Every finding on record at Morselife Hospice Institute Inc.

It is required that the patient’s pain is assessed as part of a comprehensive assessment. Assessment of pain in children and adolescents is conducted with consideration of age and neurocognitive development. The documented assessment of the patient’s pain includes history of pain and its treatment, both pharmacological and non-pharmacological, use of a standardized pain assessment tool appropriate to the patient’s developmental and cognitive status, characteristics of the pain, including location, frequency, and intensity, how pain impacts the patient’s ability to engage in usual activities and function (e.g., appetite, sleeping), and the patient’s/family’s goals for pain management and their satisfaction with the current level of pain control. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed, the agency did not ensure that the patient's pain was assessed as part of the comprehensive assessment. Clinical Record 5: The patient elected the hospice benefit on 12/27/2024 with a terminal diagnosis of Parkinson's Disease. The Registered Nurse documented on the comprehensive assessment dated 12/27/2024 that the patient had dementia and was unable to answer questions. The comprehensive assessment completed at the start of care did not include an assessment of the patient’s pain. There was no documented evidence that the nurse completed a pain assessment or that the nurse used a non-verbal pain assessment tool to assess the patient’s pain level. Clinical Record 18: The patient elected the hospice benefit 11/18/2024 with a terminal diagnosis of dementia. The start of care comprehensive assessment completed by the Registered Nurse on 11/18/2024 did not include an assessment of the patient’s pain. Clinical record review revealed the patient had Morphine concentrate ordered at the start of care at 100mg/5ml 5mg every 4 hours and the patient was receiving the medication. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed that the start of care comprehensive assessments did not include a pain assessment for the patient.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a Registered Nurse (RN) as the changes relate to the plan of care and any quality assessment and improvement activities. The hospice aide must also complete appropriate records of service, including the report of changes in the patient’s needs. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) clinical records reviewed with hospice aide services provided, the agency did not ensure the Hospice Aide reported a change in the patient’s needs to the Registered Nurse. Clinical Record 7: The patient elected the hospice benefit on 07/25/2024 with a terminal diagnosis of Alzheimer's Disease. The hospice aide care plan dated 12/30/2024 included an order for hospice aide visit frequency four times per week. The Hospice Aide documented a missed visit on the aide visit note dated 01/01/2025. However, there was no documented evidence that the Hospice Aide reported the missed visit to a Registered Nurse During an interview and record review on 02/13/2025, the QAPI [Quality Assurance Performance Improvement] Registered Nurse confirmed that the record did not include documentation that the RN was notified of the missed visit.

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. This standard was not met as evidenced by clinical record review and interview. In 2 of 2 (100%) clinical records reviewed with patient discharge or revocation, the agency did not ensure the hospice discharge summary included a summary of the patient’s hospice stay, including treatments, symptoms, and pain management. Clinical Record 14: This patient elected the hospice benefit on 12/29/2023 with a terminal diagnosis of amyotrophic lateral sclerosis. The patient revoked the hospice benefit on 02/25/2024. The hospice discharge summary sent to the patient's attending physician dated 02/25/2024 did not include a summary of the patient’s hospice stay. Clinical Record 15: This patient elected the hospice benefit on 04/12/2024 with a terminal diagnosis of exocrine pancreatic insufficiency. The patient was a live discharge on 10/08/2024. The hospice discharge summary sent to the patient's attending physician dated 10/08/2024 did not include a summary of the patient’s hospice stay. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed that the discharge summaries sent to the patient's attending physician did not include a summary of the patient’s hospice stay.

It is required that hospice care of the patient/resident is stated in a written plan of care established and maintained in consultation with SNF/NF or ICF/IID representatives. The hospice plan of care identifies the care and services that are needed and specifies which provider is responsible for performing the functions that are agreed upon and included in the plan of care. This standard was not met as evidenced by clinical record review, observation, and interview. In 3 of 3 (100%) clinical records reviewed for patients that resided in a skilled nursing facility (SNF), the agency did not ensure the hospice plan of care specified which provider was responsible for performing the functions that were agreed upon and included in the plan of care. Clinical Record 1: The patient elected the hospice benefit on 11/18/2024 with a terminal diagnosis of Alzheimer's Disease. The patient resided in a SNF. The hospice plan of care did not include documentation to specify which provider was responsible to perform the functions included in the patient’s plan of care. Clinical Record 13: The patient elected the hospice benefit on 01/05/2025 with a terminal diagnosis of benign neoplasm of meninges. The patient resided in a SNF. The hospice plan of care did not include documentation to specify which provider was responsible to perform the functions included in the patient’s plan of care. Clinical Record 18: The patient elected the hospice benefit on 11/18/2024 with a terminal diagnosis of Dementia. The patient resided in a SNF. The hospice plan of care did not include documentation to specify which provider was responsible to perform the functions included in the patient’s plan of care. During an interview and review of records on 02/13/2025, the Quality Assurance Performance Improvement Registered Nurse confirmed the hospice plans of care for patients that were in Skilled Nursing Facilities did not include which provider was responsible for performing the functions that were included in the plans of care.

