Every finding on record at Lonestar Legacy Hospice LLC

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I; and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed of patients who revoked the hospice benefit, revealed the agency did not ensure that the discharge summary was sent to the hospital when the patient transferred to a hospital for aggressive treatment. CLINICAL RECORD 4: The patient elected the hospice benefit on 11/08/2024. On 11/23/2024 the nurse completed the agency document titled “Discharge Summary Live" that was signed by registered nurse (RN), that stated, "discharge to a hospital for aggressive treatment. Patient was admitted to the hospital revoked the hospice benefit.” The "Discharge - Live" document included a summary of the patient's care while on hospice and included documentation of the patient's medications, treatments/symptom management and orders, however it was not sent. There was no documented evidence that the discharge summary was sent to the hospital where the patient was transferred for treatment. CLINICAL RECORD 6: The patient elected the hospice benefit on 02/28/2025. On 03/20/2025. the nurse completed the agency document titled “Discharge Summary Live" that was signed by registered nurse (RN), that stated, "discharge to a hospital for aggressive treatment. Patient was admitted to the hospital revoked the hospice benefit.” The "Discharge - Live" document included a summary of the patient's care while on hospice and included documentation of the patient's medications, treatments/symptom management and orders, however it was not sent. There was no documented evidence that the discharge summary was sent to the hospital where the patient was transferred for treatment. In an interview and a joint review of clinical records with the Alt Director of Nursing (Personnel Record 2), it was confirmed that the "Discharge summary was completed and there was no documentation in the clinical record that this form was sent to the hospital where the patients were admitted for care.