Every finding on record at Alleviate Care - Los Angeles, LLC

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 and interview. In 1 of 14 (7%) clinical records reviewed, the agency did not ensure that the plan of care included interventions based on problems identified in the initial and updated comprehensive assessments CLINICAL RECORD 7: The patient elected hospice on 10/17/2025. The initial comprehensive assessment dated 10/17/2025 documented dysphasia as a co-morbidity. The initial plan of care dated 10/17/2025 did not include goals and intervention for dysphagia. During the interview on 10/29/2025, The Hospice Clinical Director stated that sometimes when standing orders are entered for palliation of symptoms the nurses forget to enter goals and interventions in the plan of care. She stated she would educate the nurses on entering goals and interventions associated with all identified needs or current problems.

It is required that nursing care and services are provided by or under the supervision of a registered nurse and per the patient plan of care. Nursing services ensure that the nursing needs of the patient are met as identified in the patient’s initial assessment, comprehensive assessment, and any updated assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 14 (7%) clinical records reviewed, revealed the agency did not ensure that nursing services were provided as ordered on the plan of care. CLINICAL RECORD 7: The patient elected the hospice benefit on 10/17/2025 with a diagnosis of Senile degeneration of the brain. The plan of care dated 10/17/2025 ordered nursing visits 1 time weekly (1W12), there was an initial visit documented on 10/17/2025. As of the record review on 10/28/2025 there were no additional visits documented. There was no documentation to explain a missed or canceled visit. During the interview on 10/29/2025 the Hospice Clinical Director verified that there was no evidence of a nursing visit provided within 11 days since admission and no documentation explaining why.

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 2 of 2 (100%) clinical records reviewed of patients who accepted bereavement services, the agency did not ensure that bereavement services were provided based on the bereavement plan of care. CLINICAL RECORD 13: The patient expired on 11/22/2024. The bereavement plan of care documented that letters would be sent at 1, 3, 6, 9, 12, and 13 months. Bereavement letters for 6 months (07/06/2025) and 9 months (10/06/2025) were documented as overdue. The records lacked documented evidence that the services were declined. CLINCAL RECORD 14: The patient expired on 01/06/2025. The bereavement Plan of care documented that letters would be sent at 1, 3, 6, 9, 12, and 13 months. Bereavement letters for 6 months (07/06/2025) and 9 months (10/6/2025) were documented as overdue. The records lacked documented evidence that the services were declined During the interview on 10/29/2025, the Hospice Clinical Director reviewed the record and did not provide evidence that the letters were sent.

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 must be prepared by a registered nurse who is responsible for the supervision of a hospice aide. This standard was not met as evidenced by clinical record review and interview. In 1 of 13 (8%) clinical records reviewed of patients accepting hospice aide services the agency did not ensure that the registered nurse prepared a hospice aide plan of care that contained clear and specific instruction for patients required care. CLINICAL RECORD 1: A physician order was documented on 09/08/2025 to insert a foley catheter and per nursing assessments from 09/08/2025 through 10/28/2025 a foley catheter was present. The hospice aide plan of care dated 02/01/2025 documented a task for incontinence care. As of the review on 10/28/2025 the hospice aide plan of care was not updated with specific instructions to include foley catheter care. During an interview on 10/28/2021, the Hospice Clinical Director stated that the plan of was not updated to include the foley catheter.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. 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 , the agency did not ensure a physician order was obtained. CLINICAL RECORD 7: The patient elected the hospice benefit on 10/17/2025 with a diagnosis of Senile degeneration of the brain. The initial plan of care dated 10/17/2025 documented an oxygen concentrator on the durable medical equipment list. There was no evidence of physician order for use of oxygen, liter flow, route, or frequency. During an interview on 10/29/2025 the Hospice Clinical Director verified there was no physician order entered for oxygen.

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 and the patient’s record, if requested. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for patients who were discharged live, the agency did not ensure a discharge summary was sent to the receiving facility. CLINICAL RECORD 12: The patient elected hospice benefit on 07/30/2025 with a diagnosis of Acute on chronic combined systolic and diastolic heart failure. The patient chose to transfer to a hospice facility on 08/08/2025. There was no evidence documented that a discharge summary was sent to the Medicare Certified facility. During the interview on 10/29/2025 the Director of Patient Care stated that she spoke with nurse practitioner at the facility who was caring for patient on the day of discharge 04/30/2025 and provided a copy of the medication record and plan of care for the patient but did not complete the discharge summary or document that it was sent to the facility.

