Every finding on record at Horizon View Hospice Inc

Upon patient record review, 1 of 3 (Patient #2) 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 #2: The record reflected that this patient had a bed, suction machine and oxygen. These were not included on the Plan of Care.

Upon client record review, 1 of 3 (Patient #1) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #1: The POC listed Spiritual Counselor (SC) visit frequency of, 1x per recertification period. For recertification period from 9/28/25 to 11/26/25 there were two routine SC visits during this time.

Upon patient client record review, 1 of 3 (Patient #3) 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 #3: This patient transferred from another hospice to this agency during their second benefit period. The agency used existing CTI (populated 7/30/25) from previous hospice. However, the Plan of Care populated the agency system on 7/30/25 (same as CTI date). This patient was admitted to the agency on 8/13/25. Per agency the Hospice MD EMR would not allow for the date change.

Upon client record review, 1 of 3 (Patient #3) did not have evidence that the discharge summary includes all required information as follows: • The patient's current plan of care

Upon client record review, 2 of 5 (Patients #1,#2) did not have evidence that the plan of care included IDG's documentation of the patient's or families level of understanding, involvement and agreement with the plan of care.

Upon patient record review 2 of 5 (Patients #1,#2) did not have evidence in the patient record that the hospice conducted and documented in writing a patient-specific comprehensive assessment that identifies the patient's need for hospice care and services, and the patient's need for physical, psychosocial, emotional, and spiritual care. This assessment includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions.

Upon patient record review 2 of 5 (Patients #1,#2) did not have evidence that the hospice Registered Nurse must complete an initial assessment within 48 hours after the election of hospice care in accordance with §418.24.

Upon patient record review, 2 of 5 (Patient #1,#2) 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 and #2 had evidence of medications in new EMR but no evidence of medication profile.

Upon patient record review, 4 of 5 (Patients #1,#2,#3,#5) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The hospice interdisciplinary group (in collaboration with the individual's attending physician, if any) • Changes that have taken place since the initial assessment • Information on the patient's progress toward desired outcomes • Reassessment of the patient's response to care • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patients 1,2: There was no evidence of comprehensive assessment updates. Patient 3: There was no evidence of a physical assessment by the RN from 5/27/24 to 6/17/24, and from 6/17/24 through discharge 7/5/24. Patient 5: There was no evidence of a physical assessment by the RN from 4/25/24 to 5/16/24.

Upon patient record review, 2 of 5 (Patients #1,#2) did not have evidence in the patient record that the written plan of care is developed by the IDG, in consultation with the patient's attending physician, which specifies the services necessary to meet the patient and family-specific needs identified in the comprehensive assessment as it relates to the terminal illness and related conditions.

Upon observation, there was no evidence the hospice has an interdisciplinary group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. Interdisciplinary group members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. Patients 1,2: There was no evidence of IDG members supervising the care and services. Patient 3: There was no evidence of social worker and spiritual care participation in IDG 5/29/24 and no evidence of medical director, social worker, and spiritual care participation 6/12/24. Patients 4,5: There was no evidence of social worker participation in IDG 5/15/24 and 5/29/24.

Upon patient record review, 4 of 5 (Patients #1,#2,#3,#5) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patients 1,2:There was no evidence of continuous assessments by an RN. Patient 3: The record contained nursing visits made by an LVN weekly. The only RN visits were at admission and 6/17/24. Patient 5: There was no evidence of visits by an RN after 5/30/24. Patient discharged for extended prognosis 6/11/24 without RN assessment and supervision.

Upon client record review, 2 of 5 (Patients #1,#2) did not have evidence that the hospice follows the individualized plan of care developed in in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient's needs if any of them so desire.

Upon patient record review, 2 of 5 (Patients #1,#2) 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.

Upon patient record review, 4 of 5 (Patients #1,#2,#3,#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 medications and treatments. Patients 1,2: There was no evidence of orders for medications and treatments signed by a physician. Patient 3: The orders 7/4/24 for lactulose, scheduled and PRN lorazepam, tramadol, bismuth subsalicylate, carbidopa/levodopa, escitalopram, mirtazapine, pantoprazole, and quetiapine were not signed by a physician. Patient 4: The orders 5/15/24 for amlodipine, artificial tears, muscle rub, senna-s, tramadol, and zolpidem were not signed by a physician.

Upon client record review, 3 of 5 (Patients #1,#2,#3) did not have evidence that the IDG in collaboration with the attending physician reviewed, revised and documents the individualized plan as frequently as the patient's condition requires but no less frequently then every 15 calendar days. Patients 1,2: There was no evidence of updated plans of care. Patient 3: There was no evidence of an updated plan of care after 6/12/24. Patient discharge was not until 7/5/24.

Upon patient record review 2 of 5 (Patients #1,#2) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs.

Upon patient record review, 3 of 5 (Patients #1,#2,#5) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patients 1,2: There was no evidence of an initial CTI upon admission. Patient 5: Patient's start of care was 5/27/25. There was no evidence of a CTI to coincide with start of service.

Upon patient record review, 2 of 5 (Patients #1,#2) did not have evidence that before the recertification period for each patient, the medical director or physician designee must review the patient's clinical information and provide written documentation that it is anticipated that the patient's life expectancy is 6 months or less. Patients 1,2: There was no evidence of recertification CTIs. Certification ended 9/27/25.

Upon patient record review 2 of 5 (Patients #1,#2) did not have evidence a patient record maintained.

