Every finding on record at Hospice of Maine, LLC

Upon patient record review, 3 of 19 (Patients #1,#6,#14) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: During home visit medication reconciliation the facility and hospice medication profiles did not match. The facility profile contained an additional sertraline 25 mg dose that was not on hospice profile. Patient 6: During home visit medication reconciliation the facility and hospice medication profiles did not match. The nursing facility did not have lorazepam prn, had miconazole powder not on the hospice profile, and hospice profile contained duplicative MOM entries.- corrected Patient 14: The hospice profile with duplicative MOM entries. Corrected

Upon patient record review, 1 of 19 (Patient #4) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 4: The bereavement assessment was completed on 5/7/25 with SOC 4/21/25.

Upon patient record review, 1 of 19 (Patient #19) did not have evidence that each patient and family received education and training provided as appropriate to their responsibilities for the care and services identified in the plan of care. Patient 19: There was no evidence of patient and family education surrounding need to transfer to another hospice agency due to agency inability to continue services.

Upon patient record review, 1 of 19 (Patient #1) 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 1: Inappropriate problems/goals/interventions related to O2 with patient not on O2. In addition, no problems/goals/interventions related to neurological dysfunction and fall safety. Corrected

Upon patient record review, 2 of 19 (Patients #1,#6) 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 1: During home visit medication reconciliation, the facility and hospice medication orders did not match. The facility had two orders for sertraline with different doses that were being administrated daily, whereas hospice had one order. Patient 6: The nursing facility did not have lorazepam prn, had miconazole powder not on the hospice profile, and hospice profile contained duplicative MOM entries.- corrected

Upon patient record review, 9 of 19 (Patients #1,#3,#4,#5,#6,#8,#11,#12,#14) 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 documented patient has a hospital bed. No evidence that the equipment was included on the current DME supply list. Corrected Patient 3: The medical record documented patient has a hospital bed, wheelchair, overbed table. No evidence that the equipment was included on the current DME supply list. Corrected Patient 4: The medical record documented patient has a hospital bed. No evidence that the equipment was included on the current DME supply list. Corrected Patient 5: The medical record documented patient has a lift. No evidence that the equipment was included on the current DME supply list. Corrected Patient 6: The medical record documented patient has a bolstered mattress, fall mat, and hoyer without orders found. No evidence that the equipment was included on the current DME supply list.- order wheelchair added 11/12 during survey- corrected Patient 8: The medical record documented patient has a hospital bed. No evidence that the equipment was included on the current DME supply list. Corrected Patient 11: The medical record documented patient has a walker. No evidence that the equipment was included on the current DME supply list. Corrected Patient 12: The medical record documented patient has a cane and wheelchair. No evidence that the equipment was included on the current DME supply list. Corrected Patient 14: The medical record documented patient has a walker. No evidence that the equipment was included on the current DME supply list. Corrected

Upon patient record review, 1 of 19 (Patient #19) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 19: There was no evidence the plan of care was updated to include need for patient to transfer to another hospice due to agency inability to continue services.

Upon observation, there was no evidence the hospice investigates all adverse events, incidents, accidents, variances or unusual occurrences that involve patient care and develops a plan of correction to prevent the same or similar event from occurring again. Patient 2: The medical record contained social worker documentation 10/28/25 identifying patient was reported as having taken double doses of blood pressure medication for two nights. There was no evidence of an incident report completed and investigation conducted.

Upon patient record review, 1 of 19 (Patient #5) did not have evidence in the patient record that hospice aide assignments and duties are specific to patient needs. Patient 5: There was no evidence of instructions to utilize a lift for transfers included in the aide care plan. Corrected on site with aide care plan update.

Upon patient record review 1 of 19 (Patient #5) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient 5: There was no evidence of aide supervision completed between 10/1/25 and 10/21/25.

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. Agency annual volunteer utilization rate was 2.8% for 2024. Year to date rate is at 3.9%

Upon patient record review, 1 of 19 (Patient #3) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patient 3: There was no evidence a verbal certification was received from the attending physician upon admission. Verbal certification was documented as received from a PA and written certification was not received until 2/5/25 with admission 1/17/25.

Upon patient record review, 1 of 19 (Patient #3) 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 3: Orders for O2 DME in error, patient did not have O2. Corrected

Upon patient record review, 2 of 19 (Patients #3,#8) did not have evidence that the hospice provided the following information: • Physician certification and recertification of the terminal illness specific to each patient Patient 3: Upon observation during the home visit, the facility binder did not have any CTIs previous to benefit period started 9/14/25. Patient 8: Upon observation during the home visit, the facility binder did not contain physician narrative and signature for benefit period 5/30/25 and no CTI for benefit period 7/29/25.

