Every finding on record at Lifetime Hospice Care Inc

It is required that the hospice Interdisciplinary Group, in consultation with the individual's attending physician (if any), completes an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care, in accordance with CMS §418.24–the elements of the hospice care election statement. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure the interdisciplinary group completed the initial comprehensive assessment no later than five calendar days after the election of hospice care. CLINICAL RECORD 7: The patient elected the hospice benefit on 09/13/2025. The Chaplain documented the initial spiritual assessment, completed as part of the initial comprehensive assessment, on 9/19/2025, a total of 6 days after the election of benefit and 1 day outstanding. There was no documented evidence in the clinical record that the Chaplain attempted to contact the patient or if the patient requested to delay the assessment. During an interview on 11/25/2025, the Administrator verified the finding.

It is required that the comprehensive assessment includes an initial bereavement assessment of 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 considered in the bereavement plan of care. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure an initial bereavement assessment was documented. CLINICAL RECORD 6: The patient elected the hospice benefit on 10/30/2025 with a diagnosis of heart disease unspecified. There was no documented evidence in the clinical record that an initial bereavement risk assessment was completed, as of the date of record review on 11/25/2025. During joint review of the record and interview on 11/25/2025, the Administrator verified the initial bereavement assessment was not documented in the clinical record.

It is required that each patient’s individualized written plan of care: reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 5 of 14 (36%) clinical records reviewed, the agency did not ensure the individualized written plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/17/2025 with diagnoses of cerebral infarction and chronic obstructive pulmonary disease. The plan of care dated 10/17/2025 to 01/14/2026 did not include goals and interventions related to the patient’s diagnosis of cerebral infarction. The initial nursing assessment dated 10/17/2025 included documentation that the patient had Oxygen at 2-4 liters per nasal cannula. The plan of care dated 10/17/2025 did not include goals and interventions related to the patient’s use of Oxygen. The initial nursing assessment also included documentation that the patient had wounds. The plan of care did not include goals and interventions for wound management. CLINICAL RECORD 3: The patient elected the hospice benefit on 12/27/2024 with diagnosis of senile degeneration of the brain. The initial nursing assessment included documentation that the patient had wounds. The plan of care dated 12/27/2025 did not include goals and interventions related to skin integrity. CLINICAL RECORD 4: The patient elected the hospice benefit on 11/19/2025 with a diagnosis of intrahepatic bile duct carcinoma. The initial nursing assessment dated 11/19/2025 included documentation that the patient had a PleurX drain present for drainage of abdominal ascites. The plan of care did not include goals or interventions for management of the PleurX drain. The clinical record included an order dated 11/23/2025 for Oxygen at 2-5 liters per nasal cannula as needed for shortness of breath. The plan of care did not include respiratory goals and interventions for the use of Oxygen. CLINICAL RECORD 6: The patient elected the hospice benefit on 10/30/2025 with a diagnosis of heart disease unspecified. An interim physician order dated 11/14/2025 included documentation that Nystatin powder was ordered to skin folds. There was no documented evidence that the plan of care was updated to include goals and interventions for skin integrity related to the use of Nystatin. CLINICAL RECORD 13: The patient elected the hospice benefit on 02/17/2025 with a diagnosis of chronic obstructive pulmonary disease. The initial comprehensive nursing assessment dated 02/17/2025 included documentation that the patient was using Oxygen at 2 liters per nasal cannula. The plan of care dated 02/17/2025 did not include goals and interventions related to the patient’s use of Oxygen. During interviews on 11/24/2025 and 11/25/2025, the Administrator verified the findings.

