Professional Healthcare Resources, Inc.

“It is required that the hospice provides an initial orientation for each employee that addresses the employee’s specific job duties, including infection control and organization procedures and policies and procedures on advance directives. Orientation on the hospice philosophy is also provided to all employees and contracted staff who have patient and family contact. Orientation includes the following, as appropriate to the employee’s specific job duties: The needs and concerns of patients and families coping with a terminal illness; Education regarding the hospice’s policies and procedures on advance directives. THIS IS A CONTINUED REQUIRED ACTION THERE WERE NO NEW HIRES SINCE THE LAST SITE VISIT This standard was not met as evidenced by interview and personnel record review. In 1 of 10 (10%) This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) personnel records reviewed, it was revealed that the agency did not ensure that Orientation included the following, as appropriate to the employee’s specific job duties: the needs and concerns of patients and families coping with a terminal illness. PERSONEL RECORD 7: his Registered Nurse Case Manager was hired on 05/22/2023. The personnel record was reviewed for the years of 2023, 2024, and 2025. There was no evidence of hospice specific orientation which included the hospice philosophy. In an interview conducted with the Human Resources Director on 08/07/2025, it was stated that the hospice orientation was missing. The HR Director stated this nurse worked mainly in home health upon hire. She stated that the agency would ensure that the employee receive orientation to the hospice philosophy”

“It is required that the hospice has a written Patient Bill of Rights and Responsibilities (Bill of Rights). The patient has the right to be informed of his or her rights and responsibilities, and the hospice defines, protects, and promotes the exercise of these rights. This is a CMS CONDITION LEVEL DEFIENCY. This CONDITION was not met, as evidenced by clinical record reviews and interviews with the Registered Nurse/QAPI Coordinator which revealed the hospice: Failed to ensure the patient received effective pain management [HPFC.2. D/L512/418.52(c)(1)]. The cumulative effect of these systemic problems resulted in the hospice agency’s inability to ensure the provision of quality health care in a safe environment for the condition of participation CFR 418.52: Patient Rights. The deficient practice illustrated systemic process failures that had the potential to affect all patients cared for by the hospice agency.”

“It is required that the written Patient Bill of Rights includes the right to receive effective pain management and symptom control for conditions related to the terminal illness. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed, the agency did not ensure that the patient received effective pain management and symptom control for conditions related to the terminal illness. CLINICAL RECORD 5: This patient elected the hospice benefit on 06/20/2024 with a terminal diagnosis of protein calorie malnutrition. On 06/27/2024 the Senior Leader for Clinical Operations (SLCO) documented that there had been a “clinically significant medication issue”. The agency documented that a comfort kit had been ordered for the patient on 06/19/2025 per the request of the assisted living facility (ALF) nurse prior to admission to hospice. The nurse’s note for 06/21/2024 documented the patient was experiencing pain at 10/10 and severe agitation. In an interview with the Registered Nurse (RN) on 08/07/2025, it was stated that this nurse reached out to the Senior Leader for Clinical Operations because the comfort medications had not arrived. She was instructed to go to Staples and fax a script to the Hospice Medical Director because he was out of the country and could only receive faxes. Once the RN arrived at Staples, she was instructed to go back to the ALF. The RN returned to the ALF and then left. There was no documentation present of the patient’s pain level or agitation at the time the RN left. On 06/22/2023, the RN made a visit and stated that the comfort pack had not arrived. It was documented that “patient states he is not uncomfortable because of pain” and that patient was transitioning to the end-of-life process. It was also documented that patient was “non-verbal”. The patient was pronounced on 06/23/2024. The Senior Leader for Clinical Operations documented on 06/27/2025 that the patient died in pain and did not receive pain medication. In an interview conducted with the Registered Nurse/QAPI Coordinator on 08/07/2025, it was stated that the patient did not receive medications to provide effective treatment of pain and agitation.”

“It is required that the hospice Interdisciplinary Group, in consultation with the individual’s attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed, the agency did not ensure that the hospice interdisciplinary team completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. CLINICAL RECORD 1: This patient elected the hospice benefit 07/17/2025 with a terminal diagnosis of senile degeneration of the brain. Clinical record review revealed that the Chaplain called the daughter on 07/28/2025, and the spiritual assessment, completed as part of the initial comprehensive assessment, was conducted by the Chaplain on 07/29/2025, a total of 12 days after the patient elected the hospice benefit. In an interview conducted with the Administrator/Clinical Manager on 08/07/2025, it was stated that the Chaplain was new to this position and would be provided further training.”

