Every finding on record at Tnmo Healthcare, LLC

Upon patient record review, 3 of 14 (Patients #3,#5,#6) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 3: During home visit medication reconciliation, the facility and hospice medication profiles did not match. The facility profile did not contain nitroglycerin as needed. Patient 5: During home visit medication reconciliation, the patient's caregiver stated they do not have Tylenol and Mucinex in the home, and the patient does not take Claritin, meloxicam, and mirabegron. Patient 6: During home visit medication reconciliation, the patient's caregiver stated they have Tylenol 500 mg tablets instead of 325 mg tablets, and the patient no longer takes scheduled Lantus since facility stay.

Upon patient record review, 2 of 14 (Patients #3,#9) 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 3: The medical record contained nursing documentation upon admission identifying patient history of falls. There was no evidence of problems, goals, and interventions related to fall safety included in the plan of care. Corrected on site with plan of care update. Patient 9: The plan of care included problems, goals, and interventions related to anticoagulant use and risk for bleeding. There was no evidence the patient had a prescription for an anticoagulant currently or in the past. Corrected on site with plan of care update.

Upon patient record review, 2 of 14 (Patients #5,#6) 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 5: During home visit medication reconciliation, the patient's caregiver stated they do not have Tylenol and Mucinex in the home, and the patient does not take Claritin, meloxicam, and mirabegron. Patient 6: During home visit medication reconciliation, the patient's caregiver stated they have Tylenol 500 mg tablets instead of 325 mg tablets, and the patient no longer takes scheduled Lantus since facility stay.

Upon patient record review, 3 of 14 (Patients #7,#8,#10) 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 equipment and supply needs. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed and bedrails. There was no evidence of orders for the DME included in the plan of care. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of a walker and shower chair. There was no evidence of orders for the DME included in the plan of care. Patient 10: The medical record contained nursing documentation upon admission identifying patient use of a walker, and use of a wheelchair 12/4/25 and commode 12/9/25. There was no evidence of orders for the DME included in the plan of care.

Upon client record review, 1 of 14 (Patient #2) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patient 2: The medical record contained a change of physician form identifying the patient's POA elected a community physician as attending physician 9/22/25. There was no evidence of collaboration with the attending physician for creating and updated the plan of care no less than every 15 days.

Upon patient record review, 1 of 14 (Patient #7) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 7: The medical record contained nursing documentation 1/23/26 identifying patient had a fall. There was no evidence the plan of care was updated to include problems, goals, and interventions related to fall safety.

Upon patient record review, 2 of 14 (Patients #11,#12) did not have evidence the hospice offers bereavement counseling that includes: • Making bereavement services available to the family and other individuals in the bereavement plan of care up to 1 year following the death of the patient. Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when appropriate and identified in the bereavement plan of care • Ensuring that bereavement services reflect the needs of the bereaved Patients 11,12: The bereavement care plans contained tasks to send sympathy cards and memorial service invitations. There was no evidence of tasks completed.

Upon patient record review 1 of 14 (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 medical record contained an order for aide visits three times per week. There was no evidence of third visits completed the weeks of 12/21/25 and 1/4/26.

Upon personnel record review, 1 of 14 (Personnel #4) did not have evidence that the hospice employees have received orientation on their specific job requirements. Personnel 4: There was no evidence the employee received orientation to job requirements.

Upon personnel record review, 1 of 14 (Personnel #4) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 4: There was no evidence of a skills competency assessment completed.

Upon contract review, 1 of 6 (Alternate Medical Director contract) did not have evidence of a contract to fulfill the role of alternate medical director. The agency had former contracts for the physician to act as a consulting physician and an addendum referencing a contract as Medical Director written 12/1/2022, but the agency could not locate a current contract to identify the physician was in agreement to have responsibility of alternate medical director.

Upon patient client record review, 1 of 14 (Patient #10) did not have evidence that each patient record contains: • Signed election statement in accordance with 418.24 Patient 10: The medical record contained an election form identifying patient elected to receive the Notification of Hospice Non-Covered Items upon admission 12/2/25. There was no evidence the agency provided the addendum.

Upon inpatient contract review, 1 of 6 (CHI hospital GIP contract) did not have evidence that the inpatient provider has established patient care policies consistent with those of the hospice and agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients.

Based on agency policy review, Hospice Item Set (HIS) Manual, medical record review and interview, the agency failed to implement a bowel regimen for 2 patients (#2 and #3) of11 patients reviewed for opioid medications. --- Review of the agency policy, ";Comprehensive Assessment," revised 2019 revealed ";...An assessment of the need for a bowel regimen when the patient has been prescribed opioids..." Review of the HIS Manual Section N: Rationale showed ";...Opioids are commonly used in the management of pain and other symptoms. Constipation is one of the most common opioid-related adverse effects...Patients do not develop a tolerance to opioid-induced constipation; clinical guidelines recommend prophylactic bowel regimens..." Medical record review revealed Patient #2 was admitted to the agency on 11/4/2024 with diagnoses including Malignant Neoplasm of Transverse Colon, Neoplasm of Liver and Hepatic Encephalopathy. Medical record review of a Physician Order dated 11/4/2024, showed Patient #2 had been ordered Oxycodone-Acetaminophen (an opioid used to treat pain) 5 mg milligrams (MG)-325 MG tablet every 6 hours as needed for pain. Medical record review of the medication profile summary showed Patient #2 had not been ordered medications for constipation. Medical record review revealed Patient #3 was admitted to the agency on 10/25/2024 with diagnoses including Alzheimers Disease and Right Femur Fracture. Medical record review of a Physician Order dated 10/25/2024, showed Patient #3 had been ordered Tramadol (a medication used to treat pain) 50mg tablet every 6 hours as needed for pain. During an interview on 11/13/2024 at 12:10 PM, the Administrator confirmed the agency failed to follow the agency policy for Patient #2 and #3 who received opioids and had not been placed on a bowel regimen for constipation.