Generations Hospice

“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; Other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following, the effectiveness of drug therapy. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 19 (5%) clinical records reviewed the agency did not ensure that all of the patient’s current medications were included in the patient’s drug profile and reviewed for the effectiveness of drug therapy. Agency Policy 2-004.1, Medication Profile (dated 05/11/2020), stated in part, “Upon admission to hospice, the admitting nurse will initiate a medication profile to document the current medication regimen, including over-the-counter (OTC) medications, nutritional supplements, herbal remedies, vitamins and minerals, and oxygen therapy...A drug regimen review will be performed at the time of the initial and comprehensive assessment, when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with the addition of a new medication.” CLINICAL RECORD 9: The patient elected the hospice benefit on 08/27/2025. A physician’s order dated 08/27/2025 read in part, “Acetic Acid 0.25% solution, flush foley catheter with 60ml (milliliters) three times per week.” The patient’s medication profile dated 08/27/2025 did not include Acetic Acid solution therefore it was not included in the medication review process. During a joint record review and interview on 09/30/2025, the Director of Clinical Operations confirmed the above finding and stated, “The patient’s medication profile should have had the Acetic Acid solution included.””

“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; Other alternative treatments that could affect drug therapy. The medication review process includes the identification of the following, the effectiveness of drug therapy. This standard was not met as evidenced by clinical record review, document review and interview. In 1 of 19 (5%) clinical records reviewed the agency did not ensure that all of the patient’s current medications were included in the patient’s drug profile and reviewed for the effectiveness of drug therapy. Agency Policy 2-004.1, Medication Profile (dated 05/11/2020), stated in part, “Upon admission to hospice, the admitting nurse will initiate a medication profile to document the current medication regimen, including over-the-counter (OTC) medications, nutritional supplements, herbal remedies, vitamins and minerals, and oxygen therapy...A drug regimen review will be performed at the time of the initial and comprehensive assessment, when updates to the comprehensive assessments are performed, when care is resumed after a patient has been placed on hold, and with the addition of a new medication.” CLINICAL RECORD 9: The patient elected the hospice benefit on 08/27/2025. A physician’s order dated 08/27/2025 read in part, “Acetic Acid 0.25% solution, flush foley catheter with 60ml (milliliters) three times per week.” The patient’s medication profile dated 08/27/2025 did not include Acetic Acid solution therefore it was not included in the medication review process. During a joint record review and interview on 09/30/2025, the Director of Clinical Operations confirmed the above finding and stated, “The patient’s medication profile should have had the Acetic Acid solution included.””

“It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following, medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed the agency did not ensure that all medical supplies and appliances necessary to meet the needs of the patient were included in the patient’s individualized written plan of care. CLINICAL RECORD 8: The patient elected the hospice benefit on 05/16/2025 with a diagnosis of malignant neoplasm of the female breast. The plans of care dated 05/16/2025 through 08/13/2025 and 08/14/2025 through 11/11/2025 ordered, “Oxygen 1-5 liters via facemask as needed for shortness of breath.” The plans of care lacked documentation of the patient’s oxygen concentrator and oxygen supplies. CLINICAL RECORD 19: The patient elected the hospice benefit on 05/15/2025 with a diagnosis of cerebral atherosclerosis. The plan of care dated 05/15/2025 through 08/12/2025 ordered, “Oxygen 1-5 liters via nasal cannula as needed for shortness of breath.” The plan of care lacked documentation of the patient’s oxygen concentrator and oxygen supplies. During joint record reviews and interviews on 09/30/2025 and 10/02/2025, the Director of Clinical Operations confirmed the above findings that oxygen supplies were not included in the patients plans of care.”

“It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) clinical records reviewed, with hospice aide services provided, it was revealed that the agency did not ensure that all written patient care instructions were included in the hospice aide care plan. CLINICAL RECORD 11: The patient elected the hospice benefit on 04/10/2024. A physician’s order dated 06/12/2025 ordered wound care, with a dressing, to the wound on the patient’s right arm. The plan of care dated 06/04/2025 through 08/02/2025 ordered “Hospice aide 3 times per week.” The hospice aide care plan dated 05/07/2025 included relevant instructions of “Bed bath every visit.” The hospice aide care plan was not updated to include instructions regarding what the hospice aide should do if the wound dressing becomes wet or dislodged during the bed bath. During a joint record review and interview on 10/01/2025, the Director of Clinical Operations confirmed the above finding and stated, “We have a performance improvement plan that we have been working on over the last several months to help make sure that all patient care is included in the aide care plans.””

“It is required that hospice aides are supervised by a registered nurse who makes 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 ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 1 of 18 (6%) clinical records reviewed, with hospice aide services provided, it was revealed that the agency did not ensure that hospice aide supervisory visits were completed by a registered nurse no less frequently than every 14 days. CLINICAL RECORD 11: The patient elected the hospice benefit on 04/10/2024. The plan of care dated 08/08/2024 through 10/06/2024 ordered, “Hospice Aide one (1) time per week.” The first hospice aide visit was dated 08/09/2024. The record included a hospice aide supervisory visit was dated 09/17/2024. The next documented hospice aide supervisory visit was dated 10/02/2024, 15 days later and 1 day outstanding. During a joint record review and interview on 10/01/2025, the Director of Clinical Operations confirmed the above finding that hospice aide supervisory visits were not completed within the 14 days as required.”

“It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum, physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed the agency did not ensure that all physician’s orders were included in the patient’s clinical record. CLINICAL RECORD 14: The patient elected the hospice benefit on 02/25/2025 and resided in a skilled nursing facility (SNF). A nursing visit note dated 04/17/2025 read in part, “Patient had a 16 French foley catheter placed by facility staff yesterday.” The record lacked documentation of a physician’s order for the foley catheter. During a joint record review and interview on 10/01/2025, the Director of Clinical Operations confirmed the above finding that a physician’s order for the foley catheter was not included in the patient’s clinical record.”