Every finding on record at Moments Hospice of Miami, LLC

Based on record review, interviews, and policy review, the agency failed to ensure the Social Worker completed a comprehensive assessment within the five calendar days after the election of hospice care for one of 10 patients reviewed (Patient (P)9) out of a total of 14 sampled patients. This failure had the potential for P9's psychosocial, emotional, financial, and/or discharge planning needs to not be identified and addressed timely. Findings included: --- Review of P9's "Patient Information Report," provided by the agency, indicated P9 was admitted on 03/19/26 to the hospice agency with the terminal illness of cirrhosis of the liver. Review of P9's "Election of Benefits," provided by the agency, indicated it was signed by the patient's caregiver on 03/19/26. Review of P9's "Medical Record Coordination Notes Report," provided by the agency and dated 03/19/26, indicated the social worker's initial comprehensive assessment was completed on 03/27/26. Review of Patient 9's clinical record in its entirety with the Vice President of Clinical Operations (VPCO1) on 06/11/26 at 11:30 AM revealed no additional documentation from the Social Worker explaining why the comprehensive assessment was completed eight days after the election of benefits was signed by the caregiver. VPCO1 confirmed this finding. During a phone interview on 06/11/26 at 2:00 PM, the Social Worker (SW1) was asked why the initial assessment was completed eight days after the election of benefits was signed by the caregiver on 03/19/26. SW1 stated he/she makes a "Coordination Note" explaining the reason for this to be completed beyond the five-day timeframe. SW1 also stated he/she could not remember the exact reason why this was completed late. The VPCO1 and the surveyor reviewed P9's electronic medical record (EMR) in its entirety and could not find a "Coordination Note" to explain why the comprehensive assessment was performed after the five-day timeframe for P9. During an interview on 06/11/26 at 2:30 PM, the Director of Nursing (DON) confirmed the Social Worker’s initial comprehensive assessment should have been completed within five calendar days after the caregiver signed the election of hospice care. Review of the hospice agency's policy, "Comprehension Assessment" dated November 2024 indicated, "… A comprehension patient assessment will be performed by the interdisciplinary group no later than 5 calendar days after the election of hospice care… The patient's psychosocial status, including emotional barriers to treatment, cognitive limitations, memory and orientation, family relationships, social history, source and adequacy of environment and other resources, coping mechanisms, and the patient's and family/caregiver's reaction to illness… "

Based on record review, interview, and policy review, the agency failed to ensure that the hospice medication list was accurate and consistent with the nursing facility’s medication list for 1 of 10 patients reviewed for medications (Patient (P) 1), out of a total sample of 14 patients. This failure had the potential to result in medication errors, including missed doses, duplicate therapy, drug interactions, or adverse drug events for P1. Findings included: --- Review of P1's "Patient Information Report," provided by the agency, indicated P1 was admitted on 08/26/25 to the hospice agency with the terminal illness of degenerative disease of the nervous system, unspecified. During a review of P1's "Order Summary Report" of active orders as of 06/10/26, in P1's nursing facility, it was revealed the patient was being given acetaminophen Tablet 325 mg (milligrams) give two tablets by mouth every six hours as needed for pain and/or temp (temperature) 100F (100 degrees Fahrenheit) or above, alprazolam (for anxiety) one mg give one tablet by mouth one time a day, citalopram hydrobromide (for depression) give one tablet by mouth one time a day, multiple vitamin liquid give 15 ml (milliliters) by mouth one time a day for supplement, temazepam (for insomnia) 15 mg give one capsule by mouth at bedtime, and valproic acid (mood stabilizer) oral solution 250 mg/ml (milligrams per milliliter) give five ml by mouth three time a day. Review of P1's "Client Medication Report" dated for the certification report of 04/23/26 to 06/21/26 , and provided by the hospice agency, revealed alprazolam 0.5 mg give one tablet by mouth daily, diclofenac 1% (percent) topical gel apply one inch two times daily, ferrous sulfate 325 mg (65 mg Iron) give one tablet daily, ibuprofen 600 mg give one tablet every six hours for pain, quetiapine (depression/mood stabilizer) 100 mg give one tablet two times daily, and quetiapine 50 mg give one tablet by mouth daily at bedtime. When comparing the medication lists from the nursing facility to the hospice agency's medication list the following discrepancies were noted:-The hospice agency medication list did not contain the medications acetaminophen, citalopram hydrobromide, multiple vitamin liquid supplement, temazepam, and valproic acid.-The hospice agency had incorrect dosages amounts of alprazolam to be given to P1.-The nursing facility's order summary did not contain the medications diclofenac topical gel, ferrous sulfate, ibuprofen, and quetiapine. During an interview on 06/11/26 at 2:30 PM, the Director of Nursing confirmed the nurse is to reconcile the nursing facility's medication list with the hospice agency's medication report and update the hospice medication list to reflect the current medications P1 is actually being administered in the nursing facility. During an interview on 06/11/26 at 3:57 PM, Registered Nurse Case Manager (RNCM)1 stated he/she asked the nurse assigned to P1 whether there had been any medication changes since the last skilled nursing visit and updated the hospice medication list if needed. RNCM1 denied obtaining a copy of the nursing facility’s medication list to compare it with the hospice agency’s medication list to verify the medications actually being administered to P1 and to update the hospice medication list to reflect any changes. Review of the undated hospice agency's policy "Medication Profile" which indicated, "… The medication profile will be updated for each change to reflect current medications, and new and/or discontinued medications… Deviations from taking medication as ordered will be documented in the clinical notes, and the physician (or other authorized independent practitioner) will be notified … The drug profile is updated … at a minimum, at the time of each comprehensive assessment, recertification assessment and/or when new medication is added or changes are made to existing medication."

