Every finding on record at Hospice Preferred Choice, Inc.

Based on record review, policy and procedure review, and staff interview, the agency failed to document follow-up with a complainant, according to the agency's own policy and procedure and expectations, for 1 of 4 hospice complaints reviewed (complaint  received by the agency on 3/7/26 for Patient 5). The  census was 96; 49 at the parent and 47 at the multiple location. --- Findings are: A. Review of the agency policy and procedure titled Patient Grievances and Complaints, revised 3/19/26 revealed:  1. The agency was to have a process in place a procedure for the provision of a response to the patient or designee. 2. The policy and procedure provides a mechanism for receiving, reviewing, and resolving patient/caregiver complaints.  3. The agency was to communicate the resolution of the complaint to the patient and/or caregiver that initiated the complaint process verbally and follow-up via an individualized, scenario-specific recovery letter.  B. Review of the agency grievance/complaint log revealed: 1. A Client Complaint Report with a complaint received on 3/7/26 at 12:45 PM from a family member of Patient 5. 2. The report indicated the family member requested a follow-up call. 3. There was no documentation on the complaint investigation and follow-up notes that a follow-up phone call was made to the complainant.  C. Review of Patient 5's clinical record revealed there was no documentation that a follow-up phone call was made to the complainant regarding a complaint made on 3/7/26.  D. During an interview on 6/2/26 at 1:30 PM, the Area Vice President of Operations, and the Area Vice President of Clinical Services confirmed: 1. There was no documentation in the complaint investigation notes that a follow-up phone call was made to the family member of Patient 5 regarding the complaint made on 3/7/26. 2. The agency expectation is that follow-up is to be done with all complainants.  3. The staff did not follow the agency policy and procedure and agency expectations to complete and document follow-up with the family member of Patient 5 when they filed a complaint on 3/7/26.

Upon patient record review 1 of 19 (Patient #7) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient #7: The patient was admitted on 11/25/24. The initial psychosocial comprehensive assessment was 12/6/24 beyond the 5 calendar days.

Upon patient record review, 4 of 19 (Patient #2,10,11,13) 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. 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 #2: There is an order on 11/21/24, to remove all oxygen DME as the patient is not on oxygen. Oxygen 2L/min remained on the medication record. Additionally, during the home visit it was observed, the patient was taking Duloxetine 30 mg daily. The hospice medication record indicated Duloxetine 40 mg daily. (corrected on site) Patient #10: There is an order on 1/7/25 for Oxygen 2L PRN SOB no route is indicated on the medication record. (corrected on site) Patient #11: The hospice medication record indicates Pravastatin daily. During the home visit the patient caregiver stated Pravastatin was discontinued in July 2024. (corrected on site) Patient #13: There is an order on 2/25/24 for Oxygen supplies. The patient is using oxygen but oxygen is not on the medication record. (corrected on site)

Upon patient record review, 2 of 19 (Patient #3, 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 #3: The medication record indicates on 1/2/25 the patient was on Warfarin. The plan of care did not include bleeding precautions. (corrected on site) Patient #7: The 11/25/24 admission note by the RN indicated the patient had second round of antibiotics 2 weeks ago. Infection was not added to the plan of care until 12/31/24.

Upon patient record review, 4 of 19 (Patient #1,8,10,13) 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: There is evidence in the record on 10/16/24 of an order for Oxygen 2L/min via NC continuous. On 2/11/25 and 2/25/25, the nurses' notes indicate the Oxygen was at 4L/min. Patient #8: There is an order 1/7/25 to cleanse wound with wound spray, pat dry, apply Xeroform, cover with Opti foam. Hospice nurse to complete 2x week and facility nurse all other times. The order does not indicate how often or the location of the wound. (corrected on site) Patient #10: There is an order on 1/7/25 for Oxygen 2L PRN SOB no route is listed in the order. (corrected on site) Patient #13: There is an order on 2/25/25 for Oxygen supplies. There is no order for oxygen and the patient is using oxygen. (corrected on site)

Upon patient record review, 2 of 19 (Patient #5,8) 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 #5: The medical record indicates the care plan was updated with Infection on 11/6/24. The antibiotic was discontinued on 11/28/24 however, the problem was not discontinued from the care plan until recertification update on 1/22/25. Patient #8: There is new order 1/7/25 for wound care. The plan of care was not updated to include wounds. (corrected on site)

Upon patient record review 2 of 19 (Patient #1,11) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #1: There is evidence in the patient record on 10/22/24 the patient requested a volunteer. No volunteer is available. Patient #11: There is evidence in the patient record on 1/16/25 the patient requested a volunteer. No volunteer is available.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. During home visit with Patient #3, the RNCM was observed returning dirty equipment into her nurse's bag. The hospice bag technique indicates to clean equipment before returning to the bag.

Upon patient record review, 1 of 19 (Patient #3) 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 #3: There is evidence on the medication record 1/2/25 the patient is on Warfarin. Bleeding precautions is not on the Aide care plan. (corrected on site)

Upon patient record review 3 of 19 (Patient #3,6,14) 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: The aid care plan indicates a bath on Thursdays. The week of 2/2/25 the patient did not have a bath on Thursday. The aid visited on Monday and Wednesday. Patient #6: The aid care plan indicates assist with shower weekly on Wednesday. The week of 2/9/25 the patient did not have a shower on Wednesday. The aid visited on Monday and Thursday. Patient #14: The aid care plan indicates assist with bath (only) on Wednesdays; assist with dressing, shampoo, nail care on Thursdays. The week of 2/9 and 2/16 the aide completed all services on Wednesdays.

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. The volunteer cost savings percentage for 2024 was 1.4%

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 observation, clinical record review, and staff interview. 1 of 11 (9%) applicable records in which the hospice aide was accepted, revealed the agency RN failed to provide specific care instructions on the hospice aide care plan. Record #89481: (election of benefit: 4/15/22; diagnosis: senile degeneration of the brain): During the home visit, conducted on 4/19/22, the patient was observed to have an indwelling catheter. The RN documented an indwelling Foley catheter during the initial assessment on 4/15/22. The hospice aide care plan, with an effective date of 4/15/22, stated that the aide was to provide a tub bath. The care plan did not alert the aide that the patient had an indwelling catheter or provide instructions for catheter care. During an interview with the Clinical Manager, on 4/20/22, she confirmed the aide care plan did not state the patient had a catheter or indicate that catheter care was to be performed and she stated, "They should have included that information."