Every finding on record at Phoenix Home Care, LLC

Based on policy and procedure review, record review, home visit observation, and interview, the hospice provider failed to ensure comprehensive assessments identified the physical needs related to the patient’s terminal illness that must be addressed to promote the patient’s well-being and comfort throughout the dying process in three of five records reviewed (Records/Patients #1, #2, and #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Pain and Symptom Management,” dated 09/01/2024, showed in part, that pain would be assessed as part of the initial and comprehensive assessment and would include: - A history of pain and treatments; - Pain characteristics including:  * The severity/intensity of the pain using a standardized pain scale  * Descriptors of pain such as burning, stabbing, aching, and tingling  * The pattern of pain such as constant or intermittent  * Location and radiation of pain  * The frequency, timing and duration of pain- Impact of pain on quality of life such as sleeping, functioning, appetite, and mood; - Strategies and factors that reduce pain; - Additional symptoms associated with pain, such as nausea or anxiety; and - Pain and effective pain management will be assessed, ongoing, as part of every patent contact if patient reports pain or is at risk for pain. Review of the provider’s written procedure titled, “Guide to General Pain Management,” dated 2019, showed that clinicians were to:- Screen for pain at each visit and evaluate objectively the nature of the patient’s pain, including location, duration, quality and impact on daily activities;- Explore pain interventions that have been used and their effectiveness;- Determine whether the intensity of the pain correlated with the prescribed analgesic; - Use a pain intensity scale of 0 (zero, no pain) to 10 (ten, the worst possible pain) high or other pain scale as appropriate, and take a careful history of prior and present medications, response, and adverse effects; - Assess relief from medications and duration of relief; and- Reevaluate the pain frequently. --- RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to hospice services on 10/06/2025 with a terminal diagnosis of aortic valve insufficiency (a condition where the aortic valve in the heart is not function properly). The patient resided in his/her adult child’s home. Review of the nursing visit documentation, dated 12/05/2025, showed that:- The nursing pain assessment documentation showed that:   * The patient’s pain was 0 on a 0-10 scale;   * The patient experienced pain daily, but not constantly;   * Pain management was effective;   * Ambulation made the patient’s pain worse;   * The patient took oxycodone one or two times per day after ambulating around the house; and   * The patient had taken oxycodone (a medication used to treat moderate to severe pain) prior to the nursing visit for back pain; and- The visit note failed to contain documentation of:   * The duration, quality, and intensity of the patient’s back pain;  * The impact of the patient’s back pain on his/her daily activities and quality of life; and  * The duration of the patient’s pain relief. Review of the patient communication note, dated 12/08/2025, showed that the patient’s child was asking if the patient could have an additional oxycodone as he/she was having discomfort that was not relieved using oxycodone every four hours. The nurse notified the physician, and an order was received to administer a one-time additional dose of oxycodone. The patient’s child declined a nursing visit. Review of the nursing visit documentation, dated 12/09/2025, showed that:- The nursing pain assessment documentation showed that:   * The patient’s pain was 0 on a 0-10 scale;   * The patient experienced pain daily, but not constantly;   * Pain management was effective;   * Ambulating made the patient’s pain worse;   * The patient took oxycodone one or two times per day after ambulating around the house; and   * The patient took oxycodone prior to the nursing visit for back pain; and- The visit note failed to contain documentation of:   * The duration, quality, and intensity of the patient’s back pain including, but not limited to, the patient’s elevated pain on 12/08/2025;  * The impact of the patient’s back pain on his/her daily activities and quality of life; and  * The duration of the patient’s pain relief.Review of the nursing visit documentation, dated 12/12/2025, showed that:- The nursing pain assessment documentation showed that:   * The patient’s pain was rated 0 on a 0-10 scale;   * The patient experienced pain daily, but not constantly;   * The patient’s pain was at the location of his/her abdominal hernia;   * Pain management was effective;   * Ambulating made the patient’s pain worse, rated a 6 (six) on a 0-10 scale;   * The patient took oxycodone one or two times per day after ambulating around the house; and   * The patient had taken oxycodone five to six times a day;   * The patient was experiencing no pain at the time of the nursing visit; and- The visit note failed to contain documentation of:   * The duration and quality of the patient’s pain;  * The impact of the patient’s back and hernia pain on his/her daily activities and quality of life; and  * The duration of the patient’s pain relief.RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to hospice services on 02/01/2025 with a terminal diagnosis of lymphoma (a cancer of the system that manufactures white blood cells). The patient resided in his/her own home with the assistance of his/her spouse and paid caregivers. Review of the comprehensive, recertification nursing visit, dated 11/13/2025, showed that: - The patient had reported that he/she had no pain; - The patient reported significant pain with any movement;  - Non-verbal pain behaviors were noted during repositioning; - The patient was to be repositioned every two hours; and- The visit note failed to contain documentation of:   * The duration of the patient’s pain;   * Interventions taken to treat the patient’s pain and the effectiveness of those interventions using a 0 to 10 pain scale; and  * An assessment of the relief obtained using pain interventions and the duration of the relief.Review of the nursing visit documentation, for the dates of 11/20/2025, 11/24/2025, 12/01/2025, 12/08/2025, and 12/15/2025 showed that: - The patient was using oxycodone for pain management; - The patient had pain less often than daily; - The patient’s pain was generalized; - Movement made the patient’s pain worse; - The patient had taken no pain medication in the last 24 hours; and- The visit note failed to contain documentation of the quality, duration, and intensity of the patient’s pain during movement.  