Based on record review, interview, and agency policy review, the agency failed to complete and document a bereavement risk assessment for one of 10 patients (Patient (P)2) reviewed for bereavement services, out of a total sample of 14 patients. This failure had the potential to delay identification of bereavement risk factors and unmet grief support, counseling, or follow-up needs for P2’s family/caregiver.Findings included: --- Review of P2's "Patient Information Report," provided by the agency, indicated P2 was admitted on 11/10/25 to the hospice agency with the terminal illness of heart failure. Review of P2's "Election of Benefits," provided by the agency, indicated it was signed by the patient's caregiver on 11/10/25. Review of P2's electronic medical record (EMR) indicated the "Comprehensive Assessment" was completed by the nurse on 11/10/25 and the social worker's initial assessment was completed on 11/11/25. P2's family/caregiver had declined chaplain services on 11/12/25. Continued review of P2's EMR failed to reveal documentation of a bereavement risk assessment being completed when P2 was admitted to hospice services. During an interview on 06/11/26 at 11:00 AM, the Vice President of Clinical Operations (VPCO)1 confirmed the bereavement risk assessment was not performed when P2 was admitted to the hospice agency. VPCO1 stated there should have been a bereavement risk assessment completed when P2 was admitted to hospice services. During an interview on 06/11/26 at 2:30 PM, the Director of Nursing confirmed the bereavement risk assessment should have been completed by the nurse or the social worker since chaplain services were declined on admission. Review of the undated hospice agency's policy "Bereavement Services" indicated, "… A bereavement risk assessment will be completed by the hospice RN [registered nurse], social worker, chaplain, or Bereavement Coordinator at the time of admission to hospice …"

