Every finding on record at Camellia Home Health of Alabama, LLC

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. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; [and] drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measures are implemented to manage the side effects. The drug profile 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, interview and observation. In 1 of 14 (7%) clinical records reviewed and 1 home visit observed, the hospice did not ensure that the drug profile included all of the patient's current medications. HOME VISIT 2/CLINICAL RECORD 2: This patient elected the hospice benefit on 02/09/2026 with a terminal diagnosis of senile degeneration of the brain. During the home visit observation on 02/25/2026 with the Registered Nurse (RN - Personnel Record 2), with the Director of Nursing in attendance, the hospice drug profile was reconciled with the patient's medications. The patient's medication list included Levothyroxine 50 mg daily. The caregiver stated that the patient took this medication daily. The hospice drug profile did not include Levothyroxine. During a joint record review and interview on 02/25/2026 with the Director of Nursing, it was stated that the hospice drug profile did not include all medications that the patient was taking.

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 and use of gloves, mask, eye protection, or face shield depending on anticipated exposure. This standard was not met as evidenced by clinical record review, document review, interview and observation. In 1 of 3 (33%) home visit observations, the agency did not ensure staff performed hand hygiene as required by agency policy. Agency policy, titled "Infection Surveillance Hand Hygiene", stated in part, "4.4 At a minimum, personnel will perform hand hygiene in the following instances: 4.4.2 After any patient contact or contact with the patient's immediate environment. 4.4.3 Before and after glove use." HOME VISIT 2/CLINICAL RECORD 2: This patient elected the hospice benefit on 02/09/2026 with a terminal diagnosis of senile degeneration of the brain. During the home visit observation on 02/25/2026 with the Registered Nurse (RN - Personnel Record 2), with the Director of Nursing in attendance, the RN took off her gloves after cleaning the patient's perineal area and grabbed a medication bottle without sanitizing her hands. In an interview with the Director of Nursing on 02/25/2026, she stated that she also observed the RN take off her gloves after cleaning the patient's perineal area and grabbing a medication bottle without sanitizing her hands.

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 12 (8%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions to meet the patient's specific needs. CLINICAL RECORD 12: This patient elected the hospice benefit on 12/03/2025 with a terminal diagnosis of multiple sclerosis. The hospice plan of care dated 12/03/2025-03/02/2026 included orders for HA visits two times a week and documented the patient's DME (durable medical equipment) included a Hoyer lift. The RN comprehensive assessment dated 12/03/2025 documented the patient had paralysis which affected function and a Hoyer lift was ordered by the hospice. The HA care plan dated 12/03/2025-02/18/2026 was reviewed and did not include instructions for the Hoyer lift. During a joint record review and interview on 02/26/2025, the Director of Nursing agreed that instructions for the Hoyer lift were not included on the HA care plan.

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. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile 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, interview, and observation. 3 of 3 (100%) home visit observations, the organization did not ensure that medication profiles contained the patient's current prescriptions and over-the-counter (OTC) drugs. Home Visit 1/Clinical Record 2: During the home visit on 4/19/2023 with the Registered Nurse (RN), the agency's medication profile dated 4/18/2023 was reviewed with the patient's daughter. Two medications Lorazepam Intensol and Morphine concentrate, were included in the agency's medication profile but were not found in the home. During an interview, the RN stated they were ordered for delivery when the patient needed them. The Administrator and Director of Nursing agreed that the medications should be in the home if they are on the medication profile. Home Visit 2/Clinical Record 3: During the home visit on 4/19/2023 with the Medical Social Worker (MSW), the agency's medication profile dated 4/18/2023 and the skilled facility's medication profile were reviewed with the patient. The agency's medication profile documented "Lexapro 20mg by mouth daily" dated 11/18/2022 and "aspirin 325mg by mouth daily" dated 1/1/2021. The facility's medication profile documented "Lexapro 10mg by mouth daily" and "aspirin 81mg by mouth daily." The discrepancies were reviewed with the facility nurse and the hospice clinical team manager during the home visit. Both confirmed the medications were to be investigated and followed up for dosage accuracy. Home Visit 3/ Clinical Record 1: During the home visit on 4/19/2023 with the hospice aide, the agency's medication profile dated 4/18/2023 was reviewed with the patient's daughter. The patient had a history of constipation and fecal impaction. The agency's medication profile documented eight (8) medications for constipation: fleet enema, Gavilax, Lactulose, Linzess, milk of magnesium, Miralax, and vegetable laxative. The daughter stated the patient was taking only the Miralax 17 gram/dose oral powder by mouth twice daily, and the others were all as needed. The daughter also stated the patient was not using the albuterol sulfate 90mcg inhaler, Flonase 50mcg nasal spray, or the Restasis 0.05% eye drops. In addition, the daughter said the patient's pain regimen included Ibuprofen 800mg by mouth at bedtime. The medication profile included Ibuprofen 200mg, 2-4 tablets by mouth every 8 hours as needed, effective 8/26/2022. The medication profile included "methocarbamol 750mg by mouth three times daily," effective 6/10/2022 for muscle spasms. The daughter stated the patient takes methocarbamol, one tablet at night and as needed during the day. The blood pressure medication Toprol XL 50mg extended-release tablet, three (3) tablets by mouth daily effective 6/10/2022. The daughter stated the patient takes one Toprol XL tablet daily. After the home visit, the findings were reviewed with the Administrator, the Director of Nursing, and the Clinical Lead Manager present at the home visit. It was confirmed the medication profiles were inaccurate and would be corrected.

