Every finding on record at Seasons Hospice & Palliative Care of California -Orange LLC

It is required that the written Patient Bill of Rights includes the right to be informed about the scope of services the hospice provides and any specific limitations on those services. This standard was not met as evidenced by clinical record review, document review and interview. Agency policy #HOS 2-082 "Discharge From Hospice Program" (effective 01/01/2013) (last revised 02/02/2026) stated in relevant parts: "5. The case manager shall ensure that necessary paperwork is completed during the discharge visit, including the discharge or transfer summary, if applicable. If appropriate, a signed revocation form shall be completed." In 1 of 2 (50%) clinical records reviewed of live discharged patients, the agency did not ensure that the patient received information about the services covered under the hospice benefit. CLINICAL RECORD 16: The patient elected to revoke their hospice benefit on 01/21/2026 to seek aggressive treatment and the discharge summary was completed on 01/21/2026 indicating the patient revoked to enter the hospital. The revocation form signed on 01/22/2026, one (1) day after the discharge was effective. During an interview and joint clinical record review on 04/15/2026, the Regional Director of Clinical Operations and Administrator confirmed the revocation form had been signed 1 day late and the "correct reason for discharge should have probably been patient entered a non contracted facility."

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 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. In 2 of 4 (50%) home visits observed, the agency did not ensure that the comprehensive assessment included a drug profile that contained the patient's current over-the-counter (OTC) drugs and supplements. Home Visit 1/Clinical Record 1: The patient elected the hospice benefit on 03/24/2026 with a diagnosis of malignant neoplasm of urethra. The patient resided in an assisted living facility (ALF). During the home visit with the Registered Nurse (RN) [Personnel Record 4] on 04/13/2026, the hospice medication profile (printed on 04/13/2026) was compared to the medication bottles kept in a lock box in the patient's room. The RN asked the patient "if the Tylenol had been working for their headaches and the patient responded that they had been taking 1-2 daily and they had been effective. The hospice medication profile did not contain Tylenol. Permission was obtained to look in the locked medication box. The medication locked box contained the following medication not listed on the hospice medication profile: Tylenol 500 mg over the counter. The RN advised that they would "order it from the pharmacy today and place it on the hospice medication list." There was no evidence that Tylenol was reviewed with the patient's medication regimen. Home Visit 3/Clinical Record 3: The patient elected the hospice benefit on 06/23/2025 with a diagnosis of Alzheimer's disease. The patient resided in a skilled nursing facility (SNF). During the home visit with the Hospice Aide (HA) [Personnel Record 7] on 04/14/2026 the hospice medication profile (printed on 04/13/2026) was compared to the SNF medication profile (printed on 04/14/2026). The hospice medication profile contained the following medications not listed on the SNF list: acetaminophen 650 mg rectal suppository every 6 hours as needed (ordered 06/23/2025); ondansetron 4 mg every 6 hours as needed (ordered 06/23/2025); and Xanax 0.5 mg every 4 hours as needed (ordered 06/27/2025). The SNF medication profile contained the following medications not listed on the hospice list: ascorbic acid 500 mg daily (ordered 10/24/2025); multivitamin 1 unit daily (ordered 10/24/2025). The last comprehensive nursing visit was 04/13/2026. During an interview and joint clinical record review on 04/15/2026, the Regional Director of Clinical Operations and Administrator stated that the expectation was medications were reconciled weekly.

