Transcend 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, 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, 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 measurements 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 3 of 14 (21%) 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 8/HOME VISIT 1: During the home visit observation on 10/01/2025 with the Home Health Aide (Personnel Record 8), a medication review was completed by comparing the patient’s current home medications to the hospice medication profile. The patient’s home medications included Sertraline 100 mg tablet, take one tablet daily for depression, last filled 09/17/2025; Hydrocortisone Cream 2.5% perianal, apply to the affected area every 6 hours as needed for discomfort, last filled 06/27/2025; and Albuterol AER HFA 90 mcg, inhale 2 puffs orally every 4 hours as needed, last filled 07/23/2025. Sertraline, Hydrocortisone Cream, and Albuterol AER HFA were not included on the patient’s hospice medication profile and were not included in the medication review process. The hospice medication profile printed on 09/30/2025 included Atorvastatin 40 mg tablet, 40 mg oral nightly, started 03/20/2025; Claritin 10 mg tablet, 10 mg oral daily, started 07/11/2025; and Lisinopril 2.5 mg tablet, 2.5 mg oral daily started 03/02/2025. Atorvastatin, Claritin, and Lisinopril were not included in the patient’s current home medications. CLINICAL RECORD 10/HOME VISIT 3: During the home visit observation on 10/01/2025 with the Registered Nurse (RN) (Personnel Record 5), a medication review was completed by comparing the patient’s current home medications to the hospice medication profile. The patient’s home medications included Levothyroxine 75 mcg tablet, give one daily, last filled 08/20/2025. Levothyroxine was not included on the hospice medication profile and was not included in the medication review process. CLINICAL RECORD 11: The patient elected the hospice benefit on 03/25/2025. The RN documented on the start of care comprehensive assessment dated 03/25/2025, “Intake: Patient is only on IV (intravenous) fluids... Anxiety: Patient is very agitated and will be started on IV Morphine and also Ativan.” The RN documented on the nursing visit note dated 03/26/2025, “Patient is receiving an IV Morphine drip at 16 mg/hour.” The RN Regular Visit note dated 03/27/2025 documented in part, “Patient continues on an IV Morphine drip at 16 mg/hour.” The hospice medication profile did not include Morphine and Ativa, and the medications were not included in the medication review process. During joint record review and interview on 10/01/2025, the Administrator/ Volunteer Coordinator confirmed that the records did not include documentation that the patients’ medication profiles were up-to-date and that the patients’ current medications were reconciled. During joint record review and interview on 10/02/2025, the Director of Clinical Services confirmed that there was no documented evidence that the patients’ current medications were added to 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 1 of 14 (7%) clinical records reviewed, the agency did not ensure the individualized plan of care included the drugs and treatments necessary to meet the needs of the patient. CLINICAL RECORD 11: The patient elected the hospice benefit on 03/25/2025. The RN (Registered Nurse) documented on the comprehensive assessment dated 03/25/2025, “Intake: Patient is only on IV (intravenous) fluids... Anxiety: Patient is very agitated and will be started on IV (intravenous) Morphine and also Ativan.” The RN documented on the nursing visit note dated 03/26/2025, “Patient is receiving an IV Morphine drip at 16 mg/hour.” The RN documented on the nursing visit note dated 03/27/2025, “Patient continues on an IV Morphine drip at 16 mg/hour... Instructed the hospital RN to increase the patient’s Morphine dosage. Hospital RN stated that the patient was maxed out on the ordered Morphine dosage. MD (medical doctor) was notified. MD to place an order in the hospital records to increase the IV Morphine dosage.” The plan of care and medication profile dated 03/25/2025 did not include Morphine. During a joint record review and interview on 10/02/2025, the Director of Clinical Services confirmed that the drugs and treatment necessary to meet the needs of the patient were not added to the plan of care.”

“It is required that a hospice may contract for medical director services with either: a self-employed physician; or a physician employed by a professional entity or physician group. The contract specifies the physician who assumes the medical director responsibilities and obligations. This standard was not met as evidenced by document review and interview. The agency did not ensure the Associate Hospice Medical Director’s contract included the name of the physician as required by state regulation. The state’s administrative code, required in part, “ (b) A hospice must designate in writing a physician designee to assume the same responsibilities and obligations as the medical director when the medical director is not available. (c) A hospice may contract for a physician to serve as its medical director with either a self-employed physician or a physician employed by a professional entity or physicians’ group. The contract for medical director services must specify the name of the physician who assumes the medical director responsibilities and obligations.” CONTRACT 11: Associate Hospice Medical Director Agreement dated 05/08/2025 included documentation that read in part, “(Name) County Hospital District d/b/a (Name) Regional Medical Center... Responsibilities of Hospital: 1.01 Hospital agrees to provide an employed medical staff member to serve as Medical Director.” The contract did not include the physician’s name. During a document review and interview on 09/30/2025, the Alternate Administrator (Personnel Record 11) confirmed that the Associate Hospice Medical Director’s name was not listed on the contract and confirmed that the Associate Hospice Medical Director had not yet provided services to the agency’s patients. The Alternate Administrator stated that a new contract would be obtained. On 09/30/2025, the agency obtained a new Associate Hospice Medical Director Agreement with the effective date as 09/29/2025 that was signed by both parties on 09/30/2025. During a review of contracts, the Associate Hospice Medical Director Agreement contract with (Name) County Hospital District lacked evidence that the associate medical director was listed by name on the contract. The 26 Texas Administrative Code § 558.858 required that the physician designee(s) or other contracted physicians be listed by name in a hospice contract. On 09/30/2025, the agency obtained a new Associate Hsopice Medical Director Agreement with the effective date as 09/29/2025 that was signed by both parties on 09/30/2025.”

“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 and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed with patient transfer, the agency did not ensure the discharge summary was sent to the receiving Medicare/Medicaid certified facility. CLINICAL RECORD 11: The patient elected the hospice benefit on 03/25/2025 and was transferred to a facility on 03/29/2025. The discharge summary included sections titled “discharge summary is sent to Patient/Patient Representative/Facility”, “received by”, “date”, “Contact Person”, and “Comments.” These sections of the discharge summary were left blank. There was no documented evidence in the clinical record that the discharge summary had been sent to the receiving facility. During a review of the record and interview on 10/02/2025, the Director of Clinical Services confirmed that the record did not include documentation that the discharge summary was sent to the receiving facility.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical record reviewed with patient discharge from hospice services, the agency did not ensure the discharge summary was forwarded to the patient’s attending physician. CLINICAL RECORD 12: The patient elected the hospice benefit on 09/25/2024. The patient revoked hospice care and was discharged on 11/02/2025. The discharge summary included sections titled “discharge summary is sent to Patient/Patient Representative/Facility, “received by”, “date”, and “Contact Person.” These sections of the discharge summary were left blank. The comments section of the discharge summary included documentation that “Patient is in the hospital.” There was no documented evidence in the clinical record that the discharge summary had been sent to the patient’s attending physician. During a record review and interview on 10/02/2025, the Director of Clinical Services confirmed that the record did not include documentation that the discharge summary was sent to the patient’s attending physician.”