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge includes at least the following: A summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) clinical records reviewed for patients who were discharged the agency did not ensure that the hospice discharge summary was documented in the record. CLINICAL RECORD 11: The patient elected the hospice benefit on 04/18/2025 with a diagnosis of Hypertensive heart failure, and revoked his benefit on 04/30/2025. There was no discharge summary in the clinical record documenting his hospice stay, a summary of care provided by hospice, treatments, symptoms and pain management. During the interview on 10/29/2025 the Hospice Clinical Director verified there was no discharge summary documented in the record.

It is required that the hospice implements emergency preparedness (EP) policies and procedures, based on the emergency plan, the risk assessment, and the communication plan. The policies and procedures address the development and inclusion of a plan for each hospice patient during a natural or man-made disaster as part of a patient/family comprehensive assessment, the documented discussion of the plan provided to the patient/family, and maintained by the hospice, and informing local and state emergency officials about patients in need of evacuation from their residence at any time due to the emergency based on the patient’s medical or psychiatric condition, or home environment. The minimum information provided to facilitate patient evacuation and transportation including: if the patient is mobile or not, if the patient has life-dependent equipment, and if so, is it able to be transported (e.g. battery operated, size, condition, etc.), and any patient special needs including cognitive disorders, intellectual disabilities, or communication issues (e.g., deaf, non-English speaking, etc.). This standard was not met as evidenced by a review of clinical records, interviews and observations. 1 of 2 (50%) applicable home visit patients with an emergency plan in the home revealed, the hospice did not ensure the emergency plan included all the required elements. 1 of 3 (33%) applicable home visit patients, the hospice did not ensure the emergency plan was provided to the patient and filed in the facility chart. 11 of 11 (100%) clinical records reviewed revealed the hospice did not ensure that there was a documented emergency plan in the hospice clinical record. Clinical Record 1: Patient elected the hospice benefit on 7/25/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 2: Patient elected the hospice benefit on 10/22/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 3: Patient elected the hospice benefit on 6/13/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 4: Patient elected the hospice benefit on 12/29/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. During home visit with RN on 1/12/2023, the emergency plan in the home folder included all the required elements except the portable oxygen tanks and if the tube feeding pump was battery operated or not. Clinical Record 5: Patient elected the hospice benefit on 11/10/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 6: Patient elected the hospice benefit on 10/5/2022. During home visit with LVN on 1/12/2023, the emergency plan was present and contained the required elements. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 7: Patient elected the hospice benefit on 9/16/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 8: Patient elected the hospice benefit on 8/31/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 9: Patient elected the hospice benefit on8/30/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. Clinical Record 10: Patient elected the hospice benefit on 7/14/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. During home visit with aide on 1/12/2023, the emergency plan was missing in the facility record. Clinical Record 11: Patient elected the hospice benefit on 5/13/2022. The hospice clinical record did not include documentation of an individualized emergency plan for the patient. During an interview on 1/13/2023, the VP of Compliance confirmed that the clinical records did not contain the required patient emergency plans. Additionally, in the two emergency plans found in the patient's home, the VP of Compliance confirmed that only one of the emergency plans included the required elements and that these emergency plans were also not documented in the hospice clinical records. During an interview on 1/13/2023, the VP of Compliance confirmed that the clinical records did not contain the required patient emergency plans. Additionally, in the two emergency plans found in the patient's home, the VP of Compliance confirmed that only one of the emergency plans included the required elements and that these emergency plans were also not documented in the hospice clinical records.

It is required that hospice care and services provided to patients and families follow the individualized plan of care established by the hospice IDG in collaboration with the attending physician (if any). This standard was not met as evidenced by a review of clinical records and interviews. 2 of 11 (18%) clinical records, the hospice did not ensure that the social worker and/or the nurse followed the plan of care established by the hospice IDG. Clinical Record 5: Patient elected the hospice benefit on 11/10/2022. The initial IDG/IDT on 11/10/2022 included the plan for the initial social work assessment. There was no plan of care update or physician orders for social work visits. The social worker made a visit on 12/28/2022 without an order and/or plan of care. Clinical Record 8: Patient elected the hospice benefit on 8/31/2022. In the IDG/IDT dated 11/10/2022, the RN visit frequency was every 14 days and skilled nursing (LVN or RN) visit once a week. During the week of 11/27/2022, there was no documented nursing visit. During an interview on 1/13/2023, the VP of Compliance confirmed that there was a missing nurse visit for clinical record 8 for the week of 11/27/2022, and there was no social work frequency order for the extra social work visit in clinical record 5 for 12/28/2022. During an interview on 1/13/2023, the VP of Compliance confirmed that there was a missing nurse visit for clinical record 8 for the week of 11/27/2022, and there was no social work frequency order for the extra social work visit in clinical record 5 for 12/28/2022.

