Allstate Care Hospice, Inc.

“Upon patient record review 5 of 14 (Patient #1, #3, #7, #8, #9) did not have evidence in the patient record that the comprehensive assessment identifies the physical, psychosocial, emotional, and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process. Patient #1, #7, #8, #9: There was no evidence that a spiritual care comprehensive assessment or psychosocial comprehensive assessment of the patient or family was completed within the first 5 days of admission by any discipline. Patient #3: There was no evidence that a spiritual care comprehensive assessment of the patient or family was completed within the first 5 days of admission by any discipline.”

“Upon patient record review, 3 of 14 (Patient #1, #2, #3) 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: The medication profile included Magnesium Hydroxide 30 ML as needed for constipation. There was no evidence of further directions for what circumstances should the medication be administered. Patient #2: The medication profile included Tramadol 50 mg, to give 50 tablets every 4 hours as needed for pain. There was not evidence this discrepancy was identified during the medication reconciliation and notifying the physician. The medication profile indicated for Dulcolax 5 mg as needed for constipation. There was no evidence for further directions for what circumstances should the medication be administered. The medication profile is lacking clear guidelines on the medication administration of Carbidopa/Levodopa 48.75mg/193mg. The current medication profile instructs to give the patient 2-3 capsules 3 times a day. Family clarified the order as the patient is to take 3 tablets in the AM, 2 tablets at lunch and 2 tablets at bedtime. There was no evidence noted on the medication profile of the right dose and right frequency for the medication to be administered. Patient #3: The medication profile included amlodipine 5mg 1 tablet daily. There was no evidence blood pressure parameters were defined for when to hold the medication.”

“Upon patient record review, 2 of 14 (Patient #3, #12) did not have evidence in the patient record that the comprehensive assessment includes a bereavement component which includes the needs of the patient’s family and other individuals focusing on the social, spiritual, and cultural factors that may impact their ability to cope with the patient’s death. Information gathered from the initial bereavement assessment is incorporated into the plan of care and is considered in the bereavement plan of care. Patient #3: Patient was admitted on 6-30-26. There is not evidence a Bereavement Risk assessment was completed within the 5 day requirement. Patient #12: Patient was admitted on 12-15-2025. There is not evidence a Bereavement Risk assessment was completed within the 5 day requirement.”

“Upon patient record review, 2 of 14 (Patient #2,#12) did not have evidence in the patient record that the comprehensive assessment is updated including and by: • The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days Patient #2: Patient was admitted on 2-9-26. The Interdisciplinary group initial plan of care ordered skilled nursing visits 1 time per week. The medical record shows a nurse visit completed on 6-10-26. The next nurse visit occurred on 6-30-26 resulting in a 20 day gap between a comprehensive assessment being completed. Patient #12: Patient was admitted on 12-15-25. The interdisciplinary group initial plan of care ordered skilled nursing visits 2 times a week. The nurse completed a visit on 1-8-26. The next nurse visit occurred on 1-24-26 resulting in a16 day gap between a comprehensive assessment being completed.”

“Upon patient record review, 1 of 14 (Patient #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 #8: It is documented the patient has a PleurX drain. There is no evidence of a nursing problem statement, goals, interventions to reflect the management of the drain.”

“Upon patient record review, 3 of 14 (Patient #1,#2,#3) 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: The record indicated an order for Magnesium Hydroxide 30 ML as needed for constipation. There was not evidence under what circumstances should this medication be administered. Patient #2: The record indicated an order for Tramadol 50 mg. The order indicates to give 50 tablets every 4 hours as needed for pain. There was not evidence the discrepancy of quantity was clarified and updated. The record indicated an order for Dulcolax 5 mg as needed for constipation. There was not evidence under what circumstances should this medication be administered. The record indicates an order for Carbidopa/Levodopa 48.75mg/193mg indicating a range of 2-3 tablets 3 times a day. The order lacks clarity on the quantity of medication to be administered. Patient #3: The record indicated an order for Amlodipine 5mg 1 tablet daily. There was no evidence blood pressure parameters were provided indicating when to hold the medication.”

