Every finding on record at Centracare Hospice

Based on observation, interview and document review, the agency failed to update Centers for Medicare and Medicaid (CMS) regarding closure of branch office locations located in Montevideo, Dawson, and Appleton. --- CMS form 855a dated 9/24, indicated if currently enrolled in Medicare and need to make changes to enrollment information (e.g. add or change practice location.) Changes must be reported in accordance with the timeframes established in 42 C.F.R section 424.516 (outlines the additional requirements that Medicare providers and suppliers must meet to enroll and maintain an active enrollment status in the Medicare program.)42 C.F.R section 424.516 indicated changes must be reported to CMS within 30 days for a change in addition or deletion of a practice location. CMS system Internet Quality Improvement and Evaluation System (IQIES) identified branch locations located in Montevideo, Dawson, Ortonville, Appleton and Benson. During interview on 7/28/25 at 2:00 p.m., director stated they did not have any branch offices in Montevideo, Dawson, Ortonville, Appleton or Benson. There were no staff officed out of these locations and no client or personnel records were kept there. Director stated she had not completed any paperwork to remove them as branch offices. During sight visit on 7/29/25 at 2:00 p.m., hospital receptionist was not aware of the location for the hospice office and stated no hospice staff were there. She directed writer to look on 2nd floor.  Second Floor had a sign of another hospice agency. No other signs of a hospice office. However, a door was marked as hospice storage and contained supplies, and another door as hospice equipment and contained wheelchairs and commodes. There were two office spaces with desks, however no staff observed on second floor. When interviewed 7/30/25 at 1:45 p.m., director stated the hospice license was renewed in January. At that time, she listed three locations as satellite offices. However, they recently lost Dawson as the hospital the space back but gave offered an alcove to use for documenting if needed. The sign at Benson was never changed but it was not a location for the community to visit. Director stated Montevideo, Dawson, Ortonville, Appleton and Benson did not meet the definition for a branch office and should not be listed as such.  Reviewed Renewal Application for a License to Operate a Hospice Provider. Under Approved Office Locations were listed Benson, Dawson and Ortonville. Reviewed ASPEN Central Office (ACO) Hospice name had changed from Rice Hospice in 2018, then changed name again to current name in 2022. Reviewed current Patient Directory, there was Team A- Willmar team-7 listed 38 patients. Team B was broken down into six teams. Appleton (team-1) listed five patients, Benson (team-2) listed seven patients, Dawson (team-3) listed four patients, Montevideo (team -5) listed eleven patients, and Ortonville/Graceville (team-6) listed four patients.

Based on interview and document review the facility failed to complete a comprehensive medication review for 3 of 4 patients (P11, P12 and P13) reviewed during home visits. --- P12 P12s Plan Of Care (POC) printed on 5/22/23, at 12:35 p.m. identified P12 began hospice services on 12/20/23 and P12s primary diagnosis was spinocerebellar ataxia (degenerative condition that affects nervous system). During a home visit completed on 5/22/23, at 3:07 p.m. with hospice aide (HA)-B, P12s hospice medication list printed on 5/22/23, at 12:35 p.m. and current medications were reviewed with the group homes direct support professional (DSP)-A. P12s hospice medication list included the following medications: -benzonatate (Tessalon) (cough medication) 200 milligram (mg) -take 1 capsule (200 mg) by mouth if needed in the morning, at noon, and before bedtime for cough -ondansetron (Zofran ODT) (antiemetic-nausea medication) 4 mg- take 4 mg by mouth every six hours if needed for nausea and/or vomiting. -polyethylene glycol 3350 (MiraLAX, GlycoLax) 17 gram/dose oral powder-take 17 grams by mouth if needed each day for constipation. During the review of hospice medication list and the homes available medications, DSP-A confirmed P12 did not have the above medications in the home and was not currently receiving them. During a phone interview on 5/23/23, at 3:49 p.m. registered nurse case manager (CM)- B indicated she was not aware P12 did not have the medications identified above and was not aware if P12 received those medications. CM-B confirmed during her skilled nurse visits she inquired if as needed (PRN) medications were administered, but her usual practice was to only review patients medications during initial assessment, recertifications and if medication changes were made. During an interview on 5/24/23, at 1:56 p.m. hospice director (HD)-A confirmed she would expect the nursing staff to review medication orders every visit and to assure if medications were available and currently needed. HD-A also confirmed she would expect medication orders to be discontinued if not used and the patients medication list would be updated. P11's plan of care dated 12/15/22 indicated P11 had a diagnosis of senile degeneration of brain and her medications included ondansetron 4 milligrams by mouth in the a.m. and in the evening. P11's plan of care dated 5/23/23 indicated P11 was in her fourth 60 day hospice benefit period. P11's care plan printed 5/22/23 indicated P11 was seen by the skilled nurse one to two times a week and the hospice medication profile would contain an updated medication regimen. P11's medication list provided by the nursing facility on 5/22/23 indicated P11 had the following medication orders: 6/20/22 fluticasone propionate 50 