Every finding on record at Md Hospice LLC

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. 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 hospice Interdisciplinary Group (IDG) completed a comprehensive assessment within five (5) calendar days after the election of hospice care. CLINICAL RECORD 10: The patient elected hospice care on 05/06/2025 with a terminal diagnosis of traumatic subdural hematoma. A clinical record review on 09/17/2025 revealed that the Chaplain (SC) completed the initial SC assessment on 06/27/2025, 52 days after the election of the hospice benefit. CLINICAL RECORD 12: The patient elected hospice care on 01/14/2025 with a terminal diagnosis of malignant neoplasm of the prostate. A clinical record review on 09/17/2025 revealed that the SC completed the initial SC assessment on 01/20/2025, six (6) days after the election of the hospice benefit. During an interview and joint record review on 09/17/2025, the Director of Clinical Services confirmed the findings.

It is required that Hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to: assess the quality of care and services provided by the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 4 of 11 (36%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the Hospice Aide was supervised by a Registered Nurse at least every 14 days. CLINICAL RECORD 2: The patient elected the hospice benefit on 06/19/2025 with a diagnosis of Parkinson's Disease. The plan of care dated 06/19/2025 through 09/16/2025 ordered "HA 2x/week." The first HA visit was dated 06/23/2025. Hospice Aide supervisory visits were documented as completed on 07/03/2025 and 07/18/2025 (with 15 days outstanding). CLINICAL RECORD 8: The patient elected the hospice benefit on 07/29/2025 with a diagnosis of chronic obstructive pulmonary disease (COPD). The plan of care dated 07/29/2025 through 10/26/2025 ordered "HA 2x/week." The first HA visit was dated 07/30/2025. The first Hospice Aide supervisory visit was dated 08/15/2025 (with 16 days outstanding). CLINICAL RECORD 9: The patient elected the hospice benefit on 01/16/2025 with a diagnosis of senile degeneration of the brain. The plans of care dated 01/16/2025 through 04/15/2025 and 04/16/2025 through 07/14/2025 ordered "HA 2x/week." The first HA visit was dated 01/16/2025. Hospice Aide supervisory visits were documented as completed on 03/31/2025, 04/18/2025 (with 18 days outstanding), 05/14/2025 (with 26 days outstanding), and 05/29/2025 (with 15 days outstanding). CLINICAL RECORD 10: The patient elected the hospice benefit on 05/06/2025 with a diagnosis of traumatic subdural hematoma. The plan of care dated 05/06/2025 through 08/03/2025 ordered "HA 2x/week." The first HA visit was dated 05/08/2025. Hospice Aide supervisory visits were documented as completed on 05/21/2025, 06/10/2025 (with 20 days outstanding), 06/27/2025 (with 17 days outstanding), 07/09/2025, and 07/24/2025 (with 15 days outstanding). During a joint record review on 09/18/2025, the Director of Clinical Operations confirmed that HA supervisory visits were not completed at least every 14 days.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: a copy of the hospice discharge summary. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy "Transfer, Benefit Revocation or Discharge" stated in part: "When the patient/family is transferring to another hospice provider, the designated RN ensures that the following information is provided to the receiving provider: a) The hospice discharge summary; and b) if requested, a copy of the patient/family record." In 2 of 2 (100%) clinical records reviewed, of patients with a live discharge, the agency did not ensure that a discharge summary was sent to the patient’s attending physician. CLINICAL RECORD 11: The patient elected the hospice benefit on 11/16/2024. The patient revoked the hospice benefit on 03/19/2025 to be admitted to the hospital for additional care. The patient was seen by a Registered Nurse (RN) on 03/19/2025 for a discharge visit. A clinical record review revealed no evidence of a discharge summary being sent to the patient's physician. CLINICAL RECORD 12: The patient elected the hospice benefit on 01/14/2025. The patient revoked the hospice benefit on 03/02/2025 to be admitted to the hospital for additional care. The patient was seen by the RN on 03/02/2025 for a discharge visit. A clinical record review revealed no evidence of a discharge summary being sent to the patient's physician. During a joint clinical record review and interview on 09/17/2025, the Director of Clinical Operations agreed that the record lacked evidence of the discharge summary being sent after discharge from hospice. She stated, "The record lacks evidence that this was communicated."

