Sterling 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 but is not limited to identifying the effectiveness of drug therapy, drug side effects, and actual or potential drug interactions. The drug profile is updated per hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment, when new medication is added, and existing medication is changed. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 14 (21%) clinical records reviewed, the agency did not ensure the drug profile was reviewed and updated at each comprehensive assessment or when medications were added or changed. Clinical Record 1: The patient, an assisted living facility (ALF) resident, elected the hospice benefit on 11/03/2023. During the home visit (Home Visit 1) with the hospice aide (Personnel Record 2), a medication review was completed by comparing the hospice medication profile with the medication administration record (MAR) from the ALF. The ALF MAR included Tylenol Extra Strength (ES) 1000MG every six hours as needed for pain, Famotidine 10MG once a day as needed for acid reflux, Tramadol 50MG every six hours as needed for pain, and Trazodone 150MG given one-half tablet at every bedtime. The hospice plan of care dated 06/30/2024 and medication profile current 08/28/2024 did not include Tylenol ES, Famotidine 10MG, Tramadol 50MG, and Trazodone 150MG as ordered and administered by the ALF. Clinical Record 2: The patient, an assisted living facility (ALF) resident, elected the hospice benefit on 11/16/2023. During the home visit (Home Visit 2) with the Medical Social Worker (Personnel Record 3), a medication review was completed by comparing the hospice medication profile with the medication administration record (MAR) from the ALF. The ALF MAR included Ibuprofen 400MG given two tablets twice a day scheduled, Loratadine 10MG daily, Metoprolol succinate extended-release (ER) 25MG every bedtime, Nitrofurantoin macro 50MG every bedtime, Diclofenac gel 1% topically four times a day as needed, Hydrocortisone cream 1% topically four times a day for itching, and Milk of Magnesia suspension 30ML once a day as needed for constipation. The hospice plan of care dated 06/30/2024 and medication profile current 08/28/2024 did not include Ibuprofen 400MG, Loratadine 10MG, Metoprolol succinate ER 25MG, Nitrofurantoin macro 50MG, Diclofenac gel 1%, Hydrocortisone cream 1%, and Milk of Magnesia as ordered and administered by the ALF. Clinical Record 3: The patient, an assisted living facility (ALF) resident, elected the hospice benefit on 03/03/2023. During the home visit (Home Visit 3) with the Registered Nurse (Personnel Record 1), a medication review was completed by comparing the hospice medication profile with the medication administration record (MAR) from the ALF. The ALF MAR included Lactobacillus once a day, Lantiseptic skin protectant topically to arms and legs twice a day, Loratadine 10MG once a day, Mupirocin ointment 2% topically to fingernails once a week, Probiotic formula capsule once a day, Tramadol 50MG every six hours as needed for pain, Ativan-Benadryl-Haldol (ABH) gel 1-25-1MG/ML given two pumps every four hours as needed for agitation, Hemorrhoidal ointment topically two to four times a day as needed, and Lorazepam 0.5MG every six hours as needed for anxiety/agitation. The hospice plan of care dated 07/15/2024 and medication profile current 08/28/2024 did not include, Lactobacillus, Lantiseptic skin protectant, Loratadine 10MG daily, Mupirocine ointment 2%, Probiotic formula capsule, Tramadol 50MG, ABH gel 1-25-1MG/ML, Hemorrhoidal ointment, and Lorazepam 0.5MG as ordered and administered by the ALF. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed that the clinical records identified contained no evidence that medication reviews were completed, and drug profiles were updated with each comprehensive assessment, and when medications were added or changed.”

