Every finding on record at Caris Healthcare

Based on agency policy review, medical record review, and interview, the agency failed to complete a thorough comprehensive assessment to include the bowel elimination for 5 Patients (#3, #4, #6, #8, and #10) of 16 patients reviewed. The findings include: --- Review of the agency policy titled, "Comprehensive Assessment & Plan of Care," reviewed 2024 revealed "...The registered nurse (RN) will conduct an...assessment to determine the patient's immediate care needs...including identification of goals and interventions, will include the assessment of...bowel...elimination..." Review of the agency policy, ";Pain and Symptom Management," reviewed 2024 revealed ";...The interdisciplinary team ensures that patients receive effective pain management and symptom control from the hospice...including constipation...The patients pain and other symptoms...are thoroughly assessed during the comprehensive assessment of the patient by the RN Case Manager..." Medical record review revealed Patient #3 was admitted to the agency on 10/29/2024 with diagnoses including Congestive Heart Failure Medical record review of a nursing clinical note dated 12/31/2024 and 1/8/2025 revealed no documentation of Patient #3's bowel assessment. Medical record review revealed Patient #4 was admitted to the agency on 1/4/2025 with diagnoses including Coronary Artery Disease. Medical record review of nursing clinical note dated 1/7/2025 and 1/10/2025 revealed no documentation of Patient #4's bowel assessment. Medical record review revealed Patient #6 was admitted to the agency on 6/27/2024 with diagnoses including Congestive Heart Failure. Medical record review of nursing clinical note dated 1/3/2025 and 1/8/2025 revealed no documentation of Patient #6s bowel assessment. Medical record review revealed Patient #8 was admitted to the agency on 1/4/2024 with diagnoses including Cognitive Impairment. Medical record review of nursing clinical note dated 1/2/2025 and 1/9/2025 revealed no documentation of Patient #8s bowel assessment. Medical record review revealed Patient #10 was admitted to the agency on 11/5/2024 with diagnoses including Senile Degeneration of Brain Medical record review of nursing clinical note dated 11/7/2024 revealed no documentation of Patient #10s bowel assessment. During an interview on 1/14/2025 at 11:07 AM, the Administrator confirmed a thorough comprehensive assessment to include the bowel assessment for Patient #3, #4, #6, #8, and #10 had not been completed and documented on all visits.

Based on agency policy review, medical record review and interview, the agency failed to furnish services indicated by the individualized written plan of care (POC) established by the physicians order for 1 patient (#5) of 16 patients reviewed. The findings include: --- Review of the agency policy, ";Scheduling SOP Local Office," revised 11/2023 revealed ";...Order and Scheduling Process to ensure visits are following the plan of care...Orders are entered upon admission to indicate the amount, frequency and duration of visits made by each discipline of the team that the patient/family will require to meet their needs..." Review of the agency policy, ";Plan of Care," reviewed 2024 revealed ";...The patients plan of care specifies the care and services necessary to meet the needs of the patient/caregiver...frequency of services necessary to meet the specific patient and family needs..." Review of the agency policy ";Physician Orders," reviewed 2024 revealed ";...orders are obtained for the physician in order to provide...dressing changes/wound care...to meet the needs of the patient..." Medical record review revealed Patient #5 was admitted to the agency on 12/29/2024 with diagnoses including Parkinsons Disease. Medical record review of Patient #5's POC for the certification period 12/29/2024-3/28/2025 revealed a Physician's order effective 1/1/2025 for Hospice Nurses (SN) 2 time a week for 1 week and 1 time a week for 12 weeks. Medical record review of Physician Orders dated 12/29/2024 showed Wound Care to 1st great toe 3 times per week for 23 days, left lateral ankle 3 times per week for 23 days, and left posterior ankle 3 times per week for 30 days. Continued review showed the Skilled Nurse was ordered a visit frequency of 2 times a week for 1 week and 1 time a week for 12 weeks. There was no documentation the physician had ordered wound care to be provided by the facility or family for Patient #5. During an interview on 1/14/2025 at 10:28 AM, the Administrator confirmed the physician had not ordered a visit frequency as 3 times per week for wound care orders and had not ordered for the facility to provide care in the absence of a skilled nurse visit.

