Every finding on record at Lenus Care LLC

Upon patient record review 4 of 14 (Patients #3,#5,#8,#10) did not have evidence in the patient record that the hospice interdisciplinary group, in consultation with the individual's attending physician (if any), completed the comprehensive assessment no later than 5 calendar days after the election of hospice care. Patient 3: The medical record contained an initial psychosocial assessment completed 1/7/25 with start of care 12/26/24. Patient 5: The medical record contained an initial psychosocial assessment completed 7/2/25 and initial spiritual assessment completed 7/1/25 with start of care 6/25/25. Patient 8: The medical record contained an initial spiritual assessment completed 7/18/25 with start of care 7/5/25. Patient 10: The medical record contained an initial psychosocial assessment completed 8/7/25 and initial spiritual assessment completed 7/16/25 with start of care 7/8/25.

Upon patient record review 1 of 14 (Patient #2) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient's well-being, comfort, and dignity throughout the dying process. Patient 2: There was no evidence of psychosocial and spiritual assessments.

Upon patient record review, 4 of 14 (Patients #1,#5,#8,#9) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications. Patient 1: Upon observation during home visit, the board and care home and hospice medication lists did not match. The home did not have levsin that was on hospice medication profile. Patient 5: Upon interview during home visit, the caregiver stated the patient has not been taking the hydralazine that was still current on the hospice medication profile. Patient 8: The medication profile contained Miralax oral powder with no instructions to mix with a diluent. Corrected on site with instructions added. Patient 9: Upon observation during home visit, the board and care home and hospice medication lists did not match. The home had Senna plus instead of Senna and did not contain naproxen that was on hospice medication profile.

Upon patient record review, 2 of 14 (Patients #2,#5) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient's family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient's death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient 2: The medical record contained an initial bereavement assessment completed 8/7/25 with start of care 7/26/25. Patient 5: The medical record contained an initial bereavement assessment completed 7/1/25 with start of care 6/25/25.

Condition of Participation: Interdisciplinary Group, Care Planning, and Coordination of Services.

Upon patient record review, 9 of 14 (Patients #1,#2,#3,#4,#5,#7,#8,#9,#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 1: The medical record contained nursing documentation upon admission identifying patient issues with pitting edema and hypotensive episodes. There was no evidence of problems, goals, and interventions related to cardiovascular dysfunction included in the plan of care. Corrected on site with update to the plan of care. Patient 2: The medical record contained nursing documentation upon admission identifying patient issues with a seizure disorder, and high risk for falls and skin impairment. There was no evidence of problems, goals, and interventions related to neurological dysfunction, fall safety, and skin impairment included in the plan of care. Corrected on site with update to the plan of care. Patient 3: The medical record contained nursing documentation upon admission identifying patient issues with a seizure disorder, dysphagia and high risk for falls and skin impairment. There was no evidence of problems, goals, and interventions related to neurological dysfunction, dysphagia, fall safety, and skin impairment included in the plan of care. Corrected on site with update to the plan of care. Patient 4: The medical record contained nursing documentation upon admission identifying patient is a high risk for skin impairment. There was no evidence of problems, goals, and interventions related to skin impairment included in the plan of care. Corrected on site with update to the plan of care. Patient 5: The medical record contained nursing documentation upon admission identifying patient issues with dysphagia, alcohol dependence, and high risk for falls. There was no evidence of problems, goals, and interventions related to dysphagia, alcohol dependence, and fall safety included in the plan of care. Corrected on site with update to the plan of care. Patient 7: The medical record contained nursing documentation upon admission identifying patient issues with a seizure disorder. There was no evidence of problems, goals, and interventions related to neurological dysfunction included in the plan of care. Corrected on site with update to the plan of care. Patient 8: The medical record contained nursing documentation upon admission identifying patient issues with high risk for falls and skin impairment, and dysphagia. The record also contained an order for Eliquis. There was no evidence of problems, goals, and interventions related to fall safety, skin impairment, dysphagia, and risk for bleeding included in the plan of care. Corrected on site with update to the plan of care. Patient 9: The medical record contained nursing documentation upon admission identifying patient issues repeated falls and agitation. There was no evidence of problems, goals, and interventions related to fall safety and agitation included in the plan of care. Corrected on site with update to the plan of care. Patient 10: The medical record contained nursing documentation upon admission identifying patient issues with high risk for falls and dysphagia. The record also contained orders for Eliquis and insulin. There was no evidence of problems, goals, and interventions related to fall safety, risk for bleeding, and endocrine dysfunction included in the plan of care. Corrected on site with update to the plan of care.

