Every finding on record at Carter Healthcare Hospice of East Oklahoma, LLC

Based on record review and interview, the hospice failed to ensure imminence of death was assessed during the comprehensive assessment for six (Patients #1, 5, 6, 9, 10 and 13) of 14 patients. --- Patient #1 A review of the Initial Comprehensive Assessment dated 11/20/24 showed no assessment of imminence of death. Patient #5 A review of the Initial Comprehensive Assessment dated 01/07/25 showed no assessment of imminence of death. Patient #6 A review of the Initial Comprehensive Assessment dated 12/31/24 showed no assessment of imminence of death. Patient #9 A review of the Initial Comprehensive Assessment dated 01/20/25 showed no assessment of imminence of death. Patient #10 A review of the Initial Comprehensive Assessment dated 03/12/25 showed no assessment of imminence of death. Patient #13 A review of the Initial Comprehensive Assessment dated 12/09/24 showed no assessment of imminence of death. On 03/18/25 at 1:07 pm., Staff A stated the imminence of death was not assessed on the Initial Comprehensive Assessment for Patients #1, 5, 6, 9, 10 and 13.

Based on record review and interview, the hospice failed to ensure supervisory visits were completed every 14 days for six (Patient #1, 2, 3, 4, 5 and 8) of 14 patients. --- Patient #1 A review of the plan of care dated 11/20/24 to 01/18/25 and plan of care updates dated 12/04/24, 12/18/24, 01/02/25 and 01/15/25 showed a hospice aide frequency of two visits per week for one week and three visits per week for eight weeks. A review of the clinical record showed the following: Hospice aide visits were conducted 12/02/24, 12/04/24 and 12/06/24 for the week of 12/01/24 to 12/01/24. Hospice aide visits were conducted 12/10/24, 12/11/24 and 12/13/24 for the week of 12/08/24 to 12/14/24. Hospice aide visits were conducted 12/26/24, 12/18/24 and 12/20/20 for the week of 12/15/24 to 12/21/24. A review of supervisory visits showed supervisory aide visits were performed on 12/02/24 and 12/17/24 (15 days between supervisory aide visits). Patient #2 A review of the plan of care dated 11/28/24 to 01/26/25 and plan of care updates dated 12/04/24, 12/18/24, 01/02/25 and 01/15/25 showed a hospice aide frequency of three visits per week for eight weeks. A review of the clinical record showed the following: Hospice aide visits were conducted 12/30/24, 01/02/25 and 01/03/25 for the week of 12/29/24 to 01/04/25. Hospice aide visits were conducted 01/06/25, 01/08/25 and 01/10/25 (a missed visit) for the week of 01/05/25 to 01/11/25. Hospice aide visits were conducted 01/13/25, 01/15/25 and 01/17/25 for the week of 01/12/25 to 01/18/25. A review of supervisory visits showed supervisory aide visits were performed on 12/30/24 and 01/15/25 (16 days between supervisory aide visits). Patient #3 A review of the plan of care dated 12/20/24 to 03/19/25 and plan of care updates dated 01/02/25, 01/15/25, 01/29/25 and 02/12/2504/24 showed a hospice aide frequency of two visits per week for 12 weeks. A review of the clinical record showed the following: Hospice aide visits were conducted 12/30/24 (a missed visit) and 01/02/25 for the week of 12/29/24 to 01/04/25. Hospice aide visits were conducted 01/07/25 and 01/09/25 for the week of 01/05/25 to 01/11/25. Hospice aide visits were conducted 01/14/25 (a missed visit) and 01/16/25 for the week of 01/12/25 to 01/18/25. A review of supervisory visits showed supervisory aide visits were performed on 01/01/25 and 01/17/25 (16 days between supervisory aide visits). Patient #4 A review of the plan of care dated 11/25/24 to 02/22/25 and plan of care updates dated 12/04/24, 12/18/24, 01/02/25 and 01/15/25 showed a hospice aide frequency of two visits per week for 13 weeks. A review of the clinical record showed the following: Hospice aide visits were conducted 12/31/24 and 01/02/25 for the week of 12/29/24 to 01/04/25. Hospice aide visits were conducted 01/07/25 and 01/09/25 for the week of 01/05/25 to 01/11/25. Hospice aide visits were conducted 01/14/25 and 01/16/25 for the week of 01/12/25 to 01/18/25. A review of supervisory visits showed supervisory aide visits were performed on 01/01/25 and 01/17/25 (16 days between supervisory aide visits). Patient #5 A review of the plan of care dated 01/07/25 to 04/06/25 and plan of care updates dated 01/15/25, 01/29/25, 02/12/25 and 02/26/25 showed a hospice aide frequency of two visits per week for 13 weeks. A review of the clinical record showed the following: Hospice aide visits were conducted 01/28/25 and 01/30/25 for the week of 01/26/25 to 02/01/25. Hospice aide visits were conducted 02/04/25 and 01/06/25 for the week of 02/02/25 to 02/08/25. Hospice aide visits were conducted 02/11/25 and 02/13/25 for the week of 02/09/25 to 02/15/25. A review of supervisory visits showed supervisory aide visits were performed on 01/30/25 and 02/14/25 (15 days between supervisory aide visits). Patient #8 A review of the plan of care dated 12/17/24 to 02/14/25 and plan of care updates dated 12/18/24, 01/02/25, 01/15/25, 01/27/25 and 02/12/25 showed a hospice aide frequency of two visits per week for one week and three visits per week for eight weeks. A review of the clinical record showed the following: Hospice aide visits were conducted 12/23/24, 12/25/24 (a missed visit) and 12/27/24 for the week of 12/22/24 to 12/28/24. Hospice aide visits were conducted 12/30/24, 01/01/25 and 01/02/25 for the week of 12/29/24 to 01/04/25. Hospice aide visits were conducted 01/06/25, 01/08/25 and 01/10/25 (a missed visit) for the week of 01/05/25 to 01/11/25. A review of supervisory visits showed supervisory aide visits were performed on 12/27/24 and 01/14/25 (28 days between supervisory aide visits). On 03/18/25 at 1:40 pm., Staff A stated supervisory aide visits were not conducted within 14 days for Patients #1, 2, 3, 4, 5 and 8.

