Every finding on record at Md Care Hospice

Upon patient record review, 5 of 14 (Patient #1, 8, 9, 10 and 14) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 1: The comprehensive assessment on 10/22/25 does not show evidence of imminence of death assessed by SN. COS with updated visit note. Patient 8: The comprehensive assessment on 09/18/25 does not show evidence of imminence of death assessed by SN at SOC. COS with updated visit note. Patient 9: The comprehensive assessment on 08/04/25 does not show evidence of imminence of death assessed by SN at SOC. COS with updated visit note. Patient 10: The comprehensive assessment on 07/31/25 does not include evidence of imminence of death assessed by SN at SOC. COS with updated visit note. Patient 14: The comprehensive assessment on 8/22/2024 does not include evidence of imminence of death assessed by SN at SOC.

Upon patient record review, 2 of 14 (Patient #2 and 3) 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: Patient 2: Upon home visit, the medication profile contains multiple orders for Acetaminophen 500 mg tabs every 6 hours prn and Acetaminophen 650mg rectal suppository every 6 hour prn with no limit to not exceed in a 24 hours period. COS with updated physician order. Patient 3: Upon home visit, the medication profile contains multiple orders for Acetaminophen 500 mg tabs every 6 hours prn and Acetaminophen 650mg rectal suppository every 6 hour prn with no limit to not exceed in a 24 hours period. COS with updated physician order.

Upon patient record review, 1 of 14 (Patient # 5) 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 5:The initial POC 10/23/25 contains an order for Xarelto with no evidence of risk for bleeding noted on POC. COS with update to POC to include risk for bleeding.

Upon patient record review, 3 of 14 (Patient # 2, 3 and 6) 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 2: The updated POC on 11/3/25 contains multiple orders for Acetaminophen 500 mg tabs every 6 hours prn and Acetaminophen 650mg rectal suppository every 6 hour prn with no limit to not exceed in a 24 hours period. COS with updated physician order. Patient 3: The updated POC on 11/3/25 contains multiple orders for Acetaminophen 500 mg tabs every 6 hours prn and Acetaminophen 650mg rectal suppository every 6 hour prn with no limit to not exceed in a 24 hours period. COS with updated physician order. Patient 6: Initial POC on 10/18/25 contains wound care orders without frequency and who will provide wound care. Wound care instructions and care is being provided once weekly from Onmi wound care physicians and twice weekly by agency nurse. COS with updated orders for frequency and who will provide wound care and POC updated.

Upon patient record review, 4 of 14 (Patient # 7, 8, 9, and 10) 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 7: The initial POC on 10/14/25 contains problems/goals/interventions that have not been updated with target dates to meet by 10/28/25 for all issues including pain, edema, gastro, bowel elimination, genital-urinary and skin. COS with updated target dates to POC. Patient 8: The updated POC on 11/03/25 contains problems/goals/interventions that have not been updated with target dates to meet by 10/2/25 for all issues including pain, respiratory, and skin integrity. COS with updated target dates to POC. Patient 9: The updated POC on 11/03/25 contains problems/goals/interventions that have not been updated with target dates to meet by 08/18/25 for all issues including pain, respiratory, and skin integrity. COS with updated target dates to POC. Patient 10: The updated POC on 11/03/25 contains problems/goals/interventions that have not been updated with target dates to meet by 08/14/25 for all issues including pain, respiratory, and skin integrity. COS with updated target dates to POC.

Upon patient record review, 1 of 14 (Patient # 5) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 5: The initial POC on 10/23/25, contains orders for SN visits once weekly. There is evidence of both an LVN and RN visit being made the week of 11/02/25 and the week of 10/26/25. COS with order obtained to increase SN visits to twice weekly and POC updated.

Upon observation and home visit, 1 of 3 (Patient #2) there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Upon home visit, the SN does not show evidence of following agency bag technique policy by reaching into nursing bag with gloved hands following the cleaning of equipment prior to removing gloves and completing hand hygiene.

