Every finding on record at Premier Care at Home, Inc

It is required that the written Patient Bill of Rights includes the right to have person and property treated with respect by anyone providing services on behalf of the hospice. This standard was not met as evidenced by clinical record review, interview and observation. In 1 of 3 (33%) home visits conducted, the agency did not ensure that the person was treated with respect by honoring the privacy of the patient during the provision of personal care. HOME VISIT 2: A home visit was conducted on 07/09/2025 (clinical record 2) to observe the Hospice Aide (HA) (personnel record 2) provide personal care to the patient. The HA brought the patient from the living room to the bathroom in a wheelchair for a shower. The HA transferred the patient from the wheelchair to the shower chair with assistance from the caregiver. The HA removed the patient's clothes with the bathroom door open to the hallway. The patient was then placed in the shower and then the door to the bathroom was closed. CLINICAL RECORD 2: This patient elected the hospice benefit on 04/27/2025 with a terminal diagnosis of Alzheimer's Disease. In an interview conducted with the Director of Patient Care Services (DPCS), the DPCS was informed that the Hospice Aide did not shut the door for privacy while showering the patient. It was stated that the door should have been closed to protect the patient's right to privacy.

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, 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 clinical record review, interview and observation. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the drug administration record was updated, which resulted in the medication reconciliation being incomplete. HOME VISIT 1: A home visit was conducted on 07/08/2025 (clinical record 1) to observe the Registered Nurse (RN) (personnel record 1). During this visit at the skilled nursing facility (SNF), the facility drug profile was reviewed with the hospice RN and the SNF staff nurse. The staff nurse stated that the morphine was not listed on the facility drug profile. CLINICAL RECORD 1: This patient elected the hospice benefit on 07/12/2024 with a terminal diagnosis of COPD. In review of the hospice drug profile and the skilled nursing facility (SNF) drug profile, Morphine Sulfate (Concentrate) 0.25 ml oral solution was included on the hospice drug profile dated 07/07/2025, but not on the current facility drug profile which was reviewed for the dates 07/12/2024- 07/08/2025. An interview was conducted with the Director of Patient Care Services (DPCS) on 07/08/2025 and it was stated that the Morphine was missing from the facility drug profile. It was also stated that it was most likely that the facility removed the medication from the facility medication profile without notifying the hospice, but the agency had a responsibility to review the facility medication profile to ensure accuracy.

Observed in Record Review. In 5 of 11 patient records reviewed, the organization failed to assess and reassess its patients. During record review for HV#1HV#2, RR#5, and RR#8 the hospice nurse surveyor observed the organization did not assess information about the patient’s psychosocial status, such as family relationships, social history, the source and adequacy of environmental and other resources, coping mechanisms, and the patient’s and family’s reactions to illness. Upon discussion with the organization it was noted that the patients refused SW services but the assessment was not completed by other visiting disciplines. During record review for RR#7, the hospice nurse surveyor observed there was no documentation of a bereavement assessment. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 1 of 11 patient records reviewed, the organization failed to assess and reassess its patients. During record review for RR#7, the hospice nurse surveyor observed the hospice’s interdisciplinary group did not update the comprehensive assessment in collaboration with the patient’s attending physician, if any, as frequently as the patient’s condition requires, but no less than every 15 days. There was no documentation of IDG. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Record Review. In 10 of 11 patient records reviewed, the organization failed to plan the patients care. During record review for HV#1, HV#2, RR#1, RR#2, RR#3, RR#4, RR#5, RR#6, RR#7, and RR#8, the hospice nurse surveyor observed the organization failed to document collaboration between the RN seeing the patient and the Clinical Supervisor who was documenting and reporting off at IDG. This was discussed and reviewed with the Hospice Leadership Team.

Observed in Patient Home. In 2 of 2 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. During HV#1 and HV#2, the hospice nurse surveyor observed the staff did not follow the organizational bag technique policy regarding recommendations for disinfection related to manufacturer guidelines of a wet-time of two minutes. This was discussed and reviewed with the Hospice Leadership Team. Observed in Patient Home. In 1 of 3 home visits conducted, the organization failed to implement the infection prevention and control activities it had planned. In HV#2, staff failed to perform hand hygiene consistent with the policy. During the visit, the hospice nurse surveyor observed the staff member change gloves multiple times without performing hand hygiene in between, as required by organizational policy. This was discussed and reviewed with the Hospice Leadership Team.