Nest Home Hospice

“Based on observation, record review, and interview, the hospice failed to provide all core services directed by the hospice consistent with acceptable standards of practice to include nursing services, medical social services and counseling services to any patients on services or admitted to the hospice in that:The hospice did not provide confirmation that current nurses, social workers, and counsellors were available to provide services and oversight to patients for care.The hospice failed to provide nursing care and services by a nurse under the supervision of a registered nurse and failed to ensure nursing services met the needs of the patient as identified in the patient’s initial comprehensive assessment and updated assessments in that: a survey was attempted on 07/14/26 and the Administrator or Alternate Administrator were not available by phone or in person to allow surveyor entry to conduct a recertification survey.Refer to L0591The hospice failed to ensure medical social services were provided to patients and their families by a qualified social worker, under the direction of a physician based on the patients’ and families identified needs in that: the Administrator or Alternate Administrator were not available by phone or in person to allow surveyor entry to conduct a recertification survey during an attempted survey on 07/14/26.Refer to L0594The Hospice failed to ensure counseling services were available for potential patients and family members to assist in minimizing the stress and problems that could arise from the terminal illness, related conditions, and the dying process in that: the Administrator or Alternate Administrator were not available by phone or in person to allow surveyor entry to conduct a recertification survey during an attempted survey on 07/14/26.Refer to L0595”

“Based on observation, record review and interview the hospice failed to meet the Condition of Participation at 418.100 relating to Organization and administration of services, in that:The hospice failed to organize, manage and administer its resources to provide hospice care and services to patients, caregivers, and families necessary for the palliating and management of the patient’s terminal illness and related conditions.The hospice failed to be engaged in providing Nursing services, Medical social services, Physician services, Counseling services including spiritual counseling, dietary counseling, and bereavement counseling, Hospice aide, volunteer, and homemaker services, Physical therapy, occupational therapy, and speech-language pathology services, Short-term inpatient care, Medical supplies (including drugs and biologicals) and medical appliances in accordance with acceptable standards in that: the Administrator or Alternate Administrator were not available by phone or in person to allow Surveyor entry to conduct a recertification survey.Refer to L 652The hospice failed to ensure nursing services, physician services, drugs and biologicals routinely available to patients on a 24-hour basis 7 days a week in that: the Administrator or Alternate Administrator were not available by phone or in person to allow Surveyor entry to conduct a recertification survey.Refer to L 653”

“Based on observation, records reviews, and interviews, the hospice failed to provide nursing care and services by a nurse under the supervision of a registered nurse and failed to ensure nursing services met the needs of the patient as identified in the patient’s initial comprehensive assessment and updated assessments in that: a survey was attempted on 07/14/26 and the Administrator or Alternate Administrator were not available by phone or in person to allow surveyor entry to conduct a recertification survey.Failure of the Hospice to have nursing supervision available places potential patients at risk of not having their nursing needs met. Findings include:Review of hospice agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 07/13/2026 revealed hospice contact information as Hospice address. Agency’s phone Number as XXX-XXX-XXXX, hospice operational hours as 10am –5pm. Monday through Friday. Continued review of the hospice Agency’s TULIP account revealed agency’s census was 1 as of 06/05/2025.Observation on 07/14/26 at 11:08 am., arrived at the Hospice location listed in TULIP to conduct a recertification survey. Further observation revealed no sign posted with the Hospice name or contact phone numbers and no sign that posted a notice of voluntary suspension of the Hospice operations on the doorway at the hospice agency’s address listed in TULIP. At this time the surveyor knocked on the door five times. No one answered the door. There were no activities observed or heard in the hospice office.On 07/14/26 at 11:10 am Surveyor attempted contacting an agency representative via the hospice phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”. The phone call was disconnected, and Surveyor was unable to leave a message. At this time, the surveyor returned to the hospice agency’s main lobby located on the first floor of the building and observed the electronic directory of the building for any additional agency information. The electronic directory revealed no additional hospice agency informationInterview on 07/14/26 at 11:22 am Surveyor went to leasing office to inquire if hospice agency was located onsite. Leasing office staff stated, “the hospice agency had moved out some time ago with no forwarding address”.On 07/14/26 at 11:55am, 12:17 pm, 12:33 pm and 1:05 pm Surveyor made attempts to contact hospice agency representative via the hospice agency’s phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye” and the phone call was disconnected. The Surveyor was unable to leave a message. There was no activity observed or heard in the hospice agency’s office.Surveyor left the hospice agency on 07/14/26 at 1:12 pm unable to conduct a survey to ascertain whether Hospice staff were routinely providing core services to hospice patients as required by regulations.The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 07/14/26 at 1:02pm.”