Upon patient record review 1 of 14 (Patient # 1) did not have evidence documentation in the patient record that a hospice aide provides services that are: Patient 1: The aide POC was developed on 10/22/25 with aides weekly and there is no evidence of aide visits being completed in the EMR the week of 10/22, 10/26 and 11/2/25. COS with aide completing visit documentation.

Upon patient record review, 3 of 14 (Patient # 1, 2 and 9) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient 1: The comprehensive assessment on 10/22/25 and follow up visit on 11/2/25 do not show evidence of electronic date and signature by SN. COS with signature with approval of visit notes. Patient 2: The SN visit notes on 10/30/25 and 10/31/25 do not show evidence of electronic signature and date by SN. COS with signature with approval of visit notes. Patient 9: The medication list on 8/04/25 contains orders for NTE with Acetaminophen. NTE is not an agency accepted abbreviation per agency policy 6-023 for not to exceed. COS with update to medication list.

It is required that bags used to carry medical equipment (e.g., BP cuff) or supplies into or out of the care environment are transported and used in a manner consistent with organizational policy to prevent the spread of infections and communicable diseases. This standard was not met as evidenced by document review, interview and observation. In 1 of 3 (33%) patients who received a home visit in which visit bags were used in the home environment revealed the hospice organization did not ensure adherence to agency infection prevention and control policies and procedures. Home Visit 1: During a home visit conducted on 9/6/2023, the chaplain (staff 1) was observed placing the visit bag on the floor. Document 1: The Bag Technique Policy No. 7-016 reads in relevant parts the "the bag will be placed on a clean surface (i.e., a surface that can be easily disinfected) in the car and in the home." On 9/6/2023, the DPCS stated the chaplain should not have placed his visit bag on the floor. In 1 of 3 (33%) patients who received a home visit in which visit bags were used in the home environment revealed the hospice organization did not ensure adherence to agency infection prevention and control policies and procedures.

It is required that the hospice provides nursing care under the supervision of a registered nurse. This standard was not met as evidenced by clinical record review and interview. 1 of 14 (7%) clinical record reviewed revealed the hospice did not ensure adherence to its clinical supervisory policy. Clinical Record 11: The patient’s benefit election was dated 8/4/2022. The LVN documented a visit on 10/24/2022. There was no evidence of a documented RN supervisory visit from the date of the LVN visit through the patient's date of death on 12/2/2022. Document 2: Responsibilities/Supervision of Clinical Services Policy No. 1-031 read in relevant part " a monthly patient visit will be completed by a registered nurse to supervise licensed practical/vocational nursing services." On 9/5/2023 the DPCS was interviewed, and she stated she did not know why monthly LVN supervision was not performed by the RN. In 1 of 14 (7%) clinical records reviewed in which a licensed vocational nurse (LVN) provided services, revealed that a registered nurse (RN) did not perform LVN supervisory visits.

It is required that the hospice agency obtains a criminal background check on all hospice employees who have direct patient contact or access to patient records. This standard was not met as evidenced by document review and interview. In 2 of 5 (40%) contracts reviewed, revealed the hospice did not ensure that the contracts included the clause, in writing, between the contracted entity and the agency, for the provision that required all contracted employees who have direct patient contact or access to patient records obtain criminal background checks. Contract 3: A review of the hospice's pharmacy contract executed on 6/1/2020, revealed there was no clause between the pharmacy and the hospice documenting that the pharmacy was required to obtain criminal background checks on pharmacy employees who have direct hospice patient contact or access to hospice patient records. Contract 5: A review of the hospice's SNF/Respite/GIP contract executed on 6/1/2020, revealed there was no clause between the SNF and the hospice documenting that the SNF was required to obtain criminal background checks on SNF employees who have direct hospice patient contact or access to hospice patient records. The DPCS was interviewed on 9/7/2023 and stated that she did not see the required background check language in the pharmacy or SNF contract. In 2 of 5 (40%) contracts reviewed, revealed the hospice did not ensure that the contracts included the clause, in writing, between the contracted entity and the agency, for the provision that requires that all contracted employees who have direct patient contact or access to patient records obtain criminal background checks.