It is required that the hospice designates an Interdisciplinary Group or groups who, in consultation with the patient's attending physician, prepare a written plan of care (POC) for each patient. The plan of care specifies the hospice care and services necessary to meet the specific needs of the patient and family identified in the comprehensive assessment, relative to the terminal illness and associated conditions. THIS IS A CMS CONDITION LEVEL DEFICIENCY. This CONDITION was not met as evidenced by clinical record review and interview; the hospice failed as follows: to designate a registered nurse member of the interdisciplinary group to provide coordination of care and ensure continuous assessment of the patient's and family's needs and implementation of the interdisciplinary plan of care [HCPC.19.I/L540]; and to ensure care and services provided to patients followed the individualized plan of care established by the hospice IDG [HCPC.19.I/L543]. The cumulative effect of these deficiencies could negatively impact the organization's ability to provide safe and effective quality patient care services.

It is required that the hospice designates a registered nurse member of the IDG to provide coordination of care, ensure continuous assessment of each patient’s and family’s needs and ensure the implementation of the interdisciplinary plan of care. This standard was not met as evidenced by clinical record review and interview. 2 of 14 (14%) clinical records reviewed, the organization did not ensure coordination of care and the implementation of the interdisciplinary plan of care. Clinical Record 6: The patient elected hospice care on 12/28/2022 with the primary diagnosis of Parkinson's Disease. On 2/7/2023, the patient fell and sustained an injury to the right foot. The Registered Nurse (RN) completed a visit on 2/7/2023 to assess the patient. A physician's order was received on 2/7/2023 for an x-ray of the injured foot. The results of the x-ray dated 2/9/2023 documented an acute right fifth metatarsal shaft fracture. There was no evidence that the x-ray results were reported to the physician or the IDT. The IDT meeting notes dated 2/10/2023 contained no evidence of the fracture discussion. During the joint record review on 4/20/2023, the Administrator confirmed no follow-up of the fracture was documented. Clinical Record 7: The patient elected hospice care on 5/5/2022 with the primary diagnosis of sarcopenia. On 5/6/2022, the RN obtained the physician's order "venous doppler to the right lower extremity to rule out a deep vein thrombosis (DVT)" due to edema and pain. There was no evidence of the results in the record or documentation of its completion or cancellation. During the joint record review on 4/20/2023, the Administrator confirmed the missing documentation and later stated that after interviewing the nurse, the test was canceled due to improved symptoms.

It is required that the hospice designates a registered nurse member of the IDG to ensure the implementation of the interdisciplinary plan of care. Hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any), the patient or patient representative, [and] the primary caregiver in accordance with the patient’s needs. This standard was not met as evidenced by clinical record review and interview. 1 of 14 (7%) clinical records reviewed, the organization did not ensure care and services provided to patients followed the individualized plan of care established by the hospice IDG. Clinical Record 8: The patient elected hospice care on 12/30/2021 with a primary diagnosis of pancreatic cancer. The patient had an implanted intravenous port. On 1/3/2022, the physician ordered "flush port a cath with 10 ml normal saline monthly and as needed (PRN)." The RN documented flushing the implanted port: 1/17/2022, 2/21/2022, 3/14/2022, 6/30/2022, 7/7/2022, 8/3/2022, 9/9/2022, and 10/5/2022. There was no evidence that the port a cath was flushed in April 2022 or May 2022, and no flushes were documented after October 2022. There was no evidence of a physician's order to discontinue the monthly flushes of the implanted port. During the joint record review and interview on 4/20/2023, the Administrator confirmed the physician's order of monthly flushes was not followed.

