Everycare Hospice

“Based on record review and interview, the interdisciplinary group- core group of a physician, registered nurse, chaplain, and social worker that provided/supervised all care and services ensuring a holistic approach to terminal illness and bereavement, (in collaboration with the individual’s attending physician,(if any) failed to review, revise and document the individualized plan of care as frequently as the patient’s condition required but no less frequently than every 15 days, in that the interdisciplinary group failed to revise the plan of care regarding medications for 1 (Patient #1) of 3 patient records reviewed. The failure placed Patient #1 at risk of over-medication, under-medication, and poor symptom control. Patient #1:Record review of Patient #1’s clinical record revealed a Plan of Care dated 4/26/2026 to 7/24/2026. The Plan of Care indicated that Patient #1 started on the agency’s services on 4/26/2026. The Plan of Care listed Diffuse Large B-cell Lymphoma, unspecified site (aggressive but potentially curable cancer of white blood cells) as the terminal diagnosis. The Plan of Care listed “No prescribed Medications.” The Supervising Nurse/Alternate Administrator conducted an Initial Comprehensive Assessment on 4/26/2026. The Supervising Nurse/Alternate Administrator listed Morphine (used to treat acute or severe chronic pain) 15 milligrams twice a day, Hydrocodone (used to treat moderate to severe chronic pain) 10/325 milligrams 4 times a day, and Trazadone (used to treat depression and off-label sleep) 100 milligrams in the evening as medications that Patient #1 was taking. Patient #1’s clinical record contained a document titled “Interdisciplinary Team Review” that was dated 5/11/2026. The Interdisciplinary Team Review listed “No prescribed medications.” The review documentation did not indicate that Patient #1’s pain became elevated and that medications had been changed. On 5/19/2026 at 4:18 PM, the surveyor received a text from Witness 2. Witness 2 sent the surveyor pictures of a medication bottle for Morphine Extended Release 30 milligrams. The medication bottle was filled by Pharmacy X on 5/7/2026 and listed Patient #1’s name. During an interview on 5/19/2026 at 4:33 PM with Pharmacy X Staff, the surveyor requested the medications that were prescribed to Patient #1. Pharmacy X Staff informed the surveyor that Patient #1 had been prescribed the following medications, on the following dates: 4/17/2026-Hydrocodone 10/325 milligrams 4 times a day- prescriber Physician Z, first time filledXanax (used to treat anxiety disorders, panic disorders, and short-term anxiety symptoms) 1 milligram every 6 hrs. as needed- prescriber Physician Z, first time filledMorphine 15 milligrams 2 times each day – prescriber Physician Z, first time filled5/1/2026- Hydrocodone 10/325 milligrams, 4 times each day, refilled, prescriber Physician Z.5/7/2026Morphine 30 milligrams 2 times each day, Morphine 15 milligrams was discontinued, prescriber Physician Z, first time filled for 30 milligrams. Fentanyl 50 microgram patch (medication, roughly 100 times stronger than Morphine used to treat severe pain) every 72 hours, prescriber Physician Z- first time filled.The surveyor asked if Patient #1 was an established patient and had Patient #1 received medications from the pharmacy prior to 4/17/2026. Pharmacy X staff stated, “No. (Patient #1) was a new patient.” Physician Z was the Hospice Medical Director. During an interview on 5/20/2026 at 2:13 PM, with the Supervising Nurse/Alternate Administrator, the surveyor asked what medications Patient #1 was taking when Patient #1 was admitted to the agency. The Supervising Nurse/Alternate Administrator informed the surveyor that Patient #1 was taking Xanax, Hydrocodone, and Trazodone. The surveyor asked if Patient #1 had been prescribed Fentanyl patches and had an increase in Morphine dosage. The Supervising Nurse/Alternate Administrator stated, “Yes, recently due to extreme pain.” The surveyor asked why the medications were not included in the plan of care and the plan of care was not revised at the interdisciplinary team meeting. The Supervising Nurse/Alternate Administrator stated, “It should be in the computer, under medications.” During an interview on 5/21/2026 at 10:25 AM with the Administrator, and Supervising Nurse/Alternate Administrator, the surveyor asked why the Plan of Care did not include the medications that Patient #1 was taking and who would be responsible to ensure that the plan of care was revised to include Patient #1’s medications. The Supervising Nurse/Alternate Administrator stated, “The nurse that sees the patient would be responsible.” The surveyor asked who was the nurse that would be responsible for Patient #1, would it be Registered Nurse C. The Supervising Nurse/Alternate Administrator stated, “Yes,(Registered Nurse C).” During an interview on 5/21/2026 at 11:40 AM with the Administrator, the Supervising Nurse/ Alternate Administrator, and Registered Nurse C, the surveyor asked if Registered Nurse C had received orders for Patient #1’s Morphine dosage to be increased and to start Fentanyl patches. Registered Nurse C stated, “Yes.” The surveyor asked who Registered Nurse C obtained the order from. Registered Nurse C stated, “Physician X.” The surveyor asked why the Plan of Care was not revised to include these medications. Registered Nurse C stated, “The system wasn’t working right, we were having issues with it.” Review of the agency’s policy titled “IDG (Interdisciplinary Group) Care Planning Process, revised November 2019, read in part; “ Policy In order to assure that care provided is appropriately planned to meet each patient’s specific needs and problems, Hospice will utilize data/information gathered during the comprehensive assessment, updates to the comprehensive assessment and reassessments, in the care planning process to provide care that is consistent with the patient and family needs, with patient’s needs and goals as a priority. Purpose To define the IDG care planning process and documentation of care planning. Procedure...9. The IDG (in collaboration with the patient’s attending physician, if any) reviews, revises and documents the individualized plan as frequently as the patient’s condition requires, but no less frequently than ever 15 calendar days...””

