Every finding on record at A Path of Care Hospice IV, LLC

Based on record review and interview, the hospice failed to ensure completion of initial assessments for plans of care no later than five calendar days after election of hospice benefits for six (Patients # 1, 2, 8, 10, 12 and #13) of 14 patients. --- Findings: Patient #1A review of the clinical record showed an election of the hospice benefit on 01/07/25 with current POC from 09/04/25 to 11/02/25. The clinical record showed no MSW assessment after the initial comprehensive assessment (election of benefits) and development of the POC. The clinical record showed no patient or caregiver refusal of assessment and showed no communications or notifications to the physician.      On 09/24/25 at 11:58 a.m., Staff H stated the MSW assessment component of the initial POC was not completed within the first five days after the election of the hospice benefit. Patient #2A review of the clinical record showed an election of the hospice benefit on 08/26/24 with current POC from 08/21/25 to 10/19/25. The clinical record showed no MSW assessment after the initial comprehensive assessment (election of benefits) and development of the POC. The clinical record showed no patient or caregiver refusal of assessment and showed no communications or notifications to the physician.      On 09/24/25 at 12:05 p.m., Staff H stated the MSW assessment component of the initial POC was not completed within the first five days after the election of the hospice benefit. Patient #8A review of the clinical record showed an election of the hospice benefit on 01/14/25 with current POC from 07/22/25 to 09/19/25. The clinical record showed no MSW assessment after the initial comprehensive assessment (election of benefits) and development of the POC. The clinical record showed no patient or caregiver refusal of assessment and showed no communications or notifications to the physician.      On 09/24/25 at 1:00 p.m., Staff H stated the MSW assessment component of the initial POC was not completed within the first five days after the election of the hospice benefit. Patient #10A review of the clinical record showed an election of the hospice benefit on 01/14/25 with current POC from 09/11/25 to 11/09/25. The clinical record showed no MSW assessment after the initial comprehensive assessment (election of benefits) and development of the POC. The clinical record showed no patient or caregiver refusal of assessment and showed no communications or notifications to the physician.      On 09/24/25 at 1:09 p.m., Staff H stated the MSW assessment component of the initial POC was not completed within the first five days after the election of the hospice benefit.  Patient #12A review of the clinical record showed an election of the hospice benefit on 07/17/25 with current POC from 07/17/25 to 10/14/25. The clinical record showed a chaplain spiritual assessment dated 07/22/25 (6 days) after the initial comprehensive assessment (election of benefits) and development of the POC. The clinical record showed no patient or caregiver refusal of assessment and showed no communications or notifications to the physician.      On 09/24/25 at 1:17 p.m., Staff H stated the chaplain spiritual assessment component of the initial POC was not completed within the first five days after the election of the hospice benefit. Patient #13A review of the clinical record showed an election of the hospice benefit on 03/26/25 with current POC from 03/19/25 to 06/16/25. The clinical record showed a chaplain spiritual assessment dated 03/26/25 (7 days) after the initial comprehensive assessment (election of benefits) and development of the POC. The clinical record showed no patient or caregiver refusal of assessment and showed no communications or notifications to the physician.      On 09/24/25 at 1:25 p.m., Staff H stated the chaplain spiritual assessment component of the initial POC was not completed within the first five days after the election of the hospice benefit.