Upon patient record review 1 of 13 (Patient #7) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #7- The record did not address the spiritual needs of the patient and all physical needs as part of the comprehensive assessment. The patient refused Chaplain services on admission 07/19/22. A spiritual assessment was not performed by the Chaplain, RN or Social Worker. The patient was admitted on 07/19/22 with a skin tear to the right forearm. The initial nursing assessment 07/19/22 does not include wound measurements or a description of the wound.

Upon patient record review, 6 of 13 (Patient #1, #3, #5, #7, #8, #13) 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. Patient #1- On 09/14/22 the nurse documents requesting orders for Hyoscyamine, MSIR, and Lorazepam comfort medications. On 09/20/22 the nurse documents the comfort medications were ordered. The medication profile was not updated with the medications. (corrected on site) Patient #3- The medication profile includes Acetaminophen 325 mg 2 tabs three times daily prn pain or fever. The profile also includes Acetaminophen 500mg 1 three times daily. A maximal dosage not to be exceeded in a day is not specified in the profile. Miralax 17 gm powder is listed daily prn constipation. A diluent is not included in the profile. (corrected on site) Patient #5- Miralax 17 gm powder is listed daily prn constipation. A diluent is not included in the profile. On 09/26/22 orders were received to add Morphine 5 mg q2h prn dyspnea. The profile was updated with Morphine 20mg/5ml 5 mg q2h scheduled for dyspnea. The medication profile includes two doses of a specialty compounded Lorazepam gel for topical administration .5mg/ml, and the profile lists Lorazepam 5mg administer topically twice daily. (corrected on site) Patient #7- The medication profile includes Nitroglycerin .4 mg Sl tab as directed for chest pain. Orders are not specific for dosing. Senna Plus 8.6mg-50mg tab 2 tabs twice daily are ordered prn for bowel program. Bowel program is not a symptom for administration. Patient #8-The 08/08/22 medication profile includes two orders for Fentanyl patches. 8/8/22 Fentanyl 12 mcg/hr transdermal 1 patch q72 hours rotate sites and 8/8/22 Fentanyl 25 mcg/hr transdermal patch 1 patch q 72 h rotate sites. The orders are unclear whether both patches are to be placed for a total of 37 mcg/hr versus duplicate dosing. (corrected on site) Patient#13- The medication profile includes Acetaminophen 325 mg tablet 2 tablets every 4 hours prn pain and Acetaminophen 650 mg extended release 1 tab three times daily. A maximal dosage not to be exceeded in a day is not specified in the profile. The profile includes Latanoprost .005% 1 drop at bedtime and Timolol Maleate 0.5% eye drops 1 twice daily. The profile does not specify right,left or both eyes. Ipratropium/Albuterol nebulization is listed as every 4 hours prn COPD instead of symptom for administration. (corrected on site)

Upon patient record review, 8 of 13 (Patient #1, #3, #5, #6, #7, #8, #9, #13) did not have evidence the plan of care included all services necessary for the palliation and management of the terminal illness and related conditions, including specific/accurate orders for all medications and treatments. Patient #1- On 09/14/22 the nurse documents requesting orders for Hyoscyamine, MSIR, and Lorazepam comfort medications. On 09/20/22 the nurse documents the comfort medications were ordered. The plan of care was not updated with the medication orders. (corrected on site) Patient #3- The 08/16/22 plan of care includes Acetaminophen 325 mg 2 tabs three times daily prn pain or fever. The profile also includes Acetaminophen 500mg 1 tab three times daily. A maximal dosage not to be exceeded in a day is not specified in the plan. Miralax 17 gm powder is ordered daily prn constipation. A diluent is not included in the orders. (corrected on site) Patient #5- Miralax 17 gm powder is listed daily prn constipation on the 09/04/22 plan of care. A diluent is not included in the orders. The 09/04/22 plan of care includes two orders for a specialty compounded Lorazepam gel for topical administration .5mg/ml, and the 09/04/22 plan of care includes Lorazepam 5mg administer topically twice daily. (corrected on site) Patient #6- The 08/26/22 plan of care includes orders for the nurse to instruct the patient on blood glucose testing and insulin administration. The orders are not specific for the frequency of glucose testing and the patient is not on insulin. Patient #7- The 07/19/22 plan of care includes Nitroglycerin .4 mg Sl tab as directed for chest pain. Orders are not specific for dosing. Senna Plus 8.6mg-50mg tab 2 tabs twice daily are ordered prn for bowel program on the plan of care. Bowel program is not a symptom for prn administration. Patient #8-The 08/08/22 plan of care includes two orders for Fentanyl patches. 8/8/22 Fentanyl 12 mcg/hr transdermal 1 patch q72 hours rotate sites and 8/8/22 Fentanyl 25 mcg/hr transdermal patch 1 patch q 72 h rotate sites. The orders are unclear whether both patches are to be placed for a total of 37 mcg/hr versus duplicate dosing. (corrected on site) Patient #9-The 08/05/22 plan of care includes orders for the nurse to instruct the patient on blood glucose testing and insulin administration. The orders are not specific for the frequency of glucose testing and the patient is not on insulin. The plan of care also includes orders for SN to teach the care of indwelling catheter. The type of catheter and specific orders for maintenance are not included in the plan of care. Patient #13-The 09/13/22 plan of care includes Acetaminophen 325 mg tablet 2 tablets every 4 hours prn pain and Acetaminophen 650 mg extended release 1 tab three times daily. A maximal dosage not to be exceeded in a day is not included in the plan. The plan of care includes Latanoprost .005% 1 drop at bedtime and Timolol Maleate 0.5% eye drops 1 twice daily. The orders do not specify right,left or both eyes. Ipratropium/Albuterol nebulization is listed as every 4 hours prn COPD instead of symptom for administration. (corrected on site)

