Completetx Hospice

“Based on observation, record review, and interview the hospice failed to ensure the patient’s right to be involved in developing his or her hospice plan of care; including a discharge planning process that included any necessary family counseling, client education and other services to prepare the client and family for discharge prior to terminating hospice services for 2 (#1 and #2) of 3 discharged patient records reviewed.This failure resulted in the patient and family not being adequately prepared for the discontinuation of hospice services and created the potential for an interruption in services, and in the patient’s ability to obtain hospice services from another provider following discharge. Record review on 08/13/2026 for Patient #1 revealed election of Hospice on 02.05.2026 for Senile Degeneration of the Brain (age related decline in brain function that affects memory, thinking, and daily functioning).Review of Patient #1’s Plan of Care for the period 06/05/2026 to 08/03/2026 documented orders for care signed by the Medical Director A on 06/10/2026 as follows: Skilled nurse one a week for 8 weeks effective 06/07/2026 and once a week for one week effective 08/02/2026, Medical Social Worker once a month for three months and as needed for 3 visits, Home Health Aide five times per week for one weed effective 06/07/2026 and then five times a week for 7 weeks effective 06/14/2026, and Chaplain once a month for three months. Review of Patient #1’s clinical record assessment dated 07/09/2026 signed by RN A documented “current functional status remains PPS/KPS 30 percent (measures of functional status and ability to care for oneself), with FAST (describes progression of functional decline associated with dementia) Stage 7C (this score meant Patient #1 was severely debilitated; requires extensive or total assistance with personal care and is generally in bed or a chair most of the day and advanced dementia with loss of the ability to walk without assistance), consistent with several cognitive and functional decline secondary to end-state dementia and supportive of continued hospice eligibility. Review of Patient #1’s clinical record revealed nursing visits on 06/21/2026, 06/28/2026, 07/09/2026, 07/14/2026, 07/31/2026, and a hospice discharge with no visit on 08/09/2026.Review of Patient #1’s clinical record nurses note dated 07/14/2026 signed by RN B documented the same assessments as follows: “KPS 30 percent, with FAST Stage 7C,” and noted the caregiver was notified that patient “maybe getting discharged due to extended prognosis.”Review of Patient #1’s clinical record revealed Hospice Aide daily visits from 07/21/2026 to 07/31/2026, then one visit on 08/05/2026. Review of Patient #1’s clinical record documented no social work or chaplain visits for July and August 2026.Review of Patient #1s clinical record revealed a communication log dated 08/05/2026 which documented a letter was mailed certified 08/04/2026 with a tracking number and the document was titled: “Patient #1 5 Day Letter.” which read in part: ‘On Monday, August 2, 2026, our hospice staff made multiple attempts to contact Patient #1 and/or her family in order to provide scheduled hospice services and maintain communication regarding her care. Multiple telephone calls were made; however, there was no answer or response. Despite these attempts, our hospice team has been unable to establish contact with Patient #1 or the family. The inability to contact the patient or gain access to the residence prevents our hospice team from completing required visits, assessing the patient’s current condition, and providing services in accordance with the hospice plan of care. Please be advised that a five-day Notice of Non-Medicare Discharge will be sent via mail. Hospice services for Patient #1 will be discontinued, and Patient #1 will be discharged from the agency effective Saturday, August 8,2026. The letter was not signed and ended “Sincerely,” and then the agency name, address, and telephone number. Review of Patient #1s communication log and notes in the record did not document missed visit attempts for missed weekly nursing visits, social work, chaplain, and aide visits.Review of Patient #1’s clinical record documented the date of discharge as 08/08/2026 at 8:00 am and the reason for discharge as “Discharge no longer medically eligible.” There was no documented evidence the agency included the client or family in discharge planning and that there was no evidence that the client and family were provided necessary education about other services Review of Patient #2s record found the client elected hospice on 03/14/2026 for Heart Failure (heart cannot pump blood well enough to meet the body’s needs.)Review of Patient #2s Plan of Care for the period 06/12/2026 to 09/03/2026 documented orders for care signed by the Medical Director A on 06/10/2026 as follows: Skilled nurse one a week for 13 weeks, Medical Social