Independence Hospice

“Based on interview and record review, the agency did not ensure that revised plans of care (POC) noted patient progress toward specified outcomes and goals. Specifically, for 12 out of 14 sample patients who had a revised POC, the plans did not include progress toward outcomes and goals, except for Chaplain services. (Patient identifiers: 2, 3, 4, 5, 6, 8, 9, 10, 11, 12, 13, 14.) Findings include: A review of Patient 2’s clinical record (start of care: June 27, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the March 22, 2026, to June 22, 2026 certification POC, nor within the associated Interdisciplinary Group (IDG) notes dated March 11, March 25, April 8, and April 22, 2026. A review of Patient 3’s clinical record (start of care: December 9, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the December 9, 2025, to March 8, 2026 certification POC, nor within the associated IDG notes dated December 17, 2025 and December 31, 2025. A review of Patient 4’s clinical record (start of care: September 9, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the December 24, 2025, to March 23, 2026 certification POC, nor within the associated IDG notes dated December 31, 2025. A review of Patient 5’s clinical record (start of care: November 3, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the February 1, 2026 to May 1, 2026 certification POC, and the May 2, 2026 to June 30, 2026 certification POC, nor within the associated IDG notes dated March 25, 2026, April 8, 2026, April 22, 2026, and May 6, 2026. A review of Patient 6’s clinical record (start of care: January 24, 2026) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the January 24, 2026 to April 23, 2026 certification Plan of Care (POC), and the April 24, 2026 to July 22, 2026 certification POC, nor within the associated IDG notes dated March 25, 2026, April 8, 2026, April 22, 2026, and May 6, 2026. A review of Patient 8’s clinical record (start of care: February 3, 2026) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the May 4, 2026 to July 2, 2026 certification POC, and the April 24, 2026 to July 22, 2026 certification Plan of Care (POC) nor within the associated Interdisciplinary Group (IDG) notes dated April 8, 2026, April 22, 2026, and May 6, 2026.A review of Patient 9’s clinical record (start of care: October 9, 2024) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the February 1, 2026 to April 1, 2026 and the April 2, 2026 to May 31, 2026 certification POC, nor within the associated IDG notes dated , March 25, 2026, April 8, 2026, April 22, 2026 and May 6, 2026.A review of Patient 10’s clinical record (start of care: May 5, 2024) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the March 29, 2026 to May 27 , 2027 certification POC, nor within the associated IDG notes dated March 25, 2026, April 8, 2026, April 22, 2026, and May 6, 2026. A review of Patient 11’s clinical record (start of care: January 2, 2026) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the April 2, 2026 to June 30, 2026 certification POC, nor within the associated IDG notes dated March 25, 2026, April 8, 2026, April 22, 2026, and May 6, 2026. A review of Patient 12’s clinical record (start of care: July 1, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the February 26, 2026 to April 26, 2026 and April 27. 2026 to June 25, 20 certification POC, nor within the associated IDG notes dated April 8, 2026, April 22, 2026, and May 6, 2026. A review of Patient 13’s clinical record (start of care: October 1, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the March 30, 2026 to May 28, 2026 certification POC, nor within the associated IDG notes dated March 11, 2026, March 25, 2026, April 8, 2026, April 22, 2026, and May 6, 2026. A review of Patient 14’s clinical record (start of care: August 22, 2025) revealed no goal progression across all clinical disciplines. Specifically, no progress toward goals of care was documented within the March 20, 2026 to May 18, 2026 and the May 19, 2026 to July 17, 2026 certification POC, nor within the associated IDG notes dated March 25, 2026, April 8, 2026, April 22, 2026, and May 6, 2026. On June 3, 2026 at 1:51 PM, the surveyor interviewed the director of nursing (DON) regarding how clinical staff document progress toward POC goals. The DON stated that registered nurses (RNs) are expected to track and document goal progress as a percentage of completion in their mobile visit application. A joint review of the clinical software’s POC documentation revealed that, although the system tracks internal statuses as “in progress,” “resolved,” or “removed,” the electronic medical record (EMR) system failed to add these updates to the official POC. The DON confirmed that the agency does not include goal progress in the POC from clinical disciplines, other than chaplain services. During a joint review of Patient 6’s clinical chart by the surveyor and the DON, an RN entry was reviewed. The entry omitted both the patient’s specific care goal and any notation of progress toward that goal, contradicting the agency’s stated protocol.When the surveyor asked about the IDG process for reviewing patient goals, the DON explained that the EMR website pulls clinical “Prep Notes” into the IDG notes, which are supposed to include care plan goals and target dates. During a review of the IDG records, the surveyor and DON identified a note indicating “80% completion” for a chaplain goal. Upon cross-referencing, the DON could not identify or locate where the chaplain had documented this information in the mobile application so it could be successfully transferred to the official IDT notes.On June 3, 2026 at 3:22 PM, the surveyor received an email from the DON confirming the systemic breakdown in recording goal progress. The email stated, in part:“In regards to the Documentation for progress toward goals... After digging further, I found as you did, that the documentation is not reflecting progress toward goals. I found the specific field built into the care plan documentation for recording progress toward goals, and I will train all clinicians on using that field to document that progress.””

