Angels of Care Hospice LLC

“Based on observations, interviews and record reviews the hospice agency failed to include in the plan of care all services necessary for the palliation and management of the terminal illness and related conditions, including medical supplies and appliances necessary to meet the needs of the patient for 2 (Patients 1 and 2) of 2 active patients’ records reviewed. This failure had the potential to affect the ordering of equipment and supplies and could place patients at risk for pain, discomfort or anxiety from not having the necessary equipment and supplies needed. Record review of Patient 1 revealed a hospice plan of care (POC) with a terminal diagnosis of Alzheimer’s Disease (a progressive brain disorder that gradually destroys memory, thinking skills, and the ability to carry out simple tasks) for period 5/21/2025 to 7/19/2025 signed by the DON. Patient 1’s start of care comprehensive assessment dated 5/21/2025 and signed by the DON revealed the patient was incontinent (involuntary leakage of urine and feces), required a Hoyer lift (a mechanical lift with a sling that supports and safely moves the patient) for transfers to a wheelchair and received nebulizer (delivers liquid medicine as a fine mist that can be inhaled into the lungs) treatments. The medical equipment and supply section of the POC listed “oxygen” only and did not include the incontinent supplies, Hoyer lift, wheelchair and nebulizer. Record review of Patient 2 revealed a hospice plan of care (POC) with a terminal diagnosis of Alzheimer’s Disease (a progressive brain disorder that gradually destroys memory, thinking skills, and the ability to carry out simple tasks) for period 4/24/2025 to 6/22/2025 with a blank nurse signature section. Patient 2’s RN recertification visit dated 4/20/2025 and signed by the DON revealed the patient was incontinent (involuntary leakage of urine and feces) and required a Hoyer lift (a mechanical lift with a sling that supports and safely moves the patient) for transfers to a wheelchair. The medical equipment and supply section of the POC was blank and did not include the incontinent supplies, Hoyer lift and wheelchair. Observation of Patient 1 and an interview with the group home manager (GHM) were conducted during a home visit on 7/2/2025 at 10:15 am. Patient 1 was observed sleeping in a hospital bed. The group home manager (GHM) stated the hospice agency supplied Patient 1 with a hospital bed, nebulizer, oxygen concentrator (medical equipment that gives patients extra oxygen when needed), briefs, wipes, gloves and barrier cream (a topical cream to protect and strengthen the skin’s natural barrier). The group home manager (GHM) stated the group home owned a Hoyer lift used to transfer Patient 1 from the bed to wheelchair.Observation of Patient 2 and an interview with the group home manager (GHM) were conducted during a home visit on 7/2/2025 at 10:45 am. Patient 2 was observed sitting in a wheelchair in the living room. The group home manager (GHM) stated the hospice agency supplied Patient 2 with a hospital bed, briefs, wipes, gloves and barrier cream (a topical cream to protect and strengthen the skin’s natural barrier). The group home manager stated the group home owned a Hoyer lift used to transfer Patient 2 from the bed to wheelchair.An interview was conducted with the Director of Nurses (DON) on 7/03/2025 at 11:20 am. When asked about the agency’s policy and procedure of adding medical equipment and supplies to the POC the DON stated, “the software that we (agency nurses) use gives us the ability to add the equipment and supplies not only on admission but also on reoccurring visits to the plan of care…We (the agency nurses) entered the DME (Durable medical equipment) and supplies in the system (electronic medical record).”When asked about the medical equipment and supplies provided to Patient 1 the DON stated, the hospice agency provided a hospital bed, oxygen concentrator, nebulizer, and incontinent supplies (briefs, wipes, gloves, and barrier cream). When asked why all the medical equipment and supplies were not on the POC the DON stated, “most likely slipped my mind.” The surveyor asked if supplies and medical equipment that the patient uses but the Hospice doesn’t supply are added to the POC such as a Hoyer lift. The DON stated “Yes, just to make it known that she’s (Patient 1 is) using one (Hoyer lift).” When asked about the missing medical equipment and supplies on the POC for Patient 2 the DON stated, Patient 2’s “bed was recently switched over to Hospice and he had one in the facility already so that’s something that needs to be updated.” The DON stated the incontinent supplies, wheelchair and Hoyer lift “should have been on the admission plan of care. I can look into that.” When asked about the potential patient outcome for missing medical equipment and supplies on the POC the DON stated, “it’s more of a communication issue so that everybody (agency and facility staff) is aware…because the supplies are not mentioned, and neither is the equipment it’s a documentation issue that needs to be corrected.” An interview was conducted with the Administrator and Alternate Administrator on 7/03/2025 at 2:25pm. The surveyor shared the findings on Patients 1 and 2, and the interview with the DON. When asked about the agency’s policy on adding medical equipment and supplies to the plan of care the Adm stated, the medical equipment and supplies” has to be in the plan of care and then it has to be discussed during our IDT (interdisciplinary team) meeting.” When asked about the potential patient outcome for missing medical equipment and supplies on the POC the Adm stated, “Fall injury, if a hospital bed is not in place or if they (the patients) have bed half rails and are not using them. Not doing appropriate transfers (with a Hoyer lift) and not providing incontinent supplies.”Review of agency’s policy “5.12 IDG Team and Care Planning Process,” revision 9/29/2022 reads in part “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 a priority…Procedure. An individualized written plan of care is developed for each patient…The plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions including: Medical supplies and appliances necessary to meet the needs of the patient. “”