Every finding on record at United Hospice & Palliative Care of Arizona, LLC

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 measures 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 3 (33%) home visits observed of patients residing in an assisted living facility (ALF), the agency did not ensure that the drug profile was updated at each comprehensive assessment and/or when a new medication was added. HOME VISIT 2/ CLINICAL RECORD 3: The patient elected the hospice benefit on 09/26/2025 with a diagnosis of malignant neoplasm of the brain. The patient resided in the memory care unit of an assisted living facility (ALF). During the home visit with the Social Worker [Personnel Record 3], a review of the facility's and hospice's medication profiles revealed that the facility's medication profile dated 11/11/2025 included "Midodrine 2.5mg daily, as needed, for systolic blood pressure below 100" (order date 10/27/2025). The hospice medication profile did not include Midodrine. During an interview on 11/12/2025, the Clinical Director stated that they will educate the nursing staff to review the facility documentation, including the medication record, for any changes or discrepancies at each nursing visit. The issue was addressed and corrected on 11/12/2025.

It is required that counseling services include an organized program for providing bereavement services delivered by or under the supervision of a qualified professional with experience or education in grief or loss counseling. Bereavement services are available to the family and other individuals up to one (1) year following the death of the patient. This standard was not met as evidenced by clinical record review and interview. In 1 of 3 (33%) clinical records reviewed for bereavement services, the agency did not ensure that bereavement services were available for up to one (1) year following the death of the patient. CLINICAL RECORD 17: The patient elected the hospice benefit on 02/11/2024 and died on 11/08/2024. The bereavement plan of care initiated on 11/18/2024 documented "patient to receive 13-month bereavement program." The bereavement record note dated 11/29/2024 documented that an attempt to contact the bereaved by phone was unanswered. The bereavement record note dated 12/15/2024 documented that the 1-month letter was undeliverable. There was no evidence of additional attempts during the month 3 (February) and month 11 (October) time frames. A clinical record review revealed no further evidence of documentation in the bereavement notes of follow-up or declination of bereavement services. During an interview on 11/13/2025, the Administrator stated they would follow up with the Bereavement Coordinator, who is still orienting to their role, to be sure follow-up documentation is completed in the bereavement record.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. Written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 17 (6%) clinical records reviewed of patients who accepted Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions that met the patient's needs. CLINICAL RECORD 14: The patient elected the hospice benefit on 09/03/2025 with a diagnosis of malignant neoplasm of the colon. The initial nursing assessment dated 09/03/2025 documented that the patient had a colostomy and a wound with a dressing to the lumbar region. The HA care plan dated 09/03/2025 did not document instructions for the HA for care of the ostomy site or precautions for the lumbar dressing during bathing, should it become wet, soiled, or dislodged. During an interview on 11/13/2025, the Clinical Director confirmed the findings and stated that they will provide training to the nursing staff.

It is required that a hospice aide provides services: included in the plan of care; This standard was not met as evidenced by clinical record review and interview. In 4 of 17 (24%) clinical records reviewed of patients who accepted Hospice Aide (HA) services, the agency did not ensure that the HA provided care included in the plan of care. CLINICAL RECORD 9: The patient elected the hospice benefit on 10/16/2025 with a diagnosis of chronic obstructive pulmonary disease (COPD). The Hospice Aide care plan dated 10/16/2025 assigned the HA to provide nail care once a week. The HA documented nail care was provided on 10/27/2025 and 10/30/2025, which was twice in one week. CLINICAL RECORD 8: The patient elected the hospice benefit on 10/18/2025 with a diagnosis of heart failure, unspecified. The HA care plan dated 10/18/2025 assigned the HA the task: nail care weekly. The HA documented nail care was provided on 11/03/2025 and 11/06/2025, which was twice in one week. CLINICAL RECORD 11: The patient elected the hospice benefit on 09/11/2025 with a diagnosis of hypertensive heart disease with chronic failure. The HA care plan dated 09/12/2025 assigned the HA the task: nail care weekly. The HA visit notes dated 11/4/2025 and 11/7/2025 documented that nail care was provided on each visit, which was twice in one week. CLINICAL RECORD 13: The patient elected the hospice benefit on 10/29/2025 with a diagnosis of Alzheimer's disease. The HA care plan dated 10/29/2025 assigned the HA the task: nail care weekly. The HA visit notes dated 11/04/2025 and 11/07/2025 documented that nail care was provided on each visit, which was twice in one week. During an interview on 11/13/2025, the Clinical Director stated that they will provide training to the Hospice Aides to be sure to follow the plan of care and the nursing staff to re-evaluate instructions for "weekly" versus "every visit" details.

