Every finding on record at The Medical Team, Inc.

It is required that the written Patient Bill of Rights includes the right to voice grievances to the hospice, CHAP, or a state entity without fear of discrimination or reprisal. This standard was not met as evidenced by document review and interview. A review of the Bill of Rights document revealed that the agency did not ensure the patients were provided with the state agency or CHAP contact information. During review of the documents provided to all patients in the admission folder, the CHAP and the state agency contact phone numbers were not included as part of the contact information for the patient's right to voice grievances to CHAP, or the state entity. During interview with the Administrator on 09/30/2025 and the Corporate Director of Clinical Excellence who stated that a page was missing from the Admission Folder and they would make sure that all patients on service had the information, and they would make sure that copies were updated in their binders.

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, observation, and interview. In 1 of 14 (7%) clinical records reviewed, it was revealed that the agency did not ensure that the medication review process included all prescription and over-the-counter (OTC) drugs, supplements, and herbal remedies the patient was currently taking. CLINICAL RECORD 3/HOME VISIT 3: The hospice election of benefit was 08/28/2025 for a primary diagnosis of dementia with secondary diagnosis of congestive heart failure and diabetes. The patient resided in a skilled nursing facility (SNF). During the home visit, on 09/30/2025 with the Social Worker (Personnel Record 8), a facility medication list was obtained. The following medications were on the facility medication list but not the hospice drug profile: Lantus Solostar U-100 insulin 100unit 5units at bedtime (ordered 02/06/2025), Novolog Flex Pen U 100 insulin 100unit/milliliter 2 units subcutaneous twice a day (ordered 02/06/2025), and ferrous sulfate 325mg daily (ordered 05/08/2025). During the observed visit on 09/30/2025 the facility staff checked the patient’s blood sugar in preparation to give the insulin and stated that patient has been on insulin. The insulin was not included in the medication review process. During interview with the Corporate Director of Clinical Excellence on 10/01/2025, stated that the case manager had reviewed medications with the hospice physician on admission and the insulin was to be discontinued, and the facility was notified but the insulin was not stopped at the facility; medication reconciliation was the problem.

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, observation, and interview. In 2 of 14 (21%) clinical records reviewed, it was revealed that the agency did not ensure that the plans of care included individualized interventions based on problems identified in the comprehensive assessments. CLINICAL RECORD 3/HOME VISIT 3: The hospice benefit of election was 08/28/2025 and the initial comprehensive completed on that day included the primary diagnosis of dementia with additional diagnoses of congestive heart failure and diabetes. During the home visit, on 09/30/2025, the facility medication profile was obtained and included that blood glucose levels were monitored three times per day and that readings less than 70mg/dl or greater than 300mg/dl would be reported to the physician. During that visit with the Registered Nurse (RN) (Personnel Record 8) the patient stated that he received a “good shake” for nutrition but was not sure what it was. The facility medication plan, obtained during the visit, documented a "Mighty Shake" provided 3 times a day, with a start date of 06/24/2025.The hospice plan of care, effective 08/28/2025 including updates through the date of review (09/30/2025) did not include the interventions for blood glucose monitoring or for nutritional interventions. CLINICAL RECORD 7: The hospice election of benefit was 05/29/2024 for a primary diagnosis of Alzheimer's Disease. Clinical documentation reported that the patient has had 10 falls since admission and several abrasions and stitches from his falls. The IDG (interdisciplinary group) documented on 09/23/2025 that patient was using a fall mat. The plan of care effective at the time of the review (10/01/2025) included interventions for fall precautions: remove clutter, cords, throw rugs; use nonskid socks shoes; check home environment for threats to safety (i.e. slippery floors rugs; unstable stairs; blocked entries lighting cords; and high bed). The utilization of the fall mat was not included as an intervention. During interview on 10/01/2025, the Corporate Director of Clinical Excellence stated that the interventions were not specific.

