Every finding on record at Accentcare Hospice & Palliative Care of Houston - North, LLC

Based on record review and interview, the agency failed to document the client's record of the IDT's inclusion of FM's involvement in the plan of care for one of seven (Patient #4) patients whose clinical records were reviewed, in that,The agency failed to include Patient #4 FM’s involvement in the hospice plan of care for Patient #4's anticipated death. This failure placed patients FM not readily available during the patient transitioning. --- Findings Patient #4: Review of Patient #4's CR revealed SOC on 08/18/2023 for routine home care. The POC for the recertification period from 02/03/2026 to 02/12/2026 showed primary diagnosis of degenerative disease of nervous system, unspecified (progressive condition that gradually damages nerve cells in the brain and spinal cord, leading to impaired movement, cognition, and autonomic functions.) The orders for discipline and treatments included:SN effective 2/03/2026 once a week for nine weeks (1WK9); 3PRN for symptom management, crisis management.SW effective 2/03/2026 once every four weeks for eight weeks (1EVERY4WK8); 2PRN for coping, crisis managementHHA effective 2/03/2026, twice a week for nine weeks (2WK9) 5 times/week,CH effective 2/03/2026 once every two weeks for eight weeks (1EVERY2WK8); 1PRN for spiritual support, crisis management Review of Patient #4 IDG comprehensive Assessment and POC updated report dated 02/10/2026 revealed no involvement of the FM when Patient #4 was identified with poor prognosis and need to increase SN to daily visits due to client decline effective on 02/08/2026 and prior to IDG meeting on 02/10/2026. During interview on 05/07/2026 with AA at 11:25a.m., she was asked for the assigned staff responsible for documenting family involvement in the IDG plan of care with the Patient #4’s FM. AA stated RN/CTL was the responsible staff and nurse case manager doing the visit/assessment was responsible in notifying the FM. AA stated she was not aware that IDG POC does not include the patient’s FM involvement and would review this with the agency’s compliance team. During telephone interview on 05/07/2026 with the assigned IDT RN/CTL at 11:40 a.m., she was asked for the reason the updated IDG/POC did not include Patient #4’s FM involvement. RN/CTL stated she had worked in the past as the case manager and knew how to involve FM, usually during quarterly meetings with the ALF because the client lived at a facility. RN/CTL added that Patient #4’s FM preferred to be contacted via text messages for update and changes in Patient #4’s status and not including the involvement in updated IDG/POC was an oversight.   Review of the agency's policy titled "Interdisciplinary Group Coordination of Care" last revised 12/29/2025 revealed in part, 2. The type and scope of services provided by the IDG are based upon comprehensive assessment and ongoing assessments to meet the needs of the patient and chosen family/caregiver, are unique to each unit, and change as needs evolve.4. The IDG, including those providing contracted services, is responsible to:C. Participate in the established of the care plan for each patient and chosen family/caregiver...E. Utilize a case management system to coordinate care to patients and chosen family/caregiver Facilitate communication about changes in the patient's status between IDG members..."H. Encourage active involvement of the patient and chosen family/caregiver in the development and implementation care plan.I. Prepare a plan working with the patient and chosen family/caregiver for the patient's anticipated death."

Observed in Record Review. In 2 of 18 patient records reviewed, The organization failed to assess the need for volunteer services or follow up if requested to offer support or respite to the patient, family, or other caregivers as evidenced in RRNHV#4: Volunteer requested @ initial comprehensive visit but no referral made. RRNHV#7: No volunteer assessed @ initial comprehensive assessment, this was observed and validated by Director of Clinical Operations Observed in Record Review. In 2 of 18 patient records reviewed, The organization failed to assess the need for volunteer services to offer support or respite to the patient, family, or other caregivers as evidenced in RRNHV#9 & RRNHV#10: No volunteer assessed at SOC, this was observed and validated by the Director of Clinical Operations