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. THIS IS A CONTINUING CMS CONDITION LEVEL DEFICIENCY This CONDITION was not met as evidenced by interview, document review and clinical record review, which revealed the hospice failed to provide volunteer services used in day-today-administrative and/or direct patient care roles (HCDT.21.I/L647); and the hospice failed to provide day-to-day administrative or direct patient 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 [HSLG.7. I/L647]. The cumulative effect of these deficiencies has resulted in the hospice agency’s inability to provide quality care for the Condition of Participation CFR 418.76, Volunteers. The collective deficient practice illustrated not having a process to ensure the provision of volunteer services to all patients.”

“It is required that nursing care and services are provided by or under the supervision of a registered nurse and per the patient plan of care. Nursing services ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. This standard was not met as evidenced by clinical record review and interview. In 3 of 6 (50%) clinical records reviewed revealed that the agency did not ensure that the patient received services per the plan of care. Clinical Record 1: The patient was admitted on 07/22/2024 with a diagnosis of senile degeneration of the brain. The plan of care dated 07/22/2024 - 10/19/2024 included orders for SN 1wk 13. The scheduled nursing for the week of 08/04/2024 visit and aide supervisory visit is marked “Not Yet Started” in the EMR. There was no further documentation of a completed or missed visit for the week of 08/04/2024. Clinical Record 3: The patient was admitted on 06/28/2024 with a diagnosis of senile degeneration of the brain. The plan of care for dates 06/28/2024- 09/25/2024 included orders for SN 1 wk. 13. The week of 08/04/2025, the scheduled visit for 08/05/2024 in the EMR is labeled “Not Yet Started”. There is no other documented visit or missed visit for the week of 08/04/2024. SN visits for the week of 08/11/2024 and 08/18/2024 were also marked as “Not Yet Started”. Clinical Record 4: Patient admitted on 06/26/2024 with a diagnosis of heart failure. The plan of care dated 06/26/2024 - 09/23/2024 included an order for SN 2 x wk1, 3 wk. 12, 1 wk. 1. The week of July 28, 2024, the clinical record is missing one visit. An LPN visit was completed on 07/31/2024 and 08/02/2024. A scheduled RN visit for 08/01/2023 is marked in the EMR “Not Yet Started”. There is no missed visit or other documentation for the third visit the week of 7/28/2024. One SN visit note is missing from the clinical record for the week of 08/04/2024. LPN visits were documented on 08/07/2024 and 08/09/2024 but the scheduled RRN visit for 08/05/2024 is designated “Not Yet Started” with no other documentation.”

