Every finding on record at Integracare Hospice of Abilene, LLC

Upon patient record review, 2 of 14 (Patient #5,9) 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 5: RN documentation on 02/18/26, 02/20/26, 02/27/26, and 03/02/26 indicated that the patient was using oxygen at 6L continuously. No evidence that the medication profile had an order for oxygen at 6L. Order on medication profile, written on 02/11/2026, had oxygen liter flow perimeters as 7-9L continuously. Patient 9: Medication profile has MiraLAX ordered as needed PRN for mild constipation. No evidence that a frequency was included on the medication profile.

Upon patient record review, 1 of 14 (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: RN documentation at the time of admit and in ongoing assessments indicated that the patient has dysphagia post CVA, increased secretions, and is at high risk for aspiration. No evidence that risk for aspiration was included on the current plan of care.

Upon patient record review, 2 of 14 (Patient #5,9) 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 medications and treatments. Patient 5: RN documentation on 02/18, 02/20, 02/27, and 03/02 indicated that the was using oxygen at 6L continuously via NC. No evidence that an order was received for oxygen at 6L. Order written on 02/11/2026 had oxygen perimeters as 7-9L continuously. Patient 9: Plan of care has MiraLAX ordered as needed PRN for mild constipation. No evidence that a frequency was included on the order.

Upon patient record review, 2 of 14 (Patient #3,8) 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 3: Medical record indicated that the wound to the right breast was healed and the wound was discontinued on 01/30/26. The plan of care has active wound care treatment interventions related to the right breast wound. Patient 8: Plan of care indicated that MSW visits were discontinued on 01/26/2026. Problems, goals, and interventions related to social services remain active on the plan of care. No evidence that the plan of care was updated to remove those problems, goals, or interventions once they were identified as no longer being needed.

Upon patient record review 2 of 14 (Patient #1,9) 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 1: No evidence that an aide supervisory visit was completed every 14 days between 02/17/26 and 03/06/26, 17 days between supervisory visits. Patient 9: No evidence that an aide supervisory visit was completed every 14 days. The last documented aide supervisory visit occurred on 02/03/26. No evidence that an aide supervisory visit has been completed since that time.

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. No evidence that the volunteer percentage for 2025 met the required 5% of total patient care hours. Volunteer percentage for 2025 was 1.88%.

Upon patient record review, 1 of 14 (Patient #2) did not have evidence that the hospice provided the following information: • Physician certification and recertification of the terminal illness specific to each patient Patient 2: No evidence that the recert CTI for the current benefit period that started on 02/07/2026 was provided to the SNF.

Upon patient record review 1 of 11 records (Patient #1) 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 #1: The patient was admitted on 12/2/22. The record indicates that the spiritual assessment was completed on 2/14/23.

Upon patient record review, 3 of 11 records (Patient #3,#5,#9) 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 #3: The medication profile indicated for Bisacodyl 5mg tablets, 1 q24h prn constipation, a second Bisacodyl order for 5mg tablets, give 2 tabs, q 24h prn constipation. And, Fleets enema 19GM-7GM/118ml, 1 application q24h prn constipation. The Bisacodyl orders were in duplicate except for the number of tabs to be administered and there was not evidence of directions on the order of the medications if one was not effective. In addition, There were 2 Tylenol orders: Tylenol extra strength, 1 q6h prn pain or fever, and Tylenol extra strength, 2 q6h prn pain or fever. The Tylenol orders were in duplicate except for the number of tabs to be administered, and there was not evidence of a parameter for the fever. Corrected on site. Patient #5: The record indicated Tylenol 325mg, 2 tabs q6h prn temp or pain. There was not evidence of a parameter for the temp. Corrected on site. Patient #9: The record indicated Miralax 17 GM as needed for constipation. There was not evidence of a diluent or a specific frequency.

Upon patient record review, 2 of 11 records (Patient #2,#10) 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 #2: The patient was admitted on 2/2/23. The record indicated that the bereavement assessment was not completed until 2/9/23. Patient #10: The patient was admitted on 7/2/22. The record indicated that the bereavement assessment was not completed until 7/11/22.

