Providence at Home With Compassus Hospice Care La County

“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 2 of 6 (33%) home visits observed and clinical records reviewed, the agency did not ensure that the comprehensive assessment included a drug profile that contained the patient’s current prescription and over-the-counter (OTC) drugs, supplements, herbal remedies, and other alternative treatments that could affect drug therapy. HOME VISIT 1/CLINICAL RECORD 1: The patient elected the hospice benefit on 05/07/2026 with a diagnosis of anoxic brain injury. The patient resided in a skilled nursing facility (SNF). During the home visit with the registered nurse (RN) (Personnel Record 7) on 07/21/2026, the hospice medication profile (printed on 07/20/2026) was compared to the SNF medication profile (printed on 07/21/2026). The hospice medication profile documented the following medication not documented on the SNF medication profile: “Acetaminophen 650 mg suppository every 4 hours as needed (ordered 05/07/2026).” Additionally, the hospice medication profile documented: “Artificial tears,1 drop twice daily as needed (ordered 07/17/2026), and the SNF medication profile documented Artificial tears, 1 drop every 8 hours as needed (ordered 06/20/2026).” The SNF medication profile documented the following medications not documented on the hospice medication profile: “Acetaminophen 325 mg, give 2 tablets every 6 hours as needed (ordered 06/20/2026). Acetaminophen 500 mg, give 1 tablet every 6 hours as needed (ordered 06/20/2026); Ophthalmic solution, 1 drop both eyes three times daily (ordered 06/20/2026); Lantus 23 units at bedtime (ordered 06/20/2026); Acetaminophen 325 mg, 2 tablets daily (ordered 06/20/2026); Docusate 100 mg, 1 tablet daily (ordered 06/20/2026); Calcium carbonate 500 mg, one tablet 2 times daily (ordered 06/20/2026), milk of magnesia 400 mg/ml, 30 ml daily as needed (ordered 06/20/2026); and Pro-Stat oral liquid, 30 ml by mouth two times daily (ordered 06/20/2026).” HOME VISIT 2/CLINICAL RECORD 2: The patient elected the hospice benefit on 07/13/2026 with a diagnosis of Alzheimer’s disease. The patient resided in an assisted living facility (ALF). During the home visit with the hospice aide (Personnel Record 11) on 07/21/2026, the hospice medication profile (printed on 07/20/2026) was compared to the ALF medication profile (printed on 07/21/2026). The ALF medication profile documented the following medication not documented on the hospice medication profile: “Quetiapine 25 mg, half tablet twice daily as needed (ordered 05/08/2026).” During a joint clinical record review and interview on 07/21/2026, the Director of Quality explained that medication reconciliation was conducted at least weekly.”

“It is required that each patient’s individualized written plan of care: reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments This standard was not met as evidenced by clinical record review and interview. In 1 of 27 (4%) clinical records reviewed, the agency did not ensure that the patient’s individualized written plan of care identified planned interventions based on problems identified in the initial and updated comprehensive assessments. CLINICAL RECORD 26: The patient elected the hospice benefit on 09/11/2025 with a diagnosis of aortic aneurysm. The Skilled Nursing (SN) visit note dated 11/24/2025 documented: “Patient obtunded on arrival. Excessive secretions when breathing. Coughing excessively during visit. Placed on daily visits. Discussed end of life care.” The SN visit note dated 11/25/2025 documented: “Patient obtunded. Cheyne-Stokes breathing. Periods of apnea. Now on continuous oxygen.” The SN visit note dated 11/27/2025 documented: “Mildly agitated and with respiratory distress. Respiratory rate 32. Patient having dysphagia. Education provided to family.” The POC was not updated to include planned interventions based on the patient’s respiratory problems identified in SN assessments. An interview and joint clinical record review were conducted with the Director of Quality on 07/24/2024. During that time, the Director of Quality agreed that significant improvements were needed to their plans of care. The Director of Quality stated that the “EMR (electronic medical record) was newer to them; however, they still had several areas where they could use improvement.””

“It is required that the hospice follows accepted standards of practice to prevent the transmission of infections and communicable disease, including the use of standard precautions, such as: hand hygiene; use of gloves, mask, eye protection, or face shield depending on anticipated exposure; safe handling of equipment in the patient’s care environment if it is likely to have been contaminated with body fluids; and safe handling of soiled items in the patient’s care environment. This standard was not met as evidenced by document review, interview, and observation. In 1 of 6 (17%) home visits, the agency did not ensure the staff followed accepted standards of practice to prevent the transmission of infections and communicable diseases as required by agency policy. Agency policy #IPC.11_A2 “Infection Control: Bag Technique and Standard Precautions Procedure” (effective 08/09/2022) (revised 06/02/2026) stated in relevant part(s): “Hand Hygiene Appropriate hand hygiene is the gold standard. Should be done before direct patient contact and after direct patient contact. Before donning gloves and after removing gloves. After contact with body fluids when they are not visibly soiled. Moving between clean/contaminated body surfaces/sites.” HOME VISIT 2/CLINICAL RECORD 2: The patient elected the hospice benefit on 07/13/2026 for the diagnosis of Alzheimer’s disease. The patient resided in an assisted living facility (ALF). During the home visit with the hospice aide (aide) (Personnel Record 11) on 07/21/2026, the aide was observed cleaning the patient’s peri area and buttocks and then, without changing gloves, the aide applied lotion to the patient’s upper body. The aide did not use hand hygiene after moving between clean/contaminated body surfaces per the agency’s policy. The Director of Quality, present during the visit, confirmed the finding and stated that the “aide will be provided with re-training regarding infection control.””