“It is required that the hospice’s policies and procedures define a system of communication and integration that sustains coordination of services and provides documentation of exchange of information. The policies and procedures ensure that care and services provided are in accordance with the plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed, the agency did not ensure that the care and services were provided in accordance with the plan of care. CLINICAL RECORD 5: This patient elected the hospice benefit on 06/20/2024 with a terminal diagnosis of protein calorie malnutrition. The plan of care reviewed for the dates of 06/20/2024-06/23/2024 and included orders for a comfort kit. On 06/22/2023, the RN made a visit and stated the comfort kit had not been delivered. The patient was pronounced on 06/23/2024. The Senior Leader for Clinical Operations documented on 06/27/2025 that the patient died in pain and did not receive the pain medication.”

“It is required that nursing care and services are provided by or under the supervision of a registered nurse and per the patient plan of care. Nursing services ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed, the agency did not ensure that the nursing needs of the patient were met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. CLINICAL RECORD 5: This patient elected the hospice benefit on 06/20/2024 with a terminal diagnosis of protein calorie malnutrition. On 06/27/2024 the Senior Leader for Clinical Operations (SLCO) documented that there had been a “clinically significant medication issue”. The agency documented that a comfort kit had been ordered for the patient on 06/19/2025 per the request of the assisted living facility (ALF) nurse prior to admission to hospice. The nurse’s note for 06/21/2024 documented the patient was experiencing pain at 10/10 and severe agitation. In an interview with the Registered Nurse (RN) on 08/07/2025, it was stated that this nurse reached out to the Senior Leader for Clinical Operations because the comfort medications had not arrived. She was instructed to go to Staples and fax a script to the Hospice Medical Director because he was out of the country and could only receive faxes. Once the RN arrived at Staples, she was instructed to go back to the ALF. The RN returned to the ALF and then left. There was no documentation present of the patient’s pain level or agitation at the time the RN left. On 06/22/2023, the RN made a visit and stated that the comfort pack had not arrived. It was documented that “patient states he is not uncomfortable because of pain” and that patient was transitioning to the end-of-life process. It was also documented that patient was “non-verbal”. The patient was pronounced on 06/23/2024. The Senior Leader for Clinical Operations documented on 06/27/2025 that the patient died in pain and did not receive pain medication. In an interview with the Administrator/Clinical Manager on 08/07/2025, it was stated that she had been out of the state during the time of this patient’s hospice admission. She stated that she was never notified of the issue with the patient not receiving the comfort kit, but the process was for the ALF to obtain the comfort kit from the ALF pharmacy. She believed that it was never delivered to the patient. The RN that assessed the patient on 06/21/2025 stated that she did not contact the Hospice Medical Director as he was out of the country and she had no number to contact him. When asked if the Alternate Hospice Medical Director was available, it was stated that he was available, but the RN was told by the SLCO that the SLCO would contact the physician. This SLCO was no longer employed at the time of this site visit. The Administrator stated that the agency did not ensure that the patient’s needs were met and the patient never received the medications for pain or agitation.”

“It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The hospice documents the cost savings achieved through volunteers. Documentation includes the identification of each position that is occupied by a volunteer, the work time spent by volunteers occupying those positions, and estimates of the dollar costs that the hospice would have incurred if paid employees occupied the positions noted in Item 1 and for the durations noted in Item 2. This standard was not met as evidenced by document review and interview. A review of the documentation of the volunteer hours that were provided for 2024 per the Annual QAPI Report for 2024 did not equal five percent of the total patient care hours of all paid hospice employees and contract staff. In an interview conducted with the Volunteer Coordinator on 08/07/2025, it was stated that the volunteer hours did not meet the five percent requirement at this time, but she was new to the role and there were currently two volunteers onboarded. The percentage for 2024 was (0.0%) A review of the documentation of the volunteer hours that were provided for 2024 per the Annual QAPI Report for 2024 did not equal five percent of the total patient care hours of all paid hospice employees and contract staff. In an interview conducted with the Volunteer Coordinator on 08/07/2025, it was stated that the volunteer hours did not meet the five percent requirement at this time, but she was new to the role and there were currently two volunteers onboarded. The percentage for 2024 was (0.0%)”

“It is required that the hospice provides an initial orientation for each employee that addresses the employee’s specific job duties, including infection control and organization procedures and policies and procedures on advance directives. Orientation on the hospice philosophy is also provided to all employees and contracted staff who have patient and family contact. Orientation includes the following, as appropriate to the employee’s specific job duties: the needs and concerns of patients and families coping with a terminal illness and education regarding the hospice’s policies and procedures on advance directives. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) personnel records reviewed, it was revealed that the agency did not ensure that Orientation included the following, as appropriate to the employee’s specific job duties: the needs and concerns of patients and families coping with a terminal illness. PERSONNEL RECORD 1: This Registered Nurse Case Manager was hired on 05/22/2023. The personnel record was reviewed for the years of 2023, 2024, and 2025. There was no evidence of hospice specific orientation which included the hospice philosophy. In an interview conducted with the Human Resources Director on 08/07/2025, it was stated that the hospice orientation was missing. The HR Director stated this nurse worked mainly in home health upon hire. She stated that the agency would ensure that the employee receive orientation to the hospice philosophy.”