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 and interviews. 10 of 10 (100%) applicable clinical records reviewed of patients receiving social worker and/or chaplain services, the hospice did not ensure that each patient's care plan reflected patient and family goals and interventions based on the initial and/or updated psychosocial and/or spiritual assessments. Clinical Record 1: Patient elected the hospice benefit on 7/25/2022. In the initial spiritual assessment, the chaplain assessed the need for spiritual care and support to be provided once a month. The Interdisciplinary plan of care did not include goals or interventions to be provided to the patient based on the initial spiritual assessment for the first benefit period effective 7/25/2022 - 10/22/2022 or in the subsequent benefit period 10/23/2022 - 1/20/2023. The patient was discharged for extended prognosis on 12/28/2022. Clinical Record 2: Patient elected the hospice benefit on 10/12/2022. The social worker and chaplain made their initial assessment visits within the regulatory time frame. Social worker frequency was set by the IDG/IDT at one time a month for the benefit period effective 10/12/2022 - 1/9/2023 but there was no psychosocial plan of care developed to include interventions and goals. The patient expired on 11/10/2022. Clinical Record 3: Patient elected the hospice benefit on 6/13/2022. The initial assessment visits were made by the chaplain and the social worker. For the benefit period effective 6/13/2022 - 9/10/2022, the chaplain frequency was set at once a month, but there was no chaplain plan of care established to include interventions or goals. The patient revoked services 8/11/2022. Clinical Record 4: Patient elected the hospice benefit on 12/29/2022. The initial social work and chaplain assessments were completed within the regulatory timeframe. For the benefit period effective 12/29/2022 - 3/28/2023, there were no established social work or chaplain plan of care interventions or goals. Clinical Record 5: Patient elected the hospice benefit on 11/10/2022. The initial psychosocial assessment included the need to monitor the psychosocial status of the patient and primary caregiver (PCG). The Interdisciplinary plan of care did not include goals and interventions to be provided to the patient and PCG based on the initial psychosocial assessment for the benefit period effective 11/10/2022 - 2/7/2023. Clinical Record 6: Patient elected the hospice benefit on 10/5/2022. The initial spiritual assessment included "Will follow up monthly for spiritual support," and the initial psychosocial assessment included "Will monitor the psychosocial status of patient and primary caregiver" once a month. The Interdisciplinary plan of care did not include goals and interventions to be provided to the patient based on the initial spiritual and psychosocial assessments for the benefit period effective 10/5/2022 - 1/2/2023 or the subsequent benefit period of 1/3/2023 - 4/2/2023. Clinical Record 7 Patient elected the hospice benefit on 9/16/2022. In the IDG/IDT dated 11/10/2022, the social work and chaplain frequencies were set at once a month. There were no plan of care interventions or goals for the social work and chaplain visits for the benefit period effective for dates 12/15/2022 - 3/14/2023. Clinical Record 8 Patient elected the hospice benefit on 8/31/2022. In the IDG/IDT dated 11/10/2022, the social work frequency was set at once a month as needed. The social worker documented to monitor the caregiver's coping on 11/9/2022. There were no interventions or goals for the social work visits for the benefit period effective for dates 8/31/2022 - 11/28/2022 or subsequent benefit period 11/29/2022 - 2/26/2023. Clinical Record 10: Patient elected the hospice benefit on 7/14/2022. The initial spiritual assessment included "will follow monthly for spiritual and emotional support" and the initial psychosocial assessment included "will follow up to provide psychosocial support" one time a month. The Interdisciplinary plan of care did not include goals and interventions to be provided to the patient based on the initial spiritual and psychosocial assessments. Clinical Record 11: Patient elected the hospice benefit on 5/13/2022. In the IDG/IDT dated 11/10/2022, the chaplain and the social worker frequency was set at once a month. For the benefit period effective 11/9/2022 - 1/7/2023, there were no plan of care goals or interventions developed for the chaplain or social worker visits. During an interview on 1/13/2023, the VP of Compliance confirmed that there were missing goals and interventions based on the psychosocial and/or spiritual assessment on all clinical records reviewed. Additionally, the VP of Compliance stated the social workers and the chaplains will be trained on developing the plan of care goals and interventions based on their initial and updated assessments. During an interview on 1/13/2023, the VP of Compliance confirmed that there were missing goals and interventions based on the psychosocial and/or spiritual assessment on all clinical records reviewed. . Additionally, the VP of Compliance stated the social workers and the chaplains will be trained on developing the plan of care goals and interventions based on their initial and updated assessments.

