Tropical Health LLC A Health and Hospice Service

“It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure the plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 10: The patient elected the hospice benefit on 12/30/2024 with a terminal diagnosis of senile degeneration of the brain. The initial comprehensive assessment dated 12/30/2024 included documentation that the patient was experiencing constipation. The plan of care dated 12/30/2024 to 02/05/2025 did not include interventions related to the patient’s constipation. During an interview on 02/05/2026 with the Executive Vice President (EVP) and the Hospice Medical Director, it was stated that the patient’s family used homeopathic interventions to address constipation. The EVP stated that there was a learning curve with the nurse understanding how to add interventions to the plan of care, and the RN (Registered Nurse) staff would be re-educated to make sure the plan of care included interventions for problems that were noted in the assessments.”

“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. This standard was not met as evidenced by document review and interview. The agency did not ensure hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent of the total patient care hours of all paid hospice employees and contract staff. A joint review of the agency report titled “Hospice Volunteer Requirement Report” with the Executive Vice President and the Volunteer Coordinator on 02/04/2026 revealed that the volunteer utilization was 2.441% for the year of 2025, which did not meet the requirement of five percent of the total patient care hours of all paid hospice employees and contract staff. During an interview on 02/04/2026, the Volunteer Coordinator and the Executive Vice President stated that it had been challenging to recruit volunteers because of the unique culture in the community and stated many people were resistant to get involved. The agency had initiated a performance improvement project to re-build the volunteer program. A joint review of the agency report titled “Hospice Volunteer Requirement Report” with the Executive Vice President and the Volunteer Coordinator on 02/04/2026 revealed that the volunteer utilization was 2.441% for the year of 2025, which did not meet the requirement of five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.”

“It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed with patient live discharge, the agency did not forward a copy of the hospice discharge summary to the patient’s attending physician. CLINICAL RECORD 12: The patient elected the hospice benefit on 09/03/2024 with a terminal diagnosis of chronic obstructive pulmonary disease. The patient was discharged on 03/02/2025 for extended prognosis greater than 6 months. Clinical record review revealed no documented evidence that the attending physician was forwarded a copy of the hospice discharge summary. During an interview on 02/04/2026 with the Executive Vice President and the Administrator, it was stated that after an extensive review of the clinical record, there was no documentation that the discharge summary was sent to the attending physician.”