“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 5 of 14 (36%) clinical records reviewed, the agency did not ensure the individualized written plan of care reflected patient and family goals and identified planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 2: The patient elected hospice services on 11/16/2023 with a terminal illness of unspecified systolic (congestive) heart failure. The recertification nursing assessment dated 06/25.2024 included documentation that the patient had dyspnea with minimal exertion and orthopnea requiring the head of the bed to be elevated to at least 30 degrees. The written plan of care dated 06/30/2024 did not reflect patient and family goals and planned interventions associated with the patient’s dyspnea and orthopnea identified in the comprehensive assessment. Clinical Record 5: The patient elected hospice services on 01/29/2024 with a terminal illness of senile degeneration of the brain, not elsewhere classified. The patient revoked hospice services on 06/17/2024. The initial nursing assessment dated 01/29/2024 included documentation that the patient had an increase in agitation and aggressive behaviors with minimal stimulation and care requiring scheduled medications to manage and a history of seizures requiring scheduled anti-epileptic medications. The written plan of care dated 01/29/2024 did not reflect patient and family goals and planned interventions associated with the patient’s agitation, aggressive behaviors, and seizure risk identified in the comprehensive assessment. Clinical Record 6: The patient elected hospice services on 01/09/2023 with a terminal illness of unspecified heart failure. The patient transferred to another hospice provided on 08/12/2024The recertification nursing assessment dated 06/17/2024 included documentation that the patient had moderate dysphagia with congested lung sounds, became easily frustrated with worsening aphasia, and had ongoing hallucinations. The written plan of care dated 07/02/2024 did not reflect patient and family goals and planned interventions associated with the aspiration risk, communication deficit, and hallucinations identified in the comprehensive assessment. Clinical Record 9: The patient elected hospice services on 02/09/2024 with a terminal illness of unspecified chronic obstructive pulmonary disease. The patient revoked hospice services to seek aggressive treatment on 07/24/2024. The initial nursing assessment dated 02/09/2024 included documentation that the patient had a urostomy in place for which the patient provided care. The written plan of care dated 02/09/2024 did not reflect patient and family goals and planned interventions associated with the patient’s urostomy, urinary drainage device, maintenance, and associated risks identified in the comprehensive assessment. Clinical Record 14: The patient elected hospice services on 04/01/2014 with a terminal illness of unspecified chronic obstructive pulmonary disease. The patient died at the assisted living facility on 04/29/2024. The initial nursing assessment dated -04/01/2024 included documentation that the patient had an indwelling urinary catheter with a leg drainage bag in place. The written plan of care dated 04/01/2024 did not reflect patient and family goals and planned interventions associated with the patient’s indwelling urinary catheter maintenance and associated risks identified in the comprehensive assessment. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed the plans of care identified did not reflect the patient and family goals and planned interventions associated with all of the problems identified during the initial and comprehensive assessments, including dyspnea, orthopnea, agitation, seizure risk, aspiration risk, and urinary devices.”

“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 a detailed statement of the scope and frequency of services necessary to meet specific patient and family needs. This standard was not met as evidenced by clinical record review and interview. In 4 of 14 (29%) clinical records reviewed, the agency did not ensure the individualized written plan of care included the scope and frequency of services necessary to meet specific patient and family needs. Clinical Record 1: The patient elected the hospice benefit on 11/03/2023 with a terminal diagnosis of unspecified systolic (congestive) heart failure. Although care and services were provided, the plan of care effective, 06/30/2024 through 08/28/2024 did not include the frequency of skilled nursing services required to meet specific patient and family needs. Clinical Record 2: The patient elected the hospice benefit on 11/16/2023 with a terminal diagnosis of unspecified systolic (congestive) heart failure. Although care and services were provided, the plan of care effective, 06/30/2024 through 08/28/2024 did not include the frequency of skilled nursing services required to meet specific patient and family needs. Clinical Record 3: The patient elected the hospice benefit on 03/03/2023 with a terminal diagnosis of senile degeneration of the brain, not elsewhere classified. Although care and services were provided, the plan of care effective, 07/15/2024 through 09/12/2024 did not include the frequency of skilled nursing services required to meet specific patient and family needs. Clinical Record 4: The patient elected the hospice benefit on 03/14/2024 with a terminal diagnosis of senile degeneration of the brain, not elsewhere classified. Although care and services were provided, the plan of care effective, 07/12/2024 through 09/09/2024 did not include the frequency of skilled nursing services required to meet specific patient and family needs. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed the identified plans of care did not include the frequency for all services required to meet the specific needs of the patient and family.”

