Every finding on record at Harmony Hospice LLC

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 drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 10 (20%) clinical records reviewed, it was revealed that the agency did not ensure that the plans of care included the specific drug and treatment information necessary to meet the needs of the patient. CLINICAL RECORD 1: The plan of care dated 07/07/2025 through 10/04/2025 included orders for Atropine Sulfate 0.01% ophthalmic solution every 4 hours as needed, without specific instructions for administration and Lorazepam 0.5mg tablet oral as needed for anxiety/agitation without specific time constraints for use. CLINICAL RECORD 2: The plan of care dated 05/07/2025 through 08/04/2025 listed two medications, Bisacodyl 10mg suppository rectal as needed for constipation and Fleet enema as needed for constipation, without specific time constraints for administration. The Director of Clinical Services stated in an interview 08/05/2025 that these medications did not include time constraints or instruction for use.

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; other requirements of applicable state and federal law and regulation. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 3 (33%) observed home visits, revealed that the agency did not ensure clinician adherence with agency's infection control policies. Agency Policy: X.8 Standard Precautions For All Healthcare Workers [no review date], stated in part: "Gloves will be changed between patient contact. When gloves are removed, thorough hand washing is required. Gloves do not take the place of handwashing. Hand washing - Hands must be washed: Before and after contact with each patient. After contact with potentially infectious material. Before putting on after removing PPE, including gloves." Home Visit #1: The home visit observed with Personnel Record 10 on 8/5/2025 revealed that no hand hygiene was performed prior to applying gloves or after removing gloves during patient care. The staff registered nurse applied gloves, provided a physical assessment, and did not sanitize hands until after gloves were removed and equipment cleaned. Hands were not sanitized prior to providing a hands-on physical assessment of the patient or prior to entering nursing bag during the visit. The Director of Clinical Services stated in an interview 8/5/2025 that this hand hygiene issue would be addressed and instruction was part of their orientation.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group with 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 3 of 7 (43%) clinical records reviewed, of patients that accepted the hospice aide, the agency did not ensure that the registered nurse prepared a hospice aide plan of care that contained clear and specific instructions for the patient's required care. CLINICAL RECORD 1: The patient elected the hospice benefit on 07/07/2025 with a diagnosis of vascular dementia. The hospice aide plan of care (updated on 07/15/2025) included orders for the following relevant tasks; complete bed bath every visit and shower every visit per facility policy. The aide care plan did not provide additional instructions on when the bed bath or shower should be provided, nor did it include an identified decision maker. CLINICAL RECORD 5: The patient elected the hospice benefit on 07/31/2025 with a diagnosis of COPD (chronic obstructive pulmonary disease). The hospice aide plan of care dated 07/31/2025 included orders for the following relevant tasks to be provided at every visit: bed bound with scheduled repositioning; ambulatory with assistance of one care giver and walker; range of motion (specify); chair as tolerated. The following personal care tasks were ordered for every visit: complete bed bath with patient requiring assistance; partial bed bath with patient assisting as able to; and shower per facility policy. The aide care plan did not provide specific instructions on which tasks would be provided when (i.e. bed bound versus ambulation and bed bath versus shower). There was no identified decision maker. CLINICAL RECORD 6: The patient elected the hospice benefit on 06/10/2025 with a diagnosis of neurocognitive disorder with Lewy bodies. The hospice aide plan of care (updated 07/16/2025) included orders for the following relevant tasks to be provided at every visit: bed bound, and wheelchair bound with scheduled repositioning; ambulatory with assistance; complete bed bath with patient being total dependence; and shower per facility policy. The aide care plan did not provide specific instructions on which tasks would be provided when (i.e. bed bound versus ambulation and bed bath versus shower), or the type of assistance required. There was no identified decision maker. The Director of Clinical Services reviewed the record on 08/06/2025, and stated the directions included actions that were not clear and required the aide to assess the patient and make decisions.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care is provided in the facility in accordance with the hospice plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 2 of 2 (100%) home visit observations to patient's residing in a skilled nursing facility (SNF) the agency did not ensure the facility provided care in accordance with the hospice plan of care. CLINICAL RECORD 1: A home visit to the skilled nursing facility (SNF) was conducted on 08/05/2025, with the Registered Nurse (Personnel Record 10). The hospice plan of care dated 07/07/2025 through 10/04/2025 included a physician order for Olanzapine 2.5mg, one (1) tablet oral one time a day; this medication was not present on the facility medication list. CLINICAL RECORD 2: A home visit to the skilled nursing facility (SNF) was conducted on 08/05/2025, with the Registered Nurse (Personnel Record 1). The plan of care dated 05/07/2025 through 08/04/2025 was reviewed and four medications were not present on the facility medication list. These included Amlodipine besylate 5mg one (1) tablet oral one time a day; Bisacodyl EC 5mg enteric coated tablet, one (1) tablet oral one time a day as needed for constipation; Geri-Lanta 200-200-20mg/5ml 30ml oral every 4 hours as needed for GERD and Glucose 15gm/33GM 15 GM oral every hour as needed for diabetes. Following the visits, on 08/05/2025, the Director of Clinical Services confirmed that these medications were not on the facility medication list and said that the nurses are supposed to take updated orders to the facility after the IDG (interdisciplinary group) meeting. She said this was a new nurse and she didn’t confirm the facility had the orders.