Based on record review, interview, and hospice agency policy review, the agency failed to ensure the Registered Nurse (RN) updated patient-specific written care instructions for the hospice aide for one of 10 patients (Patient(P)1) reviewed for hospice aide services, out of a total sample of 14 patients. Specifically, the hospice aide care plan did not include instructions that P1 required "Enhanced Barrier Precautions" due to the presence of a colostomy while residing in a long-term care (LTC) facility. This failure had the potential to result in inconsistent implementation of infection-control precautions and increased risk for transmission of infectious organisms. Findings included: --- During an observation on 06/10/26 at 6:40 AM, an “Enhanced Barrier Precautions” sign was posted on P1’s door, and a plastic bin containing personal protective equipment (PPE), including gowns, gloves, and face shields, was located outside the room. The sign directed all persons to clean their hands before entering and when leaving the room and directed providers and staff to wear gloves and a gown during high-contact resident care activities, including bathing, changing linens, providing hygiene, changing briefs, or assisting with toileting. Hospice aide (HA)1 entered P1’s room and was observed providing bathing, changing bed linens, providing hygiene, and changing briefs for P1 only wearing gloves. These observed care activities were listed on the sign as requiring gloves and a gown. Review of P1's "Patient Information Report," provided by the agency, indicated P1 was admitted on 08/26/25 to the hospice agency with the terminal illness of degenerative disease of the nervous system, unspecified. P1 was at home when admitted to hospice services and was later transferred to the LTC facility on 10/27/25 where P1 currently resides while receiving hospice services. Review of P1's "Plan of Care" dated 02/22/26 and provided by the hospice agency indicated to "refer to the infection control set forth by the facility". Review of P1's "Aide Care Plan Report" dated 11/03/25 and provided by the hospice agency did not reveal documentation for the hospice aide to follow enhanced barrier precautions when providing bathing and hygiene. Review of P1's "Order Summary Report" which revealed all active orders as of 06/11/26 and provided by the LTC facility indicated an order dated 11/20/25 for "Enhanced Barrier Precautions due to colostomy every shift …" During an interview on 06/10/26 at 7:00 AM, the Director of Nursing of the LTC (DON-LTC) facility stated, "The hospice staff are expected to follow any and all of the infection control precautions in which are current for [P1]." During an interview on 06/10/26 at 7:15 AM, hospice aide (HA)1 was asked if P1 had any isolation precautions that he/she needed to observe when providing care to the patient. HA1stated, "I only have to wear gloves. [P1] isn't in any isolation." During an interview on 06/11/26 at 2:30 PM, the Director of Nursing of the hospice agency stated, "If [P1] is in any isolation precautions, then we are to observe the facility's direction for this precaution." After reviewing the aide care plan for P1, this DON confirmed the nurse did not update it to reflect the enhanced barrier precautions that need to be observed when providing bathing and hygiene to P1. During an interview on 06/11/26 at 4:00 PM, Registered Nurse Case Manager (RNCM)1 stated, "I did not know [P1] was in any isolation precautions in the [LTC facility]." RNCM1 confirmed that the aide's care plan should have reflected the enhanced barrier precautions that aide is to follow when giving personal hygiene/bathing to P1. Review of the undated hospice agency's policy, "Hospice Adie Services" indicated, "… Services provided by an aide could include bathing, shampoo, range of motion activities, dry dressing changes, assisting the patient to the bathroom, use of commode or bed pan … These activities in accordance with the plan of care and physician's (or other authorized independent practitioner's) orders will be assigned and supervised by a hospice registered nurse …"

It is required that the hospice’s policies and procedures define a system of communication and integration that sustains coordination of services and provides documentation of exchange of information. The policies and procedures ensure that: sharing of information occurs between all disciplines providing care and services in all settings and is ongoing whether or not the care and services are provided directly or under arrangement. This standard was not met, as evidenced by clinical record review, document review, and interview. Agency policy #1-035 "Interdisciplinary Group Coordination of Care" (reviewed 08/25/2022) read in part, "It will be the responsibility of the Case Manager to facilitate communication about changes in the patient's status between interdisciplinary group members and the patient's attending physician." Agency policy #1-006 "Care/Service Coordination" (reviewed 08/25/2022) read in part, "It will be the responsibility of the primary clinician to facilitate communication about changes in the patient's status among all assigned disciplines. Care coordination will include, but not be limited to: Timely documentation of coordination of care activities." Agency policy #1-024 "Revocation of Hospice Benefit Review" (11/09/2020) read in part, "The Case Manager will notify the attending physician and interdisciplinary group about the revocation and reason." In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the coordination of services and the exchange of information occurred between all disciplines providing care and services. Clinical Record 12: The patient elected hospice care on 09/17/2024 with a diagnosis of cerebrovascular disease. The patient revoked hospice services on 02/01/2025, seeking aggressive treatment. A Hospice Aide visit was documented on 02/02/2025 (one (1) day after hospice services were revoked), and a Chaplain visit was documented on 02/03/2025 (two (2) days after hospice services were revoked). In a joint record review and interview on 02/11/2025, the Regional Director of Clinical Services/Clinical Director confirmed the findings, stating in part, "The revocation form was received on 02/03/2025 (signed 02/01/2025), and that is when the discharge was entered in the system."