“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 measurable outcomes anticipated from implementing and coordinating the plan of care, This standard was not met as evidenced by clinical record review and interview. In 6 of 14 (43%) clinical records reviewed, the agency did not ensure the individualized written plan of care included measurable outcomes anticipated from implementing and coordinating the plan of care. Clinical Record 1: The patient elected the hospice benefit on 11/03/2023 with a terminal diagnosis of unspecified systolic (congestive) heart failure. The comprehensive nursing assessment dated 06/25/2024 included documentation that the patient had bradycardia, dyspnea with minimal exertion, orthopnea, two plus pitting edema to bilateral lower extremities, and generalized pain with a pain score of five out of ten. The plan of care (POC) dated 06/30/2024, identified cardiopulmonary and pain problems, and documented goals to achieve and maintain optimal physical comfort, adequate cardiac/circulatory function and fluid volume, and optimal breathing patterns, and comfort. The POC did not include measurable outcomes related to bradycardia, dyspnea, orthopnea, edema, and pain anticipated from implementing and coordinating the POC. Clinical Record 4: The patient elected the hospice benefit on 03/14/2024 with a terminal diagnosis of senile degeneration of the brain, not elsewhere classified. The comprehensive nursing assessment dated 03/14/2024 included documentation that the patient had hypoxemia and moderate dyspnea with minimal exertion and one plus pitting edema to bilateral lower extremities. The plan of care (POC) dated 03/14/2024 and updated on 07/12/2024, identified cardiac/circulatory function and fluid volume problems, and documented goals to maintain adequate cardiac/circulatory function and fluid volume. The POC did not include measurable outcomes related to hypoxemia, dyspnea, and edema anticipated from implementing and coordinating the POC. Clinical Record 6: The patient elected the hospice benefit on 01/09/2023 with a terminal diagnosis of unspecified heart failure. The comprehensive nursing assessment dated 06/17/2024 included documentation that the patient had dyspnea with minimal exertion with a score of three out of ten, cyanosis of the fingers, congestion of bilateral upper lung fields, one plus pitting edema to bilateral lower extremities, and pain scored three out of ten. The plan of care (POC) dated 07/02/2024, identified dyspnea, circulation, edema, and pain as problems, and documented goals to achieve and maintain optimal comfort, adequate cardiac/circulatory function, and adequate fluid volume. The POC did not include measurable outcomes related to dyspnea, circulation, edema, and pain anticipated from implementing and coordinating the POC. Clinical Record 7: The patient elected the hospice benefit on 08/16/2023 with a terminal diagnosis of chronic systolic (congestive) heart failure. The comprehensive nursing assessment dated 01/30/2024 included documentation that the patient had dyspnea scored three out of ten with minimal exertion, required oxygen at two liters per minute, and had two plus pitting edema to bilateral lower extremities. The plan of care (POC) dated 02/12/2024, identified dyspnea and edema as problems, and documented goals to maintain optimal breathing pattern and comfort, adequate cardiac/circulatory function, and adequate fluid volume. The POC did not include measurable outcomes related to dyspnea and edema anticipated from implementing and coordinating the POC. Clinical Record 8: The patient elected the hospice benefit on 02/06/2024 with a terminal diagnosis of unspecified diastolic (congestive) heart failure. The comprehensive nursing assessment dated 02/06/2024 included documentation that the patient had dyspnea at rest, with conversation, with activity, scored three out of ten, required oxygen at two liters per minute at night, and had orthopnea. The plan of care (POC) dated 02/06/2024, identified altered breathing pattern and comfort as a problem, and documented goals to achieve and maintain optimal breathing pattern and comfort. The POC did not include measurable outcomes related to dyspnea at rest and with exertion and orthopnea anticipated from implementing and coordinating the POC. Clinical Record 9: The patient elected the hospice benefit on 02/09/2024 with a terminal diagnosis of unspecified chronic obstructive pulmonary disease. The comprehensive nursing assessment dated 02/09/2024 included documentation that the patient had dyspnea at rest and required oxygen at three liters per minute. The plan of care (POC) dated 02/09/2024, identified dyspnea and oxygen use and documented goals to achieve and maintain optimal breathing pattern and comfort. The POC did not include measurable outcomes related to dyspnea anticipated from implementing and coordinating the POC. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed the written plans of care did not include measurable outcomes anticipated from the coordination, development, and implementation of the plan of care.”

