Every finding on record at Hospice of Orange County, Inc

Condition of Participation: Patient’s Rights. L500

Upon observation, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient's Rights and Responsibilities in a language and manner that the patient understands. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6, 13) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6, 13) did not have evidence that the hospice obtained the patient's or representative's signature confirming that they received a copy of the Patient's Rights and Responsibilities. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon observation, there was no evidence the patient has the right to voice grievances/complaints regarding treatment or care that is (or fails to be) furnished and lack of respect of property by anyone who is furnishing care/service on behalf of the hospice. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6 13) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient's rights to the extent allowed by state law. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon client record review, 2 of 15 (Patient #6, 13) 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. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6, 13) did not have evidence that the patient chooses a health care provider, including an attending physician Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6, 13) did not have evidence of the appropriate documentation for release of confidential information. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6, 13) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 2 of 15 (Patient #6, 13) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 3 of 15 (Patient #6, 7, 8) 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 #6: Patient had order for oxygen 2 LPM prn, Xarelto prescribed, and no related problems, goals or interventions for oxygen therapy/precautions and/or bleeding. Patient #7: Patient prescribed Levetiracetam for epilepsy and Rivaroxaban for DVT prophylaxis, but no related problems, goals or interventions for seizure or bleeding precautions. Patient #8: Patient prescribed Keppra and had G Tube with no problems, goals or interventions related to seizure precautions, nutrition, tube feedings or G-tube maintenance or site care.

Upon client record review, 1 of 15 (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: 10/13/25 order for ST eval. No visit was made by the ST.

Upon patient record review, 4 of 15 (Patient #6, 7, 8, 15) did not have evidence in the patient record that hospice aide assignments and duties are: • Assigned to a specific patient by a registered nurse that is a member of the interdisciplinary group • Written patient care instructions for a hospice aide must be prepared by a Registered Nurse who is responsible for the supervision of a hospice aide as specified under paragraph (h) of 418.76 • There is evidence in the patient record that the plan of care; indicate what tasks are to be done by the Aide and the frequency of these tasks. The use of “PRN” or “per patient choice”, for any task, whether personal care or non-personal care tasks, are not acceptable Patient #6: Patient had order for Oxygen 2 LPM prn, Xarelto prescribed with no related oxygen or bleeding safety precautions on the aide plan of care. Patient #7: Patient prescribed Levetiracetam for epilepsy and Rivaroxaban for DVT prophylaxis with no seizure or bleeding precautions on the aide plan of care. Patient #8: Patient had G Tube with no related reference/alert/precautions on the aide plan of care. Patient #15: Patient assignment includes task of catheter care. There is no other documented evidence of catheter, and none presented in interview for clarification.

Upon patient record review 1 of 15 (Patient #1) 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 • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #1: Hospice Aide Assignment/POC includes task of shower chair every visit- Feb 14, 18, 20, 2026. The hospice aide documented bath in bed in narrative space.

Upon patient record review, 3 of 15 (Patient #2, 8, 13) did not have evidence that there is a physician's brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification forms, or as an addendum to the certification forms. Patients #2, 8, 13: The initial CTI does not contain a physician's narrative of clinical findings to support terminal illness. The CTI only listed patient diagnosis along with physician attestation and standard prognosis statement with signature.

Upon client record review, 3 of 15 (Patient #2, 4, 6) 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. Patients #2: CTI for Benefit Period #2 does not contain a physician's narrative of clinical findings to support terminal illness. The CTI only listed patient diagnosis along with physician attestation and standard prognosis statement with signature. Patient #4: CTI Benefit periods #5, 6, 7 do not contain a physician's narrative of clinical findings to support terminal illness. The CTI only listed patient diagnosis along with physician attestation and standard prognosis statement with signature. Patient #6: CTI Benefit period #7 does not contain a physician's narrative of clinical findings to support terminal illness. The CTI only listed patient diagnosis along with physician attestation and standard prognosis statement with signature.

Upon patient client record review, 2 of 15 (Patient #6, 13) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient #6, 13: Patient election of benefit signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient client record review, 1 of 15 (Patient #6) did not have evidence that each patient record contains Advance Directives. Patient #6: The POLST form is signed by Medical Director and Alt Medical Director as patient representative and by Medical Director as physician.

Upon patient client record review, 9 of 15 (Patient #1, 2, 4, 5, 6, 7, 11, 14, 15) 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, 4, 5, 6, 7, 11, 14, 15: Patient admission forms including assessment of Advanced Directive status includes questions of : Patient does or does not have advanced directives, and does or does not have POA and subsequently, whether copy is obtained. Records listed include answer of no advanced directives/POA in place, but answers yes to copies obtained. Patient #2: 5/7/25 IDG contains note from SC dated 7/2/25, I, the new chaplain will attempt to coordinate and schedule a visit with the patient to provided spiritual support this month. I, the chaplain will continued to offer spiritual support to the patient. I will continue to monitor the patient spiritual health and update of any changes. Patient #5: Wound care referenced in 1/28/26 RN IDG note was inconsistent with patient assessments, orders/POC. Upon interview with DPCS, she states that information is "typo, a mistake. That is a different patient. Sometimes they get carried away with the copying and pasting". There was no name or other identifiable information included in the error. Patient #7: Discharge summary references patient had oxygen support but no supportive documentation in patient assessment, plan of care/orders or provided during follow up interview.

Upon observation, there was no evidence a copy is provided of the hospice written policies and procedures on the management and disposal of controlled drugs to the patient or patient representative and family. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments). Both have MSO4 prescribed

Upon observation, there was no evidence the hospice discussed the policies and procedures for managing the safe use and disposal of controlled drugs with the patient or representative and the family in a language and manner that they understand to ensure that these parties are educated regarding the safe use and disposal of controlled drugs. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon client record review, 2 of 15 (Patient #6, 13) did not have evidence that the written policies and procedures for managing controlled drugs was provided and discussed. Patient #6, 13: Patient admission consents/election signed by Medical Director and Designee with reference to Bioethics, but no evidence of legal representative for authorization of service. (Patient #6 has brother who is active in care per MSW and Bereavement assessments).

Upon patient record review, 1 of 11 (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 medication profile on 4/19/22 Meloxicam 10 mg 1 cap by mouth daily was ordered for pain. Review of medication bottle revealed on 12/20/22, the dosage was changed to Meloxicam 15 mg by mouth for pain. The medication profile had not been updated.

Upon patient record review, 1 of 11 (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 On 4/19/22 Meloxicam 10 mg 1 cap by mouth daily was ordered for pain. Review of medication bottle revealed on 12/20/22, the dosage was changed to Meloxicam 15 mg by mouth daily for pain. Meloxicam 10 mg 1 cap by mouth daily was not discontinued or updated on the plan of care.