“It is required that the hospice medical director or physician designee reviews the clinical information for each patient being evaluated for admission and provides written certification that it is anticipated that the patient’s life expectancy is six months or less if the illness runs its normal course. The physician considers the following when making this determination: Current subjective and objective medical findings. This standard was not met as evidenced by clinical record review and interview. In 1 of 11 (9%) clinical records reviewed, the agency did not ensure that the Hospice Medical Director reviewed document review of current subjective and objective medical findings for each patient being evaluated for hospice services. CLINICAL RECORD 3: This patient elected the hospice benefit on 03/01/2023 with a terminal diagnosis of essential hypertension. The CTI dated 12/12/2023 documented “82 yo male, seen in his home for F2F certification on 12/12/23. Mr. Bhatti was recently hosp”. This written certification did not consider current subjective and objective findings. In an interview conducted with the Administrator/Clinical Manager on 08/07/2025, it was stated that the CTI did not include the information that was necessary to support the hospice eligibility.”

“It is required that the Interdisciplinary Group ensures instruction of the patient, as appropriate, and the family and/or other caregivers on the proper handling, storage, and safe utilization of durable medical equipment and/or supplies. This standard was not met as evidenced by clinical record review and interview. In 2 of 11 (18%) clinical records reviewed, the agency did not ensure that the patient, as appropriate and the family and/or other caregivers were instructed on the proper handling, storage, and safe utilization of durable medical equipment and/or supplies. CLINICAL RECORD 3: This patient elected the hospice benefit on 03/01/2023 with a terminal diagnosis of essential hypertension. Clinical record review revealed physician orders for a glucometer, hospital bed, and incentive spirometer on 03/01/2023. There was no documented evidence in the clinical record that the patient and/or caregiver were instructed on the proper handling, storage, and safe utilization of the durable medical equipment ordered for the patient. CLINICAL RECORD 5: This patient elected the hospice benefit on 06/20/2024 with a terminal diagnosis of protein calorie malnutrition. Clinical record review revealed physician orders for a bedside commode, hospital bed and concentrator on 06/20/2024. There was no documented evidence in the clinical record that the patient and/or caregiver were instructed on the proper handling, storage, and safe utilization of the durable medical equipment ordered for the patient. During an interview and joint review of records on 08/06/2025, the Administrator/Clinical Manager stated there was no documentation in the clinical record of DME education provided to the patient.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: hospice election form and any advance directives. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 1(100%) home visits conducted in a skilled nursing facility (SNF), the agency did not ensure that the SNF was provided with a hospice election form and any advance directives. HOME VISIT 1/ CLINICAL RECORD 1: This patient elected the hospice benefit on 07/18/2025 with a terminal diagnosis of senile degeneration of the brain. During the home visit conducted in the skilled nursing facility (SNF) (Clinical Record 1) on 08/05/2025 to observe the Registered Nurse (Personnel Record 1), the hospice binder was reviewed and there was no documentation present for the hospice election form. An interview was conducted with the Administrator/Clinical Manager on 08/05/2025 and it was stated that the agency would ensure that the hospice election form would be added to the hospice binder in the SNF.”

“It is required that the designated IDG member provides the SNF/NF or ICF/IID with the following information for each patient/resident: physician certification and recertification of the terminal illness. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 1 (100%) home visits conducted in a skilled nursing facility (SNF), the agency did not ensure that the SNF was provided with the physician certification and recertification of the terminal illness. HOME VISIT 1/ CLINICAL RECORD 1: This patient elected the hospice benefit on 07/18/2025 with a terminal diagnosis of senile degeneration of the brain. During the home visit conducted in the skilled nursing facility (SNF) (Clinical Record 1) on 08/05/2025 to observe the Registered Nurse (Personnel Record 1), the hospice binder was reviewed and there was no documentation present of the physician certification of illness. An interview was conducted with the Administrator/Clinical Manager on 08/05/2025 and it was stated that the agency would ensure that the physician certification of terminal illness would be added to the hospice binder in the SNF.”