Observed in Record Review. In 3 of 18 patient records reviewed, The organization failed to assesses and reassesses its patients as goals remained the same into the next benefit period as evidenced in RRNHV#1: Goals Patient will demonstrate decreased symptoms related to depression in the next 14 days AEB engaging in MT sessions through verbal discussion of music, lyrics and life review RRNHV#2: Patient/family/ symptoms of anxiety or agitation will be decreased in benefit period AEB patient and family report decreased anxiety. RRNHV#5: CG will verbalize understanding of risks v's benefits of pleural drain and that these will be reviewed every 14 days based on patients changing condition. this was observed and validated by the Director of Clinical Operations Observed in Record Review. In 5 of 18 patient records reviewed, The organization failed to assess and reassess its patients as evidenced by goals remained the same into next benefit period in the following records. RRNHV#3: Care coordination services will be initiated within 5 days of request this goal on care plan since admission. RRHV#5: patient will report pain ( physicial, emotional, spiritual) is at an acceptable level within 3 weeks continued . RRHV#6: patient/facility staff will demonstrate interventions to minimize fall risk and maximize safety at each visit AEB the patient will remain injury free within the next 2 weeks. RRNHV#1: Goals remained the same into next benefit period:Patient will demonstrate decreased symptoms related to depression in the next 14 days AEB engaging in MT sessions through verbal discussion of music, lyrics and life review. RRVNHV#9:Patient symptoms of anxiety or agitation will be decreased every 14 days AEB patient showing calming behaviors. RRNHV#10: No plan of care updates for 90 days and patient has a wound that had healed RRNHV#10: Wound measurements or assessment not done for 18 days, this was observed and validated by Director of Clinical Operations

Observed in Record Review. In 4 of 18 patient records reviewed, The organization failed to create measurable outcomes anticipated from implementing and coordinating the plan of care as evidenced in RRHV#1 goal was patient/family/caregiver to verbalize need for transmission based precautions with the scope of their disease process and demonstrate precautions during each visit during the cert period. RRHV#2: patient/family will understand O2 safety and effectively. RRHV#6: Chaplain will provide patient/family/ Cg with faith rituals and spiritual support including sharing inspirational stories and recorded inspirational stories and music. RRNHV#1: Patient/family/CG will verbalize need for transmission based precautions with the scope of their disease process and demonstrate precautions during each visit during the cert period this was observed and validated by Director of Clinical Operations

Observed in Record Review. In 1 of 18 patient records reviewed, The plan of care failed to include all services needed for the management of all related conditions as evidenced in RRNHV#2: Patient is a diabetic, on insulin and there is no management of diabetes in care plan or education to patient/family, this was observed and validated by Director of Clinical Operations

Observed in Record Review. In 2 of 18 patient records reviewed, The organization failed to maintains complete and accurate patient records as evidenced is RRHV#1; during home visit it was observed that patient was on 4 litres of oxygen which RN note confirms, order in EMR is for 2 litres of oxygen and RRHV#4: Patient on 3 litres of oxygen and ordered 2 litres, this was observed and validated by Director of Clinical Operations

Observed in Proficiency Testing. In 1 of 6 home visits conducted, The organization failed to implement activities for the prevention and control of infections and communicable diseases as evidenced in RRHV#1: The RN disposed of bloodstained dressing in garbage can at bedside in SNF, without fastening/sealing bag as per policy Medical Waste Management 4006 Protocol this was observed and validated by Director of Clinical Operations

Observed in Record Review. In 1 of 18 patient records reviewed, The organization failed to provide accurate written patient care instructions for the hospice aide HHA care plan as evidenced in RRNHV#5: had no specific precautions for pleural drain dressing, this was observed and validated by the Director of Clinical Operations Observed in Record Review. In 5 of 18 patient records reviewed, The organization failed to plan the patient’s specific precautions in the HHA care plan as evidenced in RRHV#1: there was no aspiration precautions/PEG tube care specific precautions, RRHV#2; did not specify bleeding or fall specific precautions. RRHV#3: fall and oxygen precautions not specified. RRHV#5: wound care specific precautions or safety in transferring of patients not specified. RRHV#6: use of assistive devices for transfer was not specified, this was observed and validated by the Director of Clinical Operations. Observed in Record Review. In 4 of 18 patient records reviewed, The organization failed to provided specific written patient care instructions for the HHA care plan as evidenced in RRNHV#3: HHA care plan did not include wound dressing specific precautions. RRNHV#9: HHA did not have specific precautions for the aide to verify that the caregiver had given the PRN lorazepam prior to scheduled bath. RRNHV#10:HHA care plan no g-tube precautions specified. RRNHV#11: HHA care plan did not have specific instructions for the foley or wound care, this was observed and validated by the Director of Clinical Operations

