Every finding on record at Los Robles Hospice Inc

It is required that hospice aides are supervised by a registered nurse who makes 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 ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. This standard was not met as evidenced by clinical record review, document review and interview. In 3 of 18 (17%) clinical record review revealed the agency did not ensure that the hospice aides were supervised by a registered nurse with an on-site visit no less frequently than every 14 days. Document 1: The agency policy no 1-031, titled Responsibilities/supervision of clinical services (revised May 2023) stated in part, "Hospice aide supervisory visits will be conducted on-site at least every two (2) weeks by a hospice registered nurse. Supervisory visits can be made in conjunction with the hospice aide or in his/her absence." CLINICAL RECORD 2: The hospice benefit was elected on 08/13/2024. The clinical record review lacked evidence of aide supervisory visits being conducted on-site at least every 2 weeks. During the benefit period from 11/11/2024 to 02/08/2025, hospice aide frequency was ordered two times a week. The patient was seen as ordered. Aide supervisory visits were conducted on 11/11/2024, 11/25/2024, 12/09/2024, 12/17/2024, 01/07/2025 (21 days), 01/21/2025, and 02/03/2025. CLINICAL RECORD 13: The hospice benefit was elected on 04/01/2024. The clinical record review lacked evidence of aide supervisory visits being conducted on-site at least every 2 weeks. During the benefit period from 04/01/2024 to 05/30/2024, hospice aide frequency was ordered two times a week. The patient was seen as ordered. Aide supervisory visits were conducted on 04/15/2024, 04/29/2024, 05/13/2024, and 05/28/2024 (15 days). CLINICAL RECORD 14: The hospice benefit was elected on 01/12/2024. The clinical record review lacked evidence of aide supervisory visits being conducted on-site at least every 2 weeks. During the benefit period from 01/06/2025 to 03/06/2025, hospice aide frequency was ordered three times a week. The patient was seen as ordered starting on 01/06/2025. Aide supervisory visits were conducted on 01/17/2025, 01/30/2025, and 02/14/2025 (15 days). During an interview with the Director of Patient Care Services on 02/26/2025, she stated that they have been diligently working on aide supervision visits.

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. The medication review process includes the identification of the following: the effectiveness of drug therapy; drug side effects; actual or potential drug interactions; duplicate drug therapy; and drug therapy associated with laboratory monitoring. The assessment includes evidence that common side effects of medication in the hospice populations are anticipated, and, as appropriate, preventive measurements are implemented to manage the side effects. The drug profile is updated per the hospice policy and procedure, but, at minimum, at the time of each comprehensive assessment and/or when a new medication is added or changes are made to existing medication. This standard was not met as evidenced by clinical record review, observation, and interview. This standard was not met as evidenced by a review of clinical records, document review, and observation. 1 of 3 (33%) observations during home visits revealed the drug profile was not updated at the time of each comprehensive assessment. Record #27110: (Election of Hospice Benefit) 7/12/2021) Order dated 7/15/2021 for Atorvastatin 40 mg 2 tablets every evening, discontinue after current supply completely. On 5/9/2022, during the onsite review of the medication profile (Staff ID #46005), the patient was still receiving Atorvastatin 40 mg, two tablets every evening. The RN Case Manager followed up with the facility staff/physician, and the medication was discontinued on 5/9/2022. An interview with the Director of Clinical Services (Staff ID: #24328) and RN (Staff ID: #46005) acknowledged that the medication was not discontinued as ordered at admission.

It is required that a hospice aide provides services ordered by the Interdisciplinary Group and Included in the plan of care. This standard was not met as evidenced by clinical record review and interview. 1 of 11 (9%) applicable records, in which the hospice aide was accepted, revealed the agency failed to provide documented evidence that the hospice aide was compliant with visits as assigned in the hospice plan of care and/or physician’s orders. Record #91817 (election of benefit 3/30/2022): Hospice aide plan of a care order, (effective 3/30/2022) was for two visits per week, there were no aide visits documented in the clinical record until 4/4/2022. There was no documentation of why the visits were missed or documentation of communication with the Registered Nurse. An interview with the Director of Clinical Services (Staff ID: #24328) acknowledged that the documented aide visits for the first week of care did not follow the plan of care orders.