Blessed Hospice California Inc.

“Upon patient record review, 1 of 5 (Patient #3) 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 #3: The patient is on Anticoagulants. There are no interventions or goals for bleeding/anticoagulants in the POC”

“Upon patient record review, 7 of 14 (Patient #1,2,3,4,6,8,9) 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, 2, 3, 4, 6, 8, 9 - The patient had oxygen noted in the nursing comprehensive assessment and the DME list. The oxygen was not included on the patient medication profile.”

“Upon patient record review, 7 of 14 (Patient #1,2,3,4,8,9,10) 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, 8 - The medical record noted patient was listed as a full code. The record showed no evidence on patients POC that problems, goals, or interventions related to that full code status were outlined. Patient #2, 3, 9 - The medication profile listed the use of Zofran for nausea or vomiting. There was no evidence of problems, goals, or interventions related to nausea/vomiting. Patient #4 - The nursing comprehensive completed 12/06/24, showed evidence that patient was placed on aspiration precautions. The documentation also indicated that the patient has a related diagnosis of Type 2 Diabetes. There was no evidence of problems, goals or interventions related to the endocrine system as well as the aspiration precautions. Patient #10 - The medication profile listed the use of a nebulized medications. There was no evidence of problems, goals, or interventions related to that medication.”

“Upon patient record review, 4 of 14 (Patient #4,5,6,10) 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 #4 - IDG notes and orders between 2/24/24 to current, have a prn order for the MSW. There is no evidence of any routine visits. Patient #5 - IDG notes and orders between 12/10/24 to current, have a prn order for the MSW. There is no evidence of any routine visits. Patient #6 - IDG notes and orders between 12/24/24 to current, have a prn order for the MSW. There is no evidence of any routine visits. Patient #10 - IDG notes and order between 01/07/25 to current, have a prn order for the MSW. There is no evidence of any routine visits.”

“Upon patient record review, 6 of 14 (Patient #1,2,3,4,5,6) 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 - The nursing comprehensive dated 05/23/25, documented that the patient was incontinent and utilizing oxygen for comfort. There was no evidence that oxygen supplies or incontinent supplies were included on the supply list on patient’s POC. Patient #2 - The nursing comprehensive dated 04/02/25, documented that the patient was incontinent and utilizing oxygen for comfort. There was no evidence that oxygen supplies or incontinent supplies were included on the supply list on patient’s POC. Patient #3 - The nursing comprehensive dated 02/10/25, documented that the patient was incontinent and utilizing oxygen for comfort. There was no evidence that oxygen supplies or incontinent supplies were included on the supply list on patient’s POC. Patient #4 - The nursing comprehensive dated 12/06/24, documented that the patient was incontinent and utilizing oxygen for comfort. There was no evidence that oxygen supplies or incontinent supplies were included on the supply list on patient’s POC. Patient #5 - The nursing comprehensive dated 11/15/24, documented that the patient was incontinent of bowel and bladder. There was no evidence of incontinent supplies included on the supply list on patient’s POC. Patient #6 - The nursing comprehensive dates 07/04/24, documented that the patient utilizes a nebulizer machine. There was no evidence that the nebulizer was included on the supply list on patient’s POC.”

“Upon patient record review 4 of 14 (Patient #1,3,4,10) did not have evidence that the IDG ensures that the care and services provided are based on all assessments of the patient and family needs. Patient #1 - The nursing comprehensive assessment dated 05/23/25, noted the need for volunteer services. There was also documentation that the volunteer need for this patient could be provided by the “SNF staff.” There was no evidence that a volunteer evaluation was ordered or completed. Patient #3 - The nursing comprehensive assessment dated 04/02/25, noted the need for volunteer services. There was also documentation that that volunteer need could be provided by the “SNF staff.” There was no evidence that a volunteer evaluation was ordered or completed. Patient #4 - The nursing comprehensive showed evidence that a referral was made for a volunteer evaluation to assess for need. There is no evidence in the record that a volunteer evaluation was completed. Patient #10 - The spiritual comprehensive completed 01/07/25 had included a narrative note by the spiritual care coordinator which stated “patient has requested continued chaplain visits throughout his hospice journey.” Upon review of the admission IDG note dated on 01/07/25, the same spiritual care coordinator documented “patient declined spiritual care.” There was no other evidence in the record of a different conversation with the patient to where they declined spiritual care.”

“Upon personnel record review, 1 of 13 (Personnel #8) did not have evidence that all bereavement services are provided by a qualified counselor in accordance with applicable laws and regulations, professional practice standards, the hospice’s policies and procedures and/or job descriptions which includes experience or education in grief or loss counseling. Personnel #8 - The agency job description for bereavement coordinator outlines qualifications to be “bachelor’s degree or equivalent theological degree from college or university. Experience with families/caregivers and patients through death/dying issues - OR - Master’s degree in Social Work with qualifications of experienced clinical grief counseling”. There is evidence listed on her resume of a Bachelor Degree in Science and Nutrition and nine months of experience in a SNF.”

“Upon patient record review 1 of 14 (Patient #4) did not have evidence documentation in the patient record that a hospice aide provides services that are: • Ordered by the interdisciplinary group • Included in the plan of care • Permitted to be performed under state law by such hospice aide • Consistent with the hospice aide training Patient #4 - The aide plan of care 05/27/25 contained an aide frequency order for 2x/week. Patient was seen the week of 6/1/25 on 6/1/25; 6/2/25; and 6/4/25 without evidence of an order for extra visit.”