Every finding on record at Hospice of Southern California

Upon patient record review, 5 of 14 (Patient #1,2,3,8,12) did not have evidence in the patient record that the comprehensive assessment takes into consideration the imminence of death. Patient 1,2,3,8,12: There is no evidence in the RN comprehensive assessment that the RN takes into consideration the imminence of death.

Upon patient record review, 7 of 14 (Patient #2,3,4,6,7,9,10) 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 2: On Admission 4/16 MiraLAX 17g is ordered, there is no diluent. Corrected on site. There is an order for Tylenol 325mg 1 tablet every 4 hours as needed and Tylenol 650mg suppository every 4 hours as needed, there is no maximum daily allowable amount. Patient 3: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hrs. prn there is no maximum daily allowable amount. Home visit patient had Zofran 4mg 1 tab every 8 hours as needed but not on the plan of care, had lorazepam 2mg/1ml 0.5mg every 2 hours as need not on the plan of care. Corrected on Site Patient 4: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hrs. prn, there is no maximum daily allowable amount. Patient 6: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hrs. prn, there is no maximum daily allowable amount. Patient 7: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hours prn, there is no maximum daily allowable amount. On the plan of care there are two orders for Aspirin 81mg one tablet daily and Aspirin 81mg tablet, enteric coated. This is a duplicate order for Aspirin. On the plan of care there is an order for Losartan 40mg once daily and for Losartan potassium 50mg tablet once daily. This is a duplicate order for Losartan. Patient 9: In the patient record there is an order for Acetaminophen 325 mg 2 tablets every 4 hours as needed and Acetaminophen 650mg one every 6 hours as needed. There is no maximum daily allowable amount. Patient 10: In the patient record there is an order for Acetaminophen 325 mg 2 tablets every 4 hours as needed and Acetaminophen 650mg one every 6 hours as needed. There is no maximum daily allowable amount.

Upon patient record review, 3 of 14 (Patient #5,8,10) 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 5: In the patient record there is an order for IV hydration, the IV hydration is not on the plan of care with goals and interventions. In the patient record the patient has a colostomy, the colostomy is not on the plan of care with goals and interventions. Patient 8: In the patient record there is evidence the patient is taking Eliquis 2.5mg, there is not a risk for bleeding on the plan of care. Patient 10: In the patient record there is an order for aspirin 81 mg daily, there is not a risk of bleeding on the plan of care.

Upon patient record review, 7 of 14 (Patient #2,3,4,6,7,9,10) 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: On Admission 4/16 MiraLAX 17g is ordered, there is no diluent. Corrected on site. There is an order for Tylenol 325mg 1 tablet every 4 hours as needed and Tylenol 650mg suppository every 4 hours as needed, there is no maximum daily allowable amount. Corrected on site. Patient 3: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hrs. prn there is no maximum daily allowable amount. Corrected on site. Patient 4: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hrs. prn, there is no maximum daily allowable amount. Patient 6: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hrs. prn, there is no maximum daily allowable amount. Patient 7: In the patient record there is an order for Acetaminophen 650mg rectal suppository every 4 hours prn and Acetaminophen 325mg 2 tabs every 6 hours prn, there is no maximum daily allowable amount. On the plan of care there are two orders for Aspirin 81mg one tablet daily and Aspirin 81mg tablet, enteric coated. This is a duplicate order for Aspirin. On the plan of care there is an order for Losartan 40mg once daily and for Losartan potassium 50mg tablet once daily. This is a duplicate order for Losartan. Patient 9: In the patient record there is an order for Acetaminophen 325 mg 2 tablets every 4 hours as needed and Acetaminophen 650mg one every 6 hours as needed. There is no maximum daily allowable amount. Patient 10: In the patient record there is an order for Acetaminophen 325 mg 2 tablets every 4 hours as needed and Acetaminophen 650mg one every 6 hours as needed. There is no maximum daily allowable amount.

Upon patient record review, 2 of 14 (Patient #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 6: On the RN comprehensive assessment there is a need for bed, overbed table, wheelchair, nebulizer, suction machine, O2 concentrator, E-Tank these items are not listed on the Plan of care. On the RN comprehensive assessment there is documentation that the patient has a shower chair, this is not listed on the plan of care. Patient 7: On the RN comprehensive assessment there is documentation of a bed, overbed table, wheelchair, urinal, nebulizer, suction machine, O2 concentrator, E-tank, IV tubing these items are not on the plan of care.

Upon client record review, 1 of 14 (Patient #7) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 7: On 10/15/23 there is an order for daily visits and IV antibiotic administration , there is not a physician order for IV insertion and care for IV on the plan of care however, there is evidence the RN performed the daily visit with IV insertion and IV administration and care for the IV.

Upon patient record review, 5 of 14 (Patient #1,2,3,4,12) 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 1: On the Aide plan of care there are orders for "turn and reposition, record bowel movements, dress street clothes, provide oral care, change patient linens", these orders do not contain a frequency. Corrected on Site. Patient 2: On the Aide plan of care there are orders for "turn and reposition, record bowel movements, dress street clothes, change patient’s linens" these orders do not contain a frequency. Corrected on Site. Patient 3: On the Aide plan of care there are orders for "record bowel movements, change pt. linens", these orders do not contain a frequency. Corrected on Site. In addition, there is not a Hoyer lift for equipment for transfers, this is on the RN comprehensive assessment. Patient 4: On the Aide plan of care there are orders for "Empty collection bag, dressing street clothes, change patient linens", these orders do not contain a frequency. Patient 12: On the Aide plan of care there are orders for "Empty collection bag, dressing street clothes, change patient linens", these orders do not contain a frequency.

Upon patient client record review, 3 of 14 (Patient #2,7,9) did not have evidence that each patient record contains responses to medications, symptom management, treatments, and services. Patient 2: On the RN comprehensive assessment 4/16/25 completed wound care, the wound care documentation did not contain documentation of how the patient tolerated the wound care. Patient 7: On 10/16/23 the RN documented, "wound care rendered", the wound care documentation did not contain documentation of how the patient tolerated the wound care. Patient 9: On 5/2/24 there is documentation of wound care provided by the RN, did not contain documentation of how the patient tolerated the wound care.

Upon patient client record review, 8 of 14 (Patient #1,3,4,5,6,8,9,12) 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: On the Spiritual initial assessment the SC documented, “Patient resides in his own home with his wife, who serves as the AR/EC/PCG” AR and EC are not approved abbreviations. Patient 3: On the Spiritual initial assessment the SC documented, “Patient resides in his own home with his wife, who serves as the AR/EC” AR and EC are not approved abbreviations. Patient 4: On the RN comprehensive assessment there is documentation, “DMD made aware” DMD is not an approved abbreviation. Patient 5: On RN comprehensive assessment the nurse documented Flush solution “saine and heparin” Saine is misspelled. Patient 6: On 11/3/23 the SC initial assessment documentation “Malignant neoplasm of unsp part of unsp bronchus, AR/EC, these are not approved abbreviations. Patient 8: On initial Spiritual assessment the chaplain documented "Pt. was diagnosed with “Unsp part of unsp bronchus", unsp is not an approved abbreviation. Patient 9: On 5/2/24 there is documentation of wound care provided by the RN, the RN did not contain details of wound care provided. Patient 12: During the RN comprehensive assessment the RN documented that there is no pitting edema BLE, the RN also documented one plus pitting edema. This is not clear or complete.