Carilion Franklin Memorial Hospital

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. 2 of 19 (11%) clinical records reviewed revealed that the agency did not ensure that the plans of care included medical supplies and appliances necessary to meet the needs of the patient. CLINICAL RECORD 7: The patient was admitted on 08/11/2026. The initial plan of care dated 08/11/2026 included orders for wound care to the patient’s left lower leg. The plan of care did not include wound care supplies. CLINICAL RECORD 3: The patient was admitted on 10/26/2025 with a foley catheter in place. The recertification plan of care dated 08/12/2026- 10/10/2026 included interventions for foley catheter care but did not include any foley catheter supplies. The Clinical Director confirmed, in an interview on 08/25/2026, that the required medical supplies were not documented on the plans of care.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. 4 of 15 (27%) clinical records reviewed with a home health aide services revealed that the agency did not ensure that the home health aide plans of care included appropriate information to address each patient’s individual needs. CLINICAL RECORD 1: The hospice benefit was elected on 06/20/2025. The patient’s diagnosis was Mixed Alzheimer’s with Vascular Dementia. The patient had new wound care orders dated 07/25/2026 that required a dressing to the sacrum. The patient had hospice aide services ordered for a bed bath. The aide plan of care was not updated to provide instruction related to the dressing area. CLINICAL RECORD 2: The hospice benefit was elected on 06/23/2024 with a diagnosis of Severe Protein Calorie Malnutrition. Clinical record review revealed that patient has a suprapubic catheter. The hospice aide plan of care dated 06/23/2026, developed by a RN, assigned the aide to perform catheter care including to cleanse the skin and catheter tubing with soap and water. The aide care plan did not alert the aide that the catheter was a suprapubic catheter. CLINICAL RECORD 8: The patient was admitted on 06/23/2026 with a diagnosis of Diffuse Large B Cell Lymphoma and documented pressure wounds to the sacrum, right upper left and right lower leg. Orders for wound care and dressings were included on the plan of care. The hospice aide plan of care dated 06/23/2026 assigned the task of bathing but did not provide instruction related to the dressings or wound care areas. CLINICAL RECORD 9: The patient was admitted on 07/22/2026 with a diagnosis of Mass of Colon and documented wounds on the left heel and the sacrum. Wound care was ordered to both sites. The hospice aide plan of care dated 07/22/2026 assigned “assist with shower” but did not provide the aide with direction related to how to handle the wound areas and dressings. The Clinical Director confirmed, in an interview on 08/25/2026, that the aide plans of care did not include patient-specific instructions for all required care identified.”

“It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. 2 of 15 (13%) clinical records reviewed with hospice aide services revealed that the agency did not ensure that the aide(s) notified the RN for each change related to delivering services on the plans of care. CLINICAL RECORD 3: The hospice benefit was elected on 10/16/2025 with a diagnosis of Mixed Alzheimer’s with Dementia. The hospice aide care plan was created by a RN upon admission on 10/16/2025 and assigned the tasks of: assist with shaving; assist with oral care; and perform fingernail filing. The hospice aide visit note dated 10/16/2025 documented that the patient refused nail filing and shaving and oral care was “performed by others”. The clinical record contained no documented evidence that the aide notified the RN related to changes in care provided. CLINICAL RECORD 6: The patient elected the hospice benefit on 01/05/2026 with a diagnoses of Cardiovascular Disease. For the episode dated 07/04/22026 through 09/01/2026, the hospice aide care plan assigned the following tasks: aide assist with shampoo; aide assist with foot care; aide perform fingernail filing; and aide change bed linens. The aide visit note dated 07/07/2026 documented the aide-assigned tasks “Aide assist with shampoo, aide assist with foot care, aide perform fingernail filing, and aide change bed linens” were “performed by others” and not performed by the aide. The clinical record contained no documentation that the RN was notified of the changes in the care provided. In an interview on 08/25/2026 the Clinical Director confirmed that there was no documentation to indicate that the hospice aide(s) notified the nurse related to changes in the care delivered.”

“Observed in Record Review. In 3 of 14 active Hospice patient records reviewed, the organization failed to assess potential medication related problems. On HSRRHV #4, the plan of care had duplicate PRN medications of Milk of Magnesia and Dulcolax and did not address how to handle the duplicate therapy. On review of HSRRNHV #2, the plan of care had duplicate PRN constipation medications of Senna-Docusate and Bisacodyl with no indication when to use the duplicate medications. ON HSRRNHV #5, the plan of care had duplicate PRN constipation medications of senna-Docusate, Milk of Magnesia and Dulcolax supp with no indication when to use the duplicate medications.This finding was reviewed with agency leaders.”

“Observed in Record Review. In 7 of 14 active Hospice patient records reviewed, the plan of care had not updated and individualized the plan of care to reflect the patient’s condition. On HSRRHV #1, the patient had goals for teaching family methods to prevent weight loss since admit 5 months ago on a patient in the declining stages of the disease process that is expected that weight loss will occur. In addition, care plan not updated to reflect care and teaching to the family/caregiver how to care for wound in a home where the caregivers were actively caring for the wound for several months. On HSRRHV #2, the care plan had not been updated to reflect the current condition of the patient with teaching goals for management of dysphagia, aspiration management that were on the care plan for months, but caregivers were competent with the cares. On HSRRHV #4, the plan of care had not been updated to reflect the care needs of the patient including teaching of medications that had not been on the care plan since admission over a year ago. In addition, on review of HSRRNHV #1, HSRRNHV #3, HSRRNHV #7 and HSRRNHV #9 the care plan had not had goals updated on the plan of care to reflect the changes in patient with examples of patient on oxygen with no goals for the oxygen, newly started medications with no goals to reflect and teaching remaining on the care plan when education was provided months ago. This finding was reviewed and validated with agency leaders.”