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. The medication review process includes the identification of the effectiveness of drug therapy, drug side effects, actual or potential drug interactions, duplicate drug therapy, and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when new medication is added, or changes are made to existing medication. This standard was not met as evidenced by a review of clinical records, document review, and observation. 2 of 14 (14%) records reviewed revealed the hospice did not ensure the patient's drug profile included oxygen. Record #13611: For the benefit period dated 3/10/2022-6/07/2022, the comprehensive assessment completed on 3/10/2022 by the Registered Nurse documented, "Pt wears O2 2L NC prn." The drug profile did not include the patient's use of oxygen. Record #71531: For the benefit period dated 3/14/2022-6/11/2022, the comprehensive assessment completed on 3/14/2022 by the Registered Nurse documented, "Wears O2 at 2 L." During the home visit conducted on 5/11/2022, the patient's husband stated the patient uses oxygen at night. The patient’s husband pointed to an oxygen tank in the dining room. The drug profile did not include the patient's use of oxygen. The agency policy "Comprehensive Assessment- Content" (Origination date: 6/2018) stated in part, "The comprehensive assessment of the patient consists of discipline -specific assessment tools that address the following factors.... a review of all of the patient's prescription and over-the-counter drugs, herbal remedies and other alternative treatments that could affect drug therapy..." The Director of Clinical Services was interviewed on 5/11/2022 at 2:00 PM and confirmed the drug profile did not include oxygen.

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 medical supplies and appliances necessary to meet the needs of the patient. This standard was not met as evidenced by clinical record review, document review, and interview. 3 of 14 (21%) records reviewed revealed the hospice failed to ensure the plan of care included medical supplies and appliances necessary to meet the needs of the patient. Record #20439: For the benefit period dated 4/25/2022-6/23/2022, the comprehensive assessment completed 4/25/2022 by the Registered Nurse documented, "Dependent in all ADLs, with Hoyer lift...and high back wheelchair... indwelling Foley catheter. The plan of care documented "14. DME and Supplies...General...Safety Measures...General." The medical supplies and appliances necessary to meet this patient's needs were not included in the plan of care. Record #13611: For the benefit period dated 4/7/2022-7/05/2022, the comprehensive assessment completed 4/7/2022 by the Registered Nurse documented, "Foley patent with leg bag...in a Geri-chair...needs a sling lift to get out of bed. The plan of care documented "14. DME and Supplies... General...Safety Measures...General." The medical supplies and appliances necessary to meet this patient's needs were not included in the plan of care. Record #61402: For the benefit period dated 3/10/2022-6/07/2022, the comprehensive assessment completed 3/10/2022 by the Registered Nurse documented, "O2 2L NC prn and CPAP." The plan of care documented "14. DME and Supplies...General...Safety Measures... General." The medical supplies and appliances necessary to meet this patient's needs were not included in the plan of care. The agency policy "Durable Medical Equipment (DME)"" (Origination date 6/2018) stated in part DME must be approved by the hospice IDG, ordered by the physician's attending physician or hospice physician , and included in the patient's plan of care." The findings were validated by the Director of Clinical Services during an interview and a joint review of the records on 5/12/2022 at 2:00 PM.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and included in the plan of care. This standard was not met as evidenced by review of clinical records and interview. 1 of 4 (25%) records reviewed of patients receiving hospice aide services revealed the hospice did not ensure the hospice aide provided services as ordered by the interdisciplinary group and included in the plan of care. Review #71531: For the benefit period dated 3/14/2022-6/11/2022, the plan of care documented, "Orders for Discipline and Treatments...AIDE... 3/20/2022...2 x week x 12 weeks." Hospice aide visits were documented as completed on 3/29/2022, 4/5/2022, and 4/15/2022, which was an actual frequency of 0 times a week for 1 week and 1 time a week for 3 weeks as of 4/16/2022. The finding was validated by the Director of Clinical Services during an interview and a joint review of the record on May 12, 2022, at 4:00 PM.