Based on record review and interview, the hospice failed to ensure development of a bereavement POC at the time of initial assessment for nine (Patients #1, 2 3, 4, 6, 7, 11, 12 and #13) of 14 patients. --- Findings: Patient #1A review of the clinical record showed an initial bereavement assessment dated 01/07/25 with IDG updates on 08/19/25, 09/02/25 and 09/16/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 09/04/25 to 11/02/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 01/07/25.  On 09/24/25 at 11:58 a.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #2A review of the clinical record showed an initial bereavement assessment dated 09/03/24 with IDG updates on 08/19/25, 09/02/25 and 09/16/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 08/21/25 to 10/19/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 09/03/24.  On 09/24/25 at 12:05 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #3A review of the clinical record showed an initial bereavement assessment dated 09/24/24 with IDG updates on 09/02/25 and 09/16/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 09/15/25 to 11/13/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 09/24/24.  On 09/24/25 at 12:16 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #4A review of the clinical record showed an initial bereavement assessment dated 08/15/25 with IDG updates on 08/19/25, 09/02/25 and 09/16/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 08/15/25 to 11/12/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 08/15/25.  On 09/24/25 at 12:17 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #6A review of the clinical record showed an initial bereavement assessment dated 08/18/25 with IDG updates on 08/19/25, 09/02/25 and 09/16/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 08/14/25 to 11/11/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 08/18/24.  On 09/24/25 at 12:51 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #7A review of the clinical record showed an initial bereavement assessment dated 09/16/25 with IDG update on 09/16/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 09/12/25 to 12/10/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 09/16/25.  On 09/24/25 at 12:05 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #11A review of the clinical record showed an initial bereavement assessment dated 05/05/25 with IDG updates on 05/13/25 and 05/28/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 05/01/25 to 07/29/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 05/05/25.  On 09/24/25 at 1:11 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #12A review of the clinical record showed an initial bereavement assessment dated 07/21/25 with IDG updates on 07/30/25 and 08/01/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 07/17/25 to 10/14/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 07/21/25.  On 09/24/25 at 1:17 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC. Patient #13A review of the clinical record showed an initial bereavement assessment dated 03/21/25 with IDG updates on 04/01/25 and 04/15/25. The clinical record showed no bereavement POC and no bereavement interventions and goals in the overall POC dated 03/19/25 to 06/16/25. The clinical record showed no patient or caregiver refusal of a bereavement POC since the bereavement assessment dated 05/05/25.  On 09/24/25 at 1:25 p.m., Staff H stated the patient had no bereavement POC and showed no bereavement interventions and goals in the overall POC.

Based on record review and interview, the hospice failed to ensure POCs included visit frequency and duration of services for three (Patients #6, 9 and #14) of 14 patients. --- Findings: Patient #6A review of the plan of care dated 08/14/25 to 11/11/25 with IDGs dated 08/19/25, 09/02/25 and 09/16/25 showed no frequency and duration of chaplain services for visits conducted on:·      08/15/25·      08/19/25 ·      08/26/25·      09/07/25 ·      09/16/25 On 09/24/25 at 12:51 p.m., Staff H stated the plan of care should have included frequency and duration for chaplain services.  Patient #9A review of the plan of care dated 09/03/25 to 12/01/25 with IDGs dated 09/16/25 showed no frequency and duration of chaplain services for visits conducted on:·      09/05/25 ·      09/08/25·      09/16/25 On 09/24/25 at 1:07 p.m., Staff H stated the plan of care should have included frequency and duration for chaplain services.  Patient #14A review of the plan of care dated 05/07/25 to 08/04/25 with IDGs dated 05/21/25, 06/04/25 and 06/18/25 showed no frequency and duration of chaplain services for visits conducted on:·      05/15/25 ·      05/28/25·      06/10/25 On 09/24/25 at 1:30 p.m., Staff H stated the plan of care should have included frequency and duration for chaplain services.

Based on record review and interview, the hospice failed to ensure POCs included service discipline goals for three (Patients #5, 8 and #14) of 14 patients. --- Findings: Patient #5A review of the plan of care dated 07/31/25 to 09/28/25 with IDGs dated 08/15/25, 08/19/25, 09/02/25 and 09/16/25 showed no SN goals for wound site care to the left elbow, right wrist, and bilateral lower extremities for visits conducted:·      07/31/25 ·      08/03/25·      08/05/25·      08/06/25·      08/10/25·      08/11/25·      08/12/25·      08/13/25·      08/18/25·      08/22/25·      08/25/25·      08/28/25·      09/03/25·      09/05/25·      09/07/25·      09/08/25·      09/11/25·      09/12/25·      09/16/25·      09/19/25 On 09/24/25 at 12:32 p.m., Staff H stated the plan of care should have included goals for wound site care. Patient #8A review of the plan of care dated 07/22/25 to 09/19/25 with IDGs dated 08/06/25, 08/19/25, 09/02/25 and 09/16/25 showed no SN goals for foley catheter placement and management for visits conducted:·      09/02/25·      09/05/25·      09/09/25·      09/11/25·      09/12/25·      09/16/25·      09/19/25 On 09/24/25 at 1:00 p.m., Staff H stated the plan of care should have included goals for foley catheter placement and management. Patient #14A review of the plan of care dated 05/07/25 to 08/04/25 with POC updates dated 05/21/25, 06/04/25 and 06/18/25 showed no interventions and goals for MSW, chaplain and hospice aide services for visits conducted:·      05/09/25 MSW·      05/15/25 chaplain·      05/28/25 chaplain·      06/03/25 hospice aide·      06/10/25 chaplain and hospice aide On 09/24/25 at 1:30 p.m., Staff H stated the plan of care should have included goals for MSW, chaplain and hospice aide services.

