Every finding on record at Haulgistics 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 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 document review, clinical record review, and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the patient's current medications were included in the patient's drug profile. Agency policy titled Medication Management, dated 02/22/2022, required in part, "The hospice will develop a medication profile upon admission with all medications that the patient is taking, including over the counter and herbal medications and obtain a physicians order. The hospice will update the medication profile with each physician order including the following: new medications, changes in medication, and discontinued medications." CLINICAL RECORD 11: The patient elected the hospice benefit on 03/22/2024. A physician order dated 03/22/2024 included an order for "Oxygen 2.5 liters continuously via nasal cannula." The patient’s medication profile dated 03/22/2024 did not include oxygen. CLINICAL RECORD 13: The patient elected the hospice benefit on 03/20/2025. A physician order dated 03/20/2025 included an order for "Oxygen 3 liters continuously via nasal cannula." The patient’s medication profile dated 03/20/2025 did not include oxygen. During a joint records review and interview on 07/25/2025, the Director of Nursing confirmed that oxygen was not on the patients’ medication profiles.

It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 6 of 14 (43%) clinical records reviewed, the agency did not ensure the patient's individualized written plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 2: The patient elected the hospice benefit on 03/13/2025. The Registered Nurse (RN) documented on the initial nursing assessment dated 03/13/2025 that the "Patient is incontinent of bladder." The plans of care dated 03/13/2025 through 06/10/2025 and 06/11/2025 through 09/08/2025 did not include intervention(s) related to maintaining the patient’s skin integrity that would be associated with bladder incontinence. CLINICAL RECORD 3: The patient elected the hospice benefit on 03/08/2025. The RN documented on the initial nursing assessment dated 03/08/2025 that the "Patient is a fall risk due to being unsteady and uses a walker." The plans of care dated 03/08/2025 through 06/05/2025 and 06/06/2025 through 09/03/2025 did not include intervention(s) related to the patient being a fall risk. CLINICAL RECORD 4: The patient elected the hospice benefit on 05/23/2025. The RN documented on the initial nursing assessment dated 05/23/2025 that the "Patient is a fall risk due to being wheelchair bound. Patient is incontinent of bladder." The plan of care dated 05/23/2025 through 08/20/2025 did not include intervention(s) related to skin integrity or the patient being a fall risk. CLINICAL RECORD 5: The patient elected the hospice benefit on 12/04/2024. The RN documented on the initial nursing assessment dated 12/04/2024 that the "Patient is a moderate fall risk due to muscle weakness." The plans of care dated 12/04/2024 through 03/03/2025, 03/04/2025 through 06/01/2025, and 06/02/2025 through 07/31/2025 did not include intervention(s) related to the patient being a fall risk. CLINICAL RECORD 6: The patient elected the hospice benefit on 01/30/2025. The RN documented on the initial nursing assessment dated 01/30/2025 that the "Patient is incontinent of bladder. The patient is a fall risk." The plans of care dated 01/30/2025 through 04/29/2025 and 04/30/2025 through 07/28/2025 did not include intervention(s) related to skin integrity or the patient being a fall risk. CLINICAL RECORD 9: The patient elected the hospice benefit on 05/20/2025. The RN documented on the initial nursing assessment dated 05/20/2025 that the "Patient was provided education on skin breakdown due to the patient being incontinent." The plan of care dated 05/20/2025 through 08/17/2025 did not include intervention(s) related to skin integrity. During joint record reviews and interview on 07/24/2025, the Director of Nursing confirmed the above findings that skin integrity and fall risk interventions were not included in the patients plans of care.

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 the following: Medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure the individualized written plan of care included medical supplies and appliances necessary to meet the needs of the patient. CLINICAL RECORD 2: The patient elected the hospice benefit on 03/13/2025. The plans of care for the certification periods dated 03/13/2025 through 06/10/2025 and 06/11/2025 through 09/08/2025 included a physician order for "Oxygen 3 liters continuously via nasal cannula." The plans of care did not include the patient's oxygen concentrator and oxygen supplies. During a joint record review of the record and interview on 07/24/2025, the Director of Nursing confirmed the patient's oxygen concentrator and oxygen supplies were not included in the 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 a review of clinical records and interview. 1 of 5 (20%) records revealed that the agency did not ensure that the hospice care and services provided to the patient followed the individualized plan of care. Clinical Record 4: The patient elected hospice care on 8/15/2022. The Plan of Care dated 8/15/2022 ordered skilled nursing visits one (1) time a week. A missed skilled nursing visit was identified for the weeks ending 8/27/2022, and 9/3/2022. The clinical record did not have evidence of documentation of the reason for the missed visits, and physician notification of the missed visits. During an interview and joint clinical record review on 10/4/22, the Director of Nursing was provided the evidence, and confirmed that there were no visits made for the weeks ending 8/27/22 and 9/3/2022. The Director of Nursing stated that the agency did not have documentation of the missed visits, including why the visit was missed, or that the physician was notified of the missed visit.

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. This standard was not met as evidenced by document review, observation, and interview. 1 of 3 (33%) observed home visits revealed that the agency did not ensure that staff followed the accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as, hand hygiene. Agency policy, Hand Hygiene, dated 4/13/21, stated in part, "Decontaminate hands before having direct contact with clients". Home Visit 2: During the home visit with the patient on 10/5/22, it was observed that the staff member did not follow the agency policy. The clinical staff member entered the patient's room, addressed the patient, and shook hands. The staff member did not decontaminate his hands prior to having direct contact with the patient. During an interview, the Director of Nursing was presented and confirmed the evidence.