Upon patient record review, 10 of 14 (Patients #1,#2,#3,#4,#5,#6,#7,#8,#9,#10) did not have evidence the plan of care must includes all services necessary for the palliation and management of the terminal illness and related conditions, including the following: • A detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs • The IDG demonstrates a proactive approach in developing each patient's plan of care by planning ahead for anticipated patient changes and needs. Decisions should reflect the patient/family preferences rather than be solely a response to a crisis. Patients 1,2,3,5,6,7,8,9,10: The medical records contained orders for social work and spiritual care visits one time and PRN. No evidence of a routine frequency. Corrected on site. Patient 4: The medical records contained orders for social work and spiritual care visits one time and PRN. No evidence of a routine frequency. Corrected

Upon patient record review, 6 of 14 (Patients #5,#6,#7,#8,#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 5: Upon interview during home visit, the caregiver stated the patient has not been taking the hydralazine. There was no evidence the hospice received an order to discontinue the medication. Patient 6: The medical record contained nursing documentation 7/3/25 and 7/17/25 identifying patient wounds to coccyx and bilateral heels. There was no evidence of orders for wound care. Patient 7: The medical record contained nursing documentation upon admission identifying non-healing wounds and 7/28/25 identifying patient wounds to bilateral back of shoulders and coccyx. There was no evidence of orders for wound care. Corrected on site with orders received. Patient 8: The medical record contained an order for Miralax oral powder with no instructions to mix with a diluent. Corrected on site with order clarification. Patient 9: Upon observation during home visit, the board and care home and hospice medication orders did not match. The home had an order for Senna plus instead of Senna and did not have an order for naproxen. There was no evidence the hospice received an order to discontinue the medication. Patient 10: The medical record contained nursing documentation upon admission identifying multiple wounds on bilateral elbows and knees, and documentation 8/1/25 stating wound care to continue as ordered. There was no evidence of orders for wound care. Corrected on site with orders received.

Upon patient record review, 10 of 14 (Patients #1,#2,#3,#4,#5,#6,#7,#8,#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 equipment and supply needs. Patient 1: The aide care plan identified use of a shower chair. There was no evidence of an order for the DME included in the plan of care. Patient 2: The medical record contained nursing documentation upon admission identifying patient use of a walker, wheelchair, hospital bed, and air mattress. There was no evidence of orders for the DME included in the plan of care. Patient 3: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair, overbed table, and suction machine. There was no evidence of orders for the DME included in the plan of care. Patient 4: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, overbed table, wheelchair, nebulizer, and suction machine, and the aide care plan identified patient use of a shower chair. There was no evidence of orders for the DME included in the plan of care. Patient 5: The medical record contained nursing documentation upon admission identifying patient use of a walker, cane, hospital bed, and air mattress. There was no evidence of orders for the DME included in the plan of care. Patient 6: The medical record contained nursing documentation upon admission identifying patient use of a wheelchair, shower chair, commode, nebulizer, and suction machine. There was no evidence of orders for the DME included in the plan of care. Patient 7: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, air mattress, wheelchair, shower chair, and commode. There was no evidence of orders for the DME included in the plan of care. Patient 8: The medical record contained nursing documentation upon admission identifying patient use of a walker, wheelchair, hospital bed, air mattress, overbed table, and commode. There was no evidence of orders for the DME included in the plan of care. Patient 9: The aide care plan identified patient use of a shower chair. There was no evidence of an order for the DME included in the plan of care. Patient 10: The medical record contained nursing documentation upon admission identifying patient use of a hospital bed, air mattress, overbed table, and wheelchair. There was no evidence of orders for the DME included in the plan of care.

