Every finding on record at Capri Hospice Inc

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 visits #1and #2: The patients speak a primary language of Armenian. Patient rights and responsibilities were not provided in a language and manner that the patient/caregiver understands.

Upon patient record review, 2 of 15 (Patients #3, 10) did not have evidence that the patient has received effective pain management and symptom control from the hospice for conditions related to the terminal illness. Patient #3: Patient admitted on 06/07/24 with gastric cancer and complaining of a pain level of 9. Patient was on Tramadol prior to admit. No changes to pain regime and no further visit until 06/10/24 when patient revoked services. Patient #10: Patient admitted with stomach cancer on 05/03/24. Although patient did not complain of severe pain, he did complain of vomiting several times daily. The admitting nurse noted he was on "multiple nausea vomiting medication" No documentation of any changes to preadmission medications. No follow up call or visit for 5 days. Patient was seen 05/08/24, where nurse documented that patient has frequent vomiting and abdominal pain after each meal - does not document call to doctor or specific interventions for vomiting. No follow up call or visit for 9 days.

Upon patient record review, 4 of 15 (Patients #3, 7, 10, 11) did not have evidence that a Registered Nurse is designated to ensure continuous assessment of the patient and family's needs and to coordinate activities with other members of the interdisciplinary group (IDG). The IDG must work together and is responsible for supervision of the care and service for each patient and family. Patient #3: Patient admitted on 06/07/24 with gastric cancer and complaining of a pain level of 9. Patient was on Tramadol prior to admit. No changes to pain regime and no further visit until 06/10/24 when patient revoked services. Patient #7: Patient admitted with liver cancer on 07/29/24. Patient complained of pain at level 6 out of 10. Tramadol was initiated at admit. No follow up call or visit for 7 days. Patient #10: Patient admitted with stomach cancer on 05/03/24. Although patient did not complain of severe pain, he did complain of vomiting several times daily. The admitting nurse noted he was on "multiple nausea vomiting medication" No documentation of any changes to preadmission medications. No follow up call or visit for 5 days. Seen 05/08/24, where nurse documented that patient has frequent vomiting and abdominal pain after each meal - does not document call to doctor or specific interventions for vomiting. No follow up call or visit for 9 days. Patient #11: Patient admitted on 06/15/24 with uterine cancer. Pain described as sharp and deep at a level 7 out of 10. Nurse documents that patient was given oxycodone the previous day from oncologist. No documentation of if it was working or how patient was taking it. No follow up visit for 6 days. On 06/21/24, patient no longer able to swallow, med changed to morphine, continuous care began and patient died 06/25/24.

Upon patient record review, 3 of 15 (Patient #2,3,10) did not have evidence that the IDG documents the sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement. Patient #2: Patient admitted on 07/15/25 with pain of a 5 out of 10 that increases to an 8 when he walks. He listed his acceptable pain level as a 2. No orders received from physician. There was no follow up call or visit for 7 days. On 07/22/25, continued to express pain level 5 and nurse documented continue medications ordered. No follow up call or visit for 7 days. On 08/12/25, The assessment checks '0' for pain level, however writes in narrative that patient experiencing pain in back, shoulders and bilateral knees during the visit with "facial grimacing and restlessness." No call to physician or change to plan of care. No follow up call or visit for 6 days. Patient #3: Patient admitted on 06/07/24 with gastric cancer and complaining of a pain level of 9. Patient was on Tramadol prior to admit. No changes to pain regime and no further visit until 06/10/24. Patient #10: Patient admitted with stomach cancer on 05/03/24. Although patient did not complain of severe pain, he did complain of vomiting several times daily. The admitting nurse noted he was on "multiple nausea vomiting medication" No documentation of any changes to preadmission medications. No follow up call or visit for 5 days. Patient was seen 05/08/24, where nurse documented that patient has frequent vomiting and abdominal pain after each meal - does not document call to doctor or specific interventions for vomiting. No follow up call or visit for 9 days.

Upon patient client record review, 4 of 5 (Patients #1,#3,#4,#5) 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 #1: On 8/2/22 the nursing assessment included documentation the patient had achy, intermittent pain lasting 30 minutes to an hour in duration and the pain was relived with pain medications, rest, and relaxation. There is no evidence the patient was taking pain medication to relieve pain. Patient #3: As observed during a home visit the medication profile had written instructions for Lasix 20 mg 1 tablet by mouth daily. The instructions on the bottle is written as Lasix 20 mg 1 tablet by mouth every other day. Patient #4: Upon medical record review there were orders on the plan of care dated prior to the start of care date of 2/18/22. The order to begin aide services on 12/3/21. There were bleeding precautions dated 11/27/21 included on the plan of care. Patient #5: Upon medical record review there were orders on the plan of care dated prior to the start of care date of 3/25/22. The order for coordination of care and the order for spiritual care assessment on the plan of care was dated for 12/30/21.