Every finding on record at Lifecare Hospice

Based on observation, interview, and document review, the agency failed to ensure a comprehensive medication review of all client prescription and over-the-counter medications was completed for 1 of 1 patient (P1) whose medications were reviewed during a home visit. --- Findings include:P1’s plan of care (POC) 1/8/26 to 4/7/26, identified a start of care (SOC) date 1/8/26. P1’s ordered services included skilled nurse visits (SNV) one time per week for thirteen weeks for various assessments, evaluation, education and medication monitoring. plus 15 visits as needed (PRN). Diagnoses included malignant neoplasm of breast and pain related to neoplasm. A number of medications and treatments were listed which included nonformulary over the counter (OTC) sleep medication and Senokot (a laxative) 8.6-50 milligrams (mg) two tablets two times per day. During a home visit on 3/31/26, at 11:30 a.m. family member (FM)-A stated he administered P1's medications to her daily. FM-A stated he did not want the nurses to set up P1's medications and he preferred to do it himself. FM-A stated P1 had regular bowel movements every day and has not taken a laxative for quite some time. FM-A could not remember the last time he gave P1 Senokot. FM-A gave stated he bought Sleep-Aid medication from the dollar store and gave P1 the medication every night with very good results. During interview on 3/31/26, at 12:15 a.m. registered nurse (RN)-A stated P1's medication list should have been updated to show the Senokot was no longer taken two tablets twice a day, but being used as an as needed (PRN) medication. The nonformulary OTC sleep medication should have been updated to include the name of the medication that P1 was actually taking, as well as the dosage, as there were so many different OTC sleep medications available. It was important the client's medication list reflected exactly what the client was actually taking. When interview on 3/31/26, at 3:54 p.m. the director of nursing stated the nurses were supposed to match what the patient reported to the physician orders and labels on the medication bottles. If any discrepancies were noted, the physician was to be notified. The DON would have expected P1's Senokot order to be changed to PRN and all medications to be listed specifically to what medication was being taken and the dosage. The agency policy Medications dated 9/96, identified all medications would be listed on the client's chart. The list would include the date the medication was ordered, the name of the medication, and the dose and frequency for administration.

Based on interview and document review, the agency failed to ensure chaplain and volunteer visits were included on the plan of care (POC) for frequency and duration for 3 of 10 patients (P1, P4, P5) who's medical records were reviewed for services. --- Findings include:P1P1’s plan of care (POC) 1/8/26 to 4/7/26, identified a start of care (SOC) date 1/8/26. P1’s ordered services included skilled nurse visits (SNV) one time per week for thirteen weeks for various assessments, evaluation, education and medication monitoring. plus 15 visits as needed (PRN). Social worker (SW) visits were ordered one time a week for one week for emotional and psychosocial support for the grieving and dying processes. plus 10 visits PRN. Chaplain visits were ordered 15 visits PRN for spiritual assessment, to provide spiritual care, emotional and spiritual grief support to the client and family. Diagnoses included malignant neoplasm of breast and pain related to neoplasm. P1’s Interdisciplinary Team Meeting and Hospice POC update dated 1/27/26, identified the hospice chaplain had made an initial visit and further visits were planned every one to two weeks.P1’s Interdisciplinary Team Meeting and Hospice POC update dated 3/13/26, identified the chaplain visits were occurring weekly to every other week.P1’s medical record identified chaplain visits on a scheduled basis of weekly to every other week and not PRN as identified on P1’s POC.During interview on 3/31/26, at 1:44 p.m. the hospice chaplain (HC) stated when a client was admitted to hospice the nurses would call her and let her know if the client wanted chaplain services. If the client was open to chaplain services she would visit and provide spiritual care, usually at most, one time per week. HC typically made visits to clients wanting her services, every week to every other week. HC had never recorded visit frequency or duration in a client’s POC. The nurse or someone at the agency would just put in a bunch of visits in the POC that the chaplain could draw from. HC would call the clients at the beginning of each week and schedule which day to go out for a visit. The visits were not for an acute type of visit.When interviewed on 3/21/26, at 2:30 p.m. the director of nursing (DON) stated if the chaplain was scheduling weekly or every other week visits with clients, the visits were not PRN and would need to have a frequency and duration on the client’s POC to indicate what frequency and duration visits were planned with that client for that episode of care.P4P4’s POC 8/21/25 to 11/18/25, identified a SOC date 8/21/25. P4 had services ordered for SNV one visit every week for 14 weeks for various assessments, evaluation, education and medication monitoring. Social worker (SW) visits were ordered once a week for one week plus 15 visits PRN for emotional and psychosocial support for the grieving and dying processes. Diagnoses included malignant melanoma with metastatic to brain (a type of skin cancer that has spread to the brain).  P4’s Interdisciplinary Team Meeting and Hospice POC update dated 9/24/25, identified P4 had received three volunteer visits during his episode of care.P4’s medical record identified volunteer visits had occurred on a weekly basis for three weeks. P4’s POC did not identify when the volunteer services were initiated, how often scheduled visits were planned or the duration of the visits for P4’s episode of care.  P5P5’s POC dated 12/9/25 to 3/8/26, identified a SOC date 12/9/25.  SNV were ordered once per week for 13 weeks and five visits PRN for various assessments, evaluation, education and medication monitoring. Diagnoses included corticobasal syndrome (a progressive, neurological disorder), anxiety and depression. P5’s Interdisciplinary Team Meeting and Hospice POC update dated 2/13/26, identified a volunteer was visiting P5 weekly.P5’s medical record identified volunteer visits had occurred three times in December 2025 and once in January 2026. P5’s POC did not identify when the volunteer services were initiated, how often scheduled visits were planned or the duration of the visits for P5’s episode of care.  During interview on 3/31/26, at 9:10 a.m. the volunteer coordinator (VC) stated she attended the Interdisciplinary Team Meetings and documented on the updated POC if a volunteer service was being utilized but had never been told to put frequency or duration or what the volunteer was doing for the patient in the home, i.e.: homemaking, errands, respite, socialization, etc. That would be something that would need to be addressed with the DON.When interviewed on 3/31/26, at 2:30 p.m. the DON stated the volunteers would have a sign-in sheet at the nursing homes, if they were seeing clients there. When seeing clients in their private homes, she could not be sure. The VC would know when volunteers were scheduled to see clients and so nursing would notify her of any changes with the client or if the client needed to cancel a volunteer visit. The VC would also know what the duties and care the volunteer provided to the client and/or family and the volunteer documented that in their visit notes as well. The DON would expect to see the volunteer frequency of services and job duties and care provided to each client on their POC.The agency policy Documentation of Volunteer Services dated 12/97, identified the policy was to ensure all services provided to the agency’s clients were documented in the client’s file.

