Every finding on record at A and S Hospice Palliative Care, Inc.

Upon observation, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient's Rights and Responsibilities in a language and manner that the patient understands. Patient#1,#2: Record indicates patient primary language is Armenian. During home visit this was verified. There is no evidence in the home or in chart that patients rights and responsibilities were provided in writing in a language patient understands.

Upon patient record review 1 of 14 (Patient #9) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient#9: The record indicates patient admitted on 12/9/24. There is no evidence of an initial psychosocial assessment completed until 12/17/24.

Condition of participation: Interdisciplinary group, care planning, and coordination of services. The hospice must designate an interdisciplinary group or groups as specified in paragraph (a) of this section which, in consultation with the patient's attending physician, must prepare a written plan of care for each patient. The plan of care must specify the hospice care and services necessary to meet the patient and familyspecific needs identified in the comprehensive assessment as such needs relate to the terminal illness and related conditions.

Upon patient record review, 2 of 14 (Patient #3,#7) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient#3: The record indicates an order on 12/11/24 for wound care. There is no evidence of of measurements of wound noted in chart by hospice RN. Patient#7: The record indicates patient admitted with wound to right side of head from a fall. Plan of care states Assess changes in wound status - check size, integrity, location, type/stage, signs and symptoms of infection, drainage, effectiveness of current treatment. There is no evidence of measurement or description of wound. Record indicates wound is not healed.

Upon patient record review, 3 of 14 (Patient #1,#5,#7) 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#1: The record indicates there is a doctor order from admit for skin precautions and aspiration precautions. The patient also requires appetite stimulant and nurse frequently documents patient having decreased appetite and educating on nutritional needs. There is no evidence of problems with goals and interventions related to these issues. Corrected on site. Patient#5: The record indicates there is a physician order for fall precautions, aspirations, and diabetic foot protocol. There is no evidence of problems with goals and interventions related to these orders. Corrected on site. Patient#7: The record indicates the RN documented on admit that patient requires seizure precautions. There are no problems with goals and interventions related to this issue. Corrected on site.

Upon patient record review, 2 of 14 (Patient #3,#11) 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#3: There is no evidence of a physician order for referral for California Wound Healing to assess and treat patient wound. Corrected on site. Patient#11: There is no evidence of physician order for discharge due to extended prognosis.

Upon client record review, 6 of 14 (Patient #2,#3,#4,#5,#6,#7) 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: There is no evidence of notes or documentation of progress to goals by SC or MSW for IDG 4/28/25, 4/14, or 3/31. Patient#3,#5,#6,#7: There is no evidence of notes or documentation of progress to goals by SC or MSW for IDG 4/28/25, 4/14, 3/31, 3/17, 3/3, 2/17. Patient#4: There is no evidence of notes or documentation of progress to goals by SC or MSW for IDG 4/28/25, 4/14, 3/31, 3/17, 3/12.

Upon client record review, 2 of 14 (Patient #3,#9) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient#3: The record indicates nurse made a PRN visit on 4/27/25. There is no evidence of an order for PRN visits. Patient#9: The record indicates SN frequency ordered at 1 time a week. LVN visit 2/25/25, 2/4, 1/25, and 1/10 are blank. There is no evidence these visit were completed.

Upon patient record review, 1 of 14 (Patient #3) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient#3: The record indicates the patient was receiving wound services from California Wound Healing. There is no evidence of coordination of collaboration of care with the wound care company in patient record.

Condition of participation: Hospice aide and homemaker services. All hospice aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section. Homemaker services must be provided by individuals who meet the personnel requirements specified in paragraph (j) of this section.

Upon patient record review, 2 of 14 (Patient #7,#8) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • 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#7: The aide plan of care completed by RN only states for aide to report changes and report pain. The record indicates the aide is seeing patient twice a week. Aide documentation has no task checked as completed. Aide documents "CHHA service provided according to care plan. Patient verbalized satisfaction with care. Notified regarding the next visit" for all visits. Per conversation with the aide she is completing transfer, shower, change linens, dressing patient, continence care and skin care. These task are not on aide plan of care and are not documented by aide. Patient#8: The aide plan of care completed by RN only indicates for aide to assist with ambulation and incontinence care. No other task are documented by the aide as being completed . Per conversation with aide he is bathing patient, dressing patient, changing linens when soiled and performing light housekeeping at weekly visits.

Upon patient record review 1 of 14 (Patient #1) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient#1: The record indicates aide visits on 4/18/25, 4/21, 4/25, and 4/28 have no assigned task checked as being completed and is not signed. The aide narrative states "completed care per POC and patient verbalized satisfaction".

Upon patient record review 4 of 14 (Patient #1,#3,#7,#8) did not have evidence documentation in the patient record that a Registered Nurse made an on-site visit to the patient's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient#1: There is no evidence of aide supervisory visits being completed by RN between 04/03/24- 05/09/24, between 08/24/24-09/14/24, between 10/12/24-12/7/24, and from 02/15/25 to present. Patient#3: There is no evidence of aide supervisory visit being completed by RN between 11/11/24-12/09/24, between 12/9/24- 01/06/24, and between 01/06/25- 04/14/25. Patient#7: There is no evidence of aide supervisory visit being completed by RN from admit on 02/13/25 to 04/10/25. Patient#8: The record indicates aide services started on 2/24/25. There is no evidence of aide supervisory visit being completed by RN from 2/24- 3/20.

Upon patient record review, 1 of 14 (Patient #4) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patient#4: There is no evidence of a MD narrative or signature on CTI for benefit period starting 5/11/25.

Upon patient client record review, 2 of 14 (Patient #3,9) 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#3: The record indicates on 3/17 /25 visit RN documented no wounds. However, sacral wound is still active on plan of care. Patient#9: The record indicates the RN completed an aide plan of care however, aide services were declined at admit. There is also evidence the RN completed an aide supervisory visit listing an aide name on 12/23/24, 1/6/25, 2/3, 3/9, 4/6. There is no evidence of any aide visits being completed.