“It is required that hospice aides be assigned to a specific patient by a Registered Nurse (RN), who is a member of the Interdisciplinary Group. The written patient care instructions for a hospice aide are prepared by an RN, who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review, interview and observation. In 5 of 14 (36%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Registered Nurse prepared specific written patient care instructions for the aide to follow. Clinical Record 2: The patient elected the hospice benefit on 11/16/2023 with a terminal diagnosis of unspecified systolic (congestive) heart failure. The hospice aide care plan dated 08/22/2024 included instructions for the aide to perform a shower every visit or a bed bath if the patient refused the shower. The plan did not alert the aide to the patient’s cognitive ability to make decisions, forcing the aide to make decisions outside the aide’s scope of practice. Clinical Record 4: The patient elected the hospice benefit on 03/14/2024 with a terminal diagnosis of senile degeneration of the brain, not elsewhere classified. The hospice aide care plan dated 03/16/2024 included instructions for the aide to perform a shower and skin care as needed. The plan did not provide the aide with specific instructions indicating when a shower and skin care would be required, forcing the aide to make decisions outside the aide’s scope of practice. Clinical Record 5: The patient elected the hospice benefit on 01/29/2024 with a terminal illness of senile degeneration of the brain, not elsewhere classified. The initial nursing assessment dated 01/29/2024 included documentation that the patient required two persons to assist with transferring and providing personal care. The hospice aide care plan dated 03/11/2024 did not alert the aide to the need for two persons when transferring the patient or providing personal care. Clinical Record 6: The patient elected the hospice benefit on 01/09/2023 with a terminal diagnosis of unspecified heart failure. The hospice aide care plan dated 06/21/2024 included instructions for the aide to provide nail care, clean and file, and shave the patient as needed. The plan did not give the aide specific instructions indicating when nail care and shaving would be required, forcing the aide to make decisions outside the aide’s scope of practice. Clinical Record 8: The patient elected the hospice benefit on 02/06/2024 with a terminal diagnosis of unspecified diastolic (congestive) heart failure. The hospice aide care plan dated 03/11/2024 included instructions for the aide to transfer the patient to a chair or keep the patient in bed every visit. The plan did not give specific instructions that the patient would decide to get up in the chair or stay in bed and had the cognitive ability to make decisions, forcing the aide to make decisions outside the aide’s scope of practice. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed that the hospice aide care plans did not provide the aide with specific instructions on all tasks and did not alert the aide to specific patient care needs and abilities, forcing the aide to make decisions outside the aide’s scope of practice.”

