Every finding on record at Hospice of East Texas

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments, includes all services necessary for the palliation and management of the terminal illness, including interventions to manage pain and symptoms. This standard was not met as evidenced by clinical record review and interview. In 2 of 30 (7%) clinical records reviewed, the agency did not ensure the individualized plan of care included complete interventions to manage symptoms. CLINICAL RECORD 13: The patient elected the hospice benefit on 09/14/2025 with diagnosis of hydrocephalus Alzheimer’s. The skilled nurse documented on the nursing visit note dated 10/24/2025 a skin tear on patient's arm. The plan of care order dated 10/24/2025 read, assess skin, instruct family, caregiver, facility staff of proper dressing changes, nursing facility to perform scheduled and PRN (as needed) wound care, monitor and document wound care with measurements performed each week, cleanse with normal saline, pat wound dry with 4x4 gauze, change dry protective dressing when compromised or every three days. The order did not include the location of the wound. Clinical Record 15: The patient elected the hospice benefit on 10/08/2025 with a diagnosis of breast cancer. The skilled nurse documented on the nursing assessment dated 10/08/2025 that the patient had a 16 cm x 13 cm wound on the right breast. An order on the plan of care dated 10/08/2025 read in part, Initiate wound care protocol, fungating tumor, cleanse with normal saline or mild soap and water, manage odor by cleaning with antiseptic such as Hibiclens, apply skin barrier to perimeter of the wound, utilize dry protective dressing to manage drainage, may use xeroform or similar product to prevent adherence. The order on the plan of care do not specify the location of the wound. During an interview and joint record review on 11/04/2025, the Director of Clinical Strategy stated, that "the nurse needs to fix it and add the location of the wound."

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current: Prescription and over the counter (OTC) Supplements; Herbal remedies; 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; 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 a review of clinical records and interviews.1 of 16 (6%) Records in which medication changes were documented, the agency did not ensure that the medication profile was updated and consequently a full review of medications was documented. Record 2: Nursing visit on 12/22/2022 documented that ear wax softening drops were administered by nurse during visit. Additionally, nursing visit on 12/07/2022 documented that Nystatin (an antifungal medication) was started for redness. The medication profile was not updated for these changes, and these drugs were not included in the drug regimen review. During interview with the System Analyst and Quality Specialist stated that the medications were not documented on the medication profile.

It is required that each patient’s individualized written plan of care: includes all services necessary for the palliation and engagement of the terminal illness, including the following: Drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by a review of clinical records, document reviews and interviews.1 of 18 (6%) records in which changes were documented on the assessment, the agency did not ensure that the patient plan of care was updated. Agency Policy "Hospice Interdisciplinary Team Conference and Communication" [date reviewed 3/22] stated in part, "The purpose of the IDT conference is the review, updating, and revision of the plan of care as necessary and appropriate, to meet the patient and family's changing goals." Record 5: Nursing comprehensive visit documented on 12/27/2022, the facility nurse had requested Alegas Powder for wound care to replace the Dakins solution. The supplies were documented as delivered but no documented evidence that the Plan of Care (POC) was updated to reflect this change. During interview with the System Analyst and Quality Specialist stated that the change in wound care documented on the comprehensive assessment was not documented correctly on the hospice plan of care.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. 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 a review of clinical records, document reviews and interviews.1 of 19 (5%) records in which a hospice aide service was accepted, revealed a lack of clear and specific written instruction for the aide assignment, thus leaving the aide to make decisions outside of the aide scope of practice. Agency Policy "Standards of Care Home Hospice Aides" [review date April2011] stated in part, " The home hospice aide written assignment reflects planned interventions for identified needs, problems, and patient /family preference. The plan ensures that care and services provided are safe and appropriate to the functional level of the particular patient." Record 11: Hospice patient election of benefit on 02/16/2022 with a new nephrostomy tube inserted into the left back. Task for aide to shower each visit and empty ostomy bag but no direction how to manage the gauze dressing over the nephrostomy site during the shower. During an interview with System Analyst and Quality Specialist stated that the nephrostomy tube direction was not documented on the aide plan.

It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group and included in the plan of care; Permitted to be performed under state law and regulation; Consistent with the hospice aide training. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. 3 of 19 (16%) records in which a hospice aide was accepted, the agency did not ensure the hospice aide documented all care tasks required from the plan of care. Agency Policy "Standards of Care Home Hospice Aides" [review date April2011] stated in part, "Home hospice aides (HHA) provide care to hospice patients in accordance with a written plan of care from the hospice registered nurse. Record 7: Hospice aide visits on 12/23/2022 and 12/16/2022, no bath was documented as provided, and no note for reason not provided. The task ordered was chair bath on Tuesday and Friday. The date 12/23/2022 and 12/16/2022 were on a Friday. On 1/13/2023, no shampoo was provided, and no documented evidence for why it was not provided. The task ordered on the aide plan was shampoo visits Tuesday and Friday, the visit on 1/13/2023 was a Friday. Record 8: Hospice aide visits on 12/19/2022 and 12/26/2022 shampoo was not documented as provided and no reason for why it was not provided. Task assigned on the aide plan was shampoo Monday and as needed (PRN). Both dates are Mondays. Record 12: Hospice aides visit on 12/16/2021 documented that shampoo was not applicable. The task ordered on the plan was to shampoo on Thursday. The date of 12/16/2021 was a Thursday and no documented evidence for why no shampoo provided. During an interview with System Analyst and Quality Specialist stated that a recent process improvement was identified for hospice aide plans and following the plans.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. Hospice aide documentation complies with hospice policies and procedures. This standard was not met as evidenced by a review of clinical records, and interviews. 1 of 19 (5%) records in which a hospice aide was provided, the agency did not ensure that documentation of aide reports to the nurse were documented in the clinical record. Record 1: Hospice aide visit on 1/13/2023 the caregiver refused to wake the patient; no aide care was provided. No documented evidence that the refused care was reported to a nurse. During interview with the Quality Specialist stated that a recent process improvement for hospice aide documentation was identified and that a process is in place for aides to report care changes to the nurse at the office.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: Signed copies of the notice of patient rights and the hospice election statement. This standard was not met as evidenced by a review of clinical records, document reviews and interviews.1 of 20 (5%) records, revealed the agency did not ensure documentation of the date of the hospice benefit of election. Agency Policy "Admission to Hospice and Initial of Patient Care" [Date reviewed 3/22] stated in part, "Ensure that the consent to care is signed by the patient or authorized representative and that all admit forms are completed." Record 8: Patient elected Hospice benefit on 10/09/2022. The Consent Form which included the Hospice Benefit of Election contained no documented evidence of the date of election. The form was signed on 10/09/2022 but the date of election on the form was blank. During an interview with the System Analyst stated that there were two forms scanned in but that the date was missing from both.