“Based on observation, records reviews, and interviews, the hospice failed to ensure medical social services were provided to patients and their families by a qualified social worker, under the direction of a physician based on the patients’ and families identified needs in that: the Administrator or Alternate Administrator were not available by phone or in person to allow surveyor entry to conduct a recertification survey during an attempted survey on 07/14/26.This failure hindered HHSC Survey process and could place hospice Patients and their families at risk of not having their psychosocial needs identified and met by a qualified social worker. Findings include:Review of hospice agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 07/13/2026 revealed hospice contact information as Hospice address. Agency’s phone Number as XXX-XXX-XXXX, hospice operational hours as 10am –5pm. Monday through Friday. Continued review of the hospice Agency’s TULIP account revealed agency’s census was 1 as of 06/05/2025.Observation on 07/14/26 at 11:08 am., arrived at the Hospice location listed in TULIP to conduct a recertification survey. Further observation revealed no sign posted with the Hospice name or contact phone numbers and no sign that posted a notice of voluntary suspension of the Hospice operations on the doorway at the hospice agency’s address listed in TULIP. At this time the surveyor knocked on the door five times. No one answered the door. There were no activities observed or heard in the hospice office.On 07/14/26 at 11:10 am Surveyor attempted contacting an agency representative via the hospice phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”. The phone call was disconnected, and Surveyor was unable to leave a message. At this time, the surveyor returned to the hospice agency’s main lobby located on the first floor of the building and observed the electronic directory of the building for any additional agency information. The electronic directory revealed no additional hospice agency informationInterview on 07/14/26 at 11:22 am Surveyor went to leasing office to inquire if hospice agency was located onsite. Leasing office staff stated, “the hospice agency had moved out some time ago with no forwarding address”.On 07/14/26 at 11:55am, 12:17 pm, 12:33 pm and 1:05 pm Surveyor made attempts to contact hospice agency representative via the hospice agency’s phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”, and the phone call was disconnected. The Surveyor was unable to leave a message. There was no activity observed or heard in the hospice agency’s office.Surveyor left the hospice agency on 07/14/26 at 1:12 pm unable to conduct a survey to ascertain whether Hospice staff were routinely providing core services to hospice patients as required by regulations.The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 07/14/26 at 1:02pm.”

“Based on observation, interview and record review the Hospice failed to ensure counseling services were available for potential patients and family members to assist in minimizing the stress and problems that could arise from the terminal illness, related conditions, and the dying process. This failure has the potential for patients and family members not to receive the support services needed during the patient’s end stage of life. Findings include:Review of hospice agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 07/13/2026 revealed hospice contact information as Hospice address. Agency’s phone Number as XXX-XXX-XXXX, hospice operational hours as 10am –5pm. Monday through Friday. Continued review of the hospice Agency’s TULIP account revealed agency’s census was 1 as of 06/05/2025.Observation on 07/14/26 at 11:08 am., arrived at the Hospice location listed in TULIP to conduct a recertification survey. Further observation revealed no sign posted with the Hospice name or contact phone numbers and no sign that posted a notice of voluntary suspension of the Hospice operations on the doorway at the hospice agency’s address listed in TULIP. At this time the surveyor knocked on the door five times. No one answered the door. There were no activities observed or heard in the hospice office.On 07/14/26 at 11:10 am Surveyor attempted contacting an agency representative via the hospice phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”. The phone call was disconnected, and Surveyor was unable to leave a message. At this time, the surveyor returned to the hospice agency’s main lobby located on the first floor of the building and observed the electronic directory of the building for any additional agency information. The electronic directory revealed no additional hospice agency informationInterview on 07/14/26 at 11:22 am Surveyor went to leasing office to inquire if hospice agency was located onsite. Leasing office staff stated, “the hospice agency had moved out some time ago with no forwarding address”.On 07/14/26 at 11:55am, 12:17 pm, 12:33 pm and 1:05 pm Surveyor made attempts to contact hospice agency representative via the hospice agency’s phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”, and the phone call was disconnected. The Surveyor was unable to leave a message. There was no activity observed or heard in the hospice agency’s office.Surveyor left the hospice agency on 07/14/26 at 1:12 pm unable to conduct a survey to ascertain whether Hospice staff were routinely providing core services to hospice patients as required by regulations.The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 07/14/26 at 1:02pm.”