Worker once a month for three months and as needed for 6 visits, Home Health Aide 3 times a week for 3 weeks and five times per week for 12 weeks, and Chaplain once a month for three months and as needed for 6 visits.Review of Patient #2s IDT meeting notes dated 07.28.2026 by RN C documented “overall findings remain consistent with continued disease progression and declining… advanced vascular insufficiency (blood not flowing properly to area of the body most often the legs) … progressive decline in overall condition… and decrease functional capacity.”Review of Patient #2s nursing note dated 08/12/2026 by RN C documented “continued disease progression and declining independence… progressive decline in overall condition… and decreased functional capacity…” The note had no discharge planning information or information.Review of Patient #2s patient discharge summary effective 08/17/2026 documented the last service date was 08/14/2026 and “patient discharged due to extended prognosis, IDT team, patient and family aware…” Review of Patient #2s record found no evidence the agency provided appropriate discharge planning that included any necessary family counseling, client education and other services to prepare the client and family for discharge prior to terminating hospice services. The record contained no signed 5-day notice of discharge.An interview with the Administrator / DON and Alternate Administrator / DON on 08/13/2026 at 2:00 PM. The Alternate Administrator stated the agency’s board had met the night before and made the decision to close the agency effective 15 days from today due to a billing audit and the agency being unable to bill for services since March 2026. The Alternate Administrator stated they had notified the agency staff and prepared letters for the patients that the staff would deliver and assist the patients in transferring care or discharging from the agency. Observation and interview on 08/17/2026 with Patient #1 and a family member 1 at 10am. Observed Patient #1 in reclining chair with supportive straps to prevent falls. Patient #1 was observed to be assisted by a family member with drinking a protein drink with drooling down the patient’s chin when offered sips. The family member was holding the protein drink to Patient #1’s mouth. Patient #1 nodded to the surveyor and spoke a few words to the family member during the visit. Patient #1’s family member stated they received a letter on 08/08/2026, the date of discharge from hospice services, and a nurse had told them Patient #1 might be discharged from services after their long-time aid had been removed from Patient #1s care and the family member requested the newly assigned aide come in the afternoons. The family member stated they had not been referred to another agency, provided a written notice, or helped with the possible discharge before the letter received on 08/08/2026. The family member denied receiving calls from the agency staff they didn’t answer and denied not allowing staff into the home for visits. The family member stated they had called Medicare for assistance when they were denied admission to another hospice agency after they told the family member the agency could not accept Patient #1 for services as the discharging hospice agency had not billed for the hospice services. The family member stated they were referred to the QIO (Quality Improvement Organization) to address the lack of notice of discharge. The Family member state that the family was not educated or was provided information about discharge or other services. The family member stated supplies and medications were delivered today the day of the visit by the agency. The family member stated they did not have sufficient time to prepare for being discharged, were so far unable to arrange care by another hospice, and the family was caring for Patient #1 and trying to find a new hospice care provider.Observation of an IDT (meeting of members of hospice care team review and discuss the patient’s condition, needs, care progress and make decisions about the patient’s hospice care) was conducted on 08/18/2026 at 10:30 AM. The surveyor observed a listed patients identified for discharge for extended prognosis including Patient #1 and #2. The list contained a total of 10 patients of approximately 36 patients who were being discharged for extended prognosis. An interview was conducted with the Administrator / DON on 08/17/2026 at 1:31 PM. The surveyor asked about the discharges. The Administrator / DON stated Patient #1 and Patient #2 were discharged on 08/08/26 due to “extended prognosis.” The surveyor asked when the agency notified Patient #1 and care giving family of the discharge. The Administrator/DON stated: “I called Monday 08/03/26 and then multiple calls on the 08/04/26” and was not able to reach them. The Administrator / DON stated the family member was aware the week before during the last nursing visit when RN B verbally notified the