During an interview on 12/17/2025 at 2:55 PM, the administrator designee stated that they expect clinicians to assess the patient’s pain every visit, and the pain assessments were complete. RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 10/08/2024 with a terminal diagnosis of malignant neoplasm (a cancerous growth) of the colon. The patient resided alone in his/her home. Review of the recertification visit, dated 11/12/2025, showed the following:- The patient utilized morphine approximately four times daily for pain management with partial relief;- Due to increased pain and discomfort associated with diarrhea, the patient refused home health aide-assisted showers; and- Failed to show, in part, the following for the pain assessment*Location*Intensity*Description*Duration*Target pain goalObservation on 12/15/2025 at 3:10 PM, during the social worker home visit, the patient stated, “To kill the pain, it would have to kill me.”During an interview on 12/15/2025 at 4:00 PM, the patient stated that his/her acceptable pain level was two to three. The patient does not want to take more pain medication because he/she wanted to be able to function and be alert.

Based on policy review, record review, home visit observation, and interview the hospice provider failed to ensure staff maintained an accurate and updated medication profile in four of five records reviewed (Records/Patients #1, #2, #3, and #4). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Medication Management,” dated 09/08/2025, showed in part:- The comprehensive assessment will include a review of all the patient’s prescription and over-the-counter drugs, herbal remedies, and other alternative treatments that could affect drug therapy; and- Medication monitoring occurs at each scheduled clinical visit and will include gathering appropriate information to develop an accurate patient medication history and a current medication profile. --- RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 10/08/2024 with a terminal diagnosis of malignant neoplasm (a cancerous growth) of the colon. The patient resided alone in his/her home. Observation and interview on 12/15/2025 showed the following discrepancies between the provider’s medication profile (PMP), dated 12/02/2025 to 01/30/2026, and the patient’s home medication bottles:- The PMP showed acetaminophen oral suspension 160 milligrams (mg)/5 milliliters (ml) take 20 ml by mouth every four hours as needed for mild pain (started 11/03/2025). The patient was not taking the medication and stated that he/she did not like it because it made him/her nauseated;- The PMP showed Mucinex oral tablet extended release 600 mg take one every twelve hours as needed for congestion (started 10/01/2025). The patient was not taking the medication;- The PMP showed Senna-Plus oral tablet 8.6-50 mg take one tablet by mouth once daily for constipation (started 06/24/2025). The medication bottle showed two times per day. The patient took the medication twice a day, one in the morning and one in the evening, unless he/she had diarrhea;- The PMP showed lorazepam oral tablet one (1) mg take one tablet by mouth every four hours as needed for anxiety (started 01/24/2025). The patient took one in the morning and one in the evening and sometimes one in the middle of the day; - The PMP showed diphenhydramine 25 mg take one to two tablets by mouth every six hours as needed for sleep aid (11/07/2024). The patient was not taking the medication;-The PMP showed nystatin powder apply to affected area three times daily as needed for fungal rash (started 10/08/2024). The patient was not taking the medication.- The PMP showed vitamin D3 (three) 10 micrograms (mcg) take one tablet once daily. The patient was not taking the medication and it was not in the home;- The PMP showed citalopram hydrobromide 10 mg take one tablet by mouth once daily for depression (stated 10/08/2024). The patient was not taking the medication and it was not in the home;- The PMP failed to show the following medications that the patient was taking and had in the home:*Acetaminophen 500 mg takes one to two times a day for arthritis*Ondansetron takes one every eight hours*Cetrizine (antihistamine) 10 mg takes one tablet daily*Zycam (cold medication) takes as needed*Aspirin takes as needed when the patient has swelling*Zinc oxide cream as neededRECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 07/31/2025 with a terminal diagnosis of heart failure (when the heart can't pump enough blood to meet the body's needs) and stage 3 (three) chronic kidney disease (a serious condition where the kidneys are mildly to moderately damaged). The patient resided in a NF. Observation on 12/16/2025 showed the following discrepancies between the provider’s plan of care POC medication list, dated 12/02/2025, and the NF’s medication administration record (MAR) dated 12/01/2025 to 12/15/2025: - The POC showed Tylenol 325 mg take one tablet by mouth every eight hours as needed for moderate pain (started 08/09/2025). The MAR showed 650 mg every four hours as needed; - The POC showed barrier cream apply to affected area four times a day as needed to prevent skin breakdown (started 07/31/2025). The MAR showed protected skin cream two times a day; - The POC failed to show the following medications listed on the MAR* Amlodipine besylate 5 mg take one tablet at bedtime*Morphine 20 mg take .25 ml every four hours as needed*Nitroglycerin 0.4 mg take one tablet every five minutes as needed*Ondansetron 4 mg take one tablet every six hours as needed*Tylenol 500 mg take one tablet every 24 hours as needed. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to hospice services on 10/06/2025 with a terminal diagnosis of aortic valve insufficiency (a condition where the aortic valve in the heart is not function properly). The patient resided in his/her adult child’s home. Observation and interview on 12/16/2025 at 10:15 AM, showed the following discrepancies between the provider’s medication profile (PMP) and the patient’s home medications: - The PMP showed MiraLAX powder (a laxative), one capful daily, and the patient’s child stated that the patient takes one capful daily, and two capfuls if no bowel movement; and- The (PMP) showed Prolia (a medication used to strengthen bone), and the patient’s child stated that the patient had not taken the medication since he/she was in the hospital prior to his/her admission to hospice services. During an interview on 12/17/2025 at 3:20 PM, the administrator designee stated that they expect their clinicians to maintain a complete and accurate medication profile. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to hospice services on 02/01/2025 with a terminal diagnosis of lymphoma (a cancer of the system that manufactures white blood cells). The patient resided in his/her own home with the assistance of his/her spouse and paid caregivers. Observation and interview on 12/16/2025 at 10:15 AM, showed the following discrepancies between the PMP and the patient’s home medications: - The PMP showed the patient was to take Lasix (a diuretic) and potassium (an electrolyte supplement) every other day, and the medication bottles in the home showed the patient was to take Lasix and potassium daily with a start date of 11/24/2025; - The PMP showed the patient was to take a mucus relief tablet 600mg every 12 hours, and the medication box in the home showed the patient was taking mucus relief tablet 1200mg every 12 hours; and - The patient’s spouse stated that their adult relative prefilled the medication planner two times per week. During an interview on 12/16/2025 at 10:49 AM, the patient’s adult relative stated that the patient was taking Lasix and potassium daily, and mucus relief tablets 1200mg every 12 hours. During an interview on 12/17/2025 at 2:55 PM, the administrator designee stated that they were unable to provide an updated medication list containing orders for Lasix and potassium daily, or mucus relief 1200mg every 12 hours.

Based on policy review, record review, home visit observation, and interview, the hospice provider failed to ensure that each patient received a plan of care (POC) that included interventions based on problems identified in three of five full records reviewed (Records/Patients #1, #4, and #5). This deficient practice has the potential to affect all the patients served by the provider. Findings included:Review of the provider's policy titled, "Plan of Care Process," dated 09/01/2024, showed in part, the POC must reflect patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The POC will include all services necessary for the palliation and management of the terminal illness and related conditions. --- RECORD/PATIENT #1:Review of the clinical record showed the patient was admitted to hospice services on 10/08/2024 with a terminal diagnosis of malignant neoplasm (a cancerous growth) of the colon. The patient resided alone in his/her home. Review of the plan of care (POC), dated 12/04/2025, showed morphine sulfate (concentrate) oral solution 20 milligram (mg)/milliliter (ml) to be taken 0.5 ml by mouth every three hours as needed for pain and/or shortness of breath. The POC failed to show who was responsible for filling the oral syringes.During an interview on 12/15/2025 at 4:00 PM, the patient and the patient’s adult child stated that the registered nurse (RN) filled the oral syringes for him/her.During an interview on 12/17/2025 at 8:40 AM, the RN stated that the patient’s adult child filled the oral syringes for the patient.During an interview on 12/17/2025 at 11:30 AM, the administrator and administrator designee stated that the POC should identify who was filling the oral syringes for the patient.  RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted to hospice services on 02/01/2025 with a terminal diagnosis of lymphoma (a cancer of the system that manufactures white blood cells). The patient resided in his/her own home with the assistance of his/her spouse, adult relative, and paid caregivers. Observation and interview on 12/16/2025 at 10:15 AM, the patient’s spouse stated that their adult relative prefilled the patient’s medication planner two times per week for several months, and he/she privately pays for a caregiver for four hours each morning and evening to assist the patient out of and into bed. The paid caregivers did not work for the provider. Review of the updated plan of care, dated 12/04/2025, showed that the document failed to contain orders for the patient’s adult relative to prefill the patient’s medication planner, and the patient’s private paid caregiving services frequency or provider. During an interview on 12/17/2025 the administrator designee stated that they would expect the POC to contain all the interventions required for the care of the patient, and they were unable to locate interventions for the medication planner or paid caregivers on the patient’s POC.  RECORD/PATIENT #5:Review of the clinical record showed the patient was admitted to hospice services on 11/21/2025 with a terminal diagnosis of; other symptoms and signs involving cognitive functions following cerebral infarction (death of brain tissue from a lack of blood flow, oxygen, and nutrients). The patient resided in his/her home with the assistance of the spouse. Review of the chaplain assessment visit dated 11/25/2026 showed the chaplain documented in the note section his/her plan to return for ongoing spiritual and emotional support once a month. Review of the updated POC dated 11/26/2025 and 12/04/2025, and the Interdisciplinary Group (IDG) meeting note dated 12/04/2025 showed the chaplain frequency was written as two times per week.During an interview on 12/17/2025 at 3:50 PM, the hospice administrator stated that he/she would expect the POC and the chaplain's plan to match.