Upon patient/client record review, 2 of 5 (Patients #1,#2) did not have evidence that each patient record contains:(this references that the documentation is part of the patient record. Citing the inaccuracy of a component of the record is cited under other standards) • Initial plan of care • Updated plan of care • Initial assessments • Comprehensive assessments • Updated comprehensive assessments • Signed and dated clinical and progress notes

Upon patient client record review, 2 of 5 (Patients #1,#2) did not have evidence that each patient record contains responses to medications, symptom management, treatments, and services.

Upon patient client record review, 3 of 5 (Patients #1,#2,#3) did not have evidence that each patient record contains Physician certification and recertification of terminal illness. Patients 1,2: There was no evidence of initial CTIs signed by the attending physician upon admission. Patient 3: The CTI in the medical record was not signed by the attending physician and was dated 6/11/24 with start of care 5/27/24.

Upon patient client record review, 2 of 5 (Patients #1,#2) did not evidence that each patient record contains physician orders.

Upon observation, the agency did not have and could not gain access to former EMR utilized from August 2025 until 9/29/25.

Upon client record review, 3 of 5 (Patients #3,#4,#5) did not have evidence that if a patient revokes the election of hospice care or is discharged from hospice in accordance with §418.26, the hospice must forward to the patient's attending physician: • A copy of the hospice discharge summary • The patient's clinical record, if requested Patients 3,4,5: There was no evidence discharge summary sent to patient's attending physician for continuity of care.

Upon client record review, 3 of 5 (Patients #3,#4,#5) did not have evidence that the discharge summary includes all required information. Patients 3,4,5: There was no evidence of discharge summaries including the required elements.

Upon observation, there was no evidence the organizational chart matches the hospice's information submitted to CMS and/or State licensing agencies for ownership and management personnel. The agency was unable to provide evidence the most recent change in DPCS/Alternate administrator was disclosed to the CDPH.

Upon patient record review, 1 of 14 (Patient #2) 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 #2: POC included Jevity 1.5 bolus feeding. No amount of feeding or frequency listed. POC ordered Omni wound provider to replace G-tube. No frequency listed. COS.

Upon patient record review, 4 of 14 (Patient #1, 2, 6, 7) 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: Per patient POC, the patient is on nebulizer medication. Nebulizer not listed under DME on the POC. Patient #2: During home visit it was observed that patient had a hospital bed, nebulizer, oxygen, hoyer lift and wheel chair. Items not listed on the POC. Patient is incontinent of bowel. No incontinence supplies listed on the POC. Patient #6: Patient documentation indicated patient uses a walker for transfers. Walker not listed on POC for DME. Patient #7: Patient documentation indicated patient is incontinent of bowel and bladder and has hospital bed. No incontinence supplies or hospital bed listed on POC.

Upon client record review, 2 of 14 (Patient #6, 7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #6: Initial POC ordered SC 1x per month and PRN for spiritual support. Extra SC visit made in December on 12/27. No evidence that visit was PRN or of an order to support extra visit Patient #7: POC dated 12/7 discontinued MSW due to family declined. MSW visit on 12/10. No evidence to support an order for the extra visit. POC dated 1/3 ordered SN every other week. Visit due the week of 1/7. No evidence of an visit being made.

Upon patient record review 3 of 14 (Patient #2, #6, #7) did not have evidence documentation in the patient record that a Registered Nurse made 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 and to ensure that services ordered by the hospice interdisciplinary group meet the patient's needs. Patient #2: Aide services were not assessed every 14 days as visits occurred on 12/5 and then on 12/28. Patient #6: Aide services were not assessed every 14 days as visits occurred on 12/28 and then on 1/17. Patient #7: Aide services were not assessed every 14 days as visits occurred on 12/27 and then on 1/17.

Upon patient client record review, 12 of 14 (Patient #2, 3, 4, 6, 7, 8, 9, 10, 11, 12, 13, 14 ) did not have evidence that each patient record contains Advance Directives. Patient #2, 3, 4, 6, 8, 9, 10,. 11, 13: Consent of Treatment indicates that patient has a Power of Attorney. No evidence of a copy in the patient record Patient #7, 9, 12: Consent of Treatment indicates that patient has a Living Will. No evidence of a copy in the patient record Patient #9,14: Consent of Treatment indicates that patient has a Durable Power of Attorney. No evidence of a copy in the patient record

Upon patient client record review, 11 of 14 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11) 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, 2, 3, 4, 5, , 7, 8, 9, 10, 11: "Consent of treatment/Acknowledgement/Financial Responsibility" form page 2 "Financial Responsibility/Assignment of benefits" sections incomplete and not filled out. "Your Estimated Financial Responsibility" section left blank. No per visit amounts listed for each discipline. Patient #3--Physicians Certification Terminal Illness for certification period 6/14/23-9/11/23 and 9/12/23-12/10/23 is signed and Dated. There is no printed name or credentials of the person who signed and it is unclear who signed the form. Patient #4: Physicians Certification Terminal Illness for certification period 1/11/24-4/9/24 is signed and Dated. There is no printed name or credentials of the person who signed and it is unclear who signed the form. Patient #5: Physicians Certification Terminal Illness for certification period 1/11/24-4/9/24 is signed and Dated. There is no printed name or credentials of the person who signed and it is unclear who signed the form. Patient #10: . Physicians Certification Terminal Illness for certification period 9/15/23-12/13/23 is signed and Dated. There is no printed name or credentials of the person who signed and it is unclear who signed the form.