Lotus Hospice

“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 1 of 14 (7%) clinical records reviewed, the agency did not ensure an accurate review of the medications the patient was currently using to identify any potential adverse effects and drug reactions. CLINICAL RECORD 2/HOME VISIT 2: The patient elected the hospice benefit on 03/18/2026 with a diagnosis of malignant neoplasm of the prostate. The patient resided in a private home with paid caregivers. During the home visit observation on 04/16/2026 with the Registered Nurse (RN) (Personnel Record 5), a medication review was completed by comparing the patient’s current home medications with the patient’s hospice medication profile dated 04/15/2026. The patient’s home medications included Valsartan 12.5 milligrams 1 tab daily, and Valsartan was present in the home. The caregiver confirmed that the patient does take Valsartan. The hospice medication profile did not include Valsartan and Valsartan was not included in the medication review process. During an interview on 04/16/2025, the Director of Nursing confirmed that Valsartan was not on the hospice medication profile. She stated, “I spoke with the RN and verified the patient is still taking Valsartan, and it should be on the profile. I have corrected the medication profile.””

“It is required that each patient’s individualized written plan of care: Includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure the plan of care included treatments necessary to meet the needs of the patient. CLINICAL RECORD 9: The patient elected the hospice benefit on 02/18/2026 with a diagnosis of malignant neoplasm of the upper lobe of the right bronchus. The Registered Nurse (RN) documented on 02/18/2026, in the initial nursing assessment, that a PleurX drain (small flexible catheter that a doctor places within the patient’s chest to drain fluid from the pleural space around the lungs) was in place, and “(The patient) has a right pleural effusion that requires daily to every other day drainage.” The nurse documented on 02/20/2026, “Daughter drained the pleural drain yesterday, 150 milliliters. Dr Smith ordered to drain every other day instead of daily due to pain and minimal output.” The plan of care dated 02/18/2026 did not include interventions for drainage of the pleural drain or site care for the insertion site of the drain. CLINICAL RECORD 10: The patient elected the hospice benefit on 01/28/2026 with a diagnosis of senile degeneration of the brain. The initial nursing assessment dated 01/28/2026 included documentation that the patient was at high risk for aspiration (when substances that are meant to be swallowed enter the trachea/windpipe and lungs). The plan of care dated 01/28/2026 did not include interventions for dietary precautions or interventions to reduce the risk of aspiration. During an interview on 04/17/2026, the Director of Nursing (DON) reviewed the plan of care and then stated, “I will need to learn how to edit the plan of care to include patient needs that are not listed in the menu of choices.””

“It is required that hospice aides are assigned to a specific patient by a registered nurse (RN), who is a member of the Interdisciplinary group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 12 (17%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Registered Nurse provided patient specific care instructions to the hospice aide. CLINICAL RECORD 9: The patient elected the hospice benefit on 02/18/2026 with a diagnosis of malignant neoplasm of the upper lobe of the right bronchus. The Registered Nurse (RN) documented on 02/18/2026, in the initial nursing assessment, that a PleurX drain (small flexible catheter that a doctor places within the patient’s chest to drain fluid from the pleural space around the lungs) was in place. The hospice aide care plan dated 02/18/2026 did not include instructions to the aide on precautions for the PleurX drain and how to care for the PleurX insertion site while bathing the patient. CLINICAL RECORD 10: The patient elected the hospice benefit on 01/28/2026 with a diagnosis of senile degeneration of the brain. The RN documented in the initial nursing assessment dated 01/28/2026 that the patient was at a high risk for aspiration (when substances that are meant to be swallowed enter the trachea/windpipe and lungs). The hospice aide care plan dated 01/28/2026 did not include instructions to the aide related to the patient’s risk of aspiration. During an interview on 04/17/26, the Director of Nursing stated, “The aide care plan should include precautions. I will have to determine where to enter it. I will contact the EMR (electronic medical record) administrator to find out if the aide care plan can be amended to include additional precautions.””

“It is required that each patient’s record includes, at a minimum, physician orders. This standard was not met as evidenced by document review, clinical record review, and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the clinical record included physician orders. POLICY 1: Agency policy 1-025 Discharge from Hospice Program, required in part, “Procedure - 2. The case manager will ensure that necessary paperwork is completed at the time of discharge. This will include a signed revocation form, if necessary, and a written physician order to discharge if appropriate.” CLINICAL RECORD 9: The patient elected the hospice benefit on 02/18/2026 with a diagnosis of malignant neoplasm of the upper lobe of the right bronchus. The Registered Nurse (RN) documented on 02/18/2026, in the initial nursing assessment, that a PleurX drain (small flexible catheter that a doctor places within the patient’s chest to drain fluid from the pleural space around the lungs) was in place, and “(The patient) has a right pleural effusion that requires daily to every other day drainage.” The nurse documented on 02/20/2026, “Dr Smith ordered to drain every other day instead of daily due to pain and minimal output.” The clinical record did not include a physician order for drainage and care of the PleurX drain. CLINICAL RECORD 14: The patient elected the hospice benefit on 09/22/2025 with a diagnosis of senile degeneration of the brain. The patient was discharged on 10/31/2025 due to no longer meeting eligibility criteria for terminal illness. There was no evidence that a physician’s order to discharge the patient was entered into the clinical record. During a review of findings and interview on 04/17/2026 with the Administrator and the Director of Nursing, the Administrator stated, “We were not aware that a discharge order was required for a live discharge for extended prognoses. We will be sure to review the requirements with the nursing staff.” The Director of Nursing confirmed that there was no physician’s order for the PleurX drain or site care. She stated, “I will enter the order and instruct the nurses to be sure a physician’s order is obtained for all treatments.””