Every finding on record at Hospice Care of Texas, LLP

Upon patient record review, 1 of 19 (Patient #6) 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 6: The current medication list has oxygen listed without a delivery method. Medication list corrected during survey.

Upon patient record review, 1 of 19 (Patient #7) 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 7: The medical record indicated that the patient used a rolling walker daily due to shuffled gait and impaired mobility. No evidence of problems, goals, and interventions related to altered mobility/safety included in the plan of care.

Upon patient record review, 3 of 19 (Patient #6,9,10) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient 6: The medical record contained an order for oxygen with no delivery method. Physician order updated during the survey. Patient 9: The medical record indicated that the patient was to perform intermittent self catheterization 4 times a day. No evidence that the order included catheter size to use. Physician order updated during the survey. Patient 10: The RN documentation indicated that the patient used oxygen at 3.5L NC. The plan of care has the oxygen flow rate ordered at 3L via NC. No evidence that the an order was received for 3.5L NC or that a titration order was obtained.

Upon patient record review, 3 of 19 (Patient #1,7,9) did not have evidence the plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including equipment and supply needs. Patient 1: The medical record indicated that the patient uses a Hoyer lift for all transfers. The aide has instructions to use a Hoyer lift with all transfers from the bed to the chair at every visit. No evidence that the Hoyer was included on the current plan of care DME list. Plan of care DME list updated during the survey. Patient 7: The medical record indicated that the patient used a rolling walker daily due to shuffled gait and impaired mobility. No evidence that the rolling walker was added to the current plan of care DME list. Plan of care DME list updated during the survey. Patient 9: The medical record indicated that the patient was to perform intermittent catheterization 4 times a day. No evidence that catheter supplies were listed on the current supply list. Supply list on the plan of care updated during the survey.

Upon patient record review, 3 of 19 (Patient #1,2,3) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient #1: No evidence of MSW IDG contribution since IDG note documented on 03/27/2025. No evidence of MSW contribution for IDGs that occurred on 04/04/25, 04/18/25, 05/02/25, 05/16/25, and 05/30/25. No evidence of SC contribution for IDG's that occurred on 05/02/25 and 05/16/25. Patient #2: No evidence of MSW IDG contribution since 03/27/2025. No evidence of MSW contribution for IDGs that occurred on 04/11/25, 04/25/25, 05/09/25, 05/23/25, and 06/06/25. No evidence of SC contribution for IDG's that occurred on 05/09/25, 05/23/25, and 06/06/2025. Patient #3: No evidence of MSW IDG contribution since an IDG note documented on 03/27/2025. No evidence of MSW contribution for IDGs that occurred on 04/04/25, 04/18/25, 05/02/25, 05/16/25, and 05/30/25.

Upon patient record review, 3 of 19 (Patient #17,18,19) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient 17: No evidence of a bereavement plan of care was being followed. No evidence of post-death contact or mailings. No evidence that this was done at the request of the bereaved family. Patient 18: No evidence of a bereavement plan of care was being followed - one on one visits every Tuesday. No evidence of follow-up after September 12, 2024. No evidence of contact or mailings since that time. No evidence that this was done at the request of the bereaved family. Patient 19: No evidence of a bereavement plan of care. No evidence of post-death contact or mailings. No evidence that this was done at the request of the bereaved family.

Upon patient record review, 1 of 19 (Patient #4) 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 4: The medical record indicated that patient was being seen by 2 aides per visit for 2 person assist baths on 05/19/2025. No evidence that the aide plan of care was updated to include those orders at the start of survey. Aide plan of care updated during survey.

Upon patient record review 1 of 19 (Patient #3) 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 3: POC dated 7/4/24 has an Aide frequency ordered as 5 times weekly. No evidence that the Aide saw the patient 5 times for the week of 04/20/2025. No evidence of an order to decrease visits for the week. No evidence that the 5 visits was missed at the request of the patient/caregiver.

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. contract personnel. No evidence that the agency utilized volunteers at least 5% of the total patient care hours in 2024. The total usage of volunteers for 2024 was 0.7%.

Upon patient record review, 1 of 19 (Patient #13) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 13: The RN documentation included supervisory visits for the aide on 02/27/25, 03/10/25, 03/14/25, 04/09/25, 04/17/25, 04/28/25, and 05/05/25. No evidence that aide services were ordered during the patients time on service.

Upon patient record review, 1 of 19 (Patient #14) did not have evidence that the hospice plan of care identifies the care and services that are needed and specifically identify which provider (nursing facility or hospice) is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care. Patient 14: The medical records indicated that patient had a foley catheter on admit. There was an order to remove the foley catheter and record output. The RN documentation noted that the catheter was re-inserted on 03/06/2024 by the SNF staff. No evidence that the order was received from the physician to reinsert the foley catheter, that also included the size, change frequency, and who was responsible for performing care/maintenance of the foley catheter, hospice staff or facility staff. New physician order received during survey.