Observed in Patient Home. In 1 of 6 home visits conducted, The organization failed to treat the patient in a dignified and respectful manner that supports the patient's dignity as evidenced in RRHV#2: when checking patients back and buttocks, patient was standing with the assistance of RN and daughter, patient was exposed to open front door, this was observed and validated by Director of Clinical Operations

Observed in HR File Review. In 1 of 9 HR files reviewed, The HCO failed to document competency of Home Health Aide annually as evidenced by the HR#5 HHA did not have a competency for 3 years this was validated by the Executive Director Observed in HR File Review. In 1 of 9 HR files reviewed, The organization failed to provide staff competence initial assessment and documented as part of orientation as evidenced in HR#4, the Chaplain's initial competency not completed, this was verified by the Executive Director

Observed in Record Review. In 1 of 18 patient records reviewed, The organization failed to maintain complete and accurate patient records as evidenced in RRNHV#4: Documentation on initial comprehensive assessment stated patient was taking Vitamin B12 shot daily for generalized weakness, and there was no order for it, this was observed and validated by Director of Clinical Operations

Observed in Record Review. In 2 of 18 patient records reviewed, The hospice plan of care failed to identify the care and services that are needed and identifies which provider is responsible for performing the functions that have been agreed upon and included in the plan of care. This was identified in RRHV#1 plan of care did not include SNF responsibilities in providing care for the patient. RRHV#5:Patient ordered cipro 500mgs BID x 5 days, nursing note did not have documentation that assisted living staff were notified this was observed and validated by the Director of Clinical Operations

Observed in Patient Home. In 1 of 6 home visits conducted, The hospice failed to provide the SNF with the patients election forms and CTIs in RRHV#1, this observed and validated by the Director of Clinical Operations. This was resolved during the survey.