Based on record review and interview, the hospice failed to ensure care was coordinated between the IDG members and the physician for two (Patients #4 and #5) of 14 patients. --- Findings: Patient #4A review of the POC dated 08/15/25 to 11/12/25 and plan of care updates dated 08/19/25, 09/02/25 and 09/16/25 showed a hospice aide visit frequency of one time a week for 13 weeks.  A review of the clinical record showed missed hospice aide visits on:·      08/27/25·      09/01/25·      09/18/25 The clinical record showed no discussion by the IDG and showed no change in orders for the hospice aide visits. On 09/24/25 at 12:17 p.m., Staff H stated the hospice IDG team members did not discuss the hospice aide missed visits. Patient #5A review of the POC dated 07/31/25 to 09/28/25 and plan of care updates dated 08/05/25, 08/19/25, 09/02/25 and 09/16/25 showed a chaplain visit frequency of four visits in two months. A review of the clinical record showed chaplain visits on:·      08/05/25·      08/12/25·      08/18/25·      08/26/25·      09/02/25·      09/07/25·      09/16/25 The clinical record showed no discussion by the IDG for increased chaplain visit frequency and showed no change in orders for the chaplain visits. On 09/24/25 at 12:32 p.m., Staff H stated the hospice IDG team members did not discuss the need for increased chaplain visits.

Based on record review and interview, the hospice failed to ensure review and update to the hospice aide care plan for one (Patient #12) of 14 patients. --- Findings: Patient #12A review of the plan of care dated 07/17/25 to 10/14/25 and IDG plan of care updates on 07/30/25 and 08/01/25 showed an ordered hospice aide visit once a week and an hospice aide care plan dated 07/17/25.  A review of a physician’s order dated 07/22/25 showed an increase in the hospice aide visits two times a week. The POC showed no update to the hospice aide care plan dated 07/17/25. On 09/24/25 at 1:17 p.m., Staff H stated the hospice aide care plan was not updated with the increased visit frequency.

Based on record review and interview, the hospice failed to ensure volunteer services met hospice program requirements in calendar year 2024 and 01/01/25 to 09/24/25 for all patients, caregivers, and staff. --- Findings: A review of volunteer records showed the hospice program had 0% utilization of volunteer personnel and showed no recruitment activities in calendar years 2024 and 01/01/25 to 09/24/25. On 09/24/25 at 11:30 a.m., Staff J stated:1.    There has not been any utilization of volunteers.There wasn’t a volunteer coordinator for the Lawton office until last week.

Based on record review and interview, the hospice failed to ensure completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for two (Patients #2 and 11) of 16 patients. --- Patient #3 A review of the clinical record showed an election of the hospice benefit on 11/22/22 with no completion of the initial spiritual assessment from 11/22/22 to 12/27/22 (35 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplin visits. Patient #11 A review of the clinical record showed an election of the hospice benefit on 04/30/21 with no completion of the initial spiritual assessment from 04/30/21 to 06/07/21 (38 days after election of the hospice benefit) with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplin visits. On 04/06/23 at 4:09 pm, Staff B stated the initial spiritual assessments were not completed within the first five days after the election of the hospice benefit for Patients #2 and 11.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for five (Patients #1, 4, 11, 13 and 14) of 16 patients reviewed. --- Patient #1 A review of the plan of care dated 10/20/22 to 01/17/23 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #4 A review of the plan of care dated 04/06/22 to 07/04/22 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #11 A review of the plan of care dated 04/30/21 to 07/28/21 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #13 A review of the plan of care dated 06/25/21 to 09/22/21 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. Patient #14 A plan of care dated 03/26/21 to 06/23/21 showed no plan of care development for the services necessary for the palliation and management of the terminal illness. Documentation showed no services or treatment related to either the primary or secondary diagnoses. On 04/06/23 at 3:30 pm, Staff B stated the plans of care for Patients #1, 4, 11, 13 and 14 failed to include services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to ensure evaluation and measurable progress of their PIP for 1 current patient and all employees. --- A review of QAPI records showed a PIP initiated on 09/03/21. Documentation showed no measurable progress of the PIP from 09/03/21 to 04/06/23. On 04/06/23 at 4:25 pm, Staff B stated the PIP dated 09/03/21 showed no measurable progress.