Saint Angeleno Hospice Care, Inc.

“Upon patient record review, 12 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,14) did not have evidence in the patient record that the written plan of care is developed by the IDG, in consultation with the patient’s attending physician, which specifies the services necessary to meet the patient and family-specific needs identified in the comprehensive assessment as it relates to the terminal illness and related conditions. Patient 1: There is only one IDG documented from admission on 08/14/25 with no other updates to the plan of care, there are no signatures by any disciplines of the IDG. Patient 2,3,4,5,6,7,8,9,10,14: The IDG note is not signed by the physician from the start of care . Patient 11: The IDG is not signed by the physician on 7/20/25, 7/29/25 ,8/12/25, 8/26/25, 9/9/25, 9/23/25,10/07/25, 10/21/25, 11/04/25, 11/18/25, 12/02/25, 12/16/25, 12/30/25.”

“Upon observation, there was no evidence that during the initial assessment visit in advance of furnishing care, the hospice provided the patient and/or family with verbal (meaning spoken) and written notice of the Patient’s Rights and Responsibilities in a language and manner that the patient understands. Patient 1: In the patient record there is not a name of patient family or primary caregivers. During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and election of benefits statement and notice of Patient Rights, there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the hospice informed and provided written information to the patient concerning its policies on advance directives, including a description of applicable state law. Patient 1: During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the hospice obtained the patient’s or representative’s signature confirming that they received a copy of the Patient’s Rights and Responsibilities. Patient 1: During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon observation, there was no evidence the patient has the right to voice grievances/complaints regarding treatment or care that is (or fails to be) furnished and lack of respect of property by anyone who is furnishing care/service on behalf of the hospice. Patient 1: In the patient record there is not a name of patient family or primary caregivers. During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and election of benefits statement and notice of Patient Rights, there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that if a state court has not adjudged a patient incompetent, any legal representative designated by the patient in accordance with state law may exercise the patient’s rights to the extent allowed by state law. Patient 1: In the patient record there is not a name of patient family or primary caregivers. During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and election of benefits statement and notice of Patient Rights, there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient chooses a health care provider, including an attending physician. Patient 1: During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record. There is no evidence that the patient can choose a health care provider due to the patient is not oriented.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence of the appropriate documentation for release of confidential information. Patient 1: During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own Election of Benefits form and consents and there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record and the patient cannot consent to release confidential information.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient received information about the services covered under the hospice benefit. Patient 1: In the patient record there is not a name of patient family or primary caregivers. During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and election of benefits statement and notice of Patient Rights, there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon patient record review, 1 of 14 (Patient #1) did not have evidence that the patient received information about the scope of services that the hospice will provide and specific limitations on those services. Patient 1: During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon observation, there was no evidence the hospice has an interdisciplinary group (IDG) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. Interdisciplinary group members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. There was no evidence of meetings of an interdisciplinary group (IDG) or groups composed of individuals from the agency to meet the patient needs.”

“Upon patient record review, 1 of 14 (Patient #7) 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 7: On the plan of care there is medication Aspirin 81 mg daily and Pradaxa, there is not a risk for bleeding with goals and interventions on the plan of care.”

“Upon client record review, of 4 of 14 (Patient #1,2,3,4) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: In the patient record there is a document dated 8/27/25 from 1200-1245 by the MSW, the document is not completed with a psychosocial assessment, the document was left blank and without a signature by the MSW. In the record there are documents dated 11/09/25, 1100-1145 and 02/08/25, 1300-1345, the document is not completed with a psychosocial assessment for recert, the document was left blank and no signature. Patient 2: In the patient record the initial psychosocial assessment is not documented, there is an assessment started and dated 2/9/26 @ 12p-12:45. The MSW did not sign or complete documentation. MSW visit date 3/7/26. MSW did not document or sign documentation. MSW ordered to see patient once monthly. In addition, the comprehensive spiritual assessment is not signed and completed by the spiritual care on 2/9/26. Patient 3: In the patient record the initial psychosocial assessment is not documented, there is an assessment started and dated 2/5/26 10am-10:45, the MSW did not sign or complete the documentation. Patient 4: In the patient record there is a document dated 2/19/26 by the MSW, the document is not completed with an assessment, the document was left blank and without a signature by the MSW.”

“Upon patient record review 1 of 14 (Patient #8) 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 8: Upon discharge 12/16/25 the skilled nurse assessment was completed and documented, “She reported that walking from the bedroom to the bathroom now causes noticeable shortness of breath, which comes on more quickly than in previous visits, expiratory wheezing was audible, breath sounds diminished, appetite has decreased. The nurse noted that she seemed less energetic than during previous visits, moving more slowly and requiring additional support to maintain balance. Mobility limited, ankle edema, fatigue, and reduced endurance, necessitating caregiver assistance for all ADL’s, Hospice services remain crucial for comfort, symptom monitoring, and ensuring safety during daily care,” KPS, 40, PPS 50 Fast, was not assessed on admission and was alert and oriented. Pt. shows decline cognitively and at discharge has a Fast score of 6D. The patient was discharged on 12/30 without any documentation of improvement or meeting of of patient/family needs.”

“Upon personnel record review, 1 of 14 (Personnel #6) 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.) ·Communication skills, including the ability to read, write, and verbally report clinical information to patients, caregivers, and other hospice staff. ·Reading and recording temperature, pulse, and respiration ·Safe transfer techniques and ambulation. ·Normal range of motion and positioning ·Appropriate and safe techniques in personal hygiene and grooming that include-- ·(A) Bed bath ·(B) Sponge, tub, and shower bath ·(C) Shampoo, sink, tub, and bed ·(D) Nail and skin care ·(E) Oral hygiene ·(F) Toileting and elimination The other subject areas in this section may be evaluated through written examination, oral examination or after observation of a Hospice Aide with a patient. Personnel 6: There is not evidence in the personnel file that the aide was made competent of shampooing in the sink, tub, and bed.”