micrograms (mcg) two sprays to each nostril daily. ondansetron 4 milligram (MG) every six hours times three doses/day. As needed P11's medication list provided by hospice on 5/22/23 was reviewed and lacked orders for fluticasone. Additionally, the ondansetron order indicated P11 was to take 4 mg by mouth in the morning and 4 mg in the evening for nausea and vomiting. During interview on 5/23/23 at 3:44 p.m., registered nurse (RN) case manager (CM)-C stated the fluticasone was discontinued 3/31/23 in the hospice chart and stated the ondansetron orders from the facility and hospice should match. CM-C further added medications were reconciled on every recertification (every 60 or 90 days depending on a patients benefit period). During interview 5/24/23 at 1:56 p.m. the RN director stated anytime the nurses were in the home, they should follow up to make sure there were no changes and the medications the facility had aligned with what was on the hospice plan of care. RN director added medications needed to be reconciled at each visit. P13's care plan printed 5/22/23 at 4:01 p.m. indicated P13 had a terminal diagnosis of Alzheimer's disease and resided at an assisted living facility (ALF). P13's medication list provided by the assisted living facility on 5/23/23 indicated P13 had the following medications orders: metronidazol 250 milligram (MG) tablet crush tablet and sprinkle into wound bed with dressing changes Premarin 0.625 mg/gram trained staff administer one gram of medication vaginally up to one time a day for hot flashes. P13's hospice medication list printed 5/22/23, was reviewed and lacked orders for metronidazol and Premarin. During interview 5/23/23 at 8:51 a.m., registered nurse (RN) case manager (CM)-D stated the metronidazol was discontinued on 4/18/23 and verified the Premarin was on the ALF's medication list and added the facility hadn't utilized the medication. During interview on 5/24/23 the RN director stated she expected medications be reconciled at each visit. A policy, Hospice Medication Administration and Documentation dated 2023 indicated CentraCare hospice would provide medication administration and or education that will promote safe, effective and economical use of medications for terminally ill patients. As part of the assessment process, a drug history will be taken, with the patient's participation when able, and a comparison made between the physician's orders and the current medication the patient is taking. Any discrepancies or contradictions will be reported to the physician for resolution.

Based on staff interview and record review, the agency failed to ensure services were provided in accordance with the plan of care for 3 of 14 patients (P10, P12, P11) reviewed for services planned. --- P10 P10's Hospice Plan Of Care (POC) effective 3/24/23 to 5/22/23, identified P10 began hospice services on 3/24/23, with primary diagnosis of Alzheimer's disease. P10's plan identified planned visits, which included the following: -Chaplain visits-5 visits every 60 days for 60 days, for spiritual assessment and support -Volunteer visits-1-2 visits every 2 weeks for 10 weeks, for companionship and support P10's electronic record identified P10 did not receive volunteer visits 3/24/23 through 4/29/23. P10's record failed to identify the reason P10 did not receive volunteer visits those weeks. P10's electronic record also identified P10 did not receive spiritual visits from 3/24/23, to 5/24/23. P10's record failed to identify the reason P10 did not receive spiritual visits those weeks. P12 P12's Hospice Plan of Care (POC) effective 12/20/22, to 3/19/23 and 3/20/23, to 6/17/23, identified P12 began hospice services on 12/20/22, with primary diagnosis of spinocerebellar ataxia (degenerative condition that affects nervous system). P10's plan identified planned visits, which included the following: -Pet therapy-1-2 visits every 2 weeks, for companionship and enjoyment P12's electronic record identified P10 did not receive pet therapy visits the weeks of 1/22/23, through 3/18/23, and 4/16/23, to 5/6/23 . P12's record failed to identify the reason P10 did not receive pet therapy visits those weeks. During interview on 5/24/23 at 1:40 p.m., volunteer coordinator (VC)-A confirmed P10 had missed volunteer visits 3/24/23 to 4/29/23. VC-A indicated P10 had previously been on hospice services, and they had attempted to have her previous volunteer make visits, but the volunteer was unanble. VC-A also confirmed P12 had multiple pet therapy visits missed, with no documenation of reasons completed. VC-A stated she was aware the pet volunteer was unable to make those visits due to illness and vacation. VC-A stated the agency's usual practice was for the social worker (SW) to document the reasons volunteer visits were not made and to modify the POC as needed. During interview on 5/24/23, at 2:09 p.m. hospice director (HD)-A confirmed P10 and P12 had missed visits for their volunteers. HD-A indicated her expectation would be if visits were missed, documentation visits were missed, identify reason, and update the visit set to reflect the missed visit. During a follow up interview at 3:09 p.m. HD-A confirmed service plans were reviewed at interdisciplinary (IDT) meetings and she would expect that the plan of care would be reviewed and all orders were correct and being followed. P10 P10's Hospice Plan Of Care (POC) effective 3/24/23 to 5/22/23, identified P10 began hospice services on 3/24/23, with primary diagnosis of Alzheimer's disease. P10's plan identified planned visits, which included the following: -Chaplain visits-5 visits every 60 days for 60 days, for spiritual assessment and support -Volunteer visits-1-2 visits every 2 weeks for 10 weeks, for companionship and support