Hospice of the Northwest

“It is required that the documented comprehensive assessment includes a drug profile that contains the patient’s current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation, and interview. 2 of 6 (33%) observed home visits revealed that the agency did not ensure the drug profiles included the patients’ current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. HOME VISIT 5: The patient elected the hospice benefit on 12/09/2025 with a diagnosis of Huntington’s disease. The patient resided in a skilled nursing facility (SNF). During the observed home visit with the Registered Nurse (RN - Personnel Record 4) on 03/03/2026 the hospice medication profile (printed on 03/02/2026) was compared to the SNF medication profile (printed on 03/03/2026). The hospice medication profile included the following medications not listed on the SNF list: “Lorazepam 2 mg, 1 tablet daily (ordered 01/15/2026); Clonazepam 2 mg,1-2 tablets every 4 hours as needed (ordered 12/09/2025); Lorazepam 2 mg, 1 tablet every 2 hours as needed (ordered 12/23/2025). The SNF medication profile contained the following medications not listed on the hospice list: “Milk of Magnesia 30 ml, daily as needed (ordered 12/09/2025); Fleet enema, daily as needed (ordered 12/09/2025). The following discrepancies were noted: The hospice medication profile included Depakote 250 mg, 1 tablet 3 times a day (ordered 12/23/2025); and the SNF list included Depakote 250 mg/5 ml, give 5 ml twice daily; Additionally the hospice medication profile included Lactulose 15-60 ml daily as needed (ordered 12/09/2025); and the SNF medication list documented Lactulose 15 ml daily as needed (ordered 12/09/2025). The last comprehensive nursing visit was on 02/23/2026. HOME VISIT 6: The patient elected the hospice benefit on 01/27/2026 with a diagnosis of heart failure. The patient resided in an adult family home (AFH). During the observed home visit with the Hospice Aide (HA - Personnel Record 8) on 03/04/2026 the hospice medication profile (printed on 03/02/2026) was compared to the AFH medication profile (printed on 03/04/2026). The AFH medication profile included the following medications not listed on the hospice list: Nystatin 100000units/ml, four times daily (ordered 01/26/2026); Omeprazole 20 mg, 1 capsule daily (ordered 01/26/2026); Olanzapine 5 mg, twice daily as needed (ordered 01/26/2026). The following discrepancies were noted: the Hospice medication profile documented Olanzapine 5 mg, 2 times a day (ordered 02/02/2026); and the AFH medication list documented Olanzapine 5 mg tablet ,1 time daily (ordered 01/26/2026). Additionally, the Hospice medication profile documented Ipratropium-Albuterol every 4 hours as needed (ordered 01/27/2026); and the AFH medication list documented Ipratropium-Albuterol daily as needed (ordered 01/27/2026).” The last comprehensive nursing visit was on 02/23/2026 A joint clinical record review and interview was conducted with the Clinical Manager on 03/04/2026 during which time it was stated that “medication reconciliations were expected to be completed with every nursing visit.””

“It is required that the comprehensive assessment includes an initial bereavement assessment of the needs of the patient’s family and other individuals, focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. This standard was not met as evidenced by clinical record review, document review and interview. 2 of 23 (9%) clinical records reviewed revealed the agency did not ensure the comprehensive assessments included an initial bereavement assessment of the needs of the patient’s family and other individuals. Agency policy, titled “Bereavement Program”, PFC:B10, Original effective date 11/02/2010, current effective date 10/10/2025, stated in relevant part(s): “On admission to hospice: 1. Hospice social workers will complete a pre-death bereavement assessment for each primary bereaved. If the hospice social worker is declined, the pre-death bereavement assessment will be completed by the spiritual counselor or nurse. 2. The interdisciplinary group (IDG) will continue to gather pertinent information regarding the identified primary bereaved. This information is recorded in the patient’s clinical record....” CLINICAL RECORD 21: A clinical record review was performed on 03/05/2026 for a patient who elected the hospice benefit on 10/17/2025 and died on 11/25/2025. The only information documented for the initial bereavement risk assessment was the name of the primary bereaved. The clinical record did not include documentation of a full risk assessment that focused on the bereaved’s ability to cope with the patient’s death. CLINICAL RECORD 22: A clinical record review was performed on 03/05/2026 for a patient who elected the hospice benefit on 05/09/2025 and died on 06/20/2025. The only information documented for the initial bereavement risk assessment was the name of the primary bereaved. The clinical record did not include documentation of a full risk assessment that focused on the bereaved’s ability to cope with the patient’s death. An interview and joint clinical record review was conducted on 03/05/2026 with the Manager of Integrative Services regarding the lack of documentation of a bereavement risk assessment. She replied that it was “currently non standardized and inconsistent in where to document the bereavement risk assessment. Probably captured in IDG (interdisciplinary group) discussion as opposed to EMR (electronic medical record).””

