Every finding on record at Los Robles Healthcare LLC

It is required that the documented comprehensive assessment includes a drug profile that contains the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. This standard was not met as evidenced by clinical record review, observation, and interview. In 1 of 19 (5%) clinical records reviewed and home visit observations it was revealed that the agency did not ensure the drug profile contained the patient's current prescription and over-the-counter (OTC) drugs; supplements; herbal remedies; and other alternative treatments that could affect drug therapy. CLINCIAL RECORD 2/HOME VISIT 2: The patient elected the hospice benefit on 10/08/2024 and resided in an assisted living facility (ALF). During the visit with the Social Worker (Personnel Record 5) on 03/19/2025, the hospice medication profile (printed on 03/19/2025) was compared with the ALF medication profile (printed on 03/19/2025). The ALF medication profile documented the following medications that were not included on the hospice medication list: Tramadol 50 mg, take 1 or 2 tablets by mouth every 6 hours as needed for mild or moderate/severe pain (dated 10/14/2024). The facility also listed the following medication: Acetaminophen ES 500 mg. Take 2 tablets by mouth twice a day as needed for pain (dated 12/12/2024) which was a discrepancy from the hospice which listed: Acetaminophen ES 500 mg take 2 tablets by mouth every 6 hours as needed for pain. An interview and joint clinical record review was conducted with the Administrator/Director of Patient Care Services on 03/20/2025 in which he stated these medications "should have been reconciled before this date." he

It is required that written patient care instructions for a hospice aide are prepared by a RN who is responsible for the supervision of the hospice aide. This standard was not met as evidenced by clinical record review, observation, and interview. In 1 of 18 (6%) clinical records reviewed in which aide services were accepted revealed the agency did not ensure the registered nurse provided the hospice aide with specific written patient care instructions. CLINICAL RECORD 8: The hospice aide care plans dated 03/14/2024 and 06/12/2024 included the following relevant tasks: foot care, peri-care, skincare, check pressure areas, showering, incontinent care, and take dressing supplies every visit. The aide care plans dated 09/10/2024, 11/09/2024, 01//08/2025 and 03/14/2025 included the following relevant tasks: foot care, peri-care, skin care, check pressure areas, bed bath, incontinent care, take dressing supplies every visit. All tasks were to be completed every visit with an aide visit frequency of twice weekly. The initial nursing assessment dated 03/14/2024 noted "wound on left toe, covered with dressing. Left heel covered with foam dressing and wrapped with kerlix. Right buttock. Apply Calmoseptine with brief change. Frequency of 2x week." A physician order was written on 01/24/2025 which stated, "wound care to right toe to cover with bordered gauze." The clinical record review revealed the wounds continued throughout the benefit periods and were still present on the review date of 03/18/2025. The hospice aide care plan was not updated to notify the aide of the wounds or to provide the aide with specific instructions to notify the RN if the dressings became soiled, dislodged or wet. An interview and joint clinical record review was conducted with the Administrator/DPCS on 03/20/2025 in which it was agreed specific instructions for the wounds had not been included in the aide care plan.

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. This standard was not met as evidenced by document review and interview. Document review of the volunteer program revealed the agency did not ensure hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. An interview and document review were conducted with the Administrator and Clinical Supervisor on 03/20/2025 who reported that the agency's total volunteer hours documented for the past year (February 2024 to February 2025) in either an administrative or patient care role, was 0.34%. A new Volunteer Coordinator was hired in January 2025 and per the Clinical Supervisor "was already influential in bringing aboard new volunteers." Document review of the volunteer program revealed the agency did not ensure hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. An interview and document review was conducted with the Administrator and Clinical Supervisor on 03/20/2025 who reported that the agency's volunteer hours documented for the past year (February 2024 to February 2025) in either an administrative or patient care role, was 0.34%. A new Volunteer Coordinator was hired in January 2025 and per the Clinical Supervisor "was already influential in bringing aboard new volunteers."

It is required that the hospice medical director or physician-designee provides written and signed recertification of the terminal illness to meet the hospice care benefit requirement. Recertification is completed no later than two (2) calendar days after the first day of each benefit period, and no more than fifteen (15) days before the next benefit period begins. This standard was not met as evidenced by clinical record review and interview. In 1 of 10 (10%) clinical records reviewed, in which a recertification of terminal illness was required, it was revealed that the agency did not ensure the recertification was completed no later than two (2) calendar days after the first day of each benefit period, and no more than fifteen (15) days before the next benefit period begins. CLINICAL RECORD 2: The recertification of terminal illness, for Benefit Period 4 which started on 03/07/2025, was signed by the hospice physician as completed on 02/20/2025, sixteen days (16) before the next benefit period began or 1 day early. An interview and joint clinical record review was conducted with the Administrator/DPCS on 03/20/2025 in which it was agreed the recertification was 1 day outside the required timeline.

It is required that a hospice aide provides services: Ordered by the Interdisciplinary Group; Included in the plan of care; Permitted to be performed under state law and regulation; Consistent with the hospice aide training. This standard was not met as evidenced by clinical record review and interview. 1 of 12 (8%) applicable records, in which the hospice aide was accepted, revealed the agency did not ensure the hospice aide followed the aide care plan. Record #36997 (election of benefit 11/22/2021): Hospice aide plan of care order, (effective 2/20/2022) was for the patient to receive a shower. On the following dates a bed bath was documented 3/15/2022, 4/14/2022, 4/19/2022, 4/21/2022, 4/26/2022, 5/3/2022, 5/5/2022, 5/10/2022, 5/12/2022. There was no documentation that the patient refused a shower or that the RN case manager was notified. An interview with the Clinical Supervisor (Staff ID: 65341) acknowledged that the aide provided a bed bath instead of a shower on the dates noted above and did not follow the plan of care orders.