Home Nursing Company Inc.

“Based on interview, record review, and agency policy review, the agency failed to ensure that the initial comprehensive assessment was completed by the interdisciplinary group (IDG) members within five days of a hospice admission for 10 of 14 patients (Patient (P) P1, P2, P3, P4, P5, P6, P7, P8, P9, and P10) reviewed. Failure to complete the initial comprehensive assessment within five days had the potential for new patients to have physical, psychosocial, spiritual, or financial needs not to be addressed in a timely manner. Findings include:1. Record review revealed P1’s admission date was 04/22/25; however, no initial social work (SW) assessment was completed. 2. Record review revealed P2’s admission date was 05/13/25; however, no initial chaplain or SW assessments were completed. 3. Record review revealed P3’s admission date was 05/05/25; however, the initial SW assessment was not completed. 4. Record review revealed P4’s admission date was 04/23/25; however, no initial SW assessment was completed. 5. Record review revealed P5’s admission date was 04/22/25; however, no initial SW or chaplain assessment was completed. 6. Record review revealed P6’s admission date was 05/09/25; however, no initial SW assessment was completed. The chaplain initial assessment was completed on 05/19/25. 7. Record review revealed P7’s admission date was 05/23/25; however, no initial SW or chaplain assessment was completed. 8. Record review revealed P8’s admission date was 05/29/25; however, no initial SW assessment was completed. The initial chaplain assessment was completed on 06/10/25. 9. Record review revealed P9’s admission date was 05/02/25; however, no initial SW assessment was completed. 10. Record review revealed P10’s admission date was 03/13/25; however, no initial SW assessment was completed. P10 had a recertification completed on 06/10/25 with no SW assessment completed. During an interview on 06/20/25 at 12:00 PM, the chaplain confirmed that some of the initial chaplain assessments were not completed within five days of the hospice admission. The chaplain stated he/she was aware of the five-day period for completion.Multiple attempts were made to reach out to the agency SW for an interview on 06/19/25 and 06/20/25 with no contact made. During an interview on 06/20/25 at 3:00 PM, the Administrator confirmed that the SW and Chaplain initial assessments should be completed within five days of admission.Review of the hospice agency policy titled, “Interdisciplinary Group Meeting,” dated 11/2024, revealed, “. . . Admissions will be reviewed to ensure compliance with hospice policies and procedures and comprehensive assessments no later than 5 calendar days after patient’s election of Hospice care . . .””

“Based on observation, interview, record review, and policy review, the agency failed to ensure that medications listed on the hospice agency’s medication list were the same medications listed on the patient’s home medication list for one of 10 patients (Patient (P) 5) whose medications were reviewed out of a total sample of 14. This had the potential to cause P5 to suffer adverse drug events. Findings include:Review of P5’s “Patient Information,” located in the EMR, revealed P5 was admitted to hospice services on 04/23/25 with diagnoses that included malignant neoplasm of the bladder.During a review of P5’s “Client Medication Report” (CMR), dated 04/22/25, and medication set-up in the home, revealed P5 was being given Metoprolol (a blood pressure medication)50 milligram (mg) tablets with 1.5 tablets to given to equal 75 mg once a day. Review of P5’s CMR, dated 04/22/25, located in P5’s electronic medical record(EMR) under the “Medications” tab, revealed the Metoprolol was not included on the hospice agency’s medication list.During the home visit observation on 06/19/25 at 9:00 AM, P5’s blood pressure was taken with a result of 92/70.During an interview on 06/19/25 at 9:20 AM, P5’s spouse stated P5 has been on the Metoprolol for “. . . approximately five years and only gives [P5] one tablet [50 mg] and not one and half as ordered . . .” P5’s spouse also stated he/she did not inform the hospice agency that P5 was taking the medication.During an interview and review of the CMR on 06/19/25 at 9:30 AM, Registered Nurse (RN) 1 confirmed that the Metoprolol medication in P5’s home was not listed on the agency CMR. RN1 was unable to explain why a complete medication reconciliation was not completed at the time of admission or during subsequent home visits. RN1 stated medication profiles are to be reviewed with each home visit for any changes, additions, or deletions of medications.Review of the agency’s policy titled, “Medication Profile,” dated 11/2024, indicated, “. . . Upon admission to hospice, the admitting nurse will initiate a medication profile to document the current medication regimen, including name, dose, strength, route, frequency, date, and time of administration . . . drug regimen review will be performed by a registered nurse at the time of initial and comprehensive assessment . . .””