“It is required that the hospice provides nursing care under the supervision of a registered nurse (RN). THIS IS A CONTINUED REQUIRED ACTION This standard was not met as evidenced by clinical record review and interview. In 1 of 1(100%) of patients receiving care from a licensed practical nurse (LPN), there was no documented evidence of supervision by the RN. Clinical Record 4: The patient was admitted on 06/26/2024 with a diagnosis of heart failure. The patient received LPN nursing visits on 07/17/2024, 07/24/2024, 07/26/2024, 07/31/2024, 08/02/2024, 08/07/2024, 08/09/2024, 08/14/2024, 08/16/2024, and 08/20/2024. There are no LPN supervisory visits documented in the clinical record. There was an LPN Supervisory visit scheduled in the EMR for 08/12/2024 but was marked as “NOT YET STARTED”. There are no RN visits documented in the clinical record after 07/22/2024. In an interview on 08/26/2024, the administrator stated in part, “Ok, I need to have a talk with the RN and confirmed that the supervisory visit was not complete.””

“It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review and interview. In 4 of 6 (67%) clinical records reviewed with aide services revealed that the agency did not ensure that supervisory visits were completed every 14 days. Clinical Record 1: The start of care (SOC) was 07/22/2024 with a diagnosis of senile degeneration of brain. Aide services began 07/23/2024. Hospice aide supervisory visit scheduled in EMR on July 31, 2024, August 06, 2024, August 13, 2024, and August 20, 2024, all of which were scheduled but listed as “NOT YET STARTED” in the EMR with no documentation or explanation. Clinical Record 2: The patient was admitted on 08/07/2024 with a diagnosis of Alzheimer’s Disease. aide services began on 08/08/2024. The clinical record contains no aide supervisory visits. Aide supervisory visits were scheduled on August 19, 2024, in the EMR but marked “NOT STARTED YET” with no other documentation or explanation. Clinical Record 3: The patient was admitted on 06/28/2024 with a diagnosis of senile degeneration of the brain. The patient had an active home health aide since 07/01/2024. The clinical record contains a supervisory visit that was completed on 07/10/2024 but there are no further supervisory visits documented. There was a supervisory visit scheduled in the EMR on 07/17/2024, 07/22/2024, 08/01/2024, 08/05/2024, 08/12/2024, and 08/19/2024 all of which are noted “NOT STARTED YET” with no further documentation. Clinical Record 4: The patient was admitted on 06/26/2024 with a diagnosis of Heart Failure. The patient received home health aide services beginning 06/27/2024. The clinical record included a supervisory visit completed on July 8, 2024, however, there are no further documented HHA supervisory visits. The EMR indicated scheduled HHA supervisory visits on 07/22/2024, 08/05/2024, 08/12/2024, and 08/19/2024 all of which were labeled as “NOT STARTED YET” with no further documentation. In an interview on 08/26/2024, Administrator stated, “The nurse has done them she is behind in her documentation. We have sent her an email to get caught up.””

“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 IS A CONTINUED REQUIRED ACTION This standard was not met as evidenced by document review and interview. A review of volunteer hours, volunteer personnel records, and an interview revealed that the agency did not provide day to day administrative and direct patient care hours to equal 5%. Document 1: A new volunteer personnel file #1 was hired on 08/13/2024. Volunteer hours report revealed that the volunteer performed one hour of service on 08/21/2024, 08/23/2024, and 08/24/2024 for a total of 3 volunteer hours. The report does not include percentage of total patient care hours. The active census identifies 29 current patients. During an interview on 08/26/2024, the administrator stated in part, “ We are working on increasing the hours and have two more volunteers coming on board. A review of volunteer hours, volunteer personnel records, and an interview revealed that the agency did not provide day to day administrative and direct patient care hours to equal 5%.”

