Every finding on record at Choice Hospice of Oklahoma LLC

Based on record review and interview, the hospice failed to ensure volunteers provided services that equaled 5% of the total patient care hours of all paid hospice employees for 2024. --- A review of volunteer records and hours showed the hospice volunteers provided services that equaled 2.17% of the total patient care hours of all paid hospice employees for 2024. On 08/07/25 at 12:00 pm, Staff A stated the hospice volunteer services did not provide 5% of the total patient care hours of all paid hospice employees for 2024.

Based on record review and interview, the hospice failed to the ensure a coordinated plan of care was developed in conjunction with the long-term care facility for one (Patient #2) of 14 patients reviewed. --- Findings:Patient #2A review of the plan of care dated 06/27/25 to 09/24/25 showed a primary diagnosis of chronic obstructive pulmonary disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness.On 08/07/25 at 9:50 am., nursing home staff A stated the hospice did not develop a coordinated plan of care with the long-term care facility. On 08/07/25 at 12:40 pm, Staff A stated there was no coordinated plan of care for Patient #2.

Based on record review and interview, the hospice failed to ensure:1. Completion of the initial bereavement assessment no later than 5 calendar days after the election of hospice care for one (Patients #11) of 11 patients; and2. Completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for one (Patients #11) of 11 patients. --- Patient #11A review of the clinical record showed an election of the hospice benefit on 06/02/22 with no completion of the initial bereavement assessment from 06/02/22 to 08/30/22 (90 days after election of the hospice benefit) and no completion of the initial spiritual assessment from 06/02/22 to 08/30/22 (90 days after the 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 Medical Chaplain visits. On 11/18/22 at 11:20 am, Staff C stated the initial bereavement assessment, and the initial spiritual assessment were 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 the plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for eleven (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11) of 11 patients reviewed. --- Patient #1A review of the plan of care dated 06/24/22 to 09/21/22 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 #2A review of the plan of care dated 08/18/22 to 10/16/22 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 #3A review of the plan of care dated 08/20/22 to 10/18/22 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 #4A review of the plan of care dated 08/27/22 to 10/25/22 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 #5A plan of care dated 08/24/22 to 10/22/22 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 #6A plan of care dated 09/21/22 to 12/19/22 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 #7A review of the plan of care dated 09/21/22 