Elevate Hospice, LLC

“Upon patient record review, 2 of 14 (Patient #3,12) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient #3, Patient has dementia, RN initial assessment documents patient is oriented x1. Patient signed her own consents. Patient is unable to understand hospice benefit. Patient has POA with no evidence of POA signing consent forms. Patient #12, Patient signed her own consent with terminal diagnosis of Alzheimer Disease. Patient is unable to understand hospice benefit.”

“Upon patient record review, 2 of 14 (Patient #3,12) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient’s rights to the extent allowed by state law. Patient #3, Patient has dementia, RN initial assessment documents patient is oriented x1. Patient signed her own consents. Patient is unable to understand hospice benefit. Patient has POA with no evidence of POA signing consent forms. Patient #12, Patient signed her own consent with terminal diagnosis of Alzheimer Disease. Patient is unable to understand hospice benefit.”

“Upon patient record review, 4 of 14 (Patient #3,11,12,14) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient #3, Patient has dementia, RN initial assessment documents patient is oriented x1. Patient signed her own consents. Patient is unable to understand hospice benefit. Patient has POA with no evidence of POA signing consent forms. Patient #12, Patient signed her own consent with terminal diagnosis of Alzheimer Disease. Patient is unable to understand hospice benefit. Patient #11,14, No evidence patient made a choice to pick their health care provider. This area on the consent form was left empty.”

“Upon observation, there was no evidence the hospice has an interdisciplinary group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. Interdisciplinary group members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. Patient #9, Upon patient record review there was no evidence of a signature for MSW on IDG meeting note dated 6/12/25 or SC on IDG meeting note dated 6/18/25. No evidence the IDG was composed of all disciplines to meet the physical, medical, psychosocial, emotional, and spiritual needs of the patient”

“Upon patient record review, 10 of 14 (Patient #1,2,3,4,5,6,7,8,9,10) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #1-10, No evidence of initial MSW assessment documentation of funeral home and plans for funeral home arrangements noted in plan of care.”

“Upon patient record review, 3 of 14 (Patient #2,7,8) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2, Order reads oxygen gas/cannula 1-5 lpm. No evidence of frequency noted. Patient #7, Order reads Symbicort inhalation aerosol once daily oral. No evidence of correct direction of inhale. Oxygen was ordered 1 liter/NC, order was missing frequency. Patient #8, Order reads SN to change Foley catheter 14F, 10cc monthly and prn, may flush or irrigate prn for clogging or other problems. No evidence of flushing solution or amount to flush.”

“Upon patient record review, 2 of 14 (Patient #1,2) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient’s condition requires but no less frequently then every 15 calendar days. Patient #1, Patient was admitted on 10/8/24. No evidence of IDG meeting documented until 10/31/24 which is greater than 15 days. In addition, there was no evidence of a signature for MSW or SC on IDG meeting note dated 10/31/24. The disciplines were actively involved with the patient therefore there was no evidence of collaboration since there was no signature to validate participation. Patient #2, Upon patient record review there was no evidence of a signature for MSW or SC on IDG meeting note dated 5/16/25 and 6/12/25. No evidence of MSW signature on IDG meeting note dated 5/1/25 and 5/30/25. The disciplines were actively involved with the patient therefore there was no evidence of collaboration since there was no signature to validate participation.”

“Upon patient record review, 7 of 14 (Patient #1,2,4,5,7,8,10) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1, SC frequency ordered 1-2x/month effective 4/1/25, patient seen every week for the month of June. No orders for SC prior to 4/1/25 with patient seen 2x/month in December, January, February, with patient seen 3x/month for March. No orders for MSW prior to 4/1/25 with patient seen 2x in October, 1x in December, February and March. Patient #2, MSW frequency order 1x/month. No evidence of MSW visit completed for the month of July 2024. SC frequency ordered 1x/month. No evidence of any visits completed as there was no documentation. Patient #4, MSW frequency 1x/month. No evidence of MSW visit completed for the month of December 2024. SC frequency 1x/month. SC completed weekly visits for the months of May and June 2025. Patient #5, SC frequency 1x/month. SC completed weekly visit month of May and twice the month of April. Patient #7, SC frequency 1x/week. No evidence of SC visit week of 6/8/25. Patient #8, MSW frequency 1x/month. No evidence of MSW visit completed in January and February. SC frequency 1x/month. Patient seen 2x/month for March and April, 3x/month for May and 4x/month for June. Patient #10, MSW frequency 1x/month. No evidence of MSW visit completed in January and February. SC frequency1x/month. Patient seen 2x/month for April and May. 4x/month for June.”

“Upon patient record review, 2 of 14 (Patient #1,7) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #1,7, Aide care plan directs vital signs every visit. There was no evidence of parameters to report to RN.”

“Upon patient record review 4 of 14 (Patient #1,2,4,7) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1, Upon chart review, aide note dated 6/30/25 documents care plan direction of make bed as NA. Patient #2, Upon chart review, aide frequency 2x/week. Patient was seen 3x/week for the week of 6/10/24, 6/17/24, 6/24/24, 7/1/24. Patient #4, Upon chart review, aide frequency 1x/week, no evidence of a visit the week of 10/13/24. Patient #7, Upon chart review, aide care plan directions for vitals every visit. On 6/30/25 vitals marked NA.”

“Upon patient record review 2 of 14 (Patient #2,5) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient’s needs. Patient #2, Supervisory visits completed 2/24/25 then 3/11/25. No evidence supervisory visit was completed every 14 days. Patient #5, Supervisory visits completed 5/25/25 then 6/10/25. No evidence supervisory visit was completed every 14 days.”

“Upon patient record review, 5 of 14 (Patient #1,3,11,12,14) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #1, No evidence of effective date of the election was documented on the election of benefit form. Patient #3, Patient has dementia, RN initial assessment documents patient is oriented x1. Patient signed her own consents. Patient is unable to understand hospice benefit. Patient has POA with no evidence of POA signing consent forms. Patient #11,14, No evidence patient made a choice to pick their health care provider. This area on the EOB form was left empty. Patient #12, Patient signed her own consent with terminal diagnosis of Alzheimer Disease. Patient is unable to understand hospice benefit.”

“Upon observation, there was no evidence the hospice discussed the policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. Patient #3, Patient has dementia, RN initial assessment documents patient is oriented x1. Patient signed her own consents. Patient is unable to understand hospice benefit. Patient has POA with no evidence of POA signing consent forms. Patient #12, Patient signed her own consent with terminal diagnosis of Alzheimer Disease. Patient is unable to understand hospice benefit.”