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. Volunteer services are noted in the plan of care, and documented in the patient record, including the time spent. THIS IS A CONTINUED REQUIRED ACTION. This standard was not met as evidenced by volunteer hour records and interview. A review of volunteer hour records and interview revealed that the agency did not ensure that volunteers were used for day-to-day patient care. Document 1: Volunteer hours log revealed that new volunteer hired 08/13/2024. Three total volunteer hours completed with one hour each on 08/21/2024, 08/23/2024, and 08/24/2024 completing clerical work and e-filing. Administrator demonstrated 2 background checks of new volunteers who have not completed orientation and stated, “We are working on getting the volunteers up and running and increasing the hours.” A review of clinical records, volunteer hours, and records and interview revealed that the agency did not ensure that volunteers were used for day to day patient care and administrative duties equalling 5% of patient care hours.”

“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 interview and observation. THIS IS A CONTINUED REQUIRED ACTION In interview on 08/26/2024, Administrator confirmed that the agency has had no patients revoke services requiring a discharge summary to be sent to physician since the last site visit. THIS IS A CONTINUED REQUIRED ACTION - NO EVIDENCE TO EVALUATE THE AGENCY HAS NOT HAD A REVOCATION SINCE O7/22/2024 STAFF EDUCATION WAS PROVIDED 08/19/2024”

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. Volunteer services provided to patients/families are in a defined role and under the supervision of a designated hospice employee. THIS IS A CMS CONDITION LEVEL DEFICIENCY This CONDITION was not met as evidenced by interview, document review and clinical record review, which revealed the hospice failed to provide volunteer services used in day-today-administrative and/or direct patient care roles (HCDT.21.I/L647); and the hospice failed to provide day-to-day administrative or direct patient 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 [HSLG.7.I/L647]. The cumulative effect of these deficiencies has resulted in the hospice agency’s inability to provide quality care for the Condition of Participation CFR 418.76, Volunteers. The collective deficient practice illustrated not having a process to ensure the provision of volunteer services to all patients.”

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review, document review, and interview. In 3 of 14 (21%) clinical records reviewed for active patients revealed that the hospice agency did not ensure the Interdisciplinary Group completed the initial comprehensive assessment no later than five days. 013115 Hospice-CHAP, titled, Assessments, stated in part, that the hospice interdisciplinary group, in consultation with the individual’s attending physician (if any) will complete the comprehensive assessment no later than five calendar days after the election of hospice. Clinical Record 6: The patient elected their hospice benefit on 04/01/2014. The social worker documented the psychosocial assessment completed on 04/09/2024 (8 days). There were no documented attempts before 04/09/2024. Clinical Record 8: The patient elected their hospice benefit on 04/16/2024. The social worker documented the psychosocial assessment completed on 04/25/2024 (9 days). There were no documented attempts before 04/25/2024. Clinical Record 11: The patient elected their hospice benefit on 04/05/2024. The social worker documented the psychosocial assessment completed on 04/11/2024(6 days). There were no documented attempts before 04/11/2024. During an interview on 07/19/2024, the Director of Nursing agreed the psychosocial assessment had not been completed within five days.”