Upon patient record review, 5 of 14 (Patients #1,#3,#6,#7,#10) 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 medical records contained orders for social work and spiritual care visits one time and PRN. The social worker and spiritual care provider were completing monthly visits since admission with the exception of no spiritual visit in May. Patient 3: The medical records contained orders for social work and spiritual care visits one time and PRN. The social worker and spiritual care provider were completing monthly visits since admission and two spiritual care visits in June. Patient 6,7: The medical records contained orders for social work and spiritual care visits one time and PRN. The social worker and spiritual care provider were completing monthly visits since admission. Patient 10: The medical records contained orders for one to three nursing visits weekly. There were five scheduled nursing visits completed the week of 7/27/25.

Upon observation, there was no evidence the hospice documents what QAPI projects are being conducted, the reasons for conducting these projects, and the measurable progress achieved on these projects.

Upon patient record review, 3 of 14 (Patients #2,#6,#7) did not have evidence in the patient record that hospice aide assignments and duties are specific to patient needs. Patient 2: The medical record contained an order for oxygen via nasal cannula. The aide care plan contained instructions for oxygen via a mask. Corrected on site with aide care plan update. Patient 6: The medical record contained nursing documentation 7/3/25 and 7/17/25 identifying patient wounds to coccyx and bilateral heels. There was no evidence of instructions on the aide care plan regarding the wounds. Corrected on site with aide care plan update. Patient 7: The medical record contained nursing documentation upon admission and 7/28/25 identifying patient wounds to coccyx and bilateral back of shoulders. There was no evidence of instructions on the aide care plan regarding the wounds. Corrected on site with aide care plan update.

Upon patient record review 1 of 14 (Patient #3) 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 3: The medical record contained an order for aide visits three times weekly. Five aide visits were completed the weeks of 6/22/25 and 6/29/25, and four visits were completed the week of 7/6/25.

Upon patient record review 1 of 14 (Patient #10) 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 10: There was no evidence of aide supervision by the RN from admission 7/8/25 until 8/1/25.

Upon contract review, (Medical Director Contract, Alternate Medical Director Contract) did not have evidence of a contract to fulfill the role of medical director or alternate medical director. There was no differentiation in the contracts to designate who was taking responsibility as the Medical Director. Both contracts were for Medical Director.

Upon patient record review, 4 of 14 (Patients #1,#3,#4,#6) 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. Patient 1: The CTI for benefit period two starting 6/12/25 was written 6/22/25. There was no evidence of a timely verbal authorization received. Patient 3: The CTI for benefit period two starting 3/26/25 was written 4/4/25. There was no evidence of a timely verbal authorization received. Patient 4: The CTI for benefit period two starting 4/24/25 was written 5/27/25. There was no evidence of a timely verbal authorization received. Patient 6: The CTI for benefit period twelve starting 5/19/25 was written 5/27/25, and benefit period thirteen starting 7/18/25 was written 7/22/25. There was no evidence of a timely verbal authorizations received.

Upon patient record review, 1 of 14 (Patient #6) did not have evidence that each patient record contains Advance Directives. Patient 6: The medical record contained admission consents identifying patient has a power of attorney for medical care. There was no evidence the hospice had a copy of the documentation.

Upon patient record review, 1 of 14 (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 date of election section on the election form was incomplete and left blank.

Upon inpatient contract review, Rehab Center of Bakersfield contract did not have evidence that the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility; that a copy of the discharge summary be provided to the hospice at the time of discharge; and that a copy of the inpatient clinical record is available to the hospice at the time of discharge.

Upon observation, there was no evidence the hospice provides orientation to personnel of a SNF/NF or ICF/IID regarding the policies and procedures of the provision of care/service including all required content.

Upon client record review, 2 of 5 (Patient #2, 3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2 A routine visit was made by the spiritual care coordinator on 5/13/22 but the plan of care does not contain orders for SC services. Patient #3 A routine visit was made by the spiritual care coordinator on 5/6/22 but the plan of care does not contain orders for SC services.

Upon patient record review, 3 of 3 applicable (Patient #1, 2, 3) 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 Patients 1, 2, 3 The hospice aid plan of care does not reflect the frequency for performing the following tasks: shower/bath, shampoo, oral care, nail care and dressing. Patient 3 The RN and LVN documentation in the patient record since 1/29/22 reports that the patient is in a bedbound state and receives a bed bath, the Hospice Aide assignment is not updated to reflect the changes from a shower chair to bed bath for her care.