“Based on observation, records reviews, and interviews, the hospice failed to be engaged in providing Nursing services, Medical social services, Physician services, Counseling services including spiritual counseling, dietary counseling, and bereavement counseling, Hospice aide, volunteer, and homemaker services, Physical therapy, occupational therapy, and speech-language pathology services, Short-term inpatient care, Medical supplies (including drugs and biologicals) and medical appliances in accordance with acceptable standards in that: the Administrator or Alternate Administrator were not available by phone or in person to allow Surveyor entry to conduct a recertification survey.This failure did not permit Surveyor to ensure the Hospice was following federal regulations and ensure the Hospice provided adequate and safe patient care. Findings include:Review of hospice agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 07/13/2026 revealed hospice contact information as Hospice address. Agency’s phone Number as XXX-XXX-XXXX, hospice operational hours as 10am –5pm. Monday through Friday. Continued review of the hospice Agency’s TULIP account revealed agency’s census was 1 as of 06/05/2025.Observation on 07/14/26 at 11:08 am., arrived at the Hospice location listed in TULIP to conduct a recertification survey. Further observation revealed no sign posted with the Hospice name or contact phone numbers and no sign that posted a notice of voluntary suspension of the Hospice operations on the doorway at the hospice agency’s address listed in TULIP. At this time the surveyor knocked on the door five times. No one answered the door. There were no activities observed or heard in the hospice office.On 07/14/26 at 11:10 am Surveyor attempted contacting an agency representative via the hospice phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”. The phone call was disconnected, and Surveyor was unable to leave a message. At this time, the surveyor returned to the hospice agency’s main lobby located on the first floor of the building and observed the electronic directory of the building for any additional agency information. The electronic directory revealed no additional hospice agency informationInterview on 07/14/26 at 11:22 am Surveyor went to leasing office to inquire if hospice agency was located onsite. Leasing office staff stated, “the hospice agency had moved out some time ago with no forwarding address”.On 07/14/26 at 11:55am, 12:17 pm, 12:33 pm and 1:05 pm Surveyor made attempts to contact hospice agency representative via the hospice agency’s phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”, and the phone call was disconnected. The Surveyor was unable to leave a message. There was no activity observed or heard in the hospice agency office.Surveyor left the hospice agency on 07/14/26 at 1:12 pm unable to conduct a survey to ascertain whether Hospice staff were routinely providing core services to hospice patients as required by regulations.The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 07/14/26 at 1:02pm.”

“Based on observation, records reviews, and interviews, the hospice failed to ensure nursing services, physician services, drugs and biologicals routinely available to patients on a 24-hour basis 7 days a week in that: the Administrator or Alternate Administrator were not available by phone or in person to allow Surveyor entry to conduct a recertification survey.This failure hindered HHSC Survey process and could place hospice patients at risk of receiving substandard or no hospice care and services. Findings include:Review of hospice agency’s account page in Texas Unified license information portal (TULIP – a database utilized by the State of Texas to maintain licensing, demographic information, complaints, and self-reported incidents for home health and hospice agencies) on 07/13/2026 revealed hospice contact information as Hospice address. Agency’s phone Number as XXX-XXX-XXXX, hospice operational hours as 10am –5pm. Monday through Friday. Continued review of the hospice Agency’s TULIP account revealed agency’s census was 1 as of 06/05/2025.Observation on 07/14/26 at 11:08 am., arrived at the Hospice location listed in TULIP to conduct a recertification survey. Further observation revealed no sign posted with the Hospice name or contact phone numbers and no sign that posted a notice of voluntary suspension of the Hospice operations on the doorway at the hospice agency’s address listed in TULIP. At this time the surveyor knocked on the door five times. No one answered the door. There were no activities observed or heard in the hospice office.On 07/14/26 at 11:10 am Surveyor attempted contacting an agency representative via the hospice phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”. The phone call was disconnected, and Surveyor was unable to leave a message. At this time, the surveyor returned to the hospice agency’s main lobby located on the first floor of the building and observed the electronic directory of the building for any additional agency information. The electronic directory revealed no additional hospice agency informationInterview on 07/14/26 at 11:22 am Surveyor went to leasing office to inquire if hospice agency was located onsite. Leasing office staff stated, “the hospice agency had moved out some time ago with no forwarding address”.On 07/14/26 at 11:55am, 12:17 pm, 12:33 pm and 1:05 pm Surveyor made attempts to contact hospice agency representative via the hospice agency’s phone number listed in TULIP and received an automated message that “the number you dialed is not in-service at this time, goodbye”, and the phone call was disconnected. The Surveyor was unable to leave a message. There was no activity observed or heard in the hospice agency office.Surveyor left the hospice agency on 07/14/26 at 1:12 pm unable to conduct a survey to ascertain whether Hospice staff were routinely providing core services to hospice patients as required by regulations.The letter Memo 17-01: “Inability to Access Records or Perform a Survey by the Health and Human Services Commission.” was emailed to the Hospice agency Adm on 07/14/26 at 1:02pm.”