Based on agency policy review, medical record review and interview, the agency failed to implement a bowel regimen for 4 Patients (#1, #3, #4, and #6) of13 patients reviewed for opioid medications. The findings include: --- Review of the agency policy, ";Comprehensive Assessment," reviewed 2024 revealed ";...An assessment of the need for a bowel regimen when the patient has been prescribed opioids..." Review of the agency policy, ";Pain and Symptom Management," reviewed 2024 revealed ";...The interdisciplinary team ensures that patients receive effective pain management and symptom control from the hospice...including constipation...The patients pain and other symptoms...are thoroughly assessed during the comprehensive assessment of the patient by the RN Case Manager..." Medical record review revealed Patient #1 was admitted to the agency on 9/19/2024 with diagnoses including Senile Degeneration of Brain. Medical record review of a Physician Order dated 12/18/2024, showed Patient #1 had been ordered Morphine Concentrate (an opioid used to treat pain) 20 milligrams/5 milliliters (MG/ML) oral syringe every 4 hours as needed for pain. Medical record review of the medication profile summary showed Patient #1 had not been ordered medications for constipation. Medical record review revealed Patient #3 was admitted to the agency on 10/29/2024 with diagnoses including Congestive Heart Failure Medical record review of a Physician Order dated 12/18/2024, showed Patient #3 had been ordered Morphine Concentrate (an opioid used to treat pain) 20mg/5ml oral syringe every 4 hours as needed for pain and Hydrocodone 7.5 mg-Acetaminophen 325 mg tablet every 4 hours as needed for pain. Medical record review of the medication profile summary showed Patient #3 had not been ordered medications for constipation. Medical record review revealed Patient #4 was admitted to the agency on 1/4/2025 with diagnoses including Coronary Artery Disease. Medical record review of a Physician Order dated 1/5/2025, showed Patient #4 had been ordered Hydrocodone 5 mg-Acetaminophen 325 mg tablet every 6 hours as needed for pain. Medical record review of the medication profile summary showed Patient #4 had not been ordered medications for constipation. Medical record review revealed Patient #6 was admitted to the agency on 6/27/2024 with diagnoses including Congestive Heart Failure. Medical record review of a Physician Order dated 9/16/2024, showed Patient #6 had been ordered Hydrocodone 5 mg-Acetaminophen 325 mg tablet every 6 hours as needed for pain. Medical record review of the medication profile summary showed Patient #6 had not been ordered medications for constipation. During an interview on 1/14/2025 at 10:20 AM, the Administrator confirmed the agency failed implement a bowel regimen for Patients #1, #3, #4, and #6 who received opioids.

Based on agency policy, record review, and interview, the agency failed to follow the plan of care (POC) related to visit frequency for 2 of 13 sampled patients (Patient #10 and #12). The findings include: --- Review of the agency policy titled, "Plan of Care" reviewed 2/25/2020 showed "...The patient's plan of care specifies the care and services necessary to meet the needs of the patient/caregiver as identified in the initial, comprehensive and updated assessment of the patient. Medical record review revealed Patient #10 was admitted to the agency on 11/5/2024 with a diagnosis of Senile Degeneration of Brain. Medical record review showed Patient #10's Plan of Care for recertification period 11/5/2024-2/2/2025 showed orders for visit frequency for "HHA [Hospice Aide] 2 WK [week] 13..." Medical record review showed Patient #10s visit calendar (calendar that documents all disciplines scheduled to provide services) showed 1 completed Hospice Aide visit for the week of 11/5/2024 for Patient #10. Medical record review revealed Patient #12 was admitted to the agency on 4/3/2024 with a diagnosis of Coronary Artery Disease Medical record review showed Patient #12's Plan of Care for recertification period 12/29/2024-2/26/2025 showed orders for visit frequency for "HHA [Hospice Aide] 3 Week 8..." Medical record review showed Patient #12's visit calendar showed 2 completed Hospice Aide visits for the week of 12/29/2024 and 1/5/2024 for Patient #12. During an interview 1/14/2025 at 11:07 AM, the Administrator confirmed the agency had not followed the plan of care related to visit frequency for Patients #10 and #12.

