Every finding on record at True Care Hospice Southern California, Inc.

Upon patient record review, 2 of 14 (Patient #1,#2) did not have evidence in the patient record that a review was completed of all prescription and non-prescription medications, including herbal remedies that could affect drug therapy. This review includes, but is not limited to: • Effectiveness of drug therapy • Drug side effects • Actual or potential drug interactions • Duplicate drug therapy • Drug therapy currently associated with laboratory monitoring Patient 1: Facility medication profile contains Morphine 10mg/5ml administer 0.5ml Q3H PRN, however, the hospice medication profile contains Morphine 20mg/ml administer 0.5ml Q3H PRN. Patient 2: Medication profile contains Polyethylene Glycol powder with no instructions for diluent.

Upon patient record review, 3 of 14 (Patient #1,#6,#8) 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: Patient was identified as an aspiration risk upon admission, however, there is no evidence of problems, goals and interventions for aspiration precautions. Patient has been taking an anticoagulant since admission with no evidence of a care plan for risk for bleeding. Patient 6: Patient has been taking an anticoagulant since admission with no evidence of a care plan for bleeding risk. Patient 8: Patient has been taking an anticoagulant since admission with no evidence of a care plan for risk for bleeding. Also, on admission a care plan was opened for suspected blood in the stool and sample obtained. Results were negative, however, care plan remains open.

Upon patient record review, 2 of 14 (Patient #1,#2) 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 1: Facility medical record contains an order for Morphine 10mg/5ml, to administer 0.5ml Q3H PRN, however, there is an order in the hospice medical record for Morphine 20mg/ml, to administer 0.5ml Q3H PRN. Patient 2: Order for Polyethylene Glycol powder contains no instructions for diluent.

Upon patient record review, 4 of 14 (Patient #1,#5,#6,#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: In the home, patient has an e-tank, bedside commode, and shower chair with no evidence of orders in the plan of care. In addition, DME order on 12/15/25 for hospital bed with 1/2 rails. On 2/18/26 another DME order was obtained for full rails due to fall risk, however, home visit confirmed patient still has 1/2 rails the plan of care for DME was not updated. Patient 5: On admission, patient identified as using a walker, and in the home, patient has a bedside commode. However, there was no evidence of orders in the plan of care for DME. Patient 6: On admission, patient identified as using a walker, and in the home, patient has an e-tank, portable oxygen concentrator, and wheelchair. However, there was no evidence of orders for the DME. Patient 10: Patient identified on admission as using a walker, however, there was no evidence of orders in the plan of care.

Upon patient record review, 2 of 14 (Patient #2,#6) did not have evidence that a revised plan of care includes information from the patient's updated comprehensive assessment and must note the patient's progress towards outcome/goals from the plan of care. Patient 2: Care Plan opened on 2/9/26 for vaginal discharge related to antibiotic therapy. However, the problem was resolved but care plan remained open. Patient 6: 3 care plans are open for potential for altered neuro status; increased agitation. The care plan on 5/26/25 with intervention of Seroquel 25mg BID, 8/26/25 with intervention of Seroquel 50mg BID and 12/19/25 with intervention of Seroquel 75mg BID which is current. The other 2 care plans should have been discontinued.

Upon patient record review, 4 of 14 (Patient #1,#2,#6,#10) 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 Patient 1,6: Patient taking an anticoagulant, however no evidence of bleeding precautions on the aide care plan. Patient 2: Patient taking an anticoagulant, however no evidence of bleeding precautions on the aide care plan. Also, there was no frequency instructions for task to empty foley collection bag. Patient 10: Admission POC contains order for wheelchair and bedrails, however, there was no tasks or instructions in the aide care plan. Patient also identified on admission as a standby assist when using a walker, however, no instruction provided for standby assist on the aide care plan.

Upon patient record review 1 of 14 (Patient #1) 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 1: Supervisory visit was made on 1/25/26 and not another supervisory visit until 2/16/26. On 2/6/26, RN documented supervision of LVN and Aide, but only the LVN supervision section was completed.

Upon patient client record review, 1 of 14 (Patient #2) 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 2: On admission, patient is identified as incontinent and foley is not marked in the genitourinary section, however narrative documentation states patient has a 16F 10cc balloon foley catheter.

Upon patient record review 1 of 11 (Patient #6) 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 #6: SOC 11/7/22. Psychosocial assessment was completed 11/30/22.

Upon patient record review, 3 of 11 (Patient #2, 3, 5) 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 #2: Although there is a specific physician order, under GU Problems of IDG POC, it is noted "Foley catheter ______ to dependent drainage. Change Foley catheter monthly and prn." Catheter size is left blank and not specified. Also, PRN circumstance for catheter change is not specified in POC. Patient has wounds with MD orders in place, however, there is no integumentary related problem/interventions/goals for IDG POC. These are applicable for initial 12/23/22 and 1/6/23 subsequent POC update. Patient #3: Patient is on Oxygen therapy. Although there is a specific order, under Respiratory Problem, intervention says "Oxygen as ordered __ at __ l/min." for IDG/POC 12/23/22 and 1/6/23. Patient #5: Patient has suprapubic Foley catheter with related MD orders in place. (The MD order specifies monthly change and change if dislodged). However the IDG POC identifies catheter as "Suprapubic Catheter _________(size) to dependent drainage... Cath to be changed as ordered"." The size of catheter is left blank initial POC 10/25/22 and all subsequent updates.

Upon patient record review, 9 of 11 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9) 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. Patient #1, 2, 3, 4, 5, 6, 7, 9: SC 1 and PRN. MSW 1 and PRN. Patient #8: SN 2/wk and ??? prn. SC 1 and PRN. MSW 1 and PRN.

Upon client record review, 4 of 11 (Patient #4, 6, 10, 11) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #4: SOC 10/25/22. Patient admitted with suprapubic Foley catheter and initial order to change monthly. Foley was changed Oct, Nov, and January. There was no documented change for month of Dec. Patient #6: SOC 11/7/22. SC frequency ordered as 1x and prn. A second SC visit was made 12/10/22 without an order. There was no documentation to suggest that the visit was PRN. Patient #10: SC order for eval only. SC visits were made monthly 8/31/22, 9/30/22, 10/28/22. Patient #11: SC visit order eval only. In addition to initial assessment visit, SC visit was made 5/21/22. SW frequency was ordered monthly and was provided monthly except month of May. There was no SW visit for May.

Upon personnel record review, 1 of 12 (Personnel #4) did not have evidence in the personnel file that the following competency assessment was performed by the aide with a patient: (This standard applies to all Hospice Aides providing care/service who are directly employed by the hospice or through a contractual agreement.) ·(C) Shampoo, sink, tub, and bed The HA competency form utilized by the agency to document shampoo does not specify sink, tub and bed type shampoos, therefore the specific competencies can not be verified.

Upon personnel record review, 3 of 12 (Personnel #10, 11, 12) did not have evidence the hospice employees and contract employees have received orientation on the hospice philosophy.

Upon patient record review, 1 of 11 (Patient #1) did not have evidence that the medical director or physician designee provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. The physician must consider the following when making this determination: • The primary terminal condition • Related diagnosis • Current subjective and objective medical findings • Current medication and treatment orders • Information about the medical management of any of the patient's conditions unrelated to the terminal illness Patient #1: EMR identifies patient's primary dx as Alzheimer's Disease with co-morbidities including malnutrition. 12/7/22 CTI narrative by hospice physician identifies Moderate Protein-Caloric Malnutrition (E44.0) as primary dx for hospice admission with Dementia as secondary dx. Confirmed terminal diagnosis is Alzheimer's.