Every finding on record at Health at Home Hospice-Portland LLC

Based on review of 3 of 18 patient medical records, it was determined the agency failed to follow a process for obtaining a doctor's order prior to discharging patients from agency. --- Findings:Review of three patient medical records (#1, #2 and #15) who were live discharges from the agency, revealed a doctor's order was not obtained prior to discharging patient from agency as stipulated in CoP 418.26 Discharge from hospice care, (b) Discharge Order.Patient #1: Review of the patient medical record on 11/10/2025 revealed a SOC date of 07/16/2025. On 10/15/2025, Patient request to be transferred to another hospice agency. On 10/17/2025, Patient was transferred to another hospice agency. The patient medical record lacked a written physician order to transfer patient prior to transfer.Patient #2: Review of the patient medical record on 11/10/2025 revealed a SOC date of 07/25/2025. Patient was found to be noncompliant with hospice plan of care and was discharged on 10/22/2025. The patient medical record lacked a written physician order to discharge patient.Patient #15: Review of the patient medical record on 11/12/2025 revealed a SOC date of 07/02/2025. Patient revoked their hospice benefit on 07/15/2025. The patient medical record lacked a written physician order to discharge patient.During interview with the Executive Director on 11/12/2025 beginning at 1:00 PM, the above findings were presented. Executive Director was asked on 11/11/2025 if they could locate a transfer order for patient #1. On 11/11/2025, the Executive Director replied, "Unfortunately, I did not see it."

Based on interview and medical record review, it was determined the agency failed to ensure that the individualized plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including interventions to manage symptoms, for 1 of 4 active patient records reviewed (Patient #4). --- Findings: Review of the medical record for Patient #4 revealed that problems with recurrent urinary tract infections and dysphagia were present. The admission diagnosis on start of care 5/24/2022 was "Dysphagia following cerebral infarction." Review of a "HOSPICE RECERTIFICATION," dated 8/18/2022, indicated "THIS PATIENT CONTINUES TO BE APPROPRIATE FOR HOSPICE SERVICES AS EVIDENCED BY THE FOLLOWING:...PATIENT HAS EXPERIENCED MULTIPLE INFECTIONS SINCE JUNE THIS YEAR (UTI X2 AND RESPIRATORY X1). BOTH SUCCESSFULLY TREATED WITH ANTIBIOTICS....[PATIENT NAME] HAS DEVELOPED SOME DIFFICULTY WITH SWALLOWING MEDICATIONS AND AN ORDER TO CRUSH MEDS HAS BEEN PROVIDED." Review of a "HOSPICE PHYSICIAN ORDER," dated 9/6/2022, revealed "START: CIPRO (250 MG TAB). GIVE ONE TABLET BY MOUTH TWICE DAILY FOR 10 DAYS FOR SYMPTOMS OF UTI." Review of a "HOSPICE PHYSICIAN ORDER," dated 9/25/2022, revealed "START: NECTAR THICK FLUIDS, SOFT TEXTURED DIET." Review of a "HOSPICE PHYSICIAN ORDER," dated 9/26/2022, revealed "ADD THICK IT TO SUPPLY LIST DUE TO DYSPHAGIA." Review of the "IDG SUMMARY REPORT," for the meeting held on 9/29/2022, revealed that the interdisciplinary group discussed "4. (P)ROBLEM - MONITOR FOR RESOLUTION OF UTI SYMPTOMS." The "(I)NTERVENTION" portion of the document indicated that the patient had been given an antibiotic to treat a urinary tract infection, the antibiotic was completed, and the urinary tract infection had resolved. The report included "(G)OAL - TO ENSURE THAT PATIENT REMAINS FREE FROM FURTHER UTI SYMPTOMS BY NEXT SCHEDULED IDG MEETING ON THURSDAY, 10/13/22." Further review of the "IDG SUMMARY REPORT" revealed that the interdisciplinary group discussed "5. (P)ROBLEM - MONITOR FOR PROGRESSION OF 'PROBABLE' STROKE SYMPTOMS." The "(I)NTERVENTION" portion of the document indicated that the patient was seen for a "probable stroke" on 9/25/22 and presented with right sided weakness, aphasia, and new onset dysphagia for which nectar thick liquids and soft texture food was provided. The report included "(G)OAL - TO ENSURE THAT PATIENT REMAINS FREE FROM FALLS RELATED TO RIGHT SIDE WEAKNESS AND THAT PATIENT DOES NOT EXPERIECE [sic] AN EPISODE OF ASPIRATION. ALSO TO CLOSELY MONITOR AND IDENTIFY ANY NEW NEEDS RELATED TO THESE CHANGES BY NEXT SCHEDULED IDG MEETING ON THURSDAY, 10/13/22." Review of the "Hospice POC Report" on 10/6/2022, revealed the plan of care did not address Patient #4's history of urinary tract infection, completion of treatment, and/or need to monitor for further UTI symptoms. Further review revealed the plan of care did not address history of "probable stroke" and/or need to monitor for any new needs. The plan of care also did not address dysphagia, the need for thickened liquids and/or monitoring for potential aspiration. During an interview with Employees #1 and 7 on 10/6/2022 beginning at 10:30 AM, the above findings were presented. Both employees acknowledged the findings and Employee #1 stated "I appreciate your input."