“Upon patient record review, 1 of 14 (Patient #2) 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 2: On the plan of care there is an order for aides 3 times weekly, there is not an aide plan of care completed.”

“Upon observation, there was no evidence the hospice is directed by a Board of Directors/governing body which assumes full legal authority and responsibility for the operation of the hospice. This AO surveyor asked the owner/Alternate Administrator if the administrator was available to do the daily duties required of the agency and to ensure patients were cared for. The owner/Alt. Admin shrugged her shoulders. It is clear that there is not oversight in this agency. The agency is servicing patients not approved on GSA. Patient 8 has a home address for Madera County California which is not on the GSA for this agency license. Patient 9-14 have a home address of Fresno county California which is not on the GSA for this agency license. The hospice has no signed orders by the physician for 12 of 14 patients. The physician was not available to the staff during the survey, the physician did not return phone calls or text for the first two days of the survey. There is not evidence of chart reviews as evidenced by multiple incomplete and unsigned notes as well as no signed orders by the physicians. In addition, agency was making changes to patient record #1 by changing 2025 initial comprehensive assessment to state patient was oriented x3. There was no evidence of an interdisciplinary group meeting at minimum every 15 days to address patient/family needs.”

“Upon patient record review, 12 of 14 (Patient #1,2,3,4,5,6,7,8,9,10,11,14) did not have evidence that there is a physician’s brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification forms, or as an addendum to the certification forms. Patient 1,2,3,4,5,6,7,8,9,10,11,14: In the patient record there is not evidence that there is a physician’s brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification forms, or as an addendum to the certification forms. The medical director did not fill out the CTI or sign the CTI.”

“Upon client record review, 1 of 14 (Patient #1) did not have evidence that the physician provides a brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the recertification form, or as an addendum to the recertification form. Patient 1: In the patient record there is no evidence that the physician provides a brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the recertification form, or as an addendum to the recertification form. The narrative was not filled out or signed by the hospice physician.”

“Upon patient client record review, 1 of 14 (Patient #1) did not have evidence that each patient record contains: • Signed copies of the notice of patient rights in accordance with 418.52 • Signed election statement in accordance with 418.24 Patient 1: In the patient record there is not a name of patient family or primary caregivers. During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and Election of Benefits form and Notice of Patient Rights, there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record.”

“Upon patient client record review, 1 of 14 (Patient #1) did not have evidence that each patient record contains Advance Directives. Patient 1: During the initial RN assessment there is documentation, “he is oriented only to person and required consistent redirection during the visit”, RN documented that patient was confused. Patient signed own consents and there is no documentation of who the caregiver present during admission is to the patient. There is no documentation of family member or POA in the patient record and the patient signed the POLST on the date of admission.”

“Upon patient client record review, 4 of 14 (Patient #5, 6, 7, 8) 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 5: The comprehensive bereavement assessment is documented and assigned to SC. The documentation is not signed by SC. There is documentation on a MSW visit dated 1/13/26, 2/13/26 and 3/13/26, these visits are not signed by the MSW. There is documentation on a spiritual care visit dated 1/12/26, 2/12/26 1:45-2pm there is not a signature of the documentation from SC. There is documentation on an LVN visit dated 1/12/26 5:45pm-6;30pm the assessment is not signed by the LVN. The comprehensive spiritual assessment is documented on 1/12/26 and is not signed by the SC, these documents are not complete. Patient 6: The spiritual comprehensive assessment dated 1/18/26 is not signed and dated. The Initial psychosocial comprehensive assessment dated 1/19/26 is not signed and dated. Initial bereavement assessment documented on 1/8/26 is not signed and dated. Patient 7: The initial spiritual comprehensive assessment not signed and dated on 1/6/26 by spiritual care. The initial psychosocial assessment 1/6/26 is not signed and dated by the MSW. Initial bereavement assessment 1/6/26 is not signed and dated 3pm-3:20pm by SC. On 1/10, 1/12, 2/02, 2/9, 2/16, 2/23, 3/2, 3/9, 3/16, the aide visits are documented but are not signed and dated by the aide. LVN visits documented on 1/5, 1/12, 3/16 are not signed and dated MSW visits dated 2/7, 3/7, are documented but are not signed and dated by the MSW. Spiritual care visits dated on 2/6 are not signed and dated by spiritual care. Patient 8: On 12/30/25 the discharge summary states , “family have decided to revoke hospice care services as patient current health status has improved. There is also an order for discharge order on 12/30/25, “discharge patient due to improving status”.”

“Upon client record review, 1 of 14 (Patient #8) did not have evidence that the discharge summary includes all required information. Patient 8: 12/16/25 the skilled nurse assessment was completed and documented, “She reported that walking from the bedroom to the bathroom now causes noticeable shortness of breath, which comes on more quickly than in previous visits, expiratory wheezing was audible, breath sounds diminished, appetite has decreased. The nurse noted that she seemed less energetic than during previous visits, moving more slowly and requiring additional support to maintain balance. Mobility limited, ankle edema, fatigue, and reduced endurance, necessitating caregiver assistance for all ADL’s, Hospice services remain crucial for comfort, symptom monitoring, and ensuring safety during daily care,” The patient was discharged on 12/30 without any documentation of improvement. KPS, 40, PPS 50, Fast was not assessed on admission and was alert and oriented but record now shows patient decline cognitively and at discharge has a Fast score of 6D. This documentation was not included in the discharge summary including patients current plan of care, latest physician orders and continuity of care.”