Every finding on record at California's Best Hospice Services, Inc.

Observed in HR File Review. In 1 out of 1 HR files, the organization did not provide emergency preparedness training at least every 2 years. Example: In HR#7, the last documented Emergency Management training for the Volunteer's was in 2022. This was confirmed by the agency Administrator.

Observed in Tracer Activities. The organization did not review and make necessary updates to the HVA and Emergency plan based on opportunities for improvement following a recent information technology outage. Example: The agency's electronic medical record platform (Hospice MD) experienced an outage lasting several days in May resulting in the agency activating its Emergency downtime procedures. The agency did not document the incident and create an after action report related to the actual event. This was confirmed with the DPCS.

Observed in Tracer Visit. In 2 of 3 wound records, the organization did not perform reassessments of patient per policy. Example: In RRNHV#2, the patient's Stage IV wound was not measured weekly per policy. There were no wound measurements documented on weekly visits during benefit period 7. In RRNHV#6, the patient's wound was not measured weekly per policy. There were no wound measurements documented since the admission visit. This was confirmed by the DPCS.

Observed in Tracer Visit. In 3 out of 5 records reviewed, the hospice plan of care goals were not measurable. Examples found in RRHV#1 included: Patient will have relief of discomfort; Patient will have improved respiratory comfort; Patient, family and PCG will verbalize/express understanding of medication /treatment orders and side effects. Examples found in RRNHV#8 included: Patient will be comfortable; Patient will be able to sleep at night; Patient will be able to cope with changes; Family will have adequate coping skills. Example found in RRHV#2 included: Patient will achieve optimum level of comfort and safety daily . This was confirmed by the DPCS.

Observed in Tracer Visit. In 1 of 7 records reviewed, the plan of care was not updated to include all services needed for the palliation and management of the terminal illness and related conditions, including Interventions to manage symptoms. Example: In RRHV#2, on 6/28/25 the patient was reported by the family to be positive for COVID. The patient was symptomatic with increased need for prn O2. The patient's caregiver was presented with the option of Paxlovid but declined. The 7/2/25 IDG did not address the change in condition and there were no new problems or goals entered to address the change. This was confirmed by the DPCS.

Observed in Tracer Visit. In 1 of 2 records reviewed, the drugs and treatment necessary to meet the needs of the patient were not defined. Example, In RRHV#1, there are multiple PRN medications to address pain which included Tylenol 500 mg tabs, Tylenol 325 mg tabs, and tramadol. However the orders did not clarify when each medication was to be administered. This was confirmed by the DPCS.

Observed in Tracer Visit. In 3 out of 5 records, the organization did not ensure that the care and services were provided in accordance with the plan of care. Examples: In RRNHV#8, there were 2 missed aide visits in week one of admission. The nursing frequency for RRNHV#8 was 1 time per week. However, 2 routine nursing care visits were made in week 1. Three routine nursing visits were made in week 2. Two routine care visits were made in weeks 3, 4, and 5. In RRHV#1 and extra nursing visit was made in week #8 of BP2. In RRHV#2, an extra visit was made in week 6 of BP 10. This was confirmed with the DPCS.

Observed in Record Review. In 6 of 12 patient records reviewed, the organization failed to ensure that the initial bereavement risk assessment was conducted to assess the patient family's social, spiritual, and cultural factors that may impact their ability to cope with the patient's death and to incorporate these factors into the plan of care and to be considered in the bereavement plan of care. For example: upon review of HV#1 the initial bereavement risk assessment is opened however the narrative notes that a voicemail message for the family regarding bereavement support services as available when requested. There was no indication that the family called back to discuss nor that the initial bereavement assessment was conducted. In HV#3 and RR#9 the initial bereavement risk assessment was conducted months after the patient's admission. For RR#10 and RR#11there was no initial bereavement risk assessment completed. Further, on review of the bereavement #3 record it was noted that there was no documentation of an update to the bereavement risk assessment post death as required by policy. These observations were reviewed with the bereavement coordinator, DON and the DON designee.