family member. The Administrator / DON stated the family member “didn’t say no to it (the discharge) or anything, then the family member wouldn’t let a nurse in, so I sent the on- call nurse who told the office the family member would not let her in. Then I sent the certified mail. The surveyor asked about supplies and medications. The Administrator / DON stated that yes they had delivered supplies and medications on 08/17/2026. The surveyor asked why the delay in delivering supplies and medications. The Administrator / DON stated: “we make sure they have supplies and medications and I wanted them to confirm, and we made contact today, and the family member knew they were coming.” The surveyor asked if a social worker or chaplain had assisted with discharge planning. The Administrator / DON stated the social worker attempted to call Patient #1, and stated the family member didn’t complain about the discharge until Patient #1 couldn’t get other services. Patient #1’s family member “didn’t communicate that” they wanted to be transferred to another agency, or to be assisted to be referred to another agency, so staff had not done assisted with referral or transfer to another agency. The surveyor reviewed Patient #1’s clinical record findings and asked why the record didn’t contain missed visit and other communication notes about the lack of services per the plan of care and no documentation of discharge planning. The Administrator / DON stated those should have been documented and agreed they were not in the clinical record. The surveyor asked about the agency policy for discharge and if it required the agency to provide appropriate discharge planning that included any necessary family counseling, client education and other services to prepare the patient and family for discharge prior to terminating hospice services. The Administrator / DON stated the agency policy, and procedures did require discharge planning and family counseling actions and documentation of those actions in the record. An interview was attempted with RN A on 08/18/2026 at 3:09 Pm by telephone call and text message sent to return call.An Interview was attempted with RN B on 08/18/2026 at 3:15 Pm by telephone call and text message sent to return the call.No return call from RN A or RN B was received by the end of the survey.An interview was conducted on 08.19.26 at 10:15 am by telephone with RN C to discuss DC plan and process for Patient #2. RN C stated patient needed maximum assistance, had decreased endurance, shortness of breath and was very tired. RN C stated the patient was declining from admission. The surveyor asked why the patient was discharged. RN C stated the agency sent another nurse to come see Patient #2 and the nurse saw him once and decided to discharge and the agency did a 5-day discharge. The nurse thought the SW talked to the patient and the family and “no one took over the care, and I think he needed the services.” RN C stated the other nurse wanted him discharged and RN C didn’t understand why he was not transferred to another agency. The surveyor asked if RN C had provided any discharge education or told the client about other services. RN C stated she had not been given time to complete discharge education and preparation tasks. An interview with SW A was conducted on 08.19.2026 at 2:23 PM. The surveyor asked about the discharge process for Patient #2. SW A stated on Tuesday at IDT on 08.04.26 the patient was appropriate for hospice and the following Monday 08.10.2026 we are told the patient’s were told they were being discharged for extended prognosis by the aide. SW A stated she told the agency she could not reach the patient’s families and provide the notice timely. SW A stated she did not understand why the patients were being discharged instead of being transferred to another hospice. The surveyor asked if SW A had time to provide appropriate discharge planning that included any necessary family counseling, patient education and other services to prepare the patient and family for discharge prior to terminating hospice services. SW A stated she was not given the time to complete these actions.Agency policy and procedures titled “Discharge Criteria 9.28.1 revised June 2019” read in part: Policy – Patients are discharged by Hospice based on specifically defined criteria……Hospice has in place a discharge planning process that takes into account that a patient’s condition might stabilize or otherwise change such that the patient cannot continue to be certified as terminally ill. The process includes planning for any necessary family counseling, patient education or other services before the patient is discharged because he/she is no longer terminally ill. Staff will be knowledgeable about discharge procedures including instructions and follow-up responsibilities. The patient’s continuing care needs if any are assessed at discharge. Patient will receive verbal and written discharge instructions…””