Thousand Oaks Hospice Care Inc.

“Upon patient record review, 3 of 9 (Patient # 2, 3, 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 2: The medication list dated 08/13/26 recorded both Tylenol and Tramadol PRN pain with no evidence found of clarification of when to administer each medication based on pain severity or numeric rating. Further, the comprehensive assessment dated 08/13/26 detailed the use of oxygen @ 2LPM. The medication list did not record oxygen. Patient 3: The medication list recorded, “Miralax 17g powder 1 scoop oral daily PRN constipation.” There was no further evidence of clarification that the medication should be mixed with a diluent for administration. Patient 9: The medication list dated 03/09/26 recorded, “Atropine Sulfate 1% ophthalmic solution 3 drops ophthalmic every four hours as needed for excessive secretions.” There was no evidence of further clarification of the need for oral administration of this medication for the intended purpose. Also, the medication list recorded the pain medications Tramadol PRN and Tylenol with Codeine PRN, with no further clarification on when to administer each medication based on pain severity or numeric rating. In addition, oxygen 2-5 LPM was recorded, with no further directions on the method of administration (nasal cannula or facemask). The medication list effective 06/01/26 contained all of the aforementioned items with the addition of Hydrocodone/Acetaminophen PRN and Morphine Sulfate 20mg/ml PRN pain with no clarification of when to administer each medication based on pain severity or numeric rating.”

“Upon patient record review, 3 of 9 (Patient # 2, 3, 9) 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 2: The plan of care dated 08/13/26 recorded both Tylenol and Tramadol PRN Pain with no evidence found of clarification of when to administer each medication based on pain severity or numeric rating. Further, the comprehensive assessment dated 08/13/26 detailed the use of oxygen @ 2LPM. The plan of care did not record oxygen use. Patient 3: The plan of care dated 03/11/26 recorded, “Miralax 17g powder 1 scoop oral daily PRN constipation.” There was no further evidence of clarification that the medication should be mixed with a diluent for administration. Patient 9: The plan of care dated 03/09/26 recorded, “Atropine Sulfate 1% ophthalmic solution 3 drops ophthalmic every four hours as needed for excessive secretions.” There was no evidence of further clarification of the need for oral administration of this medication for the intended purpose. Also, the plan of care listed the pain medications Tramadol PRN and Tylenol with Codeine PRN, with no further clarification on when to administer each medication based on pain severity or numeric rating. In addition, oxygen 2-5 LPM was recorded, with no further directions on the method of administration (nasal cannula or facemask). The plan of care effective 06/01/26 contained all of the aforementioned items with the addition of Hydrocodone/Acetaminophen PRN and Morphine Sulfate20mg/ml PRN pain with no clarification of when to administer each medication based on pain severity or numeric rating.”

“Upon patient record review, 2 of 9 (Patient # 2, 9) 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 2: The Comprehensive assessment dated 08/13/26 documented the use of a wheelchair and shower chair with a nebulizer and oxygen concentrator needed. The plans of care dated 08/13/26 did not contain these equipment needs. Patient 9: The Comprehensive assessment dated 03/09/26 and the recertification visit dated 06/03/26 documented the use of a hospital bed, shower chair, bedside commode, oxygen concentrator and e-tank. The plans of care dated 03/09/26, 06/01/26, and 06/15/26 did not contain these equipment needs.”

“Upon client record review, 2 of 9 (Patient #1,3) did not have evidence that the IDG ensures that the care and services are provided in accordance with the plan of care. Patient 1: The Initial Plan of Care developed 06/12/26 contained a visit frequency for aide visits only. The skilled nurse made a visit on 06/13/26. There was no evidence found of any supplemental physician order or plan of care update to reflect visits performed. Patient 3: The Initial Plan of Care developed 03/11/26 contained a visit frequency for SC and MSW only. The skilled nurse made visits on 03/12/26, 03/16/26, and 03/19/26. There was no evidence found of any supplemental physician order or plan of care update to reflect visits performed.”

“Upon patient record review, 1 of 9 (Patient # 1) 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: The aide assignment sheet present in the EMR dated 06/12/26 did not contain information related to the patient’s need for oxygen as needed or the need for oxygen precautions.”

“Upon patient record review 2 of 9 (Patient # 1, 9) 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 1:All plans of care in the medical record listed the aide frequency as twice per week. The patient received aide services 5 days per week beginning 06/15/26 through 08/14/26. No evidence was found of a supplemental order or a plan of care update authorizing this aide frequency. Patient 9: The plan of care dated 05/18/26 recorded an aide frequency of 3 times weekly. There was only one aide visit provided the week of 06/21/26 with no evidence found of refused visits by the patient or family. There are no supplemental orders found to discontinue aide services and all updated plans of care through patient discharge contained this aide visit frequency.”

“Upon patient client record review, 2 of 9 (Patient #1, 3) 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: The election statement dated 06/12/26 did not include the patient’s or representative’s choice of attending physician or an acknowledgment that the attending physician was his or her choice. Patient 3: The election statement dated 03/11/26 did not contain evidence the patient elected or declined to receive the “Patient Notification of Hospice Non-Covered Items, Services, and Drugs.””