Based on interview and document review, the agency failed to ensure the plan of care (POC) included all medical supplies and appliances necessary to meet patient needs for 1 of 10 patients (P7) reviewed. --- Findings include:P7's plan of care (POC) 1/15/26 to 4/14/26, identified a start of care (SOC) date 1/15/26. Skilled nurse visits (SNV) were ordered one time per week for 13 weeks for various assessments, evaluation, pain and medication management. Ten as needed (PRN) visits were ordered to address change in condition.  Diagnoses included congestive heart failure, kidney disease and diabetes. P7's medication list on the POC included a number of medications and treatments, including an albuterol unit dose, to take 3 milliliters (ml) by nebulization every four hours PRN, budesonide take two ml by nebulization two times daily, DuoNeb take three ml by nebulization three times daily, and home oxygen as ordered, P7's admission SNV note identified P7 had a 16 French foley catheter in place that would be changed on 2/13/26 and used a Cath Secure tab to secure the catheter tubing, as well as home oxygen at all times. P7's medical record failed to identify if further catheter supplies such as a 16 French foley catheter, leg and/or bed bag, catheter secure tabs, sterile catheter insertion kits, and graduate cup would be needed in the future and how they would be obtained. P7's medical record also lacked documentation if P7 owned a nebulizer and oxygen machine and/or if they were to be supplied by the hospice agency. During interview on 3/31/26, at 9:28 a.m. the director of nursing (DON) stated she was unable to find any documentation that supplies and/or equipment were being assessed in the client's medical record. The DON stated that should be assessed at SOC and ongoing throughout a client's episode of care. The agency policy Certification and Plan of Care dated 9/96, identified a plan of care would be developed for each client/family and all care provided would be in accordance with the POC.

