Every finding on record at Pristine Hospice, Inc.

Observed in Emergency Management Session. During review of the organization emergency management plan it was noted lack of a disaster drill in 2025. This was discussed with the Administrator.

Observed in Record Review. In 3 of 5 patient records reviewed, During HV#1, D/CRR1 and 2 record reviews it was noted lack of inclusion on the consent forms of the patient's right of the choice of physician to provide care. This was discussed with the Administrator and DPCS.

Observed in Record Review. In 1 of 5 patient records reviewed, During HV#1 record review it was noted lack of an assessment of the patient's diabetic status during the initial RN assessment however diabetes was listed as a problem on the POC. This was discussed with the Administrator.

Observed in Record Review. In 5 of 5 patient records reviewed, During HV#1 record review it was noted the goals established lacked outcome time frames to be accomplished as follows: cardiac goals: Prevent discomfort due to increasing edema, Pt will verbalize and/or express decreased episodes of chest pain, Achieve and maintain peripheral circulation for Pt comfort and Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. The goals for diabetes: Assess Pt. status for on-going care, Prevent hospitalization and Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects are non specific without end dates or reference to diabetes. The goal for the MSW is an intervention: SW will educate Pt and family to express feelings and emotions and to be learned on progression of Pt`s illness, the dying process, and grieving. During D/CRR#1 it was noted lack of goals on the POC for the skilled nursing serivces. During HV#2 record review it was noted the following goals lacked specificity and were without end points to assess if accomplished: anxiety: Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. pain: Family/PCG will verbalize understanding of non-verbal signs of pain, Pain will remain in comfortable level during care, Pt/Family/PCG will verbalize confidence in the management of patient`s pain, .Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects, Altered sleep: Promote rest status for Pt/Family/PCG, Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects, spiritual: Family/PCG will freely verbalize receiving desired spiritual support and whatever else would be needed while patient is declining within the benefit period and the MSW goal was an intervention as follows: SW will continue to establish a trusting relationship with Pt/Family/PCG. During D/CRR#2 it was noted lack of goals on the POC for the skilled nursing service. During HV#3 record review it was noted the following goals lacked time frames to assess progress as follows: bowel elimination problem goal: Potential for altered bowel elimination r/t;-Abnormal Stool, Ascites, Constipation, Agitation: Pt needs will be met on a day to day basis as communicated, Will minimize episodes of confusion and forgetfulness, Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects. Pain: Family/PCG will verbalize understanding of non-verbal signs of pain, Keep pain below SIT level for comfort, Pain will remain in comfortable level during care, Pt will have increased comfort/satisfaction from pain /discomfort as exhibited by verbal and non-verbal communications, Pt/Family/PCG will verbalize confidence in the management of patient`s pain. MSW goal is an intervention: SW will continue to establish a trusting relationship with Family/PCG. Sleep: Promote rest status for Pt/Family/PCG, Pt/pcg will verbalize/express understanding of medication /treatment orders and side effects, Spiritual: Family/PCG will freely verbalize receiving desired spiritual support and whatever else would be needed while patient is declining within the benefit period This was discussed with the Administrator.

Observed in Record Review. In 3 of 5 patient records reviewed, During D/CRR#1 it was noted lack of skilled nursing interventions on the POC related to the patient's terminal diagnosis and palliative needs. During HV#2 it was noted on the RN initial assessment the patient was at high risk for falls, skin breakdown and nutritional issues related to decreased food intake with intermittent difficulty swallowing. The POC lacked interventions related to fall precautions, prevention of skin breakdown, prevention of aspiration and nutritional interventions related to poor appetite and intake. During HV#3 record review it was noted on the RN initial assessment a high risk for falls and skin breakdown however the POC lacked interventions related to fall prevention and skin breakdown prevention. In addition the RN documented recent patient weight loss, on a mechanical soft diet with episodes of dysphagia. The patient's daughter stated the patient intermittently pockets food in her mouth before swallowing. The POC lacked interventions related to nutrition, and aspiration precautions. On the initial RN assessment it was documented the patient had 1+ edema without indication of where the edema was located, no chest pain, BP WNL with no cardiac medications listed on the medication profile or in the home, however a cardiovascular problem was added to the POC. This was discussed with the Administrator.