It is required that a qualified hospice aide has successfully completed a competency evaluation program that evaluates the aide’s competency in the following subject areas by observation of the aide’s performance with a patient or a pseudo patient: Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff; reading and recording temperature, pulse, and respiration; and appropriate and safe techniques in performing personal hygiene and grooming tasks, including items on the following basic checklist: bed bath; sponge, tub, and shower bath; hair shampoo (sink, tub, and bed); nail and skin care; oral hygiene; toileting and elimination; safe transfer techniques and ambulation; and normal range of motion and positioning. This standard was not met as evidenced by a review of interviews and personnel records. 1 of 1 (100%) applicable Hospice Aide personnel record reviewed, the hospice did not ensure the initial Hospice Aide skills competency evaluation was completed by direct observation with a patient or a pseudo patient. Staff 9: Hospice Aide date of hire was 9/1/22. The Initial Competency Assessment Skills checklist Hospice Aide" form dated 8/29/22 did not include evidence the skills performance of the Hospice Aide was observed directly with a patient or a pseudo patient. The skills competency form included "V/D" (Verbal/Demonstrated) for the skills of "shower, tub bath, enema, Hoyer, dry dressings, Gastrostomy site care, ace bandage wraps, bedpan and urinal". During phone interview 1/13/23, the Hospice Aide stated "I made a patient visit with the RN and I did not perform a shower, tub bath, enema, Hoyer, dry dressing, Gastrostomy site care, ace bandage wraps, bedpan or urinal" and "When I came into the office for the interview, the RN took me out in the field to do observe the skills."

It is required that the hospice discharge summary provided to a facility receiving a hospice patient for care—or to the patient’s community attending physician upon hospice discharge—includes at least the following: a summary of the patient’s hospice stay, including treatments, symptoms, and pain management, the patient’s current plan of care, the patient’s latest physician orders, and any other documentation that will assist in the post-discharge continuity of care or that is requested by the receiving facility or the attending physician. This standard was not met as evidenced by a review of clinical records and interviews. 2 of 2 (100%) applicable clinical records of live discharged patients revealed the hospice did not ensure that the discharge summary included all the required elements. Clinical Record 3: The patient revoked hospice services on 8/11/2022. The discharge summary was missing a summary of the patient’s hospice stay, treatments, symptom and/or pain management information, the patient's current plan of care, and the latest physician orders. Clinical Record 1: The patient was discharged for extended prognosis on 12/28/2022. The discharge summary was missing a summary of the patient’s hospice stay, treatments, symptom and/or pain management information, the patient's current plan of care, and the latest physician orders. During an interview on 1/13/2023, the VP of Compliance confirmed following a review of the standard and regulation, the discharge summaries did not include the required elements. During an interview on 1/13/2023, the VP of Compliance confirmed that in the review of the standard and regulation, the discharge summary did not include the required elements.

It is required that the designated IDG member provides the SNF/NF or ICF/IDF with the following information for each patient/resident: the most recent hospice plan of care. This standard was not met as evidenced by a review of clinical records and observations. 1 of 1 (100%) applicable clinical record reviewed revealed the hospice did not ensure there was a current hospice plan of care in the SNF clinical record. Home Visit 1: The patient elected the hospice benefit on 7/14/2022. During a home visit to the SNF on 1/12/2023, the patient's hospice chart at the facility did not include a copy of the most recent hospice plan of care/IDG update for the patient. The single hospice plan of care document in the patient's facility chart was the IDG Plan of Care dated 7/14/2022.