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 one (Patient #11) of 11 patients. Findings: Patient #11 A review of the clinical record showed an election of the hospice benefit on 05/04/22 with no completion of the initial spiritual assessment from 05/04/22 to 05/23/22 (19 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 Chaplain visits. On 05/25/22 at 11:45 am, Staff A stated the initial spiritual assessment was not completed within the first five days after the election of the hospice benefit for Patient #11.

Based on record review and interview, the hospice failed to ensure: 1. Psychosocial (social worker) services were provided in accordance with the plan of care frequency for one (Patient #1) of 11 patients; and 2. Spiritual (Chaplain) services were provided in accordance with the plan of care frequency for one (Patient #2) of 11 patients. Findings: Patient #1 A review of the plan of care dated 03/04/22 to 5/02/22 and plan of care updates dated 03/14/22, 03/27/22, 04/08/22 and 04/22/22 ordered social worker visits at a frequency of one time per month for two months. A review of the electronic medical record showed one social worker visit dated 04/18/22 with no social worker visits from 03/04/22 to 03/31/22 and no social worker visits from 05/01/22 to 05/02/22 (one of two completed social worker visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Patient #2 A review of the plan of care dated 02/24/22 to 04/24/22 and plan of care updates dated 02/28/22, 03/14/22, 03/27/22 and 04/08/22 ordered Chaplain visits at a frequency of one time per month for two months. A review of the electronic medical record showed no Chaplain visits from 02/24/22 to 04/24/22 (no completed Chaplain visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. On 05/25/22 at 10:50 am, Staff A stated the ordered social worker frequency for Patient #1 was not met and the ordered Chaplain frequency was not met for Patient #2.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to reflect individualized goals in relation to the terminal diagnosis for four (Patients #1, 4, 5 and 6) of 11 patients reviewed. Findings: Patient #1 A plan of care dated 03/04/22 to 05/02/22 documented a terminal diagnosis of senile degeneration of the brain with goals which included patient to receive safety education, patient and care giver will be able to define dementia and patient pain level to remain at acceptable level as determined by the patient. Patient #4 A plan of care dated 03/10/22 to 06/07/22 documented a terminal diagnosis of Alzheimer's disease with goals which included patient to receive safety education, patient and care giver will be able to define dementia and patient pain level to remain at acceptable level as determine by the patient. Patient #5 A plan of care dated 05/11/22 to 08/08/22 documented a terminal diagnosis of Alzheimer's disease with goals which included patient to receive safety education, patient and care giver will be able to define dementia and patient pain level to remain at acceptable level as determine by the patient. Patient #6 A plan of care dated 03/07/22 to 05/05/22 documented a terminal diagnosis of Alzheimer's disease with goals which included patient to receive safety education, patient and care giver will be able to define dementia and patient pain level to remain at acceptable level as determine by the patient. On 05/25/21 at 11:00 am, Staff A stated the plan of care documented inappropriate goals in relation to the terminal illness for Patients #1, 4, 5 and 6.