“It is required that a hospice aide provide services that are ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by clinical record review, interview and observation. In 2 of 14 (14%) clinical records reviewed with hospice aide services provided, the agency did not ensure the aide provided services as ordered by the Interdisciplinary Group (IDG) and included in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 11/03/2024. The hospice aide care plan dated 08/22/2024 included an alert to the aide on barrier products in use, lantiseptic, Vaseline, and skin protectant, every visit. During the home visit (Home Visit 1) with the hospice aide (Personnel Record 2), the aide reported that the personal care provided by the aide included the application of “peri-guard” under the patient’s abdominal folds after bathing. The plan did not contain instructions for the aide to apply barrier cream to the patient’s abdominal folds. Clinical Record 3: The patient, an assisted living facility resident, elected the hospice benefit on 03/03/2023. The plan of care dated 07/15/2024 included a visit frequency order for hospice aide of five (5) per week. The hospice aide care plan dated 03/11/2024 included instructions for the aide to perform a bed bath twice a week, a shower three times a week, nail care once a week, and shampoo three times a week. The hospice aide visits completed on 08/19/2024, 08/20/2024, 08/21/2024, 08/22/2024, and 08/23/2024 included documentation that, at each visit, the following tasks were performed: bed bath, shower, nail care, and shampoo. The clinical record contained no evidence that the Registered Nurse had instructed the aide to perform the identified tasks every visit and no documentation of why the tasks were performed every visit. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed that the hospice aide care plans identified did not include instructions for the aide to apply barrier cream to abdominal folds or to provide a bed bath, shower, nail care, and shampoo every visit.”

“It is required that Volunteers are used in day-to-day administrative and/or direct patient care roles. The hospice must maintain records on the use of volunteers for patient care and administrative services, including the type of services and time worked. A review of the agency’s volunteer program and services revealed that the agency did not ensure that hospice volunteers were used in day-to-day administrative and/or direct patient care roles. There were no active volunteers available for administrative and/or direct patient care roles. During the interview with the Volunteer Coordinator on 08/27/2024, the Volunteer Coordinator confirmed the agency did not have any direct care or administrative volunteers onboard at the time of the survey. The leaders provided documented evidence of current recruitment efforts and were developing a process improvement plan (PIP) to build a robust and successful volunteer recruitment program.”

“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. The hospice documents the cost savings achieved through volunteers. This standard was not met as evidenced by volunteer program record review and interview. A review of the agency’s volunteer program and services revealed that the agency did not ensure that hospice volunteers provided day-to-day administrative or direct patient care service hours equal to five percent (5%) of all paid patient care hours. There was no documentation to track the cost savings achieved through volunteers. During the interview with the Volunteer Coordinator on 08/27/2024, the Volunteer Coordinator confirmed the agency did not have any direct care or administrative volunteers onboarded at the time of the survey. The clinical records contained no evidence of volunteer services in an amount that, at a minimum, equaled five percent (5%) of the total paid patient care hours. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed that the agency had not provided volunteer services equal to five percent (5%) of the total paid patient care hours. The leaders provided documented evidence of current recruitment efforts and were developing a process improvement plan (PIP) to build a robust and successful volunteer recruitment program. A review of the agency’s volunteer program and services revealed that the agency did not ensure that hospice volunteers provided day-to-day administrative or direct patient care service hours equal to five percent (5%) of all paid patient care hours.”

“It is required that a hospice must be primarily engaged in providing the following care and services and must do so in a manner that is consistent with accepted standards of practice: volunteer services. This standard was not met as evidence by program review and interview. A review of the agency’s volunteer program and services revealed that the agency did not have a volunteer onboard to provide direct care or administrative volunteers services. During the interview with the Volunteer Coordinator on 08/27/2024, the Volunteer Coordinator confirmed the agency did not have any direct care or administrative volunteers onboard at the time of the survey. The leaders provided documented evidence of current recruitment efforts and were developing a process improvement plan (PIP) to build a robust and successful volunteer recruitment program.”