“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 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 document review and observation. In 3 of 14 (21%) home visits observed for active patients revealed the hospice agency did not ensure that the documented comprehensive assessment included a drug profile that contained the patient’s current prescription and over-the-counter drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. Agency Policy: 022222 Hospice-CHAP, titled, Medication Management, stated in part, the hospice will develop a medication profile upon admission with all medications the patient is taking, including over the counter and herbal medications. The hospice will also update the medication profile with new medications, changes in medications, and discontinued medications. Home Visit 1: The election of the hospice benefit was dated 04/21/2024. During a home visit (Home Visit 1) on 07/18/2024 with the registered nurse (RN) (Personnel Record 5), the patient had an oxygen concentrator with a nasal cannula in the home. The patient stated he would use the oxygen when he became short of breath. The hospice agency’s medication profile did not list oxygen on its medication profile. Home Visit 2: During a home visit on 07/18/2024, the hospice agency listed Colace 100mg oral capsule, take one cap daily. This medication was not listed on the facility medication profile. The facility listed Acetaminophen 500mg tablets, take two tablets by mouth twice a day at eight in the morning and six in the evening. The hospice agency did not have Acetaminophen on their medication profile. Home Visit 3: During a home visit on 07/18/2024, the patient had the following medications in the home and was being taken daily per spouse of Metoprolol 25mg oral daily, Nitroglycerin 0.4mg sublingual (take one tab under the tongue for chest pain, may repeat twice), and Atorvastatin 40mg oral at bedtime. The hospice agency did not have any of the three medications listed on their medication profile.”

“It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient’s family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and considered in the bereavement plan of care. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 14 (21%) clinical records reviewed of active patients revealed that the hospice agency did not ensure the comprehensive assessment included an initial bereavement assessment of the needs of the patient’s family and other individuals was completed. Agency Policy: 061623, Hospice, titled, Bereavement Program, stated in part, at admission, an initial bereavement risk assessment tool will be completed for the primary caregiver and each other bereaved identified with their initial visit within five days of the admission to hospice care. Clinical Record 1: The patient elected their hospice benefit on 04/21/2024. There was no documented evidence in the clinical record that an initial bereavement assessment had been completed for the patient’s family and other bereaved identified. Clinical Record 2: The patient transferred to the hospice agency service on 12/27/2023. This was during the patient’s hospice benefit period 11/14/2023-01/12/2024. There was no documented evidence in the clinical record that an initial bereavement assessment had been completed for the patient’s family and other bereaved identified. Clinical Record 4: The patient elected their hospice benefit on 03/07/2024. There was no documented evidence in the clinical record that an initial bereavement assessment had been completed for the patient’s family and other bereaved identified. During an interview on 07/19/2024, the Director of Nursing agreed that the initial bereavement assessments had not been completed or documented in the patient’s clinical records.”

“It is required that the hospice provides nursing care under the supervision of a registered nurse. This standard was not met as evidenced by clinical record review, document review and interview. In 5 of 14 (36%) clinical records reviewed for active patients revealed that the hospice agency did not ensure the licensed vocational nursed was supervised by the registered nurse every thirty days. Agency Policy: 013115 Hospice-CHAP, titled, Nursing Services, stated in part, a registered nurse will supervise and document supervisory visits if licensed vocational nurse providing care no less frequently than every thirty days on the Nursing Clinical Progress Note. Clinical Record 1: The patient elected their hospice benefit on 04/21/2024. The plan of care included the skilled nurse (SN) frequency beginning 04/21/2024 to be one time a week. The licensed vocational nurse documented visits on 04/25/2024 and 06/21/2024. There was no documented evidence of completed supervisory visits of the licensed vocational nurse in the clinical record. Clinical Record 2: The patient transferred their hospice benefit on 12/27/2023. The licensed vocational nurse documented visits on 03/14/2024, 03/19/2024, and 04/22/2024. The last documented supervisory visit was on 03/12/2024. There was no other documented evidence of completed supervisory visits of the licensed vocational nurse in the clinical record. Clinical Record 4: The patient elected their hospice benefit on 03/07/2024. The licensed vocational nurse documented a visit on 04/22/2024. The last documented supervisory visit was on 03/19/2024. There was no documented evidence of completed supervisory visits of the licensed vocational nurse in the clinical record. Clinical Record 5: The patient elected their hospice benefit on 08/17/2023. The licensed vocational nurse document a visit on 05/28/2024. The last documented supervisory visit was on 04/24/2024. There was no documented evidence of completed supervisory visits of the licensed vocational nurse in the clinical record. Clinical Record 11: The patient elected their hospice benefit on 04/05/2024. The licensed vocational nurse documented a visit on 04/06/2024. There was no documented evidence of completed supervisory visits of the licensed vocational nurse in the clinical record. During an interview on 07/19/2024, the Director of Nursing agreed that supervisory visits of the licensed vocational nurse had not been completed every thirty days.”