“Based on record review and interview, the hospice agency failed to ensure that a registered nurse (RN) conducted a supervisory visit to the patient’s home at least once every 14 days to assess the quality of care and services provided by the hospice aide (HA) for 5 of 14 sampled patients who received hospice aide services. (Patient identifiers: 5, 7, 8, 11, 12.) Findings include: Findings include: 1. The surveyor completed a review of Patient 5’s clinical record, which indicated a start of care date of November 3, 2025, with HA services initiating on that date.The record contained documentation of 38 HA visits conducted between March 29, 2026, and May 23, 2026. However, the agency failed to ensure that an RN conducted an on-site supervisory visit at least every 14 days to assess the quality of care. Specifically:A supervisory visit was completed on February 16, 2026; the next RN supervisory assessment was not conducted until April 20, 2026. This resulted in a 63-day gap in documented HA supervision.Following the April 20, 2026 visit, the next supervisory assessment was conducted on May 11, 2026, resulting in a 21-day gap in documented HA supervision. 2. The surveyor completed a review of Patient 7’s clinical record, which revealed a start of care date of March 14, 2026, with HA services initiating on that date. The record contained documentation of 56 hospice aide visits conducted between March 29, 2026, and May 23, 2026. However, the agency failed to ensure that an RN conducted an on-site supervisory visit at least every 14 days following the initiation of services. Specifically:The first RN supervisory visit following the start of care was not conducted until April 20, 2026. This resulted in a 37-day gap between the start of aide services and the initial documented RN supervisory assessment, exceeding the 14-day regulatory standard by 23 days3. The surveyor completed a review of Patient 8’s clinical record, which revealed a start of care date of February 23, 2026, with HA services initiating on February 24, 2026.The record contained documentation of 40 HA visits conducted between March 29, 2026, and May 23, 2026. However, the agency failed to ensure that an RN conducted an on-site supervisory visit at least every 14 days during this timeframe. Specifically:The supervisory visit preceding this period was documented on February 18, 2026. The first RN supervisory visit during the specified timeframe was not conducted until April 29, 2026. This resulted in a 70-day gap in documented HA supervision between February 18, 2026, and April 29, 2026.4. The surveyor completed a review of Patient 11’s clinical record, which revealed a start of care date of January 2, 2026, with hospice aide services initiating on January 3, 2026.The record contained documentation of 40 HA visits conducted between March 29, 2026, and May 23, 2026. However, the agency failed to ensure that an RN conducted an on-site supervisory visit at least every 14 days to assess the quality of care. Specifically:A supervisory visit was completed on February 6, 2026; the next RN supervisory assessment was not conducted until May 1, 2026. This resulted in an 84-day gap in documented HA supervision, significantly exceeding the 14-day regulatory standard.5. The surveyor completed a review of Patient 12’s clinical record, which revealed a start of care date of July 1, 2025, with HA services active during the review period.The record contained documentation of 22 HA visits conducted between March 29, 2026, and May 23, 2026. However, the agency failed to ensure that an RN conducted an on-site supervisory visit at least every 14 days to assess the quality of care. Specifically:A supervisory visit was completed on February 19, 2026; the next RN supervisory assessment was not conducted until April 20, 2026. This resulted in a 60-day gap in documented HA supervision, significantly exceeding the 14-day regulatory standard.The surveyors completed interviews on June 2, 2026, and June 3, 2026, with the director of nursing (DON) and the administrator, who confirmed that nursing staff had failed to consistently perform and document the required 14-day HA supervisory visits. Specifically, on June 2, 2026, at 11:44 AM, the DON and the administrator acknowledged a recent internal finding that RN staff were failing to document aide supervisory visits. The DON explained that supervisory assessments are within the standard RN visit notes, but acknowledged that staff were not completing the supervisory visit every 14 days. On June 3, 2026, at 2:16 PM, the DON clarified that training regarding these visits consisted of verbal education provided during an interdisciplinary Team (IDT) meeting. The DON stated that they sent a communication thread message to all nursing staff on May 6, 2026, at 11:00 AM, and implemented an electronic medical record (EMR) “hard stop” system forcing function to prevent nurses from closing a skilled nursing visit note without completing the supervisory documentation. Furthermore, the DON explained that a formal Performance Improvement Project (PIP) was currently under development for future presentation to the quality assurance and performance improvement (QAPI) Committee.”

“Based on record review and interview, the agency failed to ensure that a registered nurse (RN) conducted an annual onsite supervisory visit to observe and assess the specific hands-on care skills of 4 of 5 sampled hospice aides (HA). (Employee identifiers: 3, 10, 11, and 12.) Findings include: On May 27, 2026 at 1:32 PM, surveyors requested personnel files from the agency, including documentation of annual onsite visits for two HAs. HA 3, hired on May 22, 2024 and HA 4, who was hired on October 24, 2025. On June 1, 2026, at 1:58 PM, surveyors sent a second request for the personnel files. On June 2, 2026 at 9:41 AM, surveyors interviewed the agency administrator and the director of nursing (DON). During the interview, surveyors requested personnel files for a third time. On June 3, 2026 at 10:39 AM, surveyors sent an email request to the agency, which included the addition of three HAs- HA 10, hired on May 5, 2025, HA 11 hired on August 4, 2023 and HA 12 who was hired on December 4, 2024, to the personnel sample, requesting their annual onsite visit documentation. Following these repeated requests, the agency was unable to provide documentation verifying that 4 of 5 HAs sampled on the personnel roster had an annual on-site supervisory visit completed by an RN. (HA identifier: 3, 10, 11, 12)”