Based on interview and record review, the hospice failed to maintain a system of communication and integration, in accordance with the hospices own policies and procedure to ensure that the care and services provided are based on all assessments of the patient and family needs for 1 of 2 patients reviewed (patient #1) in that: The hospice did not provide bereavement support to patient #1s FM as needed by the caregiver during the dying process. This failed practice may result in ineffective grief pattern of patients family/caregiver due to the hospice not ensuring that adequate bereavement support was available for the family/caregiver. --- Findings Include: Review of patient #1s CR revealed SOC on 1/18/23 and terminal diagnosis of malignant neoplasm (cancer) of pancreas (an organ that helps with digestion and helps control sugar level of the body), unspecified. POC completed 1/18/23 included frequency of visits: SN 2 times week 1 & 1 every week for 12 weeks, MSW 1 week 1, CH 1 week 1, MU 1 week1. MSW to evaluate social, emotional, and financial factors related to the patients illness, need for additional care/resources, adjustment to care and develop a plan of care. CH to evaluate patient/family/caregiver and develop a POC. Review of IDT POC completed on 1/31/23 showed MSW frequency changed effective 1/18/23, to 1 every 5 weeks for 5 weeks & 1 every 4 weeks for 8 weeks & 3 PRN visits for coping and crisis management. Review of Bereavement Risk Assessment Report completed at SOC on 1/18/23 by RN #C showed a low bereavement risk level was assessed. On 1/23/23, MSW2 completed initial assessment with risk level assessed as moderate. Review of Bereavement Risk Assessment Report completed on 2/15/23 after patient #1s death by the chaplain assessed risk level low. Review of hospice after hour call log showed a distress call from FM on 2/12/23 at 11:35 p.m. that read in part: ";Caller extremely unconsolably irate, states ";Do your job and get a nurse out here, my husband is dying". When asked to explain what exactly is going on with patient, caller repeated angrily ";Hes dying, why cant you understand that!!" Eventually caller was able to explain that ";He is SOB, agitated and trying to get OOB"." The call log also showed that FM called back again few hours later at 4:56 a.m. that the patient expired. Review of RN #A visit note showed that the nurse arrived in patient #1s home on 2/13/23 at 12:20 a.m. and left at 1:24 a.m. The note showed the nurses assessment of the patient showed the patient had heart rate of 42 bpm, arrhythmia, pallor, abnormal breath sound in all lungs with use of accessory muscles. The note also showed that RN #A assessed FM as being overwhelmed with the burden of care and exhibited inability to cope with potential loss. Review of the email communication among the care team showed the Marketer sent an email on 2/21/23 that FM called him about the hospice on-call process and nurse visits near the patients passing. The email also showed that the Marketer indicated that FM did not want to talk to any other agency staff, but the Marketer. During interview with patient #1s FM on 05/01/23 at 5:07 p.m., she stated the following: The care they received from the hospice was different from what the hospice promised before the patient signed up for the hospice. The hospice Marketer told them that the nurse would come to the patient whenever they requested to the nurse. Several times when she requested for the nurse because the patient was in distress, the nurse never visited, but told her to give the patient more medications. The evening of February 12th, 2023, she called the hospice that patient #1 was dying and she needed the nurse. It took RN #A two hours to arrive in the home, and when she did, she refused to stay. RN1 only told her (FM) to give the patient his medications and she (RN #A) left. She (FM) was left alone with patient #1 while the patient was dying. Patient #1 died shortly after RN #A left and she had to call the hospice again to inform them that the patient died. The nurse that came after patient #1 died was also rude to her. During follow-up interview with FM on 5/3/23 at 2:34 p.m., she stated that she did not tell anyone that she did not want to talk to the hospice staff. FM added that the hospice has not contacted her since patient #1 died. During interview with RN #B on 05/03/23 at 9:11 a.m., she stated that FM called on 02/12/23 that her husband was dying and RN #A made a visit to the home. FM called again around 4:00 am that the patient had expired. She (RN #B) visited the home to pronounce the patient dead. When she (RN #B) arrived at the home, FM was very upset, and complained that RN #A did not respond on time to her initial call, and when RN #A arrived, RN #A only told her to give him more medications and left. FM was very upset and rude to her (RN #B) during the visit, but she understood that FM was reacting in grief. RN #B was asked if the nurses were required to stay with patients family for support when the patient was dying. RN #B stated that if the family needed the nurse to stay, the nurse was required to stay with the family. RN #B stated that RN #A should have stayed with patient #1/FM for support when she (RN #A) responded to the initial call. RN #B stated that she did not report FMs concern as a complaint because she thought FM was only emotionally distraught because of the loss of her husband. During interview with RN #A on 05/03/23 at 9:35 a.m., she stated that she arrived at patient #1s home shortly after midnight on February 13th after the FMs call. RN #A stated that she found the patient slightly agitated. RN #A stated that she medicated the patient, and he was palliated. RN #A stated that when she told FM that she was leaving, FM was very upset and yelled ";oh, you want to leave him?". RN #A stated that she then asked FM if she wanted her to stay, and FM snapped ";you can go since you want to leave anyway". RN #A stated that she then left the patients home. RN #A was asked if patient #1 was actively dying when she assessed the patient. RN #A stated that it was difficult to determine whether the patient was dying, but the patients symptoms were palliated. RN #A was asked why she did not stay with patient #1 to provide emotional support to the FM. RN #A stated that FM did not want her to stay. When RN #A was asked if FM being upset when she (RN #A) told her she was leaving was not an indication that the FM wanted her to be there for support, RN #A stated that she probably did not stay with the FM because she had to respond to another call. RN #A stated that she did not request for anyone else to stay with the patient/FM. During interview with Marketer on 5/2/23 at 4:45 p.m., he stated that FM reached out to him sometime around 2/21/23 very upset and said she was not happy about the care the nurses provided to her husband. Marketer added that FM stated that the nurses ";just let him die". Marketer stated that he called MSW to follow-up with FM because he believed FM needed the intervention of a clinician. During interview with MSW on 5/3/23 at 8:19 a.m., she stated the following: She received an email from Marketer that FM was upset about the care provided to patient #1. She responded that she would reach out to FM, but Marketer replied that FM did not want to talk to any other hospice staff but the Marketer. Patient #1 and FM initially declined MSW visits. MSW stated that social work service can later be introduce after the patient initially declined if the nurses determined that the service was needed and notified the IDT during the meetings. MSW further stated that the IDT meetings were held every two weeks, and the team also met daily via teleconferencing for updates. MSW added that the RN did not inform the team that the family needed bereavement support. During interview with Adm on 5/3/23 at 2:38 p.m., Adm stated that patient #1/FM declined chaplain service. Adm acknowledged that services declined by patient can be later introduced if the services were required due to changes in patient/FM conditions. Adm was asked if the nurses were required to stay with stay dying patients family member for bereavement support. Adm stated that the nurses were not required to provide bereavement support, but they can stay with the patient and family if the family wanted the support. Adm added that the hospice had a support team consisting of the SW and chaplain that were responsible for providing bereavement support. Adm acknowledged that based on FMs emotional state while patient #1 was actively dying on 2/12/23, she (FM) would have benefited from a staff staying with her for support. Adm stated that RN #A did not call for bereavement support staff to stay with FM when the patient was dying. Adm was asked if the agency has reached out to FM since patient #1 expired for bereavement support. Adm stated that they have not reached out to FM because she (FM) said she did not want to talk to any staff of the hospice. During interview with Team Director on 5/3/23 at 1:58 p.m., she stated that she did not contact FM since patient #1s death because the email from the Marketer showed that FM did not want to talk to anyone from the hospice. Team Director stated that the nurses were supposed to stay with family for support when the patient was dying if the family needed the support. Team Director stated that based on the emotional state of FM while patient #1 was dying on 2/12/23, RN #A should have stayed to provide emotional support. Review of hospice policy titled ";Interdisciplinary Group Coordination of Care", revised 02/15/23, read in part: ";The interdisciplinary group, including those providing contracted services, is responsible to: A. Provide ongoing support for patient and family/caregiver." Review of hospice policy titled ";Bereavement Services", dated 04/18/23, read in part: ";An initial outreach phone call/contact will be made within seven days following every patient death. The assigned Social Worker or psychosocial counselor will call the client......"