“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 4 of 15 (27%) clinical records reviewed and home visits observed in which hospice aide services were accepted, the agency did not ensure the registered nurse provided specific written instructions for the hospice aide. CLINICAL RECORD 2/HOME VISIT 2: The patient elected the hospice benefit on 07/13/2026 for the diagnosis of Alzheimer’s disease. The patient resided in an assisted living facility (ALF). The hospice aide care plan dated 07/13/2026 included the following relevant tasks: “Fall precautions, turn and position in bed, bathing (bed), bathing (partial sponge bath), shampoo, hair care, skin care, perineal care, oral care, dressing, HOB (head of bed) elevated, relieve pressure points, position for comfort, transfer to/from bed/chair, empty trash, change linens, date of last BM (bowel movement), provide comfort and support, side rails up for positioning and assistance, side rails up for safety.” All tasks were to be completed every visit with an aide visit frequency of once weekly. The aide care plan had two bath types listed and did not give specific instructions for the aide describing the bath type to be given. During the home visit with the hospice aide (Personnel Record 11) on 07/21/2026, the ALF staff advised the hospice aide to “remember to remove the patient’s hearing aid in the right ear as one had already been misplaced.” The hearing aid was not reported in the aide care plan, and the aide was not provided with specific instructions for the removal of the hearing aid. CLINICAL RECORD 6: The patient elected the hospice benefit on 04/28/2026 with a diagnosis of amyotrophic lateral sclerosis (ALS). The hospice aide care plan dated 04/30/2026 included the following relevant tasks: “Bathing (bed), dressing, foot care, hair care, HOB (head of bed) elevated, nail care, oral care, perineal care, shampoo, skin care, change linens, empty trash, narrative note, RN communication for incomplete tasks, bleeding precautions, fall precautions, infection precautions, oxygen precautions.” All tasks were to be completed every visit with an aide visit frequency of twice weekly. A physician order dated 04/30/2026 and the initial nursing assessment noted the patient to be on a “continuous BiPAP for his hospice diagnosis of ALS.” The aide care plan did not provide the aide with specific instructions for oral care due to the BiPAP (Bilevel Positive Airway Pressure) machine. CLINICAL RECORD 14: The patient elected the hospice benefit on 02/27/2026 with a diagnosis of Alzheimer’s disease. The patient resided in an ALF. The hospice aide care plan dated 03/02/2026 included the relevant tasks of “Transfer to/from bed/chair with mechanical lift every visit and PRN (as needed) and bathing (bed).” The aide care plan did not include assistance with dressing. The physician’s certification of terminal illness dated 04/02/2026 noted the patient to have “severe contractures.” The contractures were not noted in the hospice aide care plan, and the PRN use of the mechanical lift was not specific. CLINICAL RECORD 15: The patient elected the hospice benefit on 04/23/2026 with a diagnosis of Parkinson’s disease. The patient resided in a skilled nursing facility (SNF). The hospice aide care plan dated 04/23/2026 included the following relevant tasks: “Bathing (bed), hair care, oral care, perineal care, position for comfort, relieve pressure points, shampoo, turn and position in bed, fall precautions.” All tasks were to be completed every visit with an aide frequency of once weekly. A physician’s order dated 06/03/2026 ordered: “Cleanse sacral wound with wound cleanser/NS (normal saline), pat dry, apply quarter size amount of hydrogel, cover with bordered gauze daily and as needed if soiled. SNF (skilled nursing facility) nurse to provide wound care in absence of hospice nurse.” The aide care plan did not include documentation of the wound or provide the aide with instructions for the dressing during the bath, should the dressing become soiled, wet, or dislodged. An interview and joint clinical record review were conducted with the Director of Quality on 07/22/2026. The Director of Quality stated: “They were working with the staff on improving the aide care plans.””

“It is required that a hospice aide provides services: included in the plan of care. This standard was not met as evidenced by clinical record review, interview, and observation. In 1 of 15 (7%) clinical records reviewed and home visits observed in which aide services were accepted, the agency did not ensure that the hospice aide provided services included in the plan of care. CLINICAL RECORD 2/ HOME VISIT 2: The patient elected the hospice benefit on 07/13/2026 with a diagnosis of Alzheimer’s disease. The patient resided in an assisted living facility (ALF). The hospice aide care plan dated 07/13/2026 included the following relevant tasks: “Fall precautions, turn and position in bed, bathing (bed), bathing (partial sponge bath), shampoo, hair care, skin care, perineal care, oral care, dressing, HOB (head of bed) elevated, relieve pressure points, position for comfort, transfer to/from bed/chair, empty trash, change linens, date of last BM (bowel movement), provide comfort and support, side rails up for positioning and assistance, side rails up for safety.” All tasks were to be completed every visit with an aide visit frequency of once weekly. During the home visit with the hospice aide (Personnel Record 11) on 07/21/2026, the aide did not complete the tasks of changing linens or oral care. During the home visit, the Assisted Living Facility (ALF) staff advised the hospice aide to “remember to remove the patient’s hearing aid in the right ear as one had already been misplaced.” The aide was observed removing the patient’s hearing aid from the right ear, which was not an assigned task. The Director of Quality, present during the visit, confirmed the aide did not complete all assigned tasks included in the plan of care. During an interview and joint clinical record review conducted with the Director of Quality on 07/22/2026, the Director of Quality stated: “The aides should be following the plan of care as written or call the registered nurse to adjust it.””