It is required that each patient’s individualized written plan of care includes all services necessary for the palliation and management of the terminal illness, including the following: drugs and treatment necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review and interview. In 3 of 14 (21%) clinical records reviewed, the agency did not ensure the individualized written plan of care included drugs and treatment necessary to meet the needs of the patient. CLINICAL RECORD 5: The patient elected the hospice benefit on 11/17/2025 with a diagnosis of unspecified kidney failure. The plan of care dated from 11/17/2025 to 02/14/2026 included a medication order for Midodrine 1 tab oral 3 times a day "as needed" for low blood pressure. The medication order on the plan of care did not include a parameter for "low blood pressure" to determine when the medication would be administered. CLINICAL RECORD 6: The patient elected the hospice benefit on 10/30/2025 with a diagnosis of heart disease unspecified. The plan of care dated from 10/30/2025 to 01/27/2026 included medication orders for Oxycodone 5mg "as needed" for pain and Morphine Sulfate "as needed" for pain. The medication orders on the plan of care did not include instructions and guidelines to assist in determining which medication to administer for a specific pain level and which medication to give first. CLINICAL RECORD 7: The patient elected the hospice benefit on 09/13/2025 with a diagnosis of senile degeneration of the brain. The plan of care dated from 09/13/2025 to 12/11/2025 included medication orders for Tylenol 325mg "as needed for pain" and Morphine Sulfate concentrate 0.5ml "as needed for pain." The medication orders on the plan of care did not include instructions and guidelines to assist in determining which medication to administer for a specific pain level and which medication to give first. During an interview on 11/25/2025, the Administrator verified that the medications did not include specific instructions for when/how to administer the medication.

It is required that hospice aides are assigned to a specific patient by a registered nurse (RN) 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 clinical record review and interview. In 4 of 11 (36%) clinical records reviewed with hospice aide services provided, the agency did not ensure the RN developed patient specific care instructions for the hospice aide. CLINICAL RECORD 1: The patient elected the hospice benefit on 10/17/2025 with a diagnosis of cerebral infarction. The hospice aide care plan assigned the aide the task of "Shower-if refuses, offer bed bath." The task did not include specific instructions to the aide related to who could make the decision for a shower or bed bath. CLINICAL RECORD 2: The patient elected the hospice benefit on 06/12/2025 with a diagnosis of unspecified protein calorie malnutrition. The hospice aide care plan assigned the aide the task of "Shower-if refuses, offer bed bath." The task did not include specific instructions to the aide related to who could make the decision for a shower or bed bath. CLINICAL RECORD 6: The patient elected hospice on 10/30/2025 with a diagnosis of heart disease unspecified. The hospice aide care plan dated 11/10/2025 assigned the aide the task of "bed bath if refuses shower." The task did not include specific instructions to the aide related to who could make the decision for a shower or bed bath. The initial plan of care dated 10/30 2025 included documentation that the patient had Oxygen at 2 liters per nasal cannula. The hospice aide care plan did not include information to the aide related to the patient’s use of Oxygen. CLINICAL RECORD 13: The patient elected the hospice benefit on 02/17/2025 with a diagnosis of chronic obstructive pulmonary disease. The initial comprehensive nursing assessment dated 02/17/2025 included documentation that the patient was using Oxygen at 2 liters per nasal cannula. The hospice aide care plan did not include information to the aide related to the patient’s use of Oxygen. During interviews on 11/25/2025 and 11/26/2025, the Administrator verified the findings.

It is required that each patient's record includes, as a minimum: Physician orders. This standard was not met as evidenced by clinical record review and interview. In 2 of 14 (14%) clinical records reviewed, the agency did not ensure that the record included a physician order. CLINICAL RECORD 11: The patient elected the hospice benefit on 09/30/2025. The patient revoked the hospice benefit and was discharged on 10/10/2025. There was no documented evidence in the clinical record of a physician order to discharge the patient. CLINICAL RECORD 12: The patient elected the hospice benefit on 09/03/2025 and transferred to another hospice on 10/07/2025. There was no documented evidence in the clinical record of a physician order to discharge the patient. During the interview on 11/26/2025, the Administrator verified the finding and stated she was not aware a physician order was required when a patient revokes or transfers.