Based on interview and record review, administrator failed in the responsibility of managing the daily operations of the agency in that: Adm did not make sure that complaint from patients FM about care provided to the patient was investigated according to the hospices policy for 1 of 2 patients reviewed (patient #1). This failed practice has the potential to harm the patients due to inadequate administrative supervision that may result in issues of substandard care delivery not being promptly identified and corrected. --- Findings Include: During interview with patient #1s FM on 05/01/23 at 5:07 p.m., she stated the following: The care they received from the hospice was different from what the hospice promised before the patient signed up for the hospice. The hospice Marketer told them that the nurse would come to the patient whenever they requested to the nurse. Several times when she requested for the nurse because the patient was in distress, the nurse never visited, but told her to give the patient more medications. She (FM) called the hospice two day after her husbands death and complained about hospice care provided by the agency, especially the care provided by the nurses in the last day of the patient. The hospice did not do anything about her complaint. When she did not hear from the hospice after a week of calling the hospice office, she then reached out to the Marketer and complained to him. The Marketer said he will contact the hospice and the hospice staff would reach out to her, but no one has since contacted her. During follow-up interview with FM on 5/3/23 at 2:34 p.m., she stated that she did not tell anyone that she did not want to talk to the hospice staff. FM added that the hospice has not contacted her since patient #1 died. Review of patient #1s CR revealed SOC on 1/18/23 and terminal diagnosis of malignant neoplasm of pancreas, unspecified. Review of the email communication among the care team showed the Marketer sent an email on 2/21/23 that FM called him crying, complaining about the hospice on-call process and nurse visits near the patients passing. The email also showed that the Marketer indicated that FM did not want to talk to any other agency staff, but the Marketer. Review of the hospice QI Event Report from January 2023 – May 2023 showed that FM complaint was not entered on the hospice complaint report. During interview with RN #B on 05/03/23 at 9:11 a.m., she stated that FM called on 02/12/23 that her husband was dying. She sent RN #A to visit the patient. FM called again around 3:00 am that the patient had expired. She visited the home to pronounce death. When she arrived at the home, FM was very upset, and complained about RN #A not responding on time to her initial call, and when RN #A arrived, she only told her to give his medications and left. RN #B stated that she did not report FMs concern as a complaint because she thought FM was only emotionally distraught because of the loss of her husband. During interview with Marketer on 5/2/23 at 4:45 p.m., he stated that FM reached out to him on sometime around 2/21/23 very upset and said she was not happy about the care the nurses provided to her husband. Marketer added that FM stated that the nurses ";just let him die". Marketer stated that he called MSW to follow-up with FM because he believed FM needed a clinician to talk to her. During interview with Adm on 5/3/23 at 1:36 pm, she was asked if the hospice received a complaint from patient #1s FM. Adm stated that she did not receive a call, but she was part of the email communication that showed that FM made a complaint. Adm was asked if the complaint was investigated. Adm stated that the Team Director or DCO was responsible was investigating patients complaints, and it was referred to her if the complaints could not be resolved. Adm stated that she did not follow-up to find out if the complaint was investigated. During follow-up interview with Adm on 5/3/23 at 2:38 p.m., she stated that every complaint received was entered in the QI event report by the employee receiving the complaint. Adm was asked why the complaint from FM was not on the QI event report. Adm stated that Marketer was the staff that received the complaint, and he should have entered the complaint on the QI event report. Adm was asked why she did not verify that the complaint was entered on the QI event report when she became aware of the complaint. Adm stated that she assumed that complaint was already entered in the QI report. During interview with Team Director on 5/3/23 at 1:58 p.m., she stated that she did not contact FM because the email showed that FM did not want to talk to anyone from the hospice. Team Director stated that she did not investigate the actual complaint in the email because she was probably preoccupied with other things. Review of hospice policy titled ";5002 Adverse Events Reports Protocol", revised 10/21/15, read in part: ";Should an employee witness an event a complaint outside of a visit, the employee will enter the QI Event using their PointCare device....." ";The DCO or designee will initiate an investigation within two business days of receipt of the QI event." ";The complete investigation should be resolved within 15 calendar days...."