“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 and interview. In 5 of 14 (36%) clinical records reviewed, the agency did not ensure the patient’s clinical record included physician orders for all care and services provided. Clinical Record 1: The patient elected the hospice benefit on 11/03/2023 with a terminal diagnosis of unspecified systolic (congestive) heart failure. The clinical record review revealed skilled nursing visit assessments documented twice a week from 06/30/2024 to 08/20/2024. The clinical record contained no evidence of a physician’s order for skilled nursing visits from 06/30/2024 to 08/20/2024. Clinical Record 3: The patient elected the hospice benefit on 03/03/2023 with a terminal diagnosis of senile degeneration of the brain, not elsewhere classified. The clinical record review revealed skilled nursing visit assessments documented twice a week from 07/15/2024 to 08/20/2024. The clinical record contained no evidence of a physician’s order for skilled nursing visits from 07/15/2024 to 08/20/2024. Clinical Record 4: The patient elected the hospice benefit on 03/14/2024 with a terminal diagnosis of senile degeneration of the brain, not elsewhere classified. The clinical record review revealed skilled nursing visit assessments documented twice a week from 07/12/2024 to 08/20/2024. The clinical record contained no evidence of a physician’s order for skilled nursing visits from 07/12/2024 to 08/20/2024. Clinical Record 5: The patient elected hospice services on 01/29/2024 with a terminal illness of senile degeneration of the brain, not elsewhere classified. The patient revoked hospice services on 06/17/2024. The plan of care dated 01/29/2024 included a visit frequency order for the hospice aide of three visits per week. The hospice aide documented completed visits five times per week from 03/25/2024 to 06/17/2024. The clinical record contained no evidence of a physician’s order to increase the frequency of hospice aide visits to five times per week. The music therapist documented completed visits on 03/14/2024, 04/17/2024, and 05/29/2024. The clinical record contained no evidence of a physician’s order for monthly visits by the music therapist. Clinical Record 7: The patient elected the hospice benefit on 08/16/2023 with a terminal diagnosis of chronic systolic (congestive) heart failure. The patient was transferred to another hospice provider on 04/25/2024. The music therapist documented completed visits on 03/08/2024 and 04/17/2024. The clinical record contained no evidence of a physician’s order for monthly visits by the music therapist. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing (DON) confirmed the clinical records identified did not include physician orders for all care and services provided including visits made by skilled nursing, hospice aide, and music therapy. The DON reported physician orders were written on 08/20/2024 for skilled nursing visit frequencies of two per week.”

“It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I. This standard was not met as evidenced by clinical record review and interview. In 1 of 3 (33%) clinical records reviewed in which the patient was transferred to another Medicare-certified hospice organization, the agency did not ensure a copy of the hospice discharge summary was forwarded to the receiving facility. Clinical Record 8: The patient elected the hospice benefit on 02/06/2024 with a terminal illness of unspecified diastolic (congestive)heart failure. The patient transferred the hospice election to another hospice provider on 04/23/2024. The clinical record contained no evidence that a copy of the hospice discharge summary was forwarded to the receiving hospice organization, a Medicare-certified hospice agency. The patient elected the hospice benefit on 02/06/2024 with a terminal illness of unspecified diastolic (congestive)heart failure. The patient transferred the hospice election to another hospice provider on 04/23/2024. The clinical record contained no evidence that a copy of the hospice discharge summary was forwarded to the receiving hospice organization, a Medicare-certified hospice agency. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed that the clinical record contained no evidence of a hospice discharge summary or that a hospice discharge summary was forwarded to the Medicare-certified hospice agency.”

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care or to the patient’s community attending physician upon hospice discharge includes at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders, and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 7 (14%) clinical records reviewed in which the patient was transferred or discharged from hospice services, the agency did not ensure a discharge summary, including a summary of the patient’s hospice stay, treatments, symptoms, pain management, current plan of care, latest physician orders, and other documentation that would assist in the post-discharge continuity of care, was developed. Clinical Record 8: The patient elected the hospice benefit on 02/06/2024 with a terminal illness of unspecified diastolic (congestive)heart failure. The patient transferred the hospice election to another hospice provider on 04/23/2024. The clinical record contained no evidence of a developed hospice discharge summary that included a summary of the patient’s hospice stay, treatments, symptoms, pain management, current plan of care, latest physician orders, and other documentation that would assist in the post-discharge continuity of care. During joint clinical record reviews and interviews on 08/29/2024, the Executive Director and Director of Nursing confirmed, that for the clinical record identified, a discharge summary was not developed.”