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management; the patient’s current plan of care; the patient’s latest physician orders; and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy "Transfer, Benefit Revocation or Discharge" states in part: "The hospice discharge summary documented by a designated Interdisciplinary Group (IDG) member includes at least the following: a) A summary of the patient's stay, including treatments, symptoms and pain management; b) The current IDG plan of care; c) The latest physician orders relating to the care of the patient; and d) Any other documentation that supports post discharge continuity of care or is requested by the attending physician or physician designee or the receiving provider." In 2 of 2 (100%) clinical records reviewed of discharged patients, the agency did not ensure that a summary of the patient's stay, including treatments, symptoms, and pain management, was completed at the time of discharge. CLINICAL RECORD 11: The patient elected the hospice benefit on 11/16/2024. The patient revoked the hospice benefit on 03/19/2025 to be admitted to the hospital for additional care. The patient was seen by a Registered Nurse (RN) on 03/19/2025 for a discharge visit. A clinical record review revealed no evidence of a discharge summary being completed by the RN. CLINICAL RECORD 12: The patient elected the hospice benefit on 01/14/2025. The patient revoked the hospice benefit on 03/02/2025 to be admitted to the hospital for additional care. The patient was seen by the RN on 03/02/2025 for a discharge visit. A clinical record review revealed no evidence of a discharge summary being completed by the RN. During joint clinical record reviews and an interview on 09/17/2025, the Director of Clinical Operations (DCO) agreed that the record lacked evidence of a discharge summary. The DCO stated, "I don't even know if the electronic medical record has a discharge summary, but I will reach out to our representative and see if they can help us."

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 a review of clinical records, document reviews, and interviews. 2 of 5 (40%) clinical records reviewed revealed the hospice did not ensure the hospice interdisciplinary group (IDG) completed an initial comprehensive assessment no later than five (5) calendar days after the election of hospice care. The policy, "Comprehensive Assessment" (Reviewed: 1/5/22), stated in part, "Procedure: 4. The comprehensive assessment process is completed by the hospice interdisciplinary group (IDG), in consultation with the individual's attending physician - if any, no later than 5 calendar days after the effective date of election by the individual." Clinical Record 2: The patient elected hospice care on 10/10/22. Review of the record revealed the Chaplain completed the initial chaplain assessment on 10/17/22, 7 days outstanding. The record did not include evidence that the initial chaplain assessment was completed no later than 5 calendar days after the effective date of election. Clinical Record 5: The patient elected hospice care on 9/7/22. Review of the record revealed the Chaplain completed the initial chaplain assessment on 10/12/22, 35 days outstanding. The record did not include evidence that the initial chaplain assessment was completed no later than 5 calendar days after the effective date of election. During an interview on 11/9/22, the Administrator and Director of Healthcare Services confirmed the findings.

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. This standard was not met as evidenced by a review of clinical records and interviews. 2 of 5 (40%) clinical records reviewed revealed the hospice did not ensure that the comprehensive assessment included an initial bereavement assessment of the patient's family and other individuals. Clinical Record 3: The patient elected hospice care on 10/11/22. The Chaplain completed the initial chaplain assessment that included the initial bereavement assessment on 11/2/22, 22 days outstanding. The record did not include an initial bereavement assessment as part of the initial comprehensive assessment. Clinical Record 2 The patient elected hospice care on 10/10/22. The Chaplain completed the initial chaplain assessment that included the initial bereavement assessment on 10/17/22 (Day 7). The record did not include an initial bereavement assessment as part of the initial comprehensive assessment. During an interview on 11/9/22, the Administrator and the Director of Healthcare Services reviewed and confirmed the findings. Prior to the exit conference, the agency had instituted a new process.