Observed in Record Review. In 2 of 5 patient records reviewed, During D/CRR#1 and #2 it was noted care was not provided in accordance with the plan of care as the POC was blank for skilled nursing interventions related to the terminal diagnosis and palliative needs. In addition during D/CRR#2 it was noted the frequency of visits on the POC was noted followed. The frequency ordered was RN 1x/week however the patient was visited every other week 3 times then once a week one time prior to D/C. This was discussed with the Administrator.

Observed in HR File Review. In 1 of 10 HR files reviewed, During HR#7 file review it was noted the required aide competencies were completed, however the documentation failed to confirm competencies completed with an actual patient or a qualified pseudo patient. The competencies completed were documented as accomplished verbally. This was discussed with the Administrator.

Observed in Record Review. In 1 of 1 patient records reviewed, who received hospice aide personal care services. During HV#2 record review it was noted first aide supervisory visit was documented 54 days after the first hospice aide visit provided. This was discussed with the Administrator.

Observed in Document Review. During review of the volunteer program it was noted lack of volunteer hours documented since October 2025. This was discussed with the Administrator.

Observed in Document Review. During review of the volunteer program it was noted lack of volunteer hours documented since October 2025 to meet the minimum requirement of 5% of the total paid patient care hours.

Observed in Record Review. In 1 of 5 patient records reviewed, During D/CRR#1and D/CRR#2 it was noted lack of documentation that the IDG reviewed the POC at least every 15 days. In discussion with the Administrator the IDG meetings for both records were completed as scheduled but were not documented in the EMR. This was reviewed with the Administrator and designee.

Observed in Individual Tracer. In 1 of 3 home visits conducted, During HV#1 it was noted the following medications were not recorded accurately on the medication profile in the home and medical record. Flexeril 5 mg prescribed twice a day on the bottle label however the medication profile listed Flexeril as 100mg once a day. Fish oil was listed on the medication list as 1000 IU and the bottle dose is 1000 mg. The medication profile listed Januvia as 100mg tabs take one tab daily. The Rx bottle listed the dose as 25 mg take 1 tab daily. The patient stated he takes 4 tabs daily however the label has not been updated to reflect the dose change. This was discussed with the Administrator and DPCS.

Observed in Document Review. During review of the California State Hospice License it was noted it had expired in April 2025. In discussion with the owner the application was not received timely from CDPH, with subsequent calls to have it resent. The license renewal was sent with the accurate late fee in December 2025. As of this survey date, the check to CDPH for renewal has been cashed and organization awaiting the renewed license.

Observed in Record Review. In 4 of 5 patient records reviewed, It was found on review of 4 of 5 patient records, HV#1, HV#2, HV#3, and RR#1 that frequencies for the Chaplain and the MSW were not individualized. MSW and Chaplain frequencies consistently are at admission and at recertification only. This was verified by the Administration.

Observed in Infection Control System Tracer. In 3 of 3 mechanical room checks, It was observed on 3 of 3 home visits: HV#1, HV#2 and HV#3 that the nurse cleaned the equipment used on the patients with Lysol Wipes contrary to organization policy. Organization policy states equipment used on patients was to wiped cleaned with 70% alcohol. This was verified with the Administrator. Observed in Individual Tracer. In 2 of 3 HR files reviewed, It was observed on HV#2 and HV#3 that the nurse went into her bag with out washing or sanitizing her hands. According to organization policy hands are to washed before entering the bag. This was verified with the Administrator.

Observed in Tracer Activities. It was found on review of the volunteer program that the organization only had one volunteer and there was no documentation of recruitment of volunteers. This was verified with the Administrator.

Observed in Tracer Activities. It was found on review of the hospice volunteer program that the organization had not documented the cost savings achieved through the use of volunteers. This was verified with the Administrator/