Observed in Record Review. In 1 of 4 patient records reviewed, the organization failed to ensure that the update of the comprehensive assessment was accomplished by an RN nursing visit no less frequently that every 15 days. For example: upon review of HV#3 it was noted that there were gaps greater that 15 days in the RN comprehensive assessments as there was a 28 day gap from March to April, and 28 day gap from April to May, and a 21 day gap in the month of May. All visits in between were conducted by the LVN. This observation was reviewed with the Administrator, DON, and DON designee.

Observed in Record Review. In 1 of 11 patient records reviewed, it was noted that the organization failed to ensure the IDG meeting contain the signature of attendance for all core IDG members, as noted in policy no. 2-050.1 which states members at the interdisciplinary meeting will sign an attendance form that will be kept by the hospice Clinical Supervisor/Nursing Supervisor. Upon review of RR#6 it was noted that most of the IDG meetings lacked the signature of the chaplain, and the final IDG following discharge lacked the signature of the MD and MSW. When discussed with the DON if there was an attendance form kept by the Clinical/Nursing Supervisor, the surveyor was told there was not an attendance form outside of the EMR.

Observed in Record Review. In 5 of 11 patient records reviewed, the organization failed to ensure that the individualized plan of care reflected the patient and family goals and interventions based on the problems identified in the initial, comprehensive and updated assessments. For example: the patient in HV#2 was receiving spiritual care services yet there was no care plan established to address spiritual care needs. In RR#11 the patient had a foley catheter, yet there was no care plan open to address genitourinary. Further many of the goals failed to be specific, measurable, and time bound. In RR#6 and RR#7 the pain goal stated Pain will remain at comfortable level during care. In RR#5 the goals for cardiovascular stated Edema of lower extremities will decrease/improve and Patient will be relieved of chest discomfort. For musculoskeletal the goal read Assist in maintaining mobility and functional independence as tolerated. These observations were reviewed with the DON, and the DON designee.

Observed in Record Review. In 1 of 7 patient records reviewed, that were discharge patients, the organization failed to ensure that the hospice IDG review, revise and document the individualized plan no less frequently than every 15 calendar days. For example: on review of RR#5 it was noted that there was no documentation of an IDG meeting to review the patient's plan after the patient's death. This observation was reviewed with the DON.

Observed in Tracer Activities. In 1 of 3 patient records reviewed, for bereavement, the organization failed to ensure that a bereavement plan of care that notes the kind of bereavement services to be offered and the frequency of service delivery was established. For example in review of bereavement record #3 the bereaved was noted to be receiving bereavement letters from the organization, however upon review of the record no bereavement plan of care was established. Upon further discussion with the bereavement coordinator, and DON it was noted that multiple bereaved were receiving bereavement letters from the hospice, however the organization was unable to produce a plan of care associated with the letters being sent to the bereaved families. This observation was reviewed with the bereavement coordinator, and DON.

Observed in Record Review. In 8 of 8 patient records reviewed, where hospice aide services were elected, the organization did not ensure that the written patient care instructions for the hospice aide by the registered nurse contained all of the elements necessary for providing care. For example: upon review of the aide assignment for HV#1 and RR#5 not all tasks were assigned a frequency by the RN. Many tasks were noted to be assigned a frequency of every visit yet the bath, hair, nail, and housekeeping tasks lacked an assigned frequency. This observation was reviewed with the DON, and DON designee.

Observed in Record Review. In 3 of 11 patient records reviewed, The organization failed to ensure that the patient record contained information that reflected that patient's care, treatment, and services. For example: on review of RR#6 the MSW order on admission was 1 time assessment within 5 days yet no MSW assessment was documented. Documentation in the record noted that the MSW services had been declined yet no order to decline MSW services, nor documentation on the circumstances leading to the declined service was noted in the record. Example 2: upon review of HV#1 and HV#3 the physician made patient visits via telehealth however the documentation of the visit did not comply with the organization's Telehealth and Telecommunication Technology policy. It was not included on the patient's plan of care and nor was written and/or verbal consent documented in the patient record. These observations were reviewed with the DON and the DON designee.