Every finding on record at Continuum Care of Mass, LLC

Upon patient record review,1 of 19 (Patient #2) did not have evidence that the patient chooses a health care provider, including an attending physician Patient #2: Election Statement: MD Choice section with patient's decision to choose or not choose physician are both blank, although there is a physician name written in.

Upon patient record review 1 of 19 (Patient #14) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #14: Spiritual assessment not completed within 5 days. RN saw patient and marked unable to respond to most related inquiries. SC did not visit until 11/19/25.

Upon patient record review, 3 of 19 records (Patient #4, 5, 8) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #4: Meds on hospice profile, but not on patient facility profile include Cetirizine. There are discrepancies in Trazodone dosages. Interview with hospice staff confirmed discrepancies. Hospice reconciled variances during survey. Patient #5: Medications listed on facility profile, but not on hospice profile include Potassium 10 mEq. Medications listed on hospice profile, but not on facility profile include Furosemide, Eliquis Patient #8: Patient resides in SNF. Facility and Hospice dosages vary for Metoprolol.

Upon patient record review, 1 of 19 (Patient #13) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #13: Admitted with pacemaker. No related problems, goals or interventions- updated during survey.

Upon patient record review, 2 of 19 (Patient #4, 13) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #4: 1/4/26 SN note referencing signs/symptoms of flu. Tamiflu ordered. No update to problems, goals interventions. Updated during survey. Patient #13: Patient experienced fall in December that was reported to SN visit 12/13/25 a few days later. Patient had reddened area to face subsequently with Augmentin and Ibuprofen ordered. No update to problem, goals, interventions. Updated during survey.

Upon client record review, 2 of 19 (Patient #6,14) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6: For Dec 9, 25 and Jan 6, 2026 IDG, Volunteer Coordinator notes say patient is receiving volunteer services 2x/month. There is no ordered frequency for current cert period 12/4-02/01/26. (Previous order 10/19-10/25 for vol 1wk1.). Interview with staff confirm that Volunteer frequency order was inadvertently omitted from 12/4/25 Plan of Care. Updated during survey. Patient #14: Nurse documents performing wound care to ankle/foot, (including but not limited to 11/20/25 SN visit) but no evidence of physician orders. Updated during survey.

Upon patient record review, 3 of 19 (Patient #6, 10, 12) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #6: 12/30/25 and 1/2/26 SN notes, RN references (ordered) ground textured diet with thin liquids related to aspiration precautions. Hospice Aide tasks include assist with feeding at every visit if present at meal time and offer sips of liquids at every visit, but diet not specified. Updated during survey. Patient #10: Patient has oxygen 2-4 liters prescribed. No reference to oxygen or related safety precautions for Hospice Aide Care Plan. Updated during survey. Patient #12: Patient's prescribed medications include Eliquis, with no reference to safety/bleeding precautions for Hospice Aide Care Plan. Updated during survey.

Upon patient record review 1 of 19 (Patient #9) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #9: Hospice Aide to change linens weekly, but changed 12/11, 12/12, 12/25, 12/26, 1/1, 1/2, 1/8, 1/9.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. Upon review of volunteer cost savings for CY2025, 3 out of 4 quarters were under 5% for a total of 3.72% for CY 2025.

Upon patient record review, 1 of 19 (Patient #14) did not have evidence that there is a physician's brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification forms, or as an addendum to the certification forms. Patient #14: Initial CTI narrative 11/5/25 identifies patient as 77 year old male with recent dx of pancreatic cancer with mets to liver. Patient list and Care Plan say hospice diagnosis of Alzheimer's with no reference to pancreatic cancer. Care Plan further identifies patient age as 82 yo female. Interview with staff confirm the information in narrative refers to a different patient. Staff contacted MD during survey.

Upon patient client record review, 1 of 19 (Patient #2) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #2: Election Statement: MD Choice section with patient's decision to choose or not choose physician are both blank, although there is a physician name written in.

Upon patient client record review, 1 of 19 (Patient #15) did not evidence that each patient record contains physician orders. Patient#15: Patient relocated out of service area, but there was no physician discharge order.

Upon patient record review 2 of 11 records (Patient #2,#6) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #2: The patient was admitted on 9/3/20. The record indicated that the spiritual assessment of the patient was not completed until 9/22/20 and the psycho-social assessment was not completed until 9/12/20. Patient #6: The patient was admitted on 3/11/22. The record indicated that the spiritual assessment of the patient was not completed until 3/21/22 and the psycho-social assessment was not completed until 3/21/22.

Upon patient record review, 2 of 11 records (Patient #2,#10) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: The medication profile included Dulcolax 1 daily prn constipation, and Fleets enema 7-19 Gm rectally once daily prn constipation and MOM 30cc daily prn constipation. There was not a clear indication of what order to administer all the laxatives. Corrected on site. Patient #10: The medication profile included Miralax 17 Gm packet by mouth. There was not evidence of a diluent.

Upon patient record review, 1 of 11 records (Patient #2) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #2: There was not evidence of a bereavement assessment.

Upon patient record review, 1 of 11 records (Patient #10) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient, that reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #10: The patient was admitted with a diagnosis of senile degeneration of the brain. There was not evidence of a neuro care plan that reflects patient/family goals and interventions.

Upon patient record review, 2 of 11 records (Patient #2,#10) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #2: The record indicated Dulcolax 1 daily prn constipation, and Fleets enema 7-19 Gm rectally once daily prn constipation and MOM 30cc daily prn constipation. There was not a clear indication of what order to administer all the laxatives. Corrected on site. Patient #10: The record indicated an order for Miralax 17 Gm packet. There was not evidence of a diluent.

Upon patient record review 4 of 11 records (Patient #3,#5,#7,#8) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #3: The aide plan of care indicated to provide nail care. Keep nails cleaned and filed. For 1/4/23, 1/11/23, 1/12/23, and 1/16/23-1/25/23, the aide documentation indicated 'not required this visit.' Patient #5: The aide plan of care indicated to shave and shower every visit. For 1/23/23, 1/24/23, and 1/25/23, the aide documentation revealed not required this visit for shave, and on 1/25/23, the aide documentation for shower revealed 'not required this visit.' Patient #7: The aide plan of care indicated to shave every visit. For the dates of 1/10/23, 1/11/23, 1/13/23, 1/20/23, 1/23/23, and 1/24/23, the aide documentation revealed 'not required at todays visit.' Nail care and max assist with transfer was also indicated to be performed with each visit. For the dates of 1/23/23 and 1/24/23 nail care was documented as 'not required this visit', and max assist was documented as 'not required this visit' for the dates of 1/17/23, 1/18/23, 1/19/23 and 1/23/23. In addition the task of wash hair was to be provided weekly. The documentation revealed for the week of 1/15/23, wash hair was performed 4 times and for the week beginning on 1/22/23, the task was performed 2 times. Patient #8. The aide plan of care indicated to provide nail care at each visit. The aide documentation for the dates of 1/18/23-1/24/23 indicated that 'nail care was not required this visit.'

Upon contract review, 1 of 5 contracts (JQ) did not have evidence of a contract to fulfill the role of alternate medical director. The contract for the alternate medical director indicated hospice physician without indicating the physician as the alternate medical director.

Upon personnel record review, 1 of 12 records (Personnel #8) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records.