Observed in Individual Tracer. In 1 of 2 home visits conducted, the organization had not ensured the weekly wound assessment included all aspects of a comprehensive wound assessment. For example the Nurse measured the wound but had not assessed for several aspects of a comprehensive wound assessment. During the same visit the Nurse had not performed a skin assessment over the entire body on a patient with fragile skin that has current wounds. This was validated by the Team Leader.

Observed in Individual Tracer. In 1 of 2 home visits conducted, the organization had not provided written instructions and evidence of training regarding care for the patient. For example, during HV2 and review of the facility record associated with this visit the Surveyor identified that there were no orders or evidence of education supporting competence of the facility staff to support consistent implementation of wound care as per the Plan of Care. This was confirmed by the Team Leader.

Observed in Record Review. In 3 of 14 patient records reviewed, the organization had not ensured the plan of care was clear in advising symptom management. For example, during review of record associated with HV2 the patient had two different doses of morphine available for pain but there was no hierarchy for which to use first or later or what type of scale is to be used by a non skilled medication passer. The second example was during review of the record associated with HV1, the patient had multiple doses of as needed hydrocodone for pain management without an identified hierarchy for use. These were confirmed by the Team Leader.

Observed in Record Review. In 3 of 14 patient records reviewed, the organization had not provided a detailed statement (order) of the scope and frequency of services necessary to meet the patients needs. For example, during RR5 the Surveyor identified that the order moving the patient from General In Patient level of care to Routine Level of Care was not clear that it was a change in from one level to another in the patients course of care. This was confirmed by the team Leader.

Observed in Record Review. In 3 of 14 patient records reviewed, the organization had not ensured that care and services were provided in accordance with the plan of care. For example during review of the record associated with HV1, RR2 and RR4 the nurse failed to complete the scheduled visits without evidence of declination by the family for the missed visit. This was confirmed by the Executive Director.

Observed in Individual Tracer. In 2 of 4 home visits conducted, the organization had not ensured the practice of universal precautions during patient care. For example, during HV4 the nurse did not sanitize her hands between glove changes and held the foot with a non gloved hand with her fingers touching the wound. This was confirmed by the Team Director. Observed in Individual Tracer. In 2 of 4 home visits conducted, the organization had not applied standard precautions while performing patient care. For example during HV2 the Nurse failed to sanitize her hands between glove changes two and three. This was validated by the Team Leader. Observed in Individual Tracer. In 1 of 2 home visits conducted, the organization had not ensured the protection from cross contamination from using cleaners that are not of sufficient strength to prevent contamination from shared use medical equipment. For example during HV2 the Nurse used a cleaning wipe that had no alcohol or other accepting disinfectant per the organizations policy. This was confirmed by the Team Leader.

Observed in Individual Tracer. In 2 of 4 home visits conducted, the organization had not ensured the record of care was complete and accurate. For example during review of the record associated with HV2 the Surveyor identified the wound was treated with medihoney but it was not reflected on the medication list or the plan of care. The second example was during HV4, the patients wound was treated with betadine but it was not reflected on the medication list. These were confirmed with the Team Director.