“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. 1 of 23 (4%) clinical records reviewed revealed the agency did not ensure the patient’s individualized written plan of care Identified planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 18: The plan of care (POC) for the benefit period dated 11/03/2025 to 01/19/2026 included a problem, dated 11/04/2025, titled “Risk for skin impairment” and “Intervention: skilled observation and assessment of integumentary status.” The patient resided in a skilled nursing facility (SNF). A nursing visit dated 12/19/2025 documented the following: “Dressings (foam 4x4) to bilateral LE (lower extremity) peeled back to view wounds then reinforced. RLE (shin) almost healed. Approximately 2 mm x 2 mm small pink open area. LLE (anterior shin) approximately 5 mm x 5 mmm pink open area with scant tan drainage. LLE (lateral shin): almost healed approx 2mm x 2mm small pink open area.” A nursing visit dated 01/02/2026 documented the following: “Dressings to LE 1 to RLE, 2 to LLE are CDI (clean, dry and intact), due to be changed tomorrow. He reports the small wounds are improving.” A nursing visit dated 01/09/2026 documented the following: “No changes to small 3 wounds on LE. Facility applying Medihoney to wound beds, covering with foam dressing.” The POC was not updated to specifically reflect the wounds identified during these nursing visits or coordination between the hospice and facility staff of the SNF for care of the wounds. A joint clinical record review and interview was conducted with the Clinical Manager on 03/06/2026 during which time it was stated that the “facility staff are doing the wound dressings but we should have captured it for our care plan.””

“It is required that a hospice aide provides services included in the plan of care. This standard was not met as evidenced by clinical record review and interview. In 2 of 17 (12%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aides provided services included in the plans of care. CLINICAL RECORD 6: The patient elected the hospice benefit on 01/27/2026. The HA care plan dated 02/10/2026 included the following tasks: “Adult brief change, apply lotion, apply silicone barrier, assist with personal care, assist with dressing, change bed linens, clean and file fingernails, toenails, comb or brush hair, document last BM (bowel movement), shampoo hair, trim fingernails and toenails on the first visit on the month, seated shower, perineal care, shampoo hair, transfer to or from shower/tub.” All tasks were to be completed every visit unless otherwise noted with an aide visit frequency of twice weekly. The hospice aide visit dated 02/23/2026 noted the following tasks were completed: “trim fingernails and toenails.” These were not scheduled as it was the last visit of the month and they had been completed on the hospice aide visit on 02/11/2026. CLINICAL RECORD 22: The patient elected the hospice benefit on 05/09/2025 and died on 06/20/2025. The HA care plan dated 05/09/2025 included the following tasks: “Adult brief change, apply lotion, apply silicone barrier, assist with personal care, assist with dressing, change bed linens, clean and file fingernails, toenails, comb or brush hair, document last BM, shampoo hair, trim toenails, seated shower, perineal care, shampoo hair, transfer to or from shower/tub.” All tasks were to be completed every visit unless otherwise noted with an aide visit frequency of twice weekly. The hospice aide visit dated 06/03/2025 noted the following: “Seated shower: No. Bed bath given.” Bed bath was not an assigned task on the HA care plan. A joint clinical record review and interview was conducted with the Clinical Manager on 03/05/2026 during which time it was agreed the “aides should not vary from the plan of care without specific direction from a registered nurse.””

“It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care, or to the patient’s community attending physician upon hospice discharge, (and) includes at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. This standard was not met as evidenced by clinical record review, document review and interview. 1 of 2 (50%) clinical records reviewed, in which a discharge summary was required, revealed the agency did not ensure the patient’s discharge summary included at least a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. Agency policy, titled “Discharge From Hospice Care”, Policy CES:D15, Original effective date 11/17/2010, current effective date 07/11/2025, stated in relevant parts, “6. The discharge summary includes: a. The reason for discharge; b. The attendings physician’s (if any) support of and/or concerns with the planned discharge; c. A summary of the patient’s stay including treatments, symptoms and pain management; d. The patient’s most recent comprehensive assessment; e. The patient’s latest physician orders; and f. Any other documentation that will assist in post-discharge continuity of care.” CLINICAL RECORD 20: The patient elected the hospice benefit on 06/08/2025 and chose to revoke the hospice benefit on 07/04/2025. The discharge summary dated 07/04/2025 included the following note: “PRN (as needed) visit at hospital due to patient seeking treatment and requesting revocation. Visit patient in his room and discussed revocation. Patient reports his symptoms were too much to handle and he has not eaten in 4-5 days. He states he may have surgery. He is interested in coming back to hospice services after treatment. He is aware the referral process may take several days. Revocation paperwork signed and emailed to medical records.” The discharge summary did not include at least a summary of the patient’s hospice stay including treatments, symptoms and pain management. An interview and joint clinical record review was conducted with the Director of Quality and the Clinical Manager on 03/06/2026 during which time it was agreed that the discharge summary narrative note written by the nurse “did not meet the requirements, although a verbal report was most likely given to the hospital staff receiving the patient.””