It is required that each patient’s individualized written plan of care reflects patient and family goals and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. 2 of 13 (15%) clinical records reviewed revealed the patient's individualized written plan of care (POC) lacked goals and interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 1: The patient was admitted to hospice on 8/8/22. The patient had urinary incontinence per the Initial Nursing Assessment dated 8/8/22. The interdisciplinary group (IDG) POC dated 12/26/22 lacked a goal and interventions for urinary incontinence. Clinical Record 3: The patient was admitted to hospice on 12/5/22. The patient had urinary incontinence per the Initial Nursing Assessment dated 12/5/22. The IDG POC dated 12/5/22 lacked a goal and interventions for urinary incontinence. Agency Plan of Care Policy #9-017, "The Plan of Care (Dated: 4/2020)," stated in part, "Policy: The plan of care will be based on the initial, comprehensive and ongoing comprehensive assessments performed by members of the interdisciplinary group . . . This plan will focus on identified problems, goals, and interventions." In an interview on 1/18/23, the Clinical Director and Quality Director reviewed and agreed with the above findings and confirmed that the POC did not include goals and interventions related to urinary incontinence as identified in the initial Nursing Assessment.

It is required that if the care of a hospice patient is transferred to a Medicare/Medicaid certified facility, the hospice forwards to the receiving facility a copy of the hospice discharge summary described in HCDT 40.I. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. 3 of 3 (100%) clinical records reviewed for patients that transferred to a facility (another Hospice or Hospital) revealed the record lacked evidence that the hospice forwarded a copy of the hospice discharge summary to the receiving facility. Agency Transfer Information Policy, Policy #1-022, "Transfer Information (Dated: November 2021)," stated in part, "Procedure: 4. Completed transfer summaries will be given to a clinical records clerk who will send a copy to the receiving organization within 72 hours of transfer and file the original in the clinical record." Clinical Record 7: The patient was admitted to hospice on 7/29/22. The family revoked hospice on 11/21/22, and the patient was transferred to the hospital to seek aggressive treatment. The record lacked evidence that the discharge summary was forwarded to the receiving hospital. Clinical Record 6: The patient was admitted to hospice on 10/24/22. The family revoked hospice on 11/23/22, and the patient was transferred to the hospital to seek aggressive treatment. The record lacked evidence that the discharge summary was forwarded to the receiving hospital. Clinical Record 5 The patient was admitted to hospice on 7/22/22. The patient was transferred to another hospice on 11/3/22. The record lacked evidence that the discharge summary was forwarded to the receiving hospice. In an interview on 1/18/23, the Clinical Director and Quality Director reviewed and agreed with the above findings and confirmed that copies of discharge summaries were not sent to the receiving hospice or hospital at the time of the transfer.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician a copy of the hospice discharge summary. This standard was not met as evidenced by a review of clinical records, document reviews and interviews. 2 of 3 (66%) clinical records reviewed for patients that revoked the Hospice Benefit or were discharged from hospice services due to no longer being terminally ill, revealed the record lacked evidence that the hospice forwarded a copy of the hospice discharge summary to the patient's attending physician. Agency Revocation of Hospice Benefit Policy #1-024, "Revocation of Hospice Benefit (Dated: 11/2021)," stated in part, "Procedure: 3. The Case Manager will notify the attending physician and interdisciplinary group about the revocation and reason. A discharge summary will be sent to the attending physician." Clinical Record 7: The patient was admitted on 7/29/22. The patient revoked hospice on 11/21/22, and the patient was transferred to the hospital to seek aggressive treatment. The record lacked evidence that the discharge summary was forwarded to the patient's attending physician. Clinical Record 6: The patient was admitted on 10/24/22. The patient revoked hospice on 11/23/22, and the patient was transferred to the hospital to seek aggressive treatment. The record lacked evidence that the discharge summary was forwarded to the patient's attending physician. In an interview on 1/18/23, the Clinical Director and Quality Director reviewed and agreed with the above findings that copy of the discharge summary was not sent to the attending physician when patients revoked the Hospice Benefit or were discharged due to no longer being terminally ill.