Based on interview and document review, the agency failed to ensure duties of volunteers who provided services to clients and families were addressed in the client's plan of care (POC) for 2 of 2 patients (P4, P5) who received volunteer services in the home. --- Findings include:P4P4’s POC 8/21/25 to 11/18/25, identified a SOC date 8/21/25. P4 had services ordered for SNV one visit every week for 14 weeks for various assessments, evaluation, education and medication monitoring. Social worker (SW) visits were ordered once a week for one week plus 15 visits PRN for emotional and psychosocial support for the grieving and dying processes. Diagnoses included malignant melanoma with metastatic to brain (a type of skin cancer that has spread to the brain). P4’s Interdisciplinary Team Meeting and Hospice POC update dated 9/24/2, identified P4 had received three volunteer visits during his episode of care. P4's medical record and POC lacked identification of the tasks and duties (such as homemaking, errands, respite care, reading, music, and/or socialization) the volunteer was assigned to perform during their volunteer visits. P5P5’s POC dated 12/9/25 to 3/8/26, identified a SOC date 12/9/25.  SNV were ordered once per week for 13 weeks and five visits PRN for various assessments, evaluation, education and medication monitoring. Diagnoses included corticobasal syndrome (a progressive neurologic disease) anxiety and depression. P5’s Interdisciplinary Team Meeting and Hospice POC update dated 2/13/26, identified a volunteer was visiting P5 weekly.P5's medical record and POC lacked identification of the tasks and duties (such as homemaking, errands, respite care, reading, music, and/or socialization) the volunteer was assigned to perform during their volunteer visits. During interview on 3/31/26, at 9:10 a.m. the volunteer coordinator (VC) stated she attended the Interdisciplinary Team Meetings and documented on the updated POC if a volunteer service was being utilized and how it was going. Volunteer duties usually included to sit and visit with patients, housekeeping, pray, but mostly visiting.  Volunteers did not do medical help at all. VC had never been told to put what the volunteer was doing for the patient in the home, i.e.: homemaking, errands, respite, socialization, etc. During interview on 3/31/26, at 2:30 p.m. the director of nursing (DON) stated she would expect to have the task and duties a volunteer was performing in a client's home to be addressed on the client's POC. The agency policy Documentation of Volunteer Services dated 12/97, identified the policy was to ensure all services provided to the agency’s clients were documented in the client’s file.

Based on interview and document review, the hospice failed to ensure a hospice aide care plan was developed and in the record for 2 of 5 patients (P2, P4) who received home health aide services. --- Review of P2's plan of care initiated 7/11/23, revealed P2's start of care date as 7/11/23. P2 had orders for hospice aide visits as one visit every week 7/11/23 to 7/15/23, then two visits every week. The Hospice Care Plan did not identify specific direct cares to be completed by the hospice aide. Review of P2's record revealed P2 had a hospice aide visit 7/13/23. The hospice aide assisted with cares such as performing oral cares, incontinence cares, assisted with dressing and transferring. Review of P4's plan of care initiated 4/18/23, revealed P4's start of care date as 4/18/23. P4 had orders for hospice aide visits as one visit every week 4/18/23 to 4/22/23, then two visits every week. The Hospice Care Plan did not identify specific direct cares to be completed by the hospice aide. Review of P4's record revealed P4 had a hospice aide visit 4/21/23, 4/25/23, 4/28/23, 5/2/23, 5/5/23, 5/9/23, and 5/11/23. The care plan indicated the hospice aide assisted with cares such as providing a shower, performing oral cares, incontinence cares, assisted with dressing and transferring. During interview on 9/27/23 at 1:40 p.m. hospice director (HD)-A confirmed P2 and P4s medical record and plan of care lacked home health aide specific services and instructions. HD-A indicated home health aide instructions were important, so the home health aides knew how to care for the patient and the services they were to provide. HD-A stated she would expect the registered nurse would develop specific written instructions for the hospice aide to follow when providing cares. The agency policy titled Hospice Aide Services dated 1/23/23, identified instructions for care (aide assignment) were prepared by a hospice nurse or therapist as appropriate. A copy was provided to the aide with the original in the electronic health record and would be updated as changes in services were indicated. The policy also identified review of the in-home aide services would be included in the interdisciplinary team meetings.

Based on record review and interview the agency failed to ensure the supervision of the hospice aide was completed by the registered nurse for 1 of 5 patients (P4) with hospice aide services. --- Review of P4's plan of care initiated 4/18/23, revealed P4's start of care date as 4/18/23. P2 had orders for hospice aide visits as one visit every week 4/18/23, to 4/22/23, then two visits every week. The Hospice Care Plan did not identify specific direct cares to be completed by the hospice aide. P4's record revealed P4 had a hospice aide visit 4/21/23, 4/25/23, 4/28/23, 5/2/23, 5/5/23, 5/9/23, and 5/11/23. P4's medical record lacked documentation the registered nurse completed any hospice aide supervisory visits. During interview on 9/27/23 at 1:40 p.m. hospice director (HD)-A confirmed P4s medical records lacked home health aide supervisory visit documentation. HD-A confirmed she would expect home health aide supervisory visits to be completed every fourteen days. The agency policy titled Hospice Aide Services dated 1/23/23, identified the purpose to assure hospice aide staff would implement correct visit protocol when providing services to clients. The policy identified the registered nurse would make a supervisory visit to the clients place of residence every fourteen days or less to observe care and/or to access relationships and determine whether goals were being met.