Every finding on record at Patriot Hospice, Inc

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 following, the effectiveness of drug therapy. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 19 (5%) clinical records reviewed, of patients with oxygen ordered as needed, it was revealed that the agency did not ensure that oxygen was added to the drug profile and was not included in the medication review process. CLINICAL RECORD 3/HOME VISIT 3: The patient elected the hospice benefit on 01/08/2025. The clinical record included a physician's order for 2 liters of oxygen via nasal cannula PRN (as needed). During the home visit on 08/27/2025 the oxygen was observed in the home. When interviewing the patient and his caregiver, they stated he uses oxygen during the day if he gets short of breath and uses it every night for sleep. The drug profile did not include the prescribed oxygen. Following a joint record review and interview on 08/28/2025, the Administrator and Director of Nursing agreed that oxygen was not included on the drug profile. The Administrator stated that if oxygen is "checked" on the original admission orders (oxygen 2-4 liters via nasal cannula (NC) prn), then the expectation is that it must be added to the patient's drug profile. The Administrator also said that while there was no written policy; this was the agency's expectation, and the nurses had been educated on this.

It is required that each patient’s individualized written plan of care identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed it was revealed that the agency did not ensure that the plan of care included necessary interventions for problems identified in the initial and updated assessments. CLINICAL RECORD 12: The patient elected the benefit on 08/25/2025 with the diagnoses of senile degeneration of the brain and chronic kidney disease stage four. The initial comprehensive assessment on 08/25/2025 documented that the patient had a nephrostomy tube and a colostomy. The initial plan of care dated 08/25/2025 did not include interventions related to the care of the nephrostomy tube or colostomy. CLINICAL RECORD 15: The patient elected the benefit on 06/14/2025 with the diagnosis of senile degeneration of the brain. On 06/20/2025, the nurse documented lesions to the left lower buttocks/peri area and obtained orders to "cleanse with normal saline or soap and water, apply Aquaphor Ointment, and cover with ABD pads. Dressing to be changed with each incontinence episode and PRN (as needed). Facility staff will change dressings, and hospice will provide wound care supplies." Skin tear noted on 06/27/2025 to right arm. The treatment documented by the nurse was "cleansed with normal saline, applied A&D ointment and covered with foam dressing. The plan of care did not include the identified problem of wounds/skin integrity or interventions for the wounds. During a joint record review and interview on 08/28/2025, the Administrator and Director of Nursing agreed that the plans of care did not include interventions related to problems identified in the initial and comprehensive assessment.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed it was revealed that the agency did not ensure the records included physician orders. CLINICAL RECORD 15: On 06/27/2025, the nurse reported a "Skin tear noted on right arm" and documented that the care provided was "cleansed with normal saline, applied A&D ointment, and covered with foam dressing." The clinical record lacked documented evidence of a physician's order for the wound care treatment documented by the nurse. Following a joint record review and discussion, the Administrator and Director of Nursing on 08/28/2025 agreed that no treatment orders were completed for the skin tear documented on 06/27/2025 and the care that was provided.

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 a review of clinical records and interviews. In 1 of 1 (100%) records reviewed of patients who revocated from hospice services, the agency did not ensure that a discharge summary was generated and sent to the patient's primary physician.. Clinical Record 4 Patient was admitted on 8/12/22. She fell on 8/28/22 and broke her hip. Patient then revocated from hospice to go to the ER for aggressive treatment. Upon discharge from hospice, a discharge summary was not generated and no information was sent to the patient's attending physician. Staff 9 In a joint record review with the Director of Nursing, he stated that their EMR does not create discharge summaries and therefore they have not been sending discharge summaries for any patient revocation.

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/IDF 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 a review of clinical records and interviews. In 4 of 4 (100%) records reviewed for patients receiving hospice services in a skilled nursing facility (SNF) revealed the agency did not ensure that the plan of care included the identification of which provider was responsible for performing the interventions on the plan of care (POC). Director of Nursing (DON) states that the organization does not delineate responsibility for performing the functions in the plan of care. . Clinical Record 4 in joint review of the record with the DON, the plan of care for this facility patient did not state whether the hospice or the facility were responsible for the interventions. Clinical Record 7 in joint review of the record with the DON, the plan of care for this facility patient did not state whether the hospice or the facility were responsible for the interventions. Clinical Record 8 in joint review of the record with the DON, the plan of care for this facility patient did not state whether the hospice or the facility were responsible for the interventions. Clinical Record 11 in joint review of the record with the DON, the plan of care for this facility patient did not state whether the hospice or the facility were responsible for the interventions.