Based on medical record review and interview the agency failed to complete a thorough comprehensive assessment to include the bowel status, for 1 patient (#2) out of 13 patients reviewed. The findings include: Medical record review revealed Patient #2 was admitted to the agency on 11/8/2021 with diagnoses of Senile Degeneration of the Brain, Dementia, and Generalized Anxiety Disorder. Medical record review of an admission nursing clinical note dated 11/8/2021 revealed no documentation of Patient #2's bowel assessment. Interview with the Clinical Manager on 12/1/2021 at 8:55 AM, confirmed the bowel assessment had not been completed on the admission assessment for Patient #2.

Based on agency policy, medical record review, and interview the agency failed to update the medication profile with new medications for 3 patients (#1, #2, and #3) of 3 patients reviewed with home visits. The findings include: Review of the agency's policy, "Medication Assessment and Reconciliation" revised 7/5/2021 revealed, "...1. On every skilled nurse visit, perform medication reconciliation to ensure all medications are correctly documented in the electronic record..." Medical record review revealed Patient #1 was admitted to the agency on 11/3/2021 with Senile Degeneration of Brain, Dementia, and Anxiety Disorder and resided in a long-term care (LTC) facility. Medical record review of Patient #1's current LTC facility Medication Administration Record (MAR) revealed Multivitamin 1 capsule once daily, Alprazolam (anti-anxiety medication) 0.25 milligram (mg) tablet twice daily, and Vistaril (anti-anxiety medication) 25 mg tablet three times daily with a start date of 10/4/2021. Review of Patient #1's agency medication profile dated 11/3/2021-1/31/2022 showed the Multivitamin, Alprazolam, and Vistaril had not been updated to reflect Patient #1's current medications. Medical record review revealed Patient #2 was admitted to the agency on 11/8/2021 with Senile Degeneration of Brain, Dementia, and Anxiety Disorder and resided in a LTC facility. Medical record review of Patient #2's LTC facility current Medication Administration Record (MAR) revealed Levothyroxine (hypothyroidism medication) 50 mcg (microgram) tablet once daily, and Namenda (medication used to treat Dementia) 10 mg tablet twice daily with a start date of 1/1/2021. Vitamin B-12-1,000 micrograms (mcg) tablet once daily with a start date of 7/8/2021. Review of Patient #2's agency medication profile dated 11/8/2021-2/5/2022 showed the Levothyroxine, Namenda, and Vitamin B-12 had not been updated to reflect Patient #1's current medications. Medical record review revealed Patient #3 was admitted to the agency on 2/11/2019 with Senile Degeneration of Brain, Dementia, and Gout and resided in a LTC facility. Review of Patient #3's agency medication profile dated 11/8/2021-2/5/2022 revealed Acetaminophen (analgesic medication) 500 mg tablet twice daily with a start date of 2/11/2019. Medical record review of Patient #3's LTC facility current Medication Administration Record (MAR) showed Acetaminophen had not been added to the MAR. Interview with the Clinical Manager on 12/1/2021 at 8:46 AM, showed the medication reconciliation are to be completed on each skilled nurse visit. The Clinical Manager confirmed the medication reconciliation had not been updated.

Based on medical record review and interview the agency failed to address a patient's report of increased pain for 1 patient (#11) out of 13 patients reviewed. The findings include: Medical record review revealed Patient #11 was admitted to the agency on 10/28/2021 with diagnoses of Chronic Obstructive Pulmonary Disease, Chronic Respiratory Failure, and Anxiety Disorder. Medical record review of Patient #11's Plan of Care (POC) with the certification period of 10/28/2021 to 1/25/2022 revealed "...SN [Skilled nurse] Assess for Pain and other symptoms, implement management and control of symptoms..." Medical record review of nursing clinical note dated 10/29/2021 showed Patient #11 reported to the SN that she was having an increase in pain since the last visit dated 10/28/2021. Further record review showed the SN had not further addressed the patient's report of increased pain. Interview with the Clinical Manager on 12/1/2021 at 9:55 AM, showed it would be her expectation that the staff would address a patient's report of increased pain and document the action taken.