It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by observation, clinical record review, document review, and interview. Agency policy #9-020 "Hospice Aide Services" (reviewed 08/25/2022) read in part, "Services provided by an aide could include bathing, shampoo, range of motion activities, dry dressing changes, assisting the patient to the bathroom, use of commode or bedpan, assisting with meal preparation, feeding the patient, light housekeeping and/or linen changes. These activities, in accordance with the plan of care and physician's (or other authorized independent practitioner's) orders, will be assigned and supervised by a hospice registered nurse." In 1 of 10 (10%) clinical records reviewed and home visits observed of patients who received Hospice Aide services, the agency did not ensure that the Hospice Aide (HA) provided services included in the plan of care. Clinical Record 1/Home Visit 1: The patient elected hospice care on 06/05/2024 with a diagnosis of Parkinsonism. The recertification plan of care dated 01/31/2025 ordered HA services five (5) times per week beginning 01/31/2025. The HA care plan was updated on 01/13/2025 to include the task of a tub bath. During the home visit with the Hospice Aide (HA) [Personnel Record 1] on 02/11/2025, the HA provided the patient with a shower. During an interview and a joint review of the HA care plan, the HA stated, "We give her showers two times per week and other days wash her up by the sink. No bed bath." During a joint record review and interview on 02/11/2025, the Regional Director of Clinical Operations/Clinical Director confirmed the HA care plan indicated the HA was to provide a tub bath, stating, "She is a newer patient to that aide, maybe that's why."

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 and to ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review, document review, and interview. Agency policy #1-037 "Hospice Aide Supervisory Visits" (revised 11/2021) read in part, "The frequency of supervisory visits will be based upon the needs of the patient after the plan of care is established. They must be conducted no less frequently than every 14 days." In 3 of 10 (30%) clinical records reviewed of patients that received Hospice Aide (HA) services, the agency did not ensure that a Registered Nurse (RN) made 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 HA. Clinical Record 1: The patient elected hospice care on 06/05/2024 with a diagnosis of Parkinsonism. The recertification plans of care dated 12/02/2024 and 01/31/2025 ordered HA services 5x/wk beginning 12/02/2024. The HA visits were provided as ordered beginning 12/02/2024. A Hospice Aide supervisory visit was documented on 01/16/2025. A clinical record review revealed no evidence that an additional HA supervisory visit was completed through the review date on 02/10/2025, with 25 days outstanding. Clinical Record 10: The patient elected hospice care on 08/29/2024 with a diagnosis of Alzheimer's disease. For the certification periods dated 10/28/2024 through 12/26/2024 and 12/27/2024 through 02/24/2025, HA services were ordered three times a week, and HA visits were provided as ordered. HA supervisory visits were documented as completed on 12/26/2024 and 01/28/2025, with 33 days outstanding. Clinical Record 12: The patient elected hospice care on 09/17/2024 with a diagnosis of cerebrovascular disease. The hospice certifications and plans of care dated 09/17/2024 and 12/16/2024 ordered HA services daily beginning 09/17/2024. The HA visits were provided beginning 09/17/2024 as ordered. The HA supervisory visits were provided on 11/20/2024 and 01/14/2025, with 55 days outstanding. In a joint record review and interview on 02/11/2025, the Regional Director of Clinical Operations/Clinical Director confirmed that HA supervisory visits were not completed every 14 days per agency policy.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: the initial plan of care, updated plans of care, initial assessment, comprehensive assessment, updated comprehensive assessments, and clinical notes, including the care and services provided. This standard was not met as evidenced by clinical record review, document review, observation, and interview. Agency policy #9-020 "Hospice Aide Services" (reviewed 08/25/2022) read in part, "Hospice aides will document care provided in accordance with the hospice aide assignment." Agency policy #6-042 "Contents of the Clinical Record" (reviewed 06/15/2022) read in part, "The following information will be available in the clinical record...Signed or electronically authenticated and dated notes documenting and describing services provided during each patient contact." In 1 of 14 (7%) clinical records reviewed and home visits observed, the agency did not ensure the clinical record contained clinical notes describing services provided. Clinical Record 1/Home Visit 1: The patient elected hospice care on 06/05/2024 with a diagnosis of Parkinsonism. The hospice recertification plan of care dated 01/31/2025 ordered HA services five times per week beginning 01/31/2025. The HA care plan, updated on 01/13/2025, assigned the HA the relevant task of a tub bath. During the home visit with the Hospice Aide (HA) [Personnel Record 1] on 02/11/2025, the HA provided the patient with a shower. A clinical record review revealed the HA visit notes dated 02/07/2025, 02/10/2025, and 02/11/2025 documented, "Service: Bathing-Tub bath Completed: Y." During an interview and a joint review of the HA care plan, the HA stated, "We give her showers two times per week and other days wash her up by the sink. No bed bath." The documentation completed did not reflect the services that were provided. In a joint record review and interview on 02/11/2025, the Regional Director of Clinical Services/Clinical Director confirmed the HA visit notes recorded that a tub bath was given and the patient received a shower.