Upon patient record review, 5 of 13 (Patient #7, #9, #11, #12, #13) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #7- The nurse is ordered to perform wound care to the patients left forearm skin tear three times weekly. On 07/28/22, 08/10/22 and 08/15/22 the nurse documents wound care was not performed as wound was covered by a nonremovable dressing. Patient #9- On 08/11/22 the nurse is ordered to visit the patient three times weekly. The week of 08/14/22 the patient was visited twice on 08/15 and 08/19. On 08/17/22 the nurse documented she was not working that day and would see on the next regularly scheduled visit. The week of 08/21/22 the nurse visited twice on 08/22 and 08/26. There is no documentation regarding the missed visit. The week of 08/28/22 the patient was visited 08/29/22 and 08/31/22 and there is no documentation regarding the missed visit. Patient #11- On 09/28/22 the nurse documents changing the patient's Foley catheter with a size 14 Fr Foley. The orders on record 08/26/22 are to replace the catheter with 16 Fr when needed for leakage or blockage. Patient #12 -Effective 09/14/22 the Social Worker frequency is once monthly for one month then twice monthly. The social worker visited twice in September on 09/15 and 09/27/22. Effective 09/14/22 the Spiritual Care Provider frequency is once monthly for one month then twice monthly. The Spiritual Care Provider visited twice in September on 09/15 and 09/28/22. Patient #13- Effective 09/13/22 the Spiritual Care Provider is ordered to visit once monthly for one month, three times monthly for one month, then twice monthly for one month. The Spiritual Care Provider visited twice in September on 09/14/22 and 09/19/22.

Upon patient record review 1 of 13 (Patient #9) did not evidence documentation in the patient record that a hospice aide provides services as ordered by the interdisciplinary group. Patient #9- As of 08/14/22 the Aide was assigned to visit five times weekly. The week of 08/14/22 the patient was visited 4 times on 08/16, 08/17, 08/18 and 08/19. There is no documentation regarding the missed visit for this week. The week of 08/21/22 the patient was visited four times on 08/22/22, 08/23, 08/24 and 08/25. On 08/26/22 the Aide documented the reason for the missed visit as the Aide was only working a 1/2 day.

Upon patient record review, 1 of 13 (Patient #9) did not evidence that each patient record contains all required physician orders. Patient #9- The patient was discharged 09/05/22 as no longer being terminally ill. There is no order on record for the discharge.

Upon patient record review, 1 of 1 (Patient #7) did not have evidence that the hospice forwarded a summary and a copy of the patient record, if requested, to a facility when transferring the patient to that facility. Patient #7- The patient transferred to another hospice on 08/12/22. There is no documentation on record that the transfer summary was sent to the receiving hospice.

Upon patient record review, 1 of 1 applicable (Patient #9) did not have evidence that the discharge summary includes all required information. Patient #9-The patient was discharged 09/05/22 as no longer terminally ill. The discharge summary only includes the reason for discharge. The discharge summary does not include a summary of the patient's stay, including treatments, symptoms and pain management.