Heartland Hospice (Newport News)

“Upon client record review, 2 of 5 (Patient #2,4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. services are provided in accordance with the plan of care. Patient 2: The plan of care has MSW routine frequency ordered as monthly starting 08/26/2025. No evidence that a routine visit occurred for the month of August 2025. No evidence that the visit were missed at the request of the family or that an order was received to change that routine frequency. Patient 4: The plan of care has MSW and Chaplain routine frequency’s ordered as monthly starting 08/27/2025. No evidence that a routine visit occurred for the month of August 2025 for either disciple. No evidence that the visits were missed at the request of the family or that an order was received to change that routine frequency.”

“Upon observation and record review, 1 of 19 records (Patient #1) did not show evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient’s Rights and Responsibilities in a language and manner that the patient understands. Patient #1: The admission CTI, Nurse admit note and Social Worker eval visit note all indicated the patient was having worsening confusion and hallucinations plus significant functional and cognitive decline. The record revealed the patient had signed the Election of Hospice Benefit, Rights and Responsibilities and all other admission paperwork on the start of care visit on 6/18/25. The Virginia Department of Health Advance Directive form also was documented that the patient was incapable of making a decision regarding end of life decisions and the patient signed it also.”

“Upon patient record review, 1 of 19 (Patient #1) 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 #1: The admission CTI, Nurse admit note and Social Worker eval visit note all indicated the patient was having worsening confusion and hallucinations plus significant functional and cognitive decline. The record revealed the patient had signed the Election of Hospice Benefit, Rights and Responsibilities and all other admission paperwork on the start of care visit on 6/18/25. The Virginia Department of Health Advance Directive form also was documented that the patient was incapable of making a decision regarding end of life decisions and the patient signed it also.”

“Upon patient record review, 1 of 19 (Patient #1) did not have evidence that the hospice obtained the patient’s or representative’s signature confirming that they received a copy of the Patient’s Rights and Responsibilities. Patient #1: The admission CTI, Nurse admit note and Social Worker eval visit note all indicated the patient was having worsening confusion and hallucinations plus significant functional and cognitive decline. The record revealed the patient had signed the Election of Hospice Benefit, Rights and Responsibilities and all other admission paperwork on the start of care visit on 6/18/25. The Virginia Department of Health Advance Directive form also was documented that the patient was incapable of making a decision regarding end of life decisions and the patient signed it also.”

“Upon patient record review, 1 of 19 (Patient #1) 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 #1: The admission CTI, Nurse admit note and Social Worker eval visit note all indicated the patient was having worsening confusion and hallucinations plus significant functional and cognitive decline. The record revealed the patient had signed the Election of Hospice Benefit, Rights and Responsibilities and all other admission paperwork on the start of care visit on 6/18/25. The Virginia Department of Health Advance Directive form also was documented that the patient was incapable of making a decision regarding end of life decisions and the patient signed it also.”

“Upon patient record review, 1 of 19 (Patient #1) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #1: The admission CTI, Nurse admit note and Social Worker eval visit note all indicated the patient was having worsening confusion and hallucinations plus significant functional and cognitive decline. The record revealed the patient had signed the Election of Hospice Benefit, Rights and Responsibilities and all other admission paperwork on the start of care visit on 6/18/25.”

“Upon patient record review, 7 of 19 (Patient #1, #2, #3, #4, 11, 12, 14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1 - The medication profile contained Lasix 40mg po daily prn edema. There was no specific instructions of the edema. Corrected onsite. Patient #2 - The medication profile contained Flagyl 500mg daily topical with instructions “crush Flagyl and put in wounds daily x 2 weeks”. There was no location of the wounds. Patient #3 - The medication profile contained Polyethylene Glycol 17Gm oral power every other day. There was no information as to the diluent to be used. Corrected onsite. Patient #4 - The medication profile contained Bisacodyl 10mg 1 supp daily with reason no BM in 3 days. The agency leadership confirmed that the entry should of been daily prn. Corrected onsite. Patient #11: Milk of Magnesia, Fleets Enema, Miralax and Tylenol were in the SNF MAR and there was no evidence that they were on the hospice medication profile. In addition Melatonin, and Oxygen were on the hospice medication list and there was no evidence that they were on the SNF MAR. Also the Senna with Docusate Sodium on the hospice medication list was PRN and on the SNF MAR it was 2xday PRN. Patient #12: D3, and Vitamin C were medications in the home but not on the hospice medication list. The Senna Plus, Atorvastatin and Pioglitazone were on the hospice medication list and not in the home (daughter confirmed patient is not taking them). Patient #14: Melatonin was on the SNF MAR but not on the hospice medication profile. Hydroxyzine, Ipratropium, Lorazepam, Mucinex, Nicotine and Zanaflex were on the hospice medication profile but not on the SNF MAR. Also the Oxygen on the hospice medication profile said 2L daily but on the SNF MAR it said 2L daily PRN.”

“Upon patient record review, 4 of 19 (Patient #1, #3, #5, #7) 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: The record identified that the patient has a history of falls and there was no evidence of a fall or safety goals and interventions on the care plan. The patient has a diagnosis of Cerebral Atherosclerosis and there was no evidence a neurological intervention in the care plan. Corrected onsite. Patient #3: The record identified that the patient had a fall with a head laceration but there was no evidence fall or safety goals and intervention on the care plan. Corrected onsite. Patient #5: In the SOC nursing note documentation revealed that the patient had several falls in the past months and patient scored a 10 on fall risk assessment making her a high risk for falls. The care plan was missing falls/safety goals and interventions. Corrected onsite. Patient #7: The record indicated that the patient was unable to sign the EOB because he was cognitively impaired and the upon admission the note said the patient could only follow 2 steps commands. The care plan is missing a cognitive goals and interventions. The documentation indicated the patient had a fall on 6/15/25 and the care plan does not reflect fall/safety goals and interventions. Corrected onsite.”

“Upon patient record review, 13 of 19 (Patient #1, #2, #3, #4, #5, #7, #8, #9, #10, #11, #12, #13, #14) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient’s plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients #1, #2, #3, #4, #5, #7, #8, #9, #10, #11, #12, #13, #14: The visit frequency for the Social Worker and Spiritual Care Provider at admission was 1 PRN. No evidence of a routine frequency. Patient #11 - The Spiritual Care Provider visit orders was 4m2, 5m1, 7 prn visits. Patient #12 - The patient refused Spiritual Care Provider visits but there was a visit order for 2 prn. Corrected onsite.”

“Upon patient record review, 7 of 19 (Patient #1, #2, #3, #4, #11, #12, #14) 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 #1 - An order contained Lasix 40mg po daily prn edema. There was no instructions to location or edema or specific instructions. Corrected on site. Patient #2 - An order contained Flagyl with instructions “crush Flagyl and put in wounds daily x 2 weeks. There was no location of the wounds. Patient #3 - An order contained Polyethylene Glycol 17Gm oral power every other day. There was information as to the diluent to be used. Corrected onsite. Patient #4 - An order contained Bisacodyl 10mg 1 supp daily with reason no BM in 3 days. The agency leadership confirmed that the entry should of been daily prn. Corrected onsite. Patient #11: Milk of Magnesia, Fleets Enema, Miralax and Tylenol were in the SNF MAR and there was no evidence of an order in the hospice record. Patient #12: D3, and Vitamin C were medications in the home but there was no evidence of an order in the hospice record. Patient #14: Melatonin was on the SNF MAR but there was no evidence of an order in the hospice record.”

“Upon patient record review, 2 of 19 (Patient #7, #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #7: The record indicated the skilled nurse frequency to be 2wk13, 3prn. There was only 1 skilled nurse visit the week of 6/29/25 and no evidence of an order or a missed visit note. Patient #13: The record indicated the skilled nurse visit frequency to be 2wk13, 1wk1, 3 prn. There was only 1 skilled nurse visit the week of 7/27/25 and no evidence of an order or a missed visit note.”

“Upon patient record review, 2 of 19 (Patient #17, #18) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #17: The documentation revealed that the 1 month letter was due to be sent per the plan on 4/29/25 but it was not sent till 6/17/25. Patient #18: The documentation revealed that the 1 month letter was due to be sent per the plan on 3/31/25 but it was not sent until 6/2/25.”

“Upon patient record review, 4 of 19 (Patient #2, #3, #7, #11) 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 #2: The aide written instructions indicated that the shampoo, hair care, shaving was to be done at patient request. Corrected onsite. Patient #3: The aide written instructions indicated assist with feeding as needed. Corrected onsite. Patient #7: The aide written instructions does not contain fall risk precautions. Corrected onsite. Patient #11: The aide written instructions indicated that the hair care was to be done at patient request. Corrected onsite.”

“Upon patient record review 6 of 19 (Patient #3, #5, #6, #9, #13, #14) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Order 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 #3: The aide care plan indicated that the patient was to receive a shampoo every visit. The documentation revealed that a shampoo was not completed (No-per frequency not needed) on 7 of 7 visits (7/3, 7/8, 7/10, 7/15, 7/17, 7/29 and 7/31). The aide care plan also indicated that nail care was to be done weekly but the documentation revealed that nail care was provided every visit. Patient #5: On 7/2/25 an order stated the following aide visit frequency - 1wk1, 2wk2, 5wk1, 4wk1, 5wk8. The 5th week which was the week of 6/29/25 should of had 4 visits but only 3 visits were made with no missed visit note or order in the record. The aide plan of care indicated to assist with feeding every visit. On 7/28/25 the aide documentation revealed No -patient preference. Patient #6: The aide care plan indicated that the patient shower was to be done weekly. The aide visit documentation on 5/29/25, 6/3, 6/5, and 7/10 did not show this task completed. In addition, on 6/18 the aide documentation said under the shower task, “Completed bed bath because the patient is in an arm cast due to fracture.” Patient #9: The aide care plan indicated that hair care was to be done weekly on the 1st visit of the week. Documentation revealed hair care completed every visit. Patient #13: The aide care plan indicated that the patient was to have a shower every visit. The aide documentation on 8/1/25 stated after shower task - No patient preference. Also the aide documented washed dishes/did laundry and those tasks were not on the aide care plan. Patient #14: The aide documentation indicated on 5 visits the following: Service-walker, Completed - no, Note - patient preference.”

“Upon patient record review 1 of 19 (Patient #4) 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 #4: The documentation indicated the first aide visit was on 6/27/25 so the supervisory visit was due by 7/11/25 but it was not done until 7/17/25. The next aide supervision was due by 7/31/25 and as of the record review on 8/5/25 it had not yet been completed.”

“Upon patient record review, 1 of 19 (Patient #1) 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: The admission CTI, Nurse admit note and Social Worker eval visit note all indicated the patient was having worsening confusion and hallucinations plus significant functional and cognitive decline. The record revealed the patient had signed the Election of Hospice Benefit, Rights and Responsibilities and all other admission paperwork on the start of care visit on 6/18/25.”