It is required that hospice aides are assigned to a specific patient by a registered nurse who is a member of the Interdisciplinary Group. 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 2 of 15 (20%) clinical records reviewed of patients who received Hospice Aide (HA) services, the agency did not ensure that the HA received written patient care instructions to meet the patient's needs.   CLINICAL RECORD 3/HOME VISIT 3:The patient elected hospice care on 06/23/2025 with a diagnosis of Alzheimer's disease. The patient resided in a skilled nursing facility (SNF). The HA care plan dated 06/23/2025 assigned the HA the relevant tasks: "Turn and position, bathing-bed bath, shampoo/style, deodorant, hair care, skin care-apply lotion too all extremities, perineal care, oral care, nail care-clean all fingernails and toenails, dressing, ear care, turn and position in bed (place pillow in between knees and under upper right arm), empty trash, change linens, date of last BM (bowel movement)." All tasks were to be completed every visit. The initial skilled nursing (SN) visit note documented the patient had "contractures to bilateral lower extremities and a severe contracture to her right hand." For the benefit period dated 02/18/2026, the plan of care ordered HA services twice weekly. During the home visit, the Hospice Aide [Personnel Record 7] was observed to be unable to open the right hand to clean the fingernails due to the contracture. The HA had not been notified of the patient's contractures, nor had specific instructions regarding this been included in the care plan. CLINICAL RECORD 14: The patient elected hospice care on 08/16/2025 with a diagnosis of hypertensive heart disease. The patient resided in a group home. The HA care plan dated 10/22/2025 assigned the HA the relevant tasks: "Bathing shower-seated, deodorant, dressing, ear care, hair care, nail care-clean nails, oral care, peri care, position with head of bed elevated, shampoo/style, skin care, turn and position in bed, change linens, empty trash, date of last BM (bowel movement)." All tasks were assigned to be completed every visit. The plans of care ordered HA services twice weekly. The skilled nursing (SN) visit note dated 03/18/2026 documented: "applied hydrocolloid dressing to buttock." The HA care plan was not updated to notify the HA of the wound and dressing on the buttock, provide specific instructions for the dressings or the wound during care, or notify the nurse if the dressing became soiled, dislodged, or wet. During an interview and joint clinical record review on 04/15/2026, the Regional Director of Clinical Operations and Administrator agreed the "aides probably had been advised about the wounds and contractures, but they hadn't been documented in the care plans."

Observed in Record Review. In 11 of 13 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including the scope and frequency of services necessary to meet the patient's and family's needs. In review of the record for HV#3, RR#1, RR#2, RR#3, RR#4, RR#5, RR#6, RR#7, RR#8, RR#9, and RR#10, the visit frequency for the MSW was documented for one (1) visit and/or prn. The established/ongoing visit frequency order for the MSW was not included in the hospice plan of care. This was reviewed and verified with the Director of Clinical Operations.

Observed in Record Review. In 1 of 13 patient records reviewed, the plan of care did not include all services needed for the palliation and management of the terminal illness and related conditions, including treatment necessary to meet the patient's needs. In RR#3, there was no frequency noted in the plan of care for the ordered wound care to the patient's abdominal wounds. This was reviewed and verified with the Director of Clinical Operations.

Observed in Record Review. In 2 of 13 patient records reviewed, the organization did not plan the patient's care by ensuring the registered nurse prepared complete written patient care instructions for the hospice aide In review of the record for HV#1 and HV#3, the hospice aide care plan prepared by the RN did not include the assistive devices used by/with the patient for transfers. This was reviewed and verified with the Director of Clinical Operations.

Observed in HR File Review. In 1 of 8 HR files reviewed, staff competence was not assessed and documented as required by organization policy or in accordance with regulation. In HR#6, the annual competency of the hospice aide was not completed/documented per organizational policy. It was noted that over the past three years, there was a year where the aide's competency was not assessed/documented. This was reviewed and verified with the Director of Business Operations.

Observed in Record Review. In 1 of 2 patient records reviewed, the organization, at the time of the hospice discharge, did not provide information regarding the patient's care, treatment, or services to other providers, including a discharge summary of the patient's current plan of care. In RR#8, there was no discharge summary completed/documented when the patient was discharged due to relocation. This was reviewed and verified with the Director of Clinical Operations.

Observed in Patient Home. In 2 of 3 home visits conducted, the organization did not take action to minimize identified safety/security risks. During HV#1, the oxygen concentrator was located at the patient's bedside. The patient was on 3 liters of oxygen per nasal cannula during visit. The Board & Care Facility caregiver indicated the back-up oxygen E-tank was being stored in a small clothes closet in the patient's room. The caregiver did not know the tank should not be stored in a closed closet. During the visit, after oxygen storage instruction was provided by the surveyor, the tank was relocated to a well-ventilated area in the room according to safety standards and organizational policy. During HV#3, it was also noted the patient's back-up E-tank was stored in the patient's closet. The facility caregiver did relocate the tank to an open/ventilated area in the room. This was reviewed and verified with the Director of Clinical Operations.

Observed in HR File Review. In 1 of 8 HR files reviewed, the organization did not define and verify staff qualifications by obtaining a criminal background check on the applicant as required by law, regulation, and the organizaiton's policy. In HR#6, a criminal background check was not conducted/documented per state and organizational requirements for the hospice aide. This was reviewed and verified with the Director of Business Operations.