Every finding on record at Anthem East LLC

It is required that the documented comprehensive assessment includes a drug profile that is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added or changes are made to existing medication. 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 drug profile was updated when a new medication was added or changes made to existing medication. CLINICAL RECORD 6: The patient elected hospice on 10/29/2025 with a diagnosis of chronic obstructive pulmonary disease. The medication profile reviewed on 01/28/2025 documented "diclofenac Sodium 1% topical gel apply topically to affected area twice daily" There was no specific body site to indicate where the cream was to be applied. During an interview on 01/28/2026, the director of nursing reviewed the medication profile and verified there were no instructions for which part of the body to apply the diclofenac gel. She stated that "this had not been brought to their attention in the past and understood the reason for including the area of application going forward". She instructed the nurse to amend the medication profile to include the specific area of application. This was corrected at the time of the site visit.

It is required that each patient’s individualized written plan of care reflects patient and family goals and 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 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the individualized plan of care reflected patient goals and interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 2: The patient elected hospice on 12/30/2025 with a diagnosis of malignant neoplasm of the esophagus. The patient resided in a residential care home. The physician's order dated 01/19/2026 ordered "Ensure tube feeding formula (237ml/carton) 4 cartons once daily at 1700 via pump/PEG tube at 115ml/hour, flush with 60ml before and after feedings". The initial comprehensive nursing assessment dated 12/30/2025 documented the patient was receiving tube feedings via a percutaneous endoscopic gastrostomy (PEG) tube. The initial plan of care (POC) dated 12/30/2025 did not include interventions and goals for care of the PEG tube, flushing, insertion site care, tube feedings, and patient/caregiver education. CLINICAL RECORD 3: The patient elected hospice on 01/12/2026 with a diagnosis of malignant neoplasm of unspecified part of unspecified bronchus or lung. The nursing assessment dated 01/12/26 documented the patient had a foley catheter. The initial plan of care (POC) dated 01/12/2026 did not include interventions and goals for care of the foley catheter, including size, irrigation, when to change catheter or how to manage it if it became obstructed. During an interview on 01/28/2025, the director of nursing reviewed the record and verified the findings. She stated "the nurses have been trained to include goals and interventions in the POC for all problems identified in their assessments. This must have been an oversight". She contacted the nurse to update the POC. This was corrected during the site visit.

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 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 1 of 14 (7%) clinical records reviewed, the agency did not ensure that each patient’s individualized written plan of care included medical supplies and appliances necessary to meet the needs of the patient. CLINICAL RECORD 1: The patient elected hospice on 05/08/2025 with a diagnosis of senile degeneration of the brain. The patient was recertified on 08/16/2025-11/03/2025, 11/04/2025- 01/02/2025 and 01/03/2025 to 03/03/2025. The physician's order dated 05/08/2025 ordered incontinent supplies, O2 concentrator, 1 e-tank, bedside table, APP mattress, fall mat, hospital bed, and shower chair. The initial plan of care and plan of care updates every 2 weeks through the date of review, 01/27/2026, did not include supplies and equipment as ordered. During an interview on 01/28/2026, the director of nursing reviewed the record and verified that the supplies as listed were not entered into the plan of care. She stated that "the supplies are usually added at the time of admission or when additional supplies are ordered. The nurse must have overlooked this." She contacted the nurse and the supplies were added to the plan of care during the site visit.

It is required that written patient care instructions for a hospice aide are prepared by a RN (registered nurse) who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed of patients accepting hospice aide services, the agency did not ensure the RN prepared written care instructions for the hospice aide. CLINICAL RECORD 2: The patient elected hospice on 12/30/2025 with a diagnosis of malignant neoplasm of the esophagus. The initial nursing assessment dated 12/30/2025 documented the patient had a coccyx wound and a percutaneous endoscopic gastrostomy (PEG) tube for feedings. The hospice aide care plan dated 12/30/2025 did not include specific instructions for the coccyx wound dressing and the PEG tube dressing to protect them during bathing or what to do if either dressing was dislodged or soiled. CLINICAL RECORD 3: The patient elected hospice on 01/12/2026 with a diagnosis of malignant neoplasm of unspecified part of unspecified bronchus or lung. The initial nursing assessment dated 01/12/2026 documented that the patient had a pressure ulcer on her coccyx area with a dressing in place. The hospice aide care plan dated 12/30/2025 did not include specific instructions for the coccyx dressing during bed bath to protect it, or what to do if dressing was dislodged or soiled during bathing. During the interview on 01/28/2026, the director of nursing reviewed the records and verified that there were no specific instructions for the hospice aide for the coccyx dressing (CR2, CR3) during bathing if it should become dislodged or became soiled, and the specific instructions related to the PEG tube (CR2) for washing around the site or if the dressing became dislodged or soiled and what to report to the nurse. She stated that "the nurses have been trained to include specific instructions for the hospice aide, this must have been an oversight". The instructions were added to the hospice aide care plan during the site visit. .

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. 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 14 (7%) clinical records reviewed, the agency did not ensure that the record contained correct clinical information that is available to the patient’s attending physician and hospice staff, including physician orders. CLINICAL RECORD 10: The patient elected hospice on 11/07/2025 with a diagnosis of Alzheimer's disease. The initial nursing assessment dated 11/07/2025 documented the patient had a "stage 2 pressure wound to his left heel, wound care is difficult because the patient picks at his dressing and is still ambulatory". During the review of the record on 1/28/2026, there was no evidence of a physician's order for wound care to the pressure ulcer of the left heel. During an interview on 01/28/2025, the director of nursing reviewed the record and verified that there was no written physician's order for wound care to the left heel. She contacted the nurse who was not able to provide evidence of a written physician's order for wound care to the heel. The nurse stated, "she thought she had written it." A late entry order was written by the nurse during the interview.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review, interview and observation. 1 of 3 (33%) home visits observed revealed the agency did not ensure that the staff member used standard precautions that followed accepted standards of practice and agency policy. Document 1: The agency policy titled: Hand Washing Policies and Procedures, effective date 8/1/22 stated in relevant part, " Personnel will wash their hands: after assisting a patient when using the toilet or changing diapers/protective garments." Home Visit 2: A home visit observation was conducted on 5/24/23 with the hospice aide (Staff 8), who was observed providing incontinent care to the patient then continuing with undressing and transferring the patient to the shower without first doffing gloves and performing hand hygiene. An interview conducted on 5/24/23 with the Director of Nurses (Staff 4) confirmed that staff 8 did not follow standard precautions and established agency policy for performing hand hygiene.