Every finding on record at Del Rosa Hospice and Palliative Care Inc

It is required that the hospice provides nursing care under the supervision of a registered nurse. This standard was not met as evidenced by clinical record review and interview. In 3 of 17 (18%) clinical records reviewed revealed the agency did not ensure the hospice provided nursing care under the supervision of a registered nurse. Document 1: Agency policy titled "Nursing Services" Policy number 9.22.1 (Revised February 2025) stated, "The LPN/LVN will be supervised by the RN at least monthly." CLINICAL RECORD 6: The patient elected the hospice benefit on 04/13/2025. A review of the clinical record for the benefit period dated 10/10/2025 to 12/08/2025 revealed the licensed vocational nurse (LVN) completed nursing visits on 11/08/2025 and 11/19/2025. LVN supervisory visits were documented on 10/22/2025 and 12/23/2025. There was no documented evidence of a registered nurse (RN) supervisory visit for the month of November 2025 as required by agency policy. CLINICAL RECORD 18: The patient elected the hospice benefit on 09/03/2025. A review of the clinical record for the benefit period dated 09/03/2025 to 11/05/2025 included documented LVN visits on 09/03/2025, 09/08/2025, 09/11/2025, 09/14/2025, 09/23/2025, 10/01/2025, 11/05/2025, 11/08/2025 and 11/19/2025. There were no documented RN supervisory visits in the clinical record since admission to hospice services on 09/03/2025. CLINICAL RECORD 19: The patient elected the hospice benefit on 05/11/2025. A review of the clinical record for the benefit period dated 05/11/2025 to 08/08/2025 revealed documented LVN visits completed on 05/11/2025, 05/14/2025, 05/30/2025, 07/02/2025, 07/07/2025, 08/05/2025, and 08/06/2025. The RN documented LVN supervisory visits on 07/11/2025 and 08/08/2025. There were no documented RN supervisory visits for the month of May 2025. During an interview with the Director of Patient Care Services (Personnel Record 5) on 02/19/2026, she stated that they were unaware that the policy required the LVN to be done monthly, but that they were preparing education for the clinical staff.

It is required that hospice aides are supervised by a registered nurse who makes 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; Ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 2 of 19 (11%) clinical records reviewed for patients receiving hospice aide services, it was revealed that the agency did not ensure hospice aide supervisory visits were conducted no less frequently than every 14 days. Document 2: Agency policy titled "Hospice Aide Supervision" Policy 4.21.1 (Revised February 2022) stated in part, “At least every 14 days, the registered nurse (RN) makes an onsite home supervisory visit to assess relationships and determine whether goals are being met. This is done with or without the aide’s presence." CLINICAL RECORD 7: The patient elected the hospice benefit on 05/25/2025. The plan of care dated 08/18/2025 to 11/15/2025 included orders for the hospice aide visit three times per week. The clinical record included documented aide supervisory visits completed on 08/21/2025, 08/26/2025, 09/03/2025, 09/09/2025, 09/16/2025, 09/26/2025, 10/03/2025, 10/10/2025, 10/15/2025, 10/24/2025, 10/29/2025, and 11/13/2025. The hospice aide supervisory visit dated 11/13/2025 was documented 15 days after the previous one dated 10/29/2025. CLINICAL RECORD 19: The patient elected the hospice benefit on 05/11/2025. The plan of care dated 05/11/2025 to 08/08/2025 included orders for a hospice aide visit twice per week for two weeks, then three times per week, with the frequency provided as ordered starting on 05/14/2025. The clinical record included documented aide supervisory visits on 05/22/2025, 06/06/2025 (15days), 06/13/2025, 06/20/2025, 06/27/2025, 07/11/2025, 07/18/2025, 08/01/2025, and 08/08/2025. The hospice aide supervisory visit dated 06/06/2025 was documented 15 days after the previous one dated 05/22/2025. During an interview with the Director of Patient Care Services (Personnel Record 5) on 02/19/2026, she stated it was missed due to the patient changing the visits to a different day; however, they will now start to complete the aide supervisory visits every week.

It is required that if a patient revokes the election of hospice care or is discharged from hospice per hospice regulation §418.26 (i.e., no longer terminally ill), the hospice forwards to the patient’s attending physician: 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 2 of 2 (100%) clinical records reviewed of patients that were discharged from hospice revealed the agency did not ensure a copy of the hospice discharge summary was sent to the attending physician. CLINICAL RECORD 18: The hospice benefit was elected on 09/03/2025, and the patient chose to revoke hospice services on 11/05/2025. The clinical record review lacked evidence that a discharge summary was sent to the attending physician upon discharge from the hospice agency. CLINICAL RECORD 19: The hospice benefit was elected on 05/11/2025, and the patient was transferred to another hospice on 09/29/2025. The clinical record review lacked evidence that a discharge summary was sent to the attending physician upon discharge from the hospice agency. During an interview with the Director of Patient Care Services (Personnel Record 5) on 02/19/2026, she stated that they missed sending a copy of the discharge summary to the attending physician because the current electronic medical record did not prompt it during discharge. She stated they will provide staff education and update the discharge summary template.