Every finding on record at Central Valley Hospice Care Inc.

Upon patient record review, 1 of 14 (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: Upon observation during the home visit, the hospice medication record contains Tamsulosin 0.4 mg @ HS. The patient does not take Tamsulosin. (Corrected on site by having the medication discontinued on the hospice medication record.)

Upon patient record review, 1 of 14 (Patient #10) 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 #10: There is evidence the initial nursing assessment indicated under Nutrition, the patient has aspiration precautions and aspiration precautions is on the aide plan of care. However, aspiration precaution is not on the patient plan of care with problem/interventions/goals. (Corrected on site by adding Aspiration precautions to the plan of care.)

Upon patient record review, 1 of 14 (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: Upon observation during the home visit, the hospice plan of care contains Tamsulosin 0.4 mg @ HS. The patient does not take Tamsulosin. (Corrected on site by having the medication discontinued.)

Upon patient record review, 8 of 14 (Patient #1,2,3,4,5,6,8,9) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient #1,2,3,5,6,8:There is evidence in the patient record that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. The revised POC/IDG update does not include patient status and/or progress towards goals for physical, spiritual or psychosocial status. For IDG on 9/2, 9/16, 9/30, 10/7/25, each note by the nurse states "POC effective". Patient #4: There is evidence in the patient record that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. The revised POC/IDG update does not include patient status and/or progress towards goals for physical, spiritual or psychosocial status. On 10/7/25 the nurse documented in the IDG nurses note "patient expired". Patient did not expire. On other dates 9/16 and 9/30 the nurse documented "POC effective". Patient #9: There is evidence on 9/3 and 9/10/25 the nurse documents the patient is anxious and her husband medicates her with Ativan. Anxiety is not on the plan of care. (Corrected on site, the plan of care was updated with Problem/Intervention/Goals for Anxiety.)

Upon client record review, 5 of 14 (Patient #2,3,6,7,8) did not have evidence that the physician provides a brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the recertification form, or as an addendum to the recertification form. Patient #2,3,6,7,8: There is evidence in the medical record the narrative explanation for the second benefit period for each record does not contain clinical findings.

Upon patient record review, 1 of 11 (Patient #8) 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 #8 - POC dated 06/08/2022 - incomplete wound care order to skin tear - did not include frequency of wound care. Corrected on site

Upon client record review, 1 of 7 applicable (Patient #8) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #8 - SN documented on 06/20/2022 "Foley catheter removed" No order noted for Foley catheter removal. Corrected on site.

Upon patient client record review, 3 of 11 (Patients #1, 5, 6) 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 #1 - SN visit note 07/22/2022 and 08/01/2022 did not contain a date that the RN signed the visit note. Corrected on site. Patient #5 - SN visit note 08/04/2022 and 08/10/2022 did not contain a date that the RN signed the visit note. Corrected on site. Patient #6 - SN visit note 08/05/2022 and 08/17/2022 did not contain a date that the RN signed the visit note. Corrected on site.