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, use of gloves, mask, eye protection, or face shield depending on anticipated exposure, safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids, safe handling of soiled items in the patient’s care environment and other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by document review, interview, and observation. Organization policy #I02, "Hand Hygiene" [reviewed on 9/20/22], stated in part, "At a minimum, personnel will perform hand hygiene in the following instances... Before and after any glove use." 1 of 1 (100%) home visit observed where wound care was performed, the organization did not ensure that staff performed hand hygiene per the organization's policy. Home Visit 1/Clinical Record 2: During the home visit on 4/19/2023 with the Registered Nurse (RN), the wound care treatment to the coccyx stage IV pressure wound was observed. Following completion of the head-to-toe assessment of the patient, the RN set up the wound care supplies, removed the soiled dressing, and doffed gloves and donned clean gloves without performing hand hygiene. The RN cleansed the wound with wound care spray and 4x4 gauze, packed the wound bed with wet 4x4 gauze, applied barrier cream, and doffed and donned new gloves without performing hand hygiene to apply the border gauze. The Clinical Lead Manager at the home visit confirmed infection control practices were not followed.

It is required that the hospice assesses the skills and competencies of all individuals providing care, including volunteers providing services and, as necessary, provides in-service training and education programs where required. The hospice has written policies and procedures describing the method(s) of assessing competency and maintains a written description of the in-service training provided during the previous 12 months. This standard was not met as evidenced by interview and personnel record review. 1 of 11 (9%) personnel records reviewed, the organization did not accurately assess the competency of a Nurse Practitioner per the scope of practice. Personnel Record 2: The Nurse Practitioner hired on 11/14/2019 had a completed competency for a Registered Nurse (RN), not a Nurse Practitioner. A RN manager assessed the skills and competency of the Nurse Practitioner. An interview with the Administrator confirmed the Nurse Practitioner was not practicing as a RN for the agency but as part of the medical team completing face-to-face assessment visits.

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 physician orders. This standard was not met as evidenced by clinical record review and interview. 4 of 14 (29%) clinical records reviewed, the organization did not ensure that physician orders were documented. Clinical Record 1: The patient elected hospice care on 8/19/2022 with the primary diagnosis of chronic obstructive pulmonary disease. The physician ordered "add skin prep wipes for boney prominences" on 9/14/2022. The physician's order did not include the frequency of the skin prep treatment. Clinical Record 2: The patient elected hospice care on 1/7/2023 with the diagnoses of senile degeneration of the brain and pressure wound. The plan of care dated 1/7/2023 ordered, "Skilled nurse to perform wound care to pressure ulcer/pressure injury to (area) irrigate with NS cleanse with wound cleaner, apply wet to dry dressing...Cover with bordered gauze using clean/aseptic technique frequency of dressing change: (blank) SN may teach wound care to patient/caregiver." The physician's order for wound care did not include the frequency of treatment: The physician's order for wound care was updated on 1/9/2023 to include "measurements to be done at the start of care, recertification, weekly and PRN." However, the frequency of the wound care was not indicated until 1/11/2023, with the daily frequency. Clinical Record 4: The patient elected hospice care on 4/13/2023 with the primary diagnosis of chronic kidney disease. The coordination note completed by the Licensed Practical Nurse (LPN) on 4/17/2023 documented, "Skin under dressing clean, dry and warm to touch. Dressing to right groin removed. Skin intact with a pin size scab." There was no evidence of physician's orders for wound care or removal of a dressing. Clinical Record 5: The patient elected hospice care on 12/20/2022 with the primary diagnosis of congestive heart failure and a history of constipation. The coordination note completed by the Registered Nurse (RN) on 1/2/2023 documented that the patient was checked for impaction, and feces was removed. There was no evidence of a physician's order to check the patient for impaction and remove feces. During the joint record reviews and an interview on 4/20/2023, the Administrator confirmed that the physician orders were either missing or inaccurate.

It is required that the hospice obtains a criminal background check on all hospice employees who have direct patient contact or access to patient records. Hospice contracts require that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. This standard was not met as evidenced by document review and interview. 2 of 4 (50%) relevant contracts reviewed, the organization did not ensure that contracts included the requirement for all contracted employees who have direct patient contact or access to patient records to have a background check. Contract 3: The skilled nursing contract dated 4/20/2021 did not include language requiring facility personnel with direct patient contact or access to patient records of hospice patients to have a criminal background check. Contract 4: The organization's contract with a hospital for general inpatient services dated 4/22/2021 did not include language requiring hospital personnel with direct patient contact or access to patient records of hospice patients to have a criminal background check. During the joint record review and an interview on 4/19/2023, the Administrator confirmed the criminal background clause was missing from the contracts.