Every finding on record at La Canada 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: During home visit medication reconciliation, the caregiver denied patient's use of Spironolactone 25 mg since admission. The medication profile contains orders for Spironolactone 25mg 1 tab daily.

Upon patient record review, 1 of 14 (Patient #3) 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 Patient 3: The RN delegated the LVN to make comprehensive assessment visits which is outside the scope of practice for an LVN. CA Nursing Practice Act Chapter 6 Section 2725 requires the RN to be accountable for an ongoing comprehensive assessment that include data collection, analysis, and drawing conclusions/making judgments. The RN had not made any visits since 3/19/26.

Upon patient record review, 1 of 14 (Patient #3) 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. Patient 3: Per CA Nursing Practice Act Chapter 6 Section 2725 the RN is required to be accountable for an ongoing comprehensive assessment that include data collection, analysis, and drawing conclusions/making judgments. The RN had not made any visits since 3/19/26. The LVN was the only nurse making visits and there was no evidence of documentation that the RN was collaborating with the LVN since 3/19/26.

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: During home visit medication reconciliation, the caregiver denied patient's use of spironolactone 25 mg since admission. There was no evidence of orders to discontinue the medication.

Upon patient record review 1 of 14 (Patient #3) 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 3: There was no evidence of an aide supervisory visit was completed by the RN since 03/19/26.

Upon patient client record review, 1 of 14 (Patient #7) 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 7: Printed name listed on hospice philosophy section of the election form is the name of the patient's representative, not the patient's name.

Upon patient client record review, 1 of 5 records (Patient #4) 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 #4: The record indicated on intake form and initial nurse comprehensive narrative that patient is a 72 y/o male, however on physician CTI narrative reads "Admitted 78 year old female to La Canada Hospice Care, Inc....". [corrected on site]