Based on interview and medical record review, it was determined the agency failed to include outcomes that could be anticipated from implementing and coordinating the plan of care, or were measurable, for 1 of 4 active patient records reviewed (Patient #1). --- Findings: Review of the medical record for Patient #1 revealed a primary hospice diagnosis of "Alzheimer's disease with late onset associated with alcoholism without behavioral disturbance." Review of the "PHYSICIAN FACE TO FACE ENCOUNTER FOR HOSPICE," dated 9/10/2022, revealed the statement "FAST 7C as patient is incontinent, non-ambulatory, and is non-verbal." Observation of a home visit on 10/4/2022 confirmed the patient was non-verbal with the exception of shaking their head yes/no to answer some, but not all, questions. Review of the "Hospice POC Report" on 10/6/2022 revealed under "SELF CARE DEFICITS - HOSPICE," the goal "PATIENT DEMONSTRATES DIGNITY HAS BEEN MAINTAINED AS EVIDENCED BY IMPROVED SENSE OF WELL BEING." The goal lacked information regarding how "improved sense of well being" would be measured in a patient with impaired cognition and verbal ability. Further review of the "Hospice POC Report" revealed under "GRIEVING - MSW - HOSPICE," the goal "PATIENT DISCUSSES LIFE'S EXPERIENCES." The care plan lacked information regarding how this outcome could be anticipated from implementing and coordinating the plan of care. Further review of the "Hospice POC Report" revealed under "COPING - MSW- HOSPICE" the goal "PATIENT'S STRESS/ANXIETY IS REDUCED TO LEVEL OF COMFORT." The goal lacked information regarding how a reduction of the patient's stress/anxiety "to level of comfort" would be measured. During an interview with Employees #1 and 7 on 10/6/2022 beginning at 10:30 AM, the above findings were presented. Both employees acknowledged the findings and Employee #1 stated "I appreciate your input."

Based on interview and medical record review, it was determined the agency failed to ensure that the hospice interdisciplinary group revised the individualized plan of care as frequently as the patient's condition requires, but no less frequently than every 15 calendar days for 3 of 4 active patient records reviewed (Patients #1, 2, and 4). --- Findings: Review of the medical record for Patients #1, 2 and 4 revealed that music therapy was provided during the current certification period. Further review revealed that all three records included a physician's order, dated 9/20/2022, to discontinue music therapy. Review of the "IDG SUMMARY REPORT" revealed that Patients #1, 2 and 4 care was discussed in the IDG meeting held on 9/29/2022. The summary for Patients #1 and 4 revealed an entry under "MEDICATION/CARE PLAN CHANGES OVER THE BENEFIT PERIOD:" that stated "MUSIC THERAPY VISITS DISCONTINUED." The summary for Patient #2 did not address the discontinuation of music therapy. Review of the current "Hospice POC Report" for all three patients on 10/6/2022, 16 days after the physician's order to discontinue music therapy and 7 days after the IDG meeting was held, revealed that "HOSPICE MUSIC THERAPY" was still listed as an active service being provided. During an interview with Employees #1 and 7 on 10/6/2022, beginning at 10:30 AM, the above findings were presented. Both employees acknowledged that the interdisciplinary group failed to revise the individualized plan of care as required. Employee #1 stated that the agency music therapist no longer worked there and acknowledged that the care plan information was not revised. Patient #4: Review of the "IDG SUMMARY REPORT," for the meeting held on 9/29/2022, revealed that the interdisciplinary group discussed "4. (P)ROBLEM - MONITOR FOR RESOLUTION OF UTI SYMPTOMS." The "(I)NTERVENTION" portion of the document indicated that the patient had been given an antibiotic to treat a urinary tract infection, the antibiotic was completed, and the urinary tract infection had resolved. The report included "(G)OAL - TO ENSURE THAT PATIENT REMAINS FREE FROM FURTHER UTI SYMPTOMS BY NEXT SCHEDULED IDG MEETING ON THURSDAY, 10/13/22." Review of the "Hospice POC Report" on 10/6/2022, revealed the plan of care did not address Patient #4's history of urinary tract infection, completion of treatment, and/or need to monitor for further UTI symptoms. Further review of the "IDG SUMMARY REPORT" revealed that the interdisciplinary group discussed "5. (P)ROBLEM - MONITOR FOR PROGRESSION OF 'PROBABLE' STROKE SYMPTOMS." The "(I)NTERVENTION" portion of the document indicated that the patient was seen for a "probable stroke" on 9/25/22 and presented with right sided weakness, aphasia, and new onset dysphagia for which nectar thick liquids and soft texture food was provided. The report included "(G)OAL - TO ENSURE THAT PATIENT REMAINS FREE FROM FALLS RELATED TO RIGHT SIDE WEAKNESS AND THAT PATIENT DOES NOT EXPERIECE [sic] AN EPISODE OF ASPIRATION. ALSO TO CLOSELY MONITOR AND IDENTIFY ANY NEW NEEDS RELATED TO THESE CHANGES BY NEXT SCHEDULED IDG MEETING ON THURSDAY, 10/13/22." Review of the "Hospice POC Report" on 10/6/2022, revealed the plan of care did not address Patient #4's history of "probable stroke" and/or need to monitor for any new needs. The plan of care also did not address dysphagia, the need for thickened liquids and/or monitoring for potential aspiration. During an interview with Employees #1 and 7 on 10/6/2022, beginning at 10:30 AM, the findings for Patient #4 were presented. Both employees acknowledged the findings.