All Seasons Hospice of Texas

“Upon patient record review, 2 of 14 (Patient #2, 5) 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: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 2: The medication list recorded, “Acetaminophen 500mg 1 tablet by mouth every 6 hours as needed pain/fever.” and “Acetaminophen 650mg rectal suppository every 4 hours as needed pain/fever.” There was no evidence of any clarification on when one medication should be administered versus the other or of a maximum dose of Acetaminophen within a 24 hour period. Also, Dermacinrx 5% cream was present on the medication list with the instructions, “apply to affected area as needed.” There was no evidence of clarification of where to apply the medication on the body or of how often a the dose stated, “per instructions” and the frequency recorded, “as needed.” Further, there was found to be three pain medications listed on the medication list; Acetaminophen, Tramadol, and Morphine Sulfate. These were all “as needed” medications with no clarification present on any medication as to when to administer one drug versus the other related to pain intensity, severity, or numeric rating. Patient 5: The medication lists recorded, “Acetaminophen 300mg with Codeine 30mg 1 tab po q 6 hours prn pain” and “Hydrocodone 5mg-Acetaminophen 325mg 1 tab po q 6 hours PRN pain.” No further documented evidence of clarification present on these medications as to when to administer one drug versus the other related to pain intensity, severity, or numeric rating.”

“Upon patient record review, 1 of 14 (Patient #5) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual’s attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient’s progress toward desired outcomes • Reassessment of the patient’s response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient 5: There is no evidence patient assessment update occurred as frequently as the condition of the patient requires, but no less frequently than every 15 days as there was no documented evidence of an RN visit completed from the last visit date of 10/24/25 through 11/12/25.”

“Upon patient record review, 1 of 14 (Patient #1) 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 1: The Recertification Plan of Care dated 11/04/25 recorded, “MSW 3 PRN for urgent psychosocial needs or interventions.” There is no documented evidence of clarification of scope and frequency of psychosocial services necessary to meet the patient and family needs.”

“Upon patient record review, 2 of 14 (Patient #2, 5) 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 plan of care recorded, “Acetaminophen 500mg 1 tablet by mouth every 6 hours as needed pain/fever.” and “Acetaminophen 650mg rectal suppository every 4 hours as needed pain/fever.” There was no evidence of any clarification on when one medication should be administered versus the other or of a maximum dose of Acetaminophen within a 24 hour period. Also, Dermacinrx 5% cream was present on the plan of care with the instructions, “apply to affected area as needed.” There was no evidence of clarification of where to apply the medication on the body or of how often as the dose stated, “per instructions” and the frequency recorded, “as needed.” Further, there was found to be three pain medications listed on the plan of care; Acetaminophen, Tramadol, and Morphine Sulfate. These were all “as needed” medications with no clarification present on any medication as to when to administer one drug versus the other related to pain intensity, severity, or numeric rating. Patient 5: The plan of care recorded, “Acetaminophen300mg with Codeine 30mg 1 tab po q 6 hours prn pain” and “Hydrocodone 5mg-Acetaminophen 325mg 1 tab po q 6 hours PRN pain.” No further documented evidence of clarification present on these medications as to when to administer one drug versus the other related to pain intensity, severity, or numeric rating.”

“Upon patient record review, 1 of 14 (Patient #5) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient 5: The recertification nursing assessment dated 09/22/25 indicated the patient is a high risk for falls with recent functional decline. The plan of care update with a date of 09/23/25 records problems, interventions, and goals related to fall precautions, safety measures and functional mobility. The aide instructions dated 06/20/25 did not provide any instruction to the aide regarding fall precautions. There is no documented evidence found of updated aide instructions to reflect the current needs of the patient.”

“Upon patient record review 1 of 14 (Patient #7) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient 7:The aide instructions dated 06/30/25 specified each required task to be completed at each visit. The aide visit dated 10/30/25 indicated shampoo and hair care tasks as, “not required this visit.” The aide visit dated 11/03/25 indicated shampoo, hair care, and change linen tasks “not required this visit.” The was no documented evidence found of collaboration with the case manager for these tasks to not be performed or of who, if anyone, refused these tasks for this patient with a terminal diagnosis of Senile Degeneration of the Brain.”

“Upon contract review, 2 of 4 (Medical Director and Alternate Medical Director contracts) did not have evidence of a contract to fulfill the role of medical director or alternate medical director, if applicable. Contracts 3 and 4 both recorded, “Hospice Medical Director Contract.” The contracts did not specify any difference in roles and responsibilities pertaining to the Medical Director or Medical Director Designee role nor clarify who was to assume the “Director” versus “Designee” role. The Governing Body minutes, Organization chart, IDG documents, and EMR did distinguish clearly who these roles fell to within the organization.”