Every finding on record at California Healthcare and Hospice

Upon observation, there was no evidence the Emergency Plan communication plan must includes a primary and alternate means for communicating with hospice's employees.

Upon patient record review, 4 of 14 (Patient #2,3,4,5) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #2: Duoneb 3mg-0.5mg/3mL is listed on medication profile and not in patient home. Per visiting nurse, this is a discontinued medication. Patient #3: Docusate Sodium 50 mg, liquid solution in patient home and not on current medication profile. Additionally, Miralax listed on medication profile(s) with no diluent. Patients #4, #5: Miralax listed on medication profile with no diluent. Ordered on 7/5/23. Corrected on site-agency updated medication profile.

Upon patient record review, 1 of 14 (Patient #10) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #10: There is no initial bereavement risk assessment completed to date on this patient.

Upon patient record review, 4 of 14 (Patients #1,2,4,5) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients #1, 2: The MSW and SC visit frequency indicated 1x month as needed. There was no baseline visit frequency. Patients #4, #5: The MSW and SC visit frequency indicated 1x month as needed. There was no baseline visit frequency.

Upon patient record review, 3 of 14 (Patient #3,4,5) 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: Miralax listed on plan of care with no diluent. Corrected on site-agency obtained a supplemental order from MD for Miralax. Patients #4, #5: Miralax listed on plan of care with no diluent. Corrected on site-agency obtained a supplemental order from MD for Miralax.

Upon patient record review, 2 of 14 (Patients #1,4) 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 #1: This patient had a bedside commode, walker and shower chair. These items were not on the plan of care. Patient #4: The record reflected this patient had walker and wheelchair. These items were no on the plan of care.

Upon patient record review, 4 of 14 (Patients #10,12,13,14) did not have evidence the hospice offers bereavement counseling that includes: • Ensuring that bereavement services reflect the needs of the bereaved • Development of a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery Patient #10, #12: There is no bereavement plan of care in these patient records. Patient #13, #14: These patients both passed in June 2025. There is no record of the one-month letter being sent per plan of care(s).

Upon personnel record review, 1 of 13 (Personnel #10) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·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 ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel #10: The Initial Skills Competency for the Aide showed all tasks observed/demonstrated as indicated. However, there was no signature of Supervising RN in the space provided on this document.

Upon patient record review 6 of 14 (Patient #1,2,3,5,8,14) 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 #1: The POC listed aide visit frequency of 2 X's per week (6/15/25). The aide visited this patient prior to start date on 6/14/25. Patient #2: The POC listed aide visit frequency of 2 X's per week (7/20/25). For benefit week 7/27/25 there were no visits documented for aide services. Patient #3: The POC listed aide visit frequency of 2 X's per week (5/29/25). The IDG listed aide visit frequency of 3X's per week (5/29/25). There were no documented aide visits until 6/24/25. Patient #5: The POC listed aide visit frequency of 2 X's per week (6/17/25). The first benefit week the Aide visited 1X on 6/19/25 only. Patient #8: The POC listed aide visit frequency of 3 X's per week (8/25/24). The first benefit week the aide visited 2X on 8/28/24 and 8/30/24. The second benefit week the aide visited 1 X on 9/5/24. Patient #14: The POC listed aide visit frequency of 2 X's per week (5/26/25). There are no documented aide visits to date.

Upon contract review, 3 of 5 (Medical Director Contract, Alt Medical Director Contract, Hospice Aide Contract) did not have evidence the agreement to furnish any services under arrangement included that the hospice must retain administrative and financial management, and oversight of staff and services for all arranged services, to ensure the provision of quality care. Arranged care/services are supported by written contract/agreement that requires all care/services are: • Authorized by the hospice • Furnished in a safe and effective manner by qualified personnel • Delivered in accordance with the patient's plan of care Contracts 1,2,5: The Medical Director, Medical Director Designee and Aide contract did not have all CMS requirements as follows: • Furnished in a safe and effective manner by qualified personnel/organization

Upon personnel record review, 3 of 13 (Personnel #3, 4, 13) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy. Personnel #3, 4, 13: Did not have evidence of hospice philosophy training in their employee files at the time of survey.

Upon personnel record review, 1 of 13 (Personnel #12) 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 #12: This employee did not have skills competency for Bereavement Coordinator or Volunteer Coordinator in his file. He did have skills competency for Spiritual Counselor.

Upon client record review, 4 of 14 (Patients #6,7,8,9) did not have evidence that the discharge summary includes all CMS required information. Patients #6,7,8,9: The discharge summary did not include all of the CMS required elements as follows: • A summary of the patient's stay, including treatments, symptoms and pain management • The patient's current plan of care • The patient's latest physician orders

Upon personnel record review, 1 of 13 (Personnel #8) did not have evidence that all Speech Therapy Services are provided by a qualified licensed Speech-Language Pathologist (SLP) or Audiologist in accordance with the state's Speech-Language Pathology Practice Act and the hospice's policies and procedures and/or job descriptions. Personnel #8: There was no state licensing credential in the Speech Therapist file at the time of survey. There was a graduating education document only.

Upon personnel record review, 1 of 13 (Personnel #8) did not have evidence the hospice obtained a criminal background check on all contracted individuals who have direct patient care and access to patient records. Personnel #8: The contracted Speech Therapist did not have a criminal background check in her file at the time of survey.

Upon patient record review, 1 of 5 (Patient #1) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient #1 The medication profile includes Silver Sulfadiazine 1% and does not include a site of application for the medication. It reads "apply to affected area 1x per day." The medication profile includes levothyroxine is entered as 50mg and should be 50mcg.

Upon patient record review, 5 of 5 (Patients #1, 2, 3, 4, 5) 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. Patients 1-5 There is a current problem statement on each patient that includes Volunteer services, with interventions and goals, but the patient records all indicate that Volunteer services were declined at the time of each admission. Patient #1 The nursing notes for 7/15/22 & 7/22/22 identify that the patients pain is greater than her self identified threshold, but there is no update to the interventions or goals. Patient #2 The nursing notes for visits on 7/5/22, 7/12/22 and 7/19/22 all have indicators that patient has pain greater than her self identified threshold, but there is no update to the interventions or goals related to the complaints. Patient #3 The nursing notes for 7/13/22 & 7/20/22 indicate that the patient has rhonci with diminished breath sounds and 2+ edema to RLE, there is no problem statement with goals and interventions addressing these issues. Patient #4 The nursing notes for 3/8/22 , 3/29/22 & 4/12/22 all indicate that the patients pain is greater than the self identified threshold of 1, there is no update to the interventions or goals for this problem. Patient #5 The nursing note for the 7/5/22 visit indicates that the patient reported constipation. There was no problem statement with goals or interventions included in the plan of care. The POC includes a problem statement for nausea & vomiting that was added at the time of admit on 4/26/22 with a goal to resolve the N/V within 2 weeks, but the problem statement with the interventions and goals remained on the plan of care until the patient discharge on 7/20/22.

Upon patient record review, 1 of 5 (Patient #1) 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 #1 The plan of care includes topical application of Silver sulfadiazine 1% but does not include a site of application, the order states "apply to affected area 1 x per day. The patient has levothyroxine that is entered as 50mg into the plan of care, but the correct dose is 50mcg as observed during the home visit.