It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as hand hygiene, use of gloves, mask, eye protection, or face shield depending on anticipated exposure. This standard was not met as evidenced by document review, interview and observation. In 1 of 3 (33%) home visits observed it was revealed that the agency did not ensure that hand hygiene was provided in accordance with agency policy. Agency Policy IC.07, Hand Hygiene and Compliance Program, stated in part, "Hand hygiene will be done by all employees, volunteers and contract staff to reduce the transfer of microbes to patients and to prevent the growth of microorganisms on the nails hands and forearms … Indications for hand hygiene are: Before and after direct patient care; and Before and after each procedure. … After any contact with contaminated materials. … Before re-entering the nursing bag or patient's clean supplies.” HOME VISIT 3: Registered Nurse (RN) (Personnel Record 11) sanitized hands and donned gloves, then reached into her pocket and removed her phone to start her documentation. With the same gloves on she reached into the nursing bag and removed the blood pressure cuff, after use it was returned to the bag. Still donning the same gloves, the RN re-entered the bag to retrieve the pulse oximeter, tape measure, and stethoscope; all of these were used on the patient and returned to the bag. Hand hygiene was not completed after patient contact or before entry into the nursing bag, in accordance with the agency policy. During an interview on 09/30/2025, the Administrator stated that the nurse did not follow the policy.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. A review of the volunteer program documentation revealed that the agency did not ensure the hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equaled five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. In a review of the quality meeting minutes the documented volunteer hours for each quarter of 2024: Quarter 1 was 7%, Quarter 2 was 2.6%, Quarter 3 was 1.64%, and Quarter 4 was 0.23%. The 2024 total average equalled 2.46%. So far for 2025 the volunteer hours were at 0.45%. During an interview, on 09/30/2025, with the Volunteer Coordinator, who assumed the role within the last 3 months, stated that recruitment activities have been occurring and that applications were moving forward with onboarding and plans for orientation but that the program was in a rebuild. The Corporate Director of Clinical Excellence stated that the current Volunteer Coordinator was working with another corporate volunteer coordinator to rebuild the program. Review of quality meeting minutes with volunteer cost savings documented each quarter. For the year of 2024: Quarter 1 - was 7%, Quarter 2 was - 2.6%, Quarter 3 was -1.64%, Quarter 4 was 0.23% for a year end of 2024 was 2.46%. For 2025, quarter 1 was 0.9%, Quarter 2 was 0%, Quarter 3 was incomplete for data yet. The current cost savings for 2025 was 0.45%. During interview with the volunteer coordinator, who is new in the last 3 months, stated that the recruitment areas and applications were moving forward with onboarding and plans for orientation but that the program was in a rebuild. During interview with the Corporate Director of Clinical Excellence who stated that the current volunteer coordinator is working with another corporate volunteer coordinator to rebuild the program.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. 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 14 (7%) clinical records reviewed, it was revealed that the agency did not ensure physician orders were documented for the patient care needed. CLINICAL RECORD 2: Hospice election of benefit was 09/24/2025 for a primary diagnosis of atherosclerotic heart disease of native coronary artery without angina. The endocrine problem and interventions documented on the plan of care included, “monitor blood sugars as ordered.” The clinical record lacked specific physician orders to define the frequency in which the blood sugars needed to be monitored. During an interview on 09/30/2025 the Corporate Director of Clinical Excellence stated that the order was not documented.

It is required that bags used to carry medical equipment (e.g., BP cuff) or supplies into or out of the care environment are transported and used in a manner consistent with organizational policy to prevent the spread of infections and communicable diseases. This standard was not met as evidenced by a review of documents, interviews, and observations. 2 of 3 (67%) home visits observed the agency did not ensure that the bag used to carry medical equipment and supplies was used in a manner consistent with organizational policy to prevent the spread of infections and communicable disease. Policy IC.04 Titled Exposure Control Plan: OSHA Regulation, states in relevant parts: "Nurse, Hospice Aide, and other Staff Bags I. "are classified as clean on the inside". Nursing Bag Technique II. A. Wash hands thoroughly with bacteriostatic foam/gel/liquid gel. B. Remove all items needed for the visit. 1. Close the bag and give care to the patient. B.4. Wash hands and return equipment to the Bag: close bag." Home Visit 2 on 11/22/22, Staff 10 (RN) was observed reaching into the inside area of the nursing bag (defined as "clean" in agency policy) to access supplies (hand sanitizer) without first performing hand hygiene. It was also observed that staff member did not close the nursing bag after removing needed supplies and proceeding to provide care to the patient or after returning cleaned supplies to the nursing bag at the end of the visit as identified in the agency policy. Home Visit 3 on 11/22/22, Staff (10) (RN) was observed reaching into the inside area of the nursing bag (defined as "clean" in agency policy) to access their car keys without first performing hand hygiene. It was also observed that staff member did not close the nursing bag after removing needed supplies and proceeding to provide care to the patient as identified in the agency policy During an interview on 11/22/22, the Administrator (Staff 2) confirmed that the agency policies and procedures for use of the nursing bag were not followed.

It is required that hospice aides must report changes in the patient’s medical, nursing, rehabilitative, and/or social needs to a registered nurse 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 a review of clinical records and interviews. 1 of 11 (9%) applicable records of patients receiving hospice aide services revealed that the agency did not ensure that the hospice aides reported changes to the RN that could have impacted the plan of care. Clinical Record 10 identified the start of care date on 6/15/2022. The clinical record contained home health aide documentation that the patient had refused all assigned tasks on the aide care plan on 10/21/22 and 10/28/22. There was no documentation explaining the reason for the refusal of care. There was no evidence that the registered nurse was notified. During an interview on 11/23/22, the Administrator (Staff 2) verified that there was no documentation that the registered nurse had been notified of the patient's refusal of care.