Every finding on record at Reliant Hospice of Houston LLC

Upon patient record review 1 of 19 (Patient #14) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient #14: There was no evidence of a psychosocial assessment.

Upon patient record review, 4 of 19 (Patient #1,2,3,4) 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:The hospice medication profile indicated the patient was taking Omeprazole and Senna plus. The caregiver showed me the home medication list which indicated the patient was also receiving Atorvastatin, lisinopril, Clopidogrel, Levothyroxine, and ASA. Patient #2:The hospice medication profile indicated the patient was receiving Eliquis, Lasix, KCL and, Seroquel which was not on the facility medication profile. Additionally, The facility medication profile indicated the patient was receiving Lorazepam, Trazadone and Tylenol which was not on the hospice medication profile. Patient #3:The hospice medication profile indicated the patient was receiving Pantoprazole and Remeron which was not on the facility medication profile. Additionally, the facility medication profile indicated the patient was receiving Famotidine, Cholecalciferol which was not on the hospice medication profile. Patient #4: Trazadone was on the medication profile, but the caregiver stated the patient was not taking the medication and it is not in the home.

Upon client record review, 3 of 19 (Patient #1,#4,#6) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1:The plan of care dated 2/19/25 indicated the nurse frequency was 1 every 2wk2, 1wk8. However, the patient received a visits on 2/25/25, 3/4 and 3/13 indicating the actual frequency was 1 x per week. Patient #4:The nurse frequency on the plan of care dated 2/11/25, indicated the frequency was 2wk1, and 1wk6, During the week beginning 2/23/25, there were 2 visits one on 2/25/25 by an RN and 2/27/25 by an LVN. Patient #6:The initial plan of care indicated nurse frequencies were 3wk1, 1wk12, On week 1, there were 2 visits on 12/30 and 1/2/25, and on the week of 1/26 - 2/1/25, there were no visits and no evidence of a missed visit note.

Upon observation, there was no evidence the hospice follows acceptable standards of practice to prevent the transmission of infections and communicable diseases, including standard precautions. Patient #3: The RN used Walgreen's 70% Isopropyl Alcohol Wet Wipes to clean equipment. The directions indicated this was used for skin abrasions and not for equipment. The RN stated she bought these and I confirmed it was not supplied by the agency.

Upon patient record review 1 of 19 (Patient #5) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care Patient #5:The initial plan of care effective 02-10-25 showed the aide frequency was 2wk1, 3wk12. For the week of 2/9-2/15/25, there was 1 missed visit note for 2/13 and no evidence of a visit, indicating 1 visit in week 1. For the week of 2/16-2/22/25, there was a missed visit for 2/16, and 3 visits for the17th, 19th, and the 21st indicating 4 visits.

Upon observation, there was no evidence the annual report documents the use of volunteers providing day to day administrative and/or direct patient care services in an amount that, at a minimum, equals 5 percent of the total patient care hours of all paid hospice employees and contract personnel. The annual report documented 0 volunteer hours.

Upon patient client record review, 3 of 19 (Patient #2, #6, #11) did not have evidence that all entries are legible, clear, complete, and appropriately authenticated and dated in accordance with the organizations policies and procedures and currently accepted standards of practice. Electronic signatures are acceptable as long the hospice is following appropriate safeguards to prevent unauthorized access to the patient records. Patient #2:A supervisory assessment was completed by the RN on 11-12-24, but there was no aide visit until 11-13-24. Patient#6:An aide supervisory visit was completed by the RN on 2/14/25, 2/16/25, and 03/04/25, but the aide was discontinued on 02/05/25. Patient #11:An aide supervisory visit was completed on 03/10/25, but there was no aide assigned.

Upon client record review, 1 of 19 (Patient #2) did not have evidence that a written hospice plan of care is established and maintained in consultation with SNF/NF or ICF/IID representatives. All hospice care provided is in accordance with this hospice plan of care. Patient #2:The plan of care dated 02-07-25 indicated nursing visits were 1q2wk2, 1wk12. Nursing visits were provided on 2/12, 2/20, 2/25 indicating 1 x per week.

Upon observation, there was not evidence of the Hospice having a written contract/agreement with an other Facility/Agency/Hospice in order to receive Reliant Hospice's patients in the event that Reliant Hospice cannot provide care/services to their patients during an emergency event.

Upon patient record review, 4 of 13 (Patients #3, 4, 8, and 9) did not contain evidence of a complete Medication Profile: Patient #3: The Medication Profile did not include Allergies, or the absence of such. The section for this entry had been left blank. The Medication Profile listed, "Acetaminophen Suppository i Q 6 hours rectal as needed"; without an indication for such as needed dosing. Patient #4: SOC was 03/20/22 in the hospital for GIP level of care, and the patient passed on 03/21/22. There was no evidence within the Hospice's clinical record of a Medication Profile having been established. Patients #8 and 9: These Medication Profile(s) did not include Allergies, or the absence of such.

Upon patient record review, 1 of 13 (Patient #4) did not have evidence in the patient record that the hospice has developed an individualized written plan of care for each patient. The plan of care must reflect patient/family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions. Patient #4 SOC was 03/20/22 in the hospital for GIP level of care, and the patient passed on 03/21/22. There was no evidence within the Hospice's clinical record of an initial Plan of Care having been established.

