or how it could affect the agency’s patients. Review of the agency’s policy titled “Patient Discharge Notice/Expedited Determination (NOMNC),” labeled PE.6, and dated 9/1/2024 read in part: “Policy Agency will discharge patient when the patient no longer meets hospice criteria...Purpose To ensure an appropriate, timely, coordinated discharge process...Procedure...A...11. The Discharge summary includes at least the following: A. summary of the patients stay including treatments, symptoms and pain management, the patient’s current POC (Plan of Care), the patient’s latest physician orders...””