“Upon patient record review, 3 of 14 (Patient #1, #2, #3) 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: It was documented that the patient utilized a walker for short distances and wheelchair for mobility. There was not evidence the plan of care was updated to include this equipment. Patient #2: It is documented that the patient utilized a rollator, walker and cane for mobility. There was not evidence the plan of care was updated to include this equipment. Patient #3: It is documented the patient utilizes a bed, wheelchair and walker for mobility and bedside commode. There was not evidence the plan of care was updated to include this equipment.”

“Upon client record review, 2 of 14 (Patient #2, #12) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient #2: Patient was admitted on 2-9-26. The Interdisciplinary group initial plan of care ordered skilled nursing visits 1 time per week. The medical record shows a Registered Nurse visit completed on 6-10-26. The next Registered nurse visit occurred on 6-30-26 resulting in a 20 day gap between Registered nurse visits. The patient declined MSW at the time of admission. On 3-3-26 a new order present for MSW evaluation. The 5-10-26 IDG plan of care contained a MSW visit frequency of 1 x per month. The medical record shows no MSW visits have been scheduled since the comprehensive assessment on 3-3-26. There is no evidence the MSW was following the visit frequency as noted on the current plan of care. Patient #12: Patient was admitted on 12-15-25. The interdisciplinary group initial plan of care ordered skilled nursing visits 2 times a week. The Registered nurse completed a visit on 1-8-26. The next registered nurse visit occurred on 1-24-26 resulting in a16 day gap between registered nurse visits.”

“Upon patient record review, 4 of 14 (Patient #1, #4, #9,#12) 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: It was noted in the clinical documentation the patient utilized a walker to ambulate short distances and a wheelchair for mobility. There was not evidence the aide plan of care was updated to include instructions for mobility and current DME in the home. Patient #4: Upon review of the hospice aide care plan, no care tasks were initiated to be completed during the hospice aide visits. Upon review of the medical record, the aide obtained and documented vital signs during scheduled visits. The aide care plan did not include vital sign parameters or instructions on when to notify the registered nurse with any abnormal readings. Patient #9: The aide care plan has tasks for both bathing and shower marked without distinction on when to perform which type of bathing. Documentation noted in the medical record that the patient requires a Hoyer for all transfers. There is not evidence the aide care plan was updated to reflect transfers with the use of a Hoyer lift. Patient #12: The aide plan of care has shower selected to be completed weekly and bed bath selected to be completed every visit. The care plan is lacking distinction of when to provide which bathing task.”

“Upon patient record review 3 of 14 (Patient #4, #7, #12) 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 #4, #7, #12: The patient received hospice aide services. There is no evidence an aide supervisory visit was completed by the registered nurse within every 14 days to assess the quality of care and services provided by the aide.”

“Upon patient client record review, 2 of 14 (Patient #1, #2) did not have evidence that each patient record contains Advance Directives. Patient #1: The patients daughter signed the hospice election of benefit documents as the legal representative / power of attorney for the patient to initiate hospice services. There is no evidence the legal document was provided to the hospice agency and scanned into the medical record at the time of survey. Patient #2: The patients son signed legal documents on behalf of the patient to initiate hospice services as the patients power of attorney. There is no evidence the legal document was provided to the hospice agency and scanned into the medical record.”

“Upon observation, there was no evidence the patient record, whether hard copy or in electronic form, is made readily available on request by an appropriate authority and that agency is in compliance with CA Title 22. Social Security, Division 5 Licensing and Certification of Health Facilities, Home Health Agencies, Clinics, and Referral Agencies, Chapter 6.5 Hospice. Agency was unable to produce all patient records until last day of survey. California regulations code #74888: Medical Record Services -Upon observation of the policy and procedure, there was no evidence that the policy for defining retrieval, reconciliation, coding, quality review, audit trail required after EMR back up.”