Upon patient record review, 1 of 13 (Patient #1) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including the following: A detailed statement of both the scope and frequency of all services/disciplines necessary to meet the specific patient and family needs. The Hospice Plan of Care dated 05/11/22 ordered Chaplain visits at a frequency of, "1 p.r.n. every 30 days", without a baseline visit frequency having been established/ordered.

Upon patient record review, 1 of 13 (Patient #3) did not contain evidence that the Plan of Care included all services necessary for the palliation and management of the terminal illness and related conditions, including medications and treatments. The current Plan of Care included, "Acetaminophen Suppository i Q 6 hours rectal as needed", without an indication for as such needed dosing.

Upon patient record review, 2 of 13 (Patients #3 and 10) did not contain evidence that the IDG had ensured that care and services were provided in accordance with the Plan of Care: Patient #3: The SOC nursing note included, "Sacral area skin loss. Cleansed with soap and water, patted dry, and covered with dressing to reduce potential increase in size." This wound care intervention was provided without a Physician order. During the Surveyor-attended home visit on 05/24/22 the patient's wife reported that she had been instructed to provide and was providing wound care as well. Patient #10: 03/07/22 SN visit, the nurse documented, "Skin breakdown on sacrum and left heel. Have been placing a cushioned foam on feet, but patient keeps pulling them off. Sacral area with slough starting to come off, and pink showing through wound bed. Washed with wound cleanser spray, and debrided with gauze. Applied a 4x4 foam gauze." These wound care interventions were provided without a Physician order.

Upon patient record review, 2 of 13 (Patients #5 and 6) did not provide evidence that the Hospice is offering and/or providing Spiritual Counseling to all patients, in accordance with the patient/family desires. Patients #5 and 6: Both had a verbal order within their records to, "Discontinue Chaplain services. Not available at this time. Will add back to POC when available."

Upon patient record review, 3 of 11 applicable (Patients #2, 5, and 9) did not contain evidence that the Hospice Aide Plan of Care/assignments and duties were: • Written patient care instructions for a Hospice Aide must be prepared, and maintained as updated, by a Registered Nurse • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #2: The Aide POC dated 05/02/22 assigned the Aide task of, "Apply Barrier Cream as needed." Patient #5: An order was obtained on 05/16/22 for Aide visits at a frequency of 5x per week. The most current Aide POC in the clinical record continued to order Aide visits at a frequency of 2x per week. The Aide POC had not been updated by the R.N. Patient #9: The SOC for this patient was 01/20/22. The Aide Plan of Care in the clinical record had last been reviewed on 08/28/21; during a previous period of patient Election of Hospice Benefit services.

Upon patient record review, 1 of 11 applicable (Patient #2) did not contain documented evidence that a Hospice Aide had provided care/services that were : • Ordered by the interdisciplinary group • Included in the plan of care The Aide POC assigned Aide visits at a frequency of 3x per week. There were only 2 Aide visits made during the weeks of January 23, January 30, and February 6, 2022. The same Aide POC assigned: Nail care; Oral care, Shampoo, Shave, Shower, and Skin Care. These assigned tasks were not provided/documented during either the 05/18/22 or 05/19/22 visits. The Aide POC also assigned: Assist Transfers and Utilize Fall precautions. These assigned tasks were not provided/documented during the 05/19/22 visit. The Aide POC also assigned: Foot care. This assigned task was not provided/documented during the 05/18/22 visit.

Upon patient record review, 3 of 13 (Patients #2, 3, and 4) did not contain evidence that the Medical Director or Physician Designee had provided written Certification of Terminal Illness, within the CMS-required time-frame: Patient #2: SOC was 10/30/2021. The Hospice Medical Director signed/dated the Initial CTI on 11/03/2021, no evidence of a verbal order for the CTI. Patient #3: SOC was 05/05/2022. The Hospice Medical Director signed/dated the Initial CTI on 05/11/2022, no evidence of a verbal order for the CTI. Patient #4: SOC was 03/20/2022. The Hospice Medical Director signed/dated the Initial CTI on 03/30/2022, no evidence of a verbal order for the CTI.

Upon patient record review, 1 of 13 (Patient #3) did not contain evidence that all entries are clear and complete. On the 05/16/21 SN visit, "Dressing to sacrum changed", without the details of the actual wound care provided.

Upon patient record review, 2 of 3 applicable (Patients #9, and 10) transferred, did not contain evidence that the Hospice had forwarded a Transfer Summary to the receiving healthcare provider: Patient #9: Transfer Summary was completed for a 03/15/22 transfer to another Hospice. However, there was no documented evidence that such Transfer Summary had been forwarded to the next Hospice provider. Patient #10: Transfer Summary was completed for a 05/02/22 transfer to another Hospice. However, there was no documented evidence that such Transfer Summary had been forwarded to the next Hospice provider.

Upon patient record review, 2 of 2 applicable (Patients #7 and 8) did not contain evidence that the Discharge Summary included all CMS-required content, as follows: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current Plan of Care • The patient's latest Physician orders

Upon inpatient contract review, 1 of 2 applicable (GIP) did not contain a provision that, "A copy of the Discharge Summary shall be provided to the Hospice at the time of the patient's discharge from the inpatient Facility.

Upon patient record review, 1 of 1 applicable (Patient #1) did not contain evidence that the Hospice had provided the SNF with the following information: Physician certification and/or Re-certification of the Terminal Illness.