Upon patient record review, 3 of 11 records (Patient #3,#5,#9) did not have evidence the plan of care includes all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. Patient #3: The record indicated an order for Bisacodyl 5mg tablets, 1 q24h prn constipation, a second Bisacodyl order for 5mg tablets, give 2 tabs, q 24h prn constipation. And, Fleets enema 19GM-7GM/118ml, 1 application q24h prn constipation. The Bisacodyl orders were in duplicate except for the number of tabs to be administered and there was not evidence of directions on the order of the medications if one was not effective. In addition, There were 2 Tylenol orders: Tylenol extra strength, 1 q6h prn pain or fever, and Tylenol extra strength, 2 q6h prn pain or fever. The Tylenol orders were in duplicate except for the number of tabs to be administered, and there was not evidence of a parameter for the fever. Corrected on site. Patient #5: The record indicated Tylenol 325mg, 2 tabsq6h prn temp or pain. There was not evidence of a parameter for the temp. Corrected on site. Patient #9: Patient #9: The record indicated Miralax 17 GM as needed for constipation. There was not evidence of a diluent or a specific frequency.

Upon patient record review 3 of 11 records (Patient #1,#3,#5) did not have evidence of documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #1: The aide visit frequency was 2x/week. The record did not indicate a visit or missed visit documentation from 2/16/23-3/6/23. Patient #3: The aide visit frequency was 2x/week. For the week of 2/19/23-2/25/23, the record indicated only 1 visit on 2/20/23. Patient #5: The aide visit frequency was 1w1, 3w12,2w1. The patient was admitted on 12/23/22. For the week of 12/25/22-12/31/22, the record indicated only 2 visits (12/28/23 and 12/30/23). For the week of 1/1/23-1/7/23, the record indicated only 2 visits (1/4/23 and 1/6/23). For the week of 2/12/23-2/18/23, the record indicated 1 visit (2/17/23) and documentation of 1 missed visit (2/14/23).

Upon patient client record review, 1 of 11 records (Patient #1) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient #1: The patient was admitted on 12/2/22 and the election statement on admission indicated that the patient wished to receive the Patient Notification of Hospice Non-Covered Items, Services, and Drugs. The date on the addendum form indicated that the patient requested this document on 12/6/22 and also signed it on 12/6/22. There was no indication on the document of the date furnished and no indication that the document was signed/witnessed by a hospice representative, A second document was again noted in the record with a request date of 12/21/22, and a patient signature date of 12/27/22. Again there was not evidence on the document of a date that the document was furnished or a witnessed signature by a hospice representative, A third document was also noted in the record with a request date of 1/5/23, and a patient signature date of 1/9/23. Again there was not evidence of a date on the document that the document was furnished or a witnessed signature by a hospice representative.

Upon patient client record review, 1 of 11 records (Patient #3) did not have evidence that each patient record contains Advance Directives. Patient #3: The record indicated that the patient had an Advance Directive. There was not evidence that this document was a part of the patient record.

Upon client record review, 1 of 11 records (Patient #9) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patient #9: The record indicated that the patient revoked from hospice. There was not evidence that the discharge summary was sent to the attending physician.

Upon client record review, 1 of 11 records (Patient #9) did not have evidence that the discharge summary includes all required information. The patient revoked from hospice due to wanting to receive aggressive treatment. There was not evidence of a summary of the patient's stay, including treatments, symptoms and pain management. • Any instructions or referral information given to the patient or family • A brief description of services provided and ongoing needs that cannot be met

Upon client record review, 3 of 11 records (Patient #3,#8,#9) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #3: The record indicated that visits were conducted by the volunteer on 1/31/23, 2/23/23, 2/28/23 and 3/16/23. There was not evidence of an order. Corrected on site. Patient #8: The record indicated an order for volunteers to start on 1/24/23 at a frequency of 1x/week. The record indicated a volunteer visit on 1/18/23. There was not evidence of an order for this visit. Corrected on site. Patient #9: The visit frequency for the spiritual care counselor was 2 every 2m2. The record revealed that an evaluation was conducted on 9/30/22 and subsequent routine visits were conducted on 10/14/22, 10/27/22, 11/18/22, 11/30/22, and 12/9/22. In addition, the social work visit frequency was 1 every 2m2. The record revealed that an evaluation was conducted on 9/29/22, and subsequent routine visits were conducted 10/26/22, 11/22/22, and 12/13/22.