Every finding on record at Journeys Hospice of Texas LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, 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 clinical record review and interview. In 1 of 14 (7%) clinical records reviewed revealed the agency did not ensure a medication reconciliation was completed and medications updated to the medication profile. HOME VISIT 3: The date of election was 06/17/2025. The Medication Profile was printed on 07/28/2025 revealed Bisacodyl 10 mg rectal suppository, one suppository rectally once a day as needed for no bowel movement in three days; Senna-S 50 mg-8.6 mg tablet, two tablets orally once daily as needed for no bowel movement in two days; Hydromorphone Hydrochloride 1mg/ml solution, 1 ml orally every three hours as needed for severe breakthrough pain; Bisacodyl 5 mg tablet, two tablets orally once daily as needed for no bowel movement in two days; and Ondansetron 4 mg orally disintegrating tablet, one tablet orally every eight hours as needed for nausea/vomiting. During the Home Visit (Clinical Record 10) on 07/29/2025 with the Certified Nurse Aide (Personnel Record 8), the medication at the assisted living facility revealed Hydromorphone Hydrochloride 1 mg/ml solution, 1 ml orally every four hours as needed for breakthrough started 06/23/2025 (different frequency); APAP [acetaminophen] with Codeine 300-30 mg tablet, one tablet orally every six hours as needed started 02/20/2025; and Ibuprofen 600mg tablet, one tablet orally every six hours as needed started 04/02/2025. The facility medication record did not have the following listed: Bisacodyl 10 mg rectal suppository, one suppository rectally once a day as needed for no bowel movement in three days; Senna-S 50 mg-8.6 mg tablet, two tablets orally once daily as needed for no bowel movement in two days; Bisacodyl 5 mg tablet, two tablets orally once daily as needed for no bowel movement in two days; and Ondansetron 4 mg orally disintegrating tablet, one tablet orally every eight hours as needed for nausea/vomiting. The facility staff stated that the patient did have these medications available for use. During a joint record review and interview on 07/30/2025, the Alternate Administrator/Medical Social Worker confirmed that there was no documented evidence that the medications were reconciled when new medication is added, or changes are made to existing medication.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene. This standard was not met as evidenced by document review, interview, and observation. In 1 of 3 (33%) home visit observations revealed the agency did not ensure the staff followed the hand hygiene policy. DOCUMENT 1: Agency Policy: Hand Hygiene IC.3 dated 08/01/2021, stated in part, "Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations due to evidence of better compliance compared to soap and water. Staff may use an alcohol-based hand rub for routinely decontaminating hands in the clinical situations described below: 3. After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings and used supplies (PPE [personal protective equipment]) if hands are not visibly soiled. 4. Before moving from a contaminated body site to a clean body site during patient care... 8. After removing gloves." HOME VISIT 3: During the home visit (Clinical Record 10) on 07/29/2025 with the Certified Nurse Aide (CNA) (Personnel Record 8), the CNA was observed to don gloves and proceed with patient care. The CNA provided pericare, turned the patient, removed a urine-soiled brief, placed it in the trash, and completed the rest of the pericare. The CNA opened a drawer and then the closet to look for a dressing. The HA started to change the linens, picked up a tube of cream to apply to the buttocks, and returned it to the table. The CNA removed the glove used for the cream and then donned another glove. The CNA finished changing the linens and started to apply lotion. The CNA did not disinfect the hands after moving from a contaminated body site to a clean site, after contact with body fluids, excretions, or mucous membranes, and after removing gloves. During a joint document review and interview on 07/30/2025, the Alternate Administrator/Medical Social Worker confirmed that the staff did not follow the hand hygiene policy.

It is required that a hospice aide provides services that are ordered by the interdisciplinary group and included in the plan of care. This standard was not met as evidenced by a review of clinical records and interviews. 1 of 10 (10%) records reviewed for patients receiving aide services revealed that the agency did not ensure that the aide followed the plan of care (POC). Clinical Record #3: An order was written on 8/28/22, increasing the Aide visit frequency to "3 times per week." The week of 9/4/22, two visits were not provided as ordered. The record lacked evidence of documentation of why the visits were not provided or that the physician was notified. During an interview, the alternate administrator confirmed these findings during joint record review.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. 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. This standard was not met as evidenced by a review of clinical records and interviews. 2 of 11 (18%) records reviewed revealed the agency did not ensure that there was a signed copies of the notice of patient rights. Clinical Record #6: The patient elected hospice care on 7/15/21. The clinical record lacked evidence of signed copies of the notice of patient rights upon the election of services. Clinical Record #10: The patient elected hospice care on 5/23/22. The clinical record lacked evidence of signed copies of the notice of patient rights upon the election of services. During an interview and a joint record review on 10/4/22, the Alternate Administrator confirmed that the signed form was missing.