Hickory Hospice LLC

“Based on record review and interview, the agency failed to show they were able to provide medical social services by a qualified social worker in the event they admit a patient due to not having a social worker on staff or on services via arrangement in two out of four years reviewed (2024, 2025, and 2025). This failure could result in a patient not getting a timely assessment by a medical social worker if the agency were to receive a referral. Findings included: Review of the document titled, “Discharge Patients 2023,” revealed the last time the hospice agency had patients was 2023, who were discharged in July of 2023. Review of the document titled, “Active Patients 2026,” revealed a document which read, “Zero Patients.” Review of the document titled, “Active Patients 2025,” revealed a document which read, “Zero Patients.”Review of the document titled, “Active Patients 2024,” revealed a document which read, “Zero Patients.”Review of the document titled, “Employee List,” undated, revealed a list of the agency’s employees. Only 2 names were listed - Admin/SN and AA/ASN. No Medical Social Worker was listed. Review of the agency’s contracts provided by the Administrator revealed no contract with a licensed medical social worker. In an interview with the administrator conducted at 11:37 AM on 6/24/26, the Surveyor asked if they had a Medical Social worker on staff. The Administrator stated they did not. The Surveyor asked if they had a contract with a Medical Social Worker in City 2 area. The Administrator stated they did not. When asked why, the Administrator stated that since they had no patients, they did not think they needed to retain a medical social worker on staff. She stated they would get a Medical Social Worker before admitting patients. In an interview with the Admin/SN at 10:15 AM on June 25, 2026, the surveyor asked who was responsible for ensuring a medical social worker was available to provide services for the hospice agency. Admin/SN stated that it was her responsibility as the Supervising Nurse. When asked what the hospice’s policy was on providing medical social services, the Admin/SN stated, “It is our policy that we have a MSW available to assess patients as soon as possible and evaluate their needs.” When asked how lacking an available MSW to provide services to any patients the hospice may admit could affect patient care, the Admin/SN stated that if they had patients, they would need a MSW because “it is vital that they have those services.” Review of the agency’s policy titled, “Social Services,” Undated, revealed a policy which read in part: “Psychosocial needs will be assessed and provided…. Psychosocial services are based on initial assessment within 5 days of admission to hospice services. Continuing assessment of patient/family/caregiver psychosocial needs is conducted by a licensed social worker at least every two weeks or as warranted by the patient’s psychosocial status through IDG.””

“Based on record review and interview, the hospice failed to be primarily engaged in providing care and services including nursing services, medical social services, physician services, counseling services, hospice aide and volunteer services, therapy services, short-term inpatient care, or medical supplies in that they had zero patients and provided no services in the since July 2023 (July 2023 to the end of the year, all of 2024, all of 2025, and 2026 through current). This failure resulted in the hospice being unprepared to accept clients and could place patients at risk for not having their needs met if they were to be admitted to this hospice. Findings included: Review of the document titled, “Discharge Patients 2023,” revealed the last time the hospice agency had patients was 2023, who were discharged in July of 2023. Review of the document titled, “Active Patients 2026,” revealed a document which read, “Zero Patients.” Review of the document titled, “Active Patients 2025,” revealed a document which read, “Zero Patients.”Review of the document titled, “Active Patients 2024,” revealed a document which read, “Zero Patients.”Review of the document titled, “Employee List,” undated, revealed a list of the agency’s employees. Only 2 names were listed - Admin/SN and AA/ASN. Review of the personnel records provided by the Admin/SN on 6/24/26 revealed files for AA/ASN, Admin/SN, and Aide C. Review of these records confirmed that Admin/SN and AA/ASN were Registered Nurses. In an interview with the Admin/SN at 10:00 AM on 6/25/26, the Surveyor asked what steps the agency had taken to recruit patients; why were there no patients? The Admin/SN stated they were not currently taking any steps to recruit patients. She stated the hospice agency was “on hold” at the direction of the owner, who’s plan was to move the agency back to [City 1]. The Surveyor asked what the agency had done about their annual QAPI meetings. The Admin/SN stated that she still ran the QAPI program and reviewed it every quarter, but since there were 0 patients there was no real data to review. She stated she was continuing to do the annual agency evaluations of the agency as well, but “there was not much to evaluate.” The Surveyor asked the Admin/SN if a patient referral was received, what would the agency’s plan be to provide care and do they have staff who would be able/available. The Admin/SN stated if they were to receive a patient referral “right now”, she would call whoever sent the referral and let them know to place the patient in another agency right away, since they were not currently accepting patients. The Surveyor asked what was happening with the 24 hour emergency phone line/ is there one if they have no patients? The Admin/SN confirmed they still did have an after-hours line as they used the same number as the home health agency she ran, which was currently operating with patients and maintained an after-hour line. The Surveyor asked who was responsible for ensuring the hospice was “primarily engaged in providing services”. The Admin/SN stated, “That would be me as the administrator.” The Surveyor asked how not being primarily engaged in providing services could affect patient care. The Admin/SN stated that it did not affect patient care because the patients would be served by other hospices in the area.”