Based on policy review, record review, home visit observation, and interview, the provider failed to ensure the nursing facility (NF) had the necessary information to assure the patient received the necessary care and services in one of one home visit conducted in a NF (Record/Patient #3). This deficient practice has the potential to affect all the patients served by the provider who reside in a facility.Findings included:Review of the provider’s policy titled, “Hospice Care in a Skilled Nursing Facility (SNF)/NF or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)," dated 11/22/2024, showed the provider was to provide the facility with the following hospice information/documentation on admission and on-going:- The hospice election form;- Any advance directives specific to each patient;- The physician certification and recertification of the terminal illness specific to each patient; and- The hospice physician and attending physician (if any) orders specific to each patient. --- RECORD/PATIENT #3:Review of the clinical record showed the patient was admitted to hospice services on 07/31/2025 with a terminal diagnosis of heart failure (a decrease in the ability of the heart to pump blood) and stage 3 (three) chronic kidney disease (a serious condition where the kidneys are mildly to moderately damaged). The patient resided in a NF. During the home visit observation on 12/16/2025 at 1:25 PM, review of the hospice binder located in the NF showed the binder failed to include the following:- Hospice election form;- Advanced directive;- Physician certification and recertification; and- Hospice physician and attending physician orders.During an interview on 12/17/2025 at 2:55 PM, the administrator and administrator designee stated that they expected the documents to be in the binder and did not know why they were not there.

Upon patient record review, 3 of 5 (Patient #1,#2,#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: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1: On the medication profile, Voltaren External Gel 1% was ordered PRN to affected area as needed for comfort. There was not evidence of where the affected area was located. In addition, Calmoseptine External Ointment 0.44-20.6% was ordered to apply to affected site topically with peri care as the frequency. There was no evidence of where the site is located, should have been apply to buttocks. All were corrected on site. Patient 2: Calmoseptine external ointment 0.44-20.6% was ordered for 3 times a day, applied to affected area. There is not evidence of a location to apply the ointment. In addition, Miralax oral powder 17gm/scoop, take one dose as needed daily for no BM greater than 3 days. There is not evidence of a diluent. Also, Nystatin-Triamcinolone cream, apply to affected area twice daily. There is no evidence of a location to apply the cream. All were corrected on site. Patient 3: Miralax 17gm/scoop. Take one scoop daily as needed for constipation. There is not evidence of a diluent. Corrected on site.

Upon patient record review, 3 of 5 (Patient #1,#2,#3) 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 1: Voltaren External Gel 1% was ordered PRN to affected area as needed for comfort. There was not evidence of where the affected area was located. In addition, Calmoseptine External Ointment 0.44-20.6% was ordered to apply to affected site topically with peri care as the frequency. There was no evidence of where the site is located, site should have included buttocks. All were corrected on site. Patient 2: Calmoseptine external ointment 0.44-20.6% was ordered for 3 times a day, applied to affected area. There is not evidence of a location to apply the ointment. In addition, Miralax oral powder 17gm/scoop, take one dose as needed daily for no BM greater than 3 days. There is not evidence of a diluent. Also, Nystatin-Triamcinolone cream, apply to affected area twice daily. There is no evidence of a location to apply the cream. All were corrected on site. Patient 3: Miralax 17gm/scoop was ordered. The patient was to take one scoop daily as needed for constipation. There is not evidence of a diluent. Corrected on site.