Lindenwood Hospice & Palliative Care

“Observed in Record Review. In 5 of 10 patient records reviewed, the hospice surveyor observed that the organization failed to plan the patient’s care. In HOSRRNHV #3 the Plan of Care had only RN and MSW frequencies. The plan of care did not specify the care and services necessary to meet the patient needs as there wee not interventions for nursing or social services on the plan of care. The POC only include the visit frequency for those disciplines.. The RN and MSW care plans were added after the patient was on service for one month and the care plans were discussed in IDG at this time. In HOSRRNHV #4 the POC had no frequency for nursing or MSW. Care Plans were in the POC for both disciplines. The frequencies were added 18 days after admission in IDG. In HOSRRNHV #5 .the POC on 6/11/25 had RN, MSW, and Chaplain frequency but there were no care plans entered for these disciplines. The care plans were added 13 days later in IDG. In HOSRRNHV #6 the patient was discharged in October and readmitted 5 days later and there was no POC completed at readmission. The first new POC was entered 39 days later. In HOSRRNHV #7 the MSW care plans were not on the POC at admission they were entered in IDG 11 days later. The visit frequency for the SW was one time per week. This was reviewed and validated with the RN Clinical Manager.”

“Observed in Record Review. In 1 of 14 patient records reviewed, the hospice surveyor observed that HOSRRHV #2 the MSW and Chaplain care plans were not individualized. In HOSRRHV #2 the MSW care plan goal for Impaired social interaction stated Patient will develop ways to be more involved with others, patient will develop satisfying relationships. The other care plan for Caregiver Burnout the goal stated, The patient will verbalize feelings about the present situation. The Chaplain care plan for HOSRRHV #2 stated The patient will verbalize feelings regarding spirituality. The patient will verbalize feelings regarding spirituality. When talking with the patient’s spouse he stated that due to patient’s diagnosis of Lewy body dementia he was the one working with the MSW and Chaplain. Observed in Record Review. In 2 of 10 patient records reviewed, the hospice surveyor observed that in HOSRRHV #1 the MSW care plan for Funeral Prearrangements was vague and time frames were all 0-24 hours. An example of the MSW care plan for Funeral Prearrangements, The patient will verbalize feelings about the present situation. This has been on the care plan for a month and was not resolved in the 24 hour time frame. In HOSRRHV #2 each goal for the MSW and Chaplain were expected to be achieved by death or discharge and all the RN care plan goals were expected to be achieved within 0-24 hours, the Admission date for this patient was 2 months ago. The example for a nursing goal is Patient/cg will report satisfactory pain control and decreased intensity using standardized pain scale-vague and not individualized and was not completed within 0-24 hour timeframe. The MSW Care Plan goal for impaired social interaction states, The Patient will develop ways to be more involved with others within 0-24 hrs. this is vague and not individualized and was not completed within the 24 hour time frame. The Chaplain care plan states, The patient will verbalize feelings regarding spirituality by time of death/discharge. This was vague and not specific and as it was the only goal for the chaplain and the time frame was not individualized. The patient has been on service for 2 months. This was reviewed and validated with the RN Clinical Manager.”

“Observed in Record Review. In 1 of 14 patient records reviewed, the hospice surveyor observed that duplicate medications were ordered without clear instructions when to use one over the other. In HOSRRHV #1 the patient was on Acetaminophen ER 650 mg one tablet every 4 hours as needed for mild pain/fever, Tramadol HCL 50 mg tables every 8 ours as needed for pain, and Acetaminophen Rectal Suppositories 650 mg one suppository every 6 hours as needed for pain or fever. It is not clear when to take one over the other. In HOSRRHV #1 the patient had an order for Oxygen 2 liters via nasal canula as needed. The O2 order did not include an indication for when O2 should be applied and per the agency policy Medication Orders all prn medications need to have a clear indication for use. This was reviewed and validated with the RN Clinical Manager.”