“It is required that the 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. This standard was not met as evidenced by document review, personnel records, and interview. A review of the agency’s volunteer binder records revealed that the hospice agency did not ensure volunteers were used in day-to-day administrative and/or direct patient care roles in an amount that, at a minimum, equaled five percent of the total patient care hours of all paid hospice employees and contract staff. This standard was not met, as evidenced by document review, personnel records, and interview. A review of the agency’s volunteer binder records revealed that the organization did not ensure that qualified volunteers provided day-to-day administrative and/or direct patient care services in an amount that, at a minimum, equaled five percent of the total patient care hours of all paid hospice employees and contract staff. There was no documented evidence that the agency had any qualified volunteers. The review of personnel records revealed that there was no documented evidence of any active hospice volunteers. There was no evidence of volunteer training or volunteer competency completion. Document 1: The Volunteer Program binder did not have documented evidence of past or current volunteer hours tracking in 2023 and year-to-date for 2024. The agency reported zero volunteer hours were provided during this period. There was no evidence that the agency provided a minimum of five percent volunteer hours of the total patient care hours of all paid hospice employees and contract staff. During an interview on 07/19/2024, the Volunteer Coordinator was asked if the hospice agency had volunteered. The Volunteer Coordinator answered that they currently do not have any volunteers. The Volunteer Coordinator was asked if the hospice agency had any volunteer hours for the previous year. The response was that the agency had two IT techs who helped with all of the agency’s Technology Programs. However, the hospice agency did not have employee/volunteer files for them. The Administrator/Volunteer Coordinator was informed the hours could not be counted without completed employee/volunteer files, documented hours, and training.”

“It is required that volunteers are used in day-to-day administrative and/or direct patient care roles. This standard was not met as evidenced by document review, personnel records, and interview. A review of the agency’s volunteer binder records revealed that the hospice agency did not ensure volunteers were used in day-to-day administrative and/or direct patient care roles in an amount that, at a minimum, equaled five percent of the total patient care hours of all paid hospice employees and contract staff. A review of the personnel records revealed that the organization did not ensure that the hospice had any volunteers in 2023 and year to date in 2024. Document 1: The Volunteer Program binder did not have documented evidence of past or current volunteers completed hours in an amount in 2023 and year to date for 2024. During an interview on 07/19/2024, the Volunteer Coordinator was asked if the hospice agency had volunteers. The Volunteer Coordinator answered that they currently did not have any volunteers. The Volunteer Coordinator was asked if the hospice agency had any volunteer hours for the previous year and the response was the agency had two IT techs that helped with all of the agency’s Technology Programs. However, the hospice agency did not have employee/volunteer files for them. The Administrator/Volunteer Coordinator was informed the volunteer services provided by the IT techs could not be counted without documented evidence of employee/volunteer files, and volunteer training completion.”

“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. This standard was not met as evidenced by clinical record review and interview. In 1 of 1 (100%) clinical records reviewed for live discharges revealed that the hospice agency did note ensure a copy of the hospice discharge summary was forwarded to the patient’s attending physician. Clinical Record 11: Patient elected their hospice benefit on 04/05/2024. The patient chose to seek aggressive treatment with hospitalization on 05/25/2024 and revoked the remaining days of their hospice benefit. The Director of Nursing completed the discharge documentation on 05/25/2024. The documentation did not include that a copy of the discharge summary had been forwarded to the patient’s attending. During an interview on 07/19/2024, the Director of Nursing agreed the documentation did not include the discharge summary had been forwarded to the patient’s attending physician.”