P10's electronic record identified P10 did not receive volunteer visits 3/24/23, through 4/29/23. P10's record failed to identify the reason P10 did not receive volunteer visits those weeks. P10's electronic record also identified P10 did not receive spiritual visits from 3/24/23, to 5/24/23. P10's record failed to identify the reason P10 did not receive spiritual visits those weeks. P12 P12's Hospice Plan Of Care (POC) effective 12/20/22, to 3/19/23, and 3/20/23, to 6/17/23, identified P12 began hospice services on 12/20/22, with primary diagnosis of spinocerebellar ataxia (degenerative condition that affects nervous system). P10's plan identified planned visits, which included the following: -Pet therapy-1-2 visits every 2 weeks, for companionship and enjoyment P12's electronic record identified P10 did not receive pet therapy visits the weeks of 1/22/23, through 3/18/23, and 4/16/23, to 5/6/23. P12's record failed to identify the reason P10 did not receive pet therapy visits those weeks. During interview on 5/24/23, at 1:40 p.m. volunteer coordinator (VC)-A confirmed P10 had missed volunteer visits 3/24/23, to 4/29/23, and no reasons identified in P10's medical record. VC-A indicated P10 had previously been on hospice services, and they had attempted to have her previous volunteer make visits, but the volunteer was not able. VC-A also confirmed P12 had multiple pet therapy visits missed, with no reasons documented in P10's medical record. VC-A stated she was aware the pet volunteer was unable to make those visits due to illness and vacation. VC-A stated the agency's usual practice was for the social worker (SW) to document the reasons volunteer visits were not made and to modify the POC as needed. During interview on 5/24/23, at 2:09 p.m. hospice director (HD)-A confirmed P10 and P12 had missed visits for their volunteers. HD-A indicated her expectation would be if visits were missed, the staff would documentation the visits as missed, identify the reason, and update the visit set to reflect the missed visit. During a follow up interview at 3:09 p.m. HD-A confirmed service plans were reviewed at interdisciplinary (IDT) meetings, and she would expect that the entire plan of care would be reviewed, and all orders were correct and being followed. P11's Hospice Plan of Care (POC) effective 12-15-22 thru 3-14-23 indicated P11 began her second benefit period 12/15/22 with a primary diagnosis of senile degeneration of brain. The POC indicated P11 would have volunteer visits, one to two visits every two weeks for 14 weeks for companionship and socialization. P11's electronic record identified P11 did not receive volunteer visits on the following dates: 12/15/22 thru 12/24/22 1/22/23 thru 2/4/23 2/5/23 thru 2/18/23 2/19/23 thru 3/4/23 3/5/23 thru 3/14/23 3/15/23 thru 3/25/23 3/26/23 thru 4/8/23 4/9/23 thru 4/22/23 4/23/23 thru 5/6/23 5/7/23 thru 5/13/23 P11's electronic record did not identify the reason P11 did not receive volunteer visits during the specified timeframes. P11's volunteer visit records were requested and received an email 5/25/23 that included volunteer visits for time frames listed with the exception of 1/22/23 thru 2/4/23, and 2/5/23 thru 2/18/23. These visits were not conducted due to the nursing facility not being opened to the public due to illness. The email also indicated during a COVID or influenza outbreak hospice provides the essential core services and they ask volunteers not to make visits due to infection risks.

Based on interview, observation, and document review, the agency failed to ensure written patient care instructions had been updated on the aide care plan by the registered nurse for 1 of 4 patients (P11) reviewed during home visits. --- P11's care plan printed 5/22/23 indicated P11 had a terminal diagnosis of senile degeneration of brain and had a hospice aide once weekly. P11's Hospice Recert Assessment form dated 3/14/23 indicated P11 was at risk for falling. P11's aide care plan printed 5/22/23, indicated P11 was at risk for falls and interventions included: assist with ambulation and transfers, assist to toilet as needed using same safety equipment and human assist. The aide care plan lacked information regarding P11 having a mat on the floor, low bed, and call light in reach. During interview and observation 5/22/23 at 3:57 p.m., P11 had a mat on the floor and the bed was positioned all the way down to the floor. Registered nurse (RN) case manager (CM)-C provided P11 the call light and instructed P11 to push the call button so P11 didn't have any more falls. CM-C stated P11 had confusion, rolled out of bed, and fell and sustained a skin tear. CM-C stated P11's last fall was on 4/19/23. During interview 5/24/23 at 1:56 p.m. the hospice director stated home health aides (HHA) followed a HHA care plan and added the aide only sees their care plan and if a patient is at risk for falling, the nurse was responsible for updating the HHA care plan if interventions were put in place. During interview 5/24/23 at 2:20 p.m. HHA-A stated she followed the HHA care plan in order to know the cares a patient required. A policy, Plan of Care dated 2023 indicated care and services provided to patients and families were in accordance with an individualized, written plan of care established by the hospice interdisciplinary group (IDG) in collaboration with the patient's attending physician. The patient's plan of care (POC) specifies the care and services necessary to meet the needs of the patient/caregiver as identified in the initial, comprehensive and updated assessments of the patient. Revisions to the plan of care are based on information from the patient's updated comprehensive assessment and the patient's progress toward outcomes specified in the plan.