“Observed in Record Review. In 2 of 10 tracers conducted, HOSRRHV #2 and HOSRRHV #3 the RN care plan states goals to be met within 0-24 hours an example for the RN care plan is the Skin Problem: Prevent the occurrence of pressure ulcers and maintain skin integrity within 0-24 hours. This would be difficult to measure within this a 24 h. timeframe pt on service for 2 months. In HOSRRNHV #2 the MSW care plan states CG will feel supported and confident in providing safe effective care within 0-24 hours. patient has been on service for 3 weeks. In HOSRRNHV #2 the RN care plan states Patient will achieve and maintain acceptable level as defined by pt/family with minimal to absence of medication side effects within 0-24 hours. Patient had been on service for 4 monthsIn HOSRRHV #3 all of the RN care plans had time frames 0-24 hours. An example is Skin Problem: Prevent the occurrence of pressure ulcers and maintain skin integrity within 0-24 hours. This has been on the care plan for over one month. This was reviewed and validated with the RN Clinical Manager.”

“Observed in Record Review. In 6 of 10 patient records reviewed, the hospice surveyor observed in HOSRRHV #2 that the aide care plan did not include precautions. The patient was deemed a fall risk but there were not fall risk precautions in the aide care plan. In HOSRRNHV #2, HOSRRNHV #3, HOSRRNHV #5, and HOSRRNHV #6, the patient was deemed a fall risk but this was not entered into the aide care plan as a precaution. In HOSRRNHV #7 the patient was both a fall risk and had seizure precautions and neither were entered as precautions in the aide care plan. This patient also had oxygen precautions selected in the aide care plan and the patient did not have oxygen in the home. This was reviewed and validated with the RN Clinical Manager.”

“Observed in HR File Review. In 3 of 7 mechanical room checks, the HOS surveyor observed that the Alternate Medical Director, Chaplain, and MSW did not have an initial competency. This was reviewed and validated with the HR Director. Observed in HR File Review. In 2 of 8 HR files reviewed, the organization failed to complete ongoing competencies. In HR #1 the Director of Nursing did not have 2024 or 2025 competencies. The Medical Director HR #3 did not have a competency validation performed since 2022. The This was reviewed and validated with the HR Director.”

“Observed in Patient Home. In 2 of 3 home visits conducted, the hospice surveyor observed that the medication list in the home was discovered to be inaccurate. For example during medication reconciliation in HOSRRHV #1 the medication list in the home states the patient is taking Acetaminophen ER 650 mg every 4 hours as needed for pain. The caregiver states that she is giving the patient Acetaminophen 500 mg every 4 hours as needed for pain. This patient also has Oracit Oral Solution 490-640mg/5 ml solution after each meal on the medication list but the bottle in the home states Sodium Citrate Acid 500mg 5ml diluted with 3 ounces of juice or water after each meal. In HOSRRHV #2 the patient did not have the following medications listed on the medication list: Alpha lipoic acid 600 mg 1 by mouth daily,, Acetaminophen 500 mg 1 tablet by mouth every 4 hours for pain, Niacin 500 mg 1/2 tablet every day, D3 2,000 IU 2 tablets once a day, MVI 1 tablet every day, B-100 complex 1 tablet every day, Magnesium 400 mg 2 tablets every day. In HOSRRHV #2 the patient had Memantine 5 mg by mouth every day but the pill bottle stated Memantine 10 mg by mouth every day. The care giver states this was changed on 8/13/25. This was reviewed and validated with the RN Clinical Manager.”

“Observed in Record Review. In 10 of 10 patient records reviewed, the hospice surveyor observed that in HOSRRHV #1, HOSRRHV #2, HOSRRHV #3, HOSRRNHV #1, HOSRRNHV #2, HOSRRNHV #3, HOSRRNHV #4, HOSRRNHV #5, HOSRRNHV #6, and HOSRRNHV #7 that the organization failed to reflect the patient’s care, treatment or services. An example is in HOSRRNHV #1 in the IDG on 9/2/25 the surveyor observed that there was a medication change from Hydrocodone-Acetaminophen 5-325 one half tablet twice a day to one tablet twice a day and in the summary section it was noted that the changes were not clearly defined as to what medications was changed and when the order for the change was received. The language in the IDG summary was a statement was also non specific and vague and the following was the statement The team collaboratively performed a review of medications, ongoing assessment of the patient and families needs, determination of continued eligibility for hospice services, coordination of care across disciplines, discussion of changes in level of care and update and review of the POC. This was reviewed and validated with the RN Clinical Manager.”