“Based on interview, record review, and review of agency job description, the facility failed to provide medically related social services to meet the needs of the patients for 10 of 10 current patients (Patient (P) 1, P2, P3, P4, P5, P6, P7, P8, P9 and P10) reviewed for social service needs out of a total sample of 14. This increased the risk of patient and family needs going unmet. Findings include:1. Review of P1’s “Patient Information,” located in the electronic medical record (EMR), revealed P1 was admitted to hospice services on 04/22/25 with diagnoses that included malignant neoplasm of the bladder.Review of P1’s EMR revealed no documentation by the Social Worker (SW) for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P1 might have.2. Review of P2’s “Patient Information,” located in the EMR, revealed P2 was admitted to hospice services on 05/13/25 with diagnoses that included Alzheimer’s disease.Review of P2’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P2 might have.3. Review of P3’s “Patient Information,” located in the EMR, revealed P3 was admitted to hospice services on 05/05/25 with diagnoses that included Alzheimer’s disease.Review of P3’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P3 might have.4. Review of P4’s “Patient Information,” located in the EMR, revealed P4 was admitted to hospice services on 05/13/25 with diagnoses that included hypertensive heart disease.Review of P4’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P4 might have.5. Review of P5’s “Patient Information,” located in the EMR, revealed P5 was admitted to hospice services on 04/23/25 with diagnoses that included malignant neoplasm of the bladder.Review of P5’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P5 might have.6. Review of P6’s “Patient Information,” located in the EMR, revealed P6 was admitted to hospice services on 05/09/25 with diagnoses that included chronic respiratory failure with hypoxia.Review of P6’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P6 might have.7. Review of P7’s “Patient Information,” located in the EMR, revealed P7 was admitted to hospice services on 05/23/25 with diagnoses that included malignant neoplasm of the colon.Review of P7’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P7 might have.8. Review of P8’s “Patient Information,” located in the EMR, revealed P8 was admitted to hospice services on 05/29/25 with diagnoses that included Alzheimer’s disease.Review of P8’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P8 might have.9. Review of P9’s “Patient Information,” located in the EMR, revealed P9 was admitted to hospice services on 05/02/25 with diagnoses that included chronic obstructive pulmonary disease (COPD).Review of P9’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P9 might have.10. Review of P10’s “Patient Information,” located in the EMR, revealed P10 was admitted to hospice services on 03/13/25, with a recertification on 06/11/25, with diagnoses that included acute and chronic respiratory failure.Review of P10’s EMR revealed no documentation by the SW for the initial assessment, comprehensive assessment, home visits, or phone calls to determine what SW needs P10 might have.Review of the facility’s job description for Medical Social Worker (MSW), revised 02/2022 and signed by the SW on 04/02/25, revealed, “. . . Assesses the psychosocial status of patients and families/caregivers related to the patient’s terminal illness and environment and communicates findings to the registered nurse and other members of the interdisciplinary group. Provides an assessment in the patient’s identified residence and assistance when this is not safe, and another plan is required . . .”Multiple attempts were made to reach out to the agency SW for an interview on 06/19/25 and 06/20/25 with no contact made. During an interview on 06/20/25 at 3:00 PM, the Administrator confirmed that the SW was not completing initial or comprehensive assessments, home visits, or phone calls. The Administrator confirmed the SW participated in the agency IDG meetings.”

“Based on interview, record review, and policy review, the hospice agency failed to develop and implement effective volunteer recruitment and retention efforts to meet the needs of the current hospice patients and new admissions. This deficient practice had the potential to affect all 10 current patients seen by the agency and have needs unmet due to no volunteers in the correct capacity. Findings include:During an interview on 06/18/25 at 10:30 AM, the Administrator stated the agency did not have an active volunteer program and had zero volunteers. The Administrator was unaware of what volunteer recruitment efforts were in place.During an interview on 06/20/24 at 1:00 PM, the Administrator stated the agency had a Performance Improvement Plan (PIP) for the volunteer coordinator or recruitment efforts dated 06/04/25. The Administrator also provided the surveyor with a monthly binder for volunteer notices or postings, but they was not specific to the agency’s location/region. The Administrator further stated the volunteer notices were handled by “. . . corporate . . .” Review of the agency’s policy titled, “Volunteer Services Monthly Report,” dated 03/2020, revealed, “. . . Recruitment and retention efforts will be documented each month for the prior month’s efforts on the Volunteer Services Monthly Report tracker. . . Names of volunteer inquiries, volunteer applicants and volunteers who completed orientation will be documented also…” . . .””