Every finding on record at Narinas Hospice Services

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: During home visit it was confirmed that patient primary language is Russian. Patient did sign her consents. However, there is no evidence of patient rights and responsibilities being provided to patient in her primary language.

Upon patient record review 1 of 14 (Patient #8) 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#8: The record indicates SC entered a note on 4/6/25 stating spiritual services were declined. There is no evidence of an initial spiritual assessment being completed.

Upon patient record review, 3 of 14 (Patient #1,#5,#9) 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#1: The record indicates the initial bereavement assessment was completed on 7/28/24. However, there is no primary bereaved identified. Patient#5: The record indicates the initial bereavement assessment was completed on 7/29/24. However, there is no primary bereaved identified. Patient#9: The record indicates the initial bereavement assessment was completed on 2/28/25. However, there is no primary bereaved identified.

Upon patient record review, 1 of 14 (Patient #2) 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 measurable outcomes are anticipated from implementing and coordinating the plan of care for each patient by using data elements identified by the hospice and is used as part of the Hospice's QAPI program. Patient#2: The record indicates patient was admitted with terminal illness of cerebral infarction. However, there is no evidence of problems, goals, or interventions related to neuro.

Upon patient record review, 2 of 14 (Patient #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#2:The record indicates a physician order was placed effective on 1/31/25 stating "fluid thickener". There is no evidence of instructions for preparing the liquids to be nectar thick or honey thick. Corrected on site. Patient#3: The record indicates a physician order was placed effective on 2/18/25 stating "fluid thickener". There is no evidence of instructions for preparing the liquids to be nectar thick or honey thick. Corrected on site.

Upon patient record review, 2 of 14 (Patient #2,#10) 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: The record indicates the aide plan of care includes feeding assistance and encourage fluids as tolerated. However, there is no evidence of the specified diet of puree with thickened liquids on aide plan of care. Corrected on site. Patient#10: The record indicates physician order on 1/27/25 stating patient ordered mechanical soft NAS diet. The aide POC states regular NAS under diet. Corrected on site.

Upon patient client record review, 1 of 14 (Patient #1) did not have evidence that each patient record contains responses to medications, symptom management, treatments, and services. Patient#1: The record indicates that during RN visit on 6/12/25 the nurse administered nitroglycerin as ordered. However, there is no documentation in the visit as to why the nitroglycerin was given or if the patient condition improved after the medication was given.

Upon patient record review, 2 of 5 (Patient #2 and 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 #2: The comprehensive nursing assessment on 6-13-22 the nurse documented the patient was taking pain medication twice per day and the medication profile did not contain evidence of pain medication twice per day. Patient #3: The medication profile did not include evidence of Celebrex 200 mg by mouth BID for pain that was identified during the home visit on 6-17-22.

Upon patient record review, 1 of 5 (Patient #1) 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 #1: There is no evidence of a completed bereavement risk assessment within 5 days noted in the patients record.

Upon patient record review, 3 of 5 (Patient #1,#2,#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 #1: The comprehensive nursing assessment dated 6-13-22 indicated the patient had a poor appetite patient eating 30-50% of meals there was no evidence of problems with interventions or goals on the plan of care related to nutrition. The comprehensive nursing assessment identified pain as a problem and the plan of care does not address problems, interventions, or goals related to managing pain and symptoms. Patient #2: The comprehensive nursing assessment dated 6-13-22 indicated the patient was eating 30-50% of meals and increased confusion there was no evidence of problems with interventions or goals on the plan of care related to nutrition or neurological status. The comprehensive nursing assessment identified pain as a problem and the plan of care does not address problems, interventions, or goals related to managing pain and symptoms. Corrected on site. Patient #3: The comprehensive nursing assessment dated 6-13-22 indicated the patient lost 20 pounds in 2 months there was no evidence of problems, interventions or goals on the plan of care related to nutrition. Corrected on site.

Upon patient record review, 2 of 5 (Patient #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 #2: The comprehensive nursing assessment on 6-13-22 the nurse documented the patient was taking pain medication twice per day and the record did not contain evidence of pain medication twice per day on the plan of care. Patient #3: The plan of care did not include evidence of Celebrex 200 mg by mouth BID for pain that was identified during the home visit on 6-17-22.

Upon personnel record review, 2 of 13 (Personnel #1,#6) did not have evidence that a skills competency assessment, specific to each discipline had been conducted for all personnel including volunteers initially during orientation. Personnel 1: Did not contain evidence of competency for volunteer coordinator included in personnel file. Personnel 2: Did not contain evidence of competency for bereavement coordinator included in personnel file.

Upon client record review, 3 of 5 (Patient #1,#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: The nursing comprehensive assessment dated 6-13-22 documented a referral to spiritual care the nursing narrative notates a discrepancy which documented that spiritual care was declined. Patient #4: Multiple discrepancies throughout the medical record. Discharge Plan dated 3/16/22 states patient wishes to revoke hospice services at this time "as of 10/1/21 hospice services will be terminated". Discharge Summary dated 3/16/22 states patient wishes to revoke services at this time" as of 10/13/21. CTI narrative dated 3/7/21 states admit to "Ardor Care Hospice", Comprehensive Nursing Assessment states initial period of 10/3/21-1/1/23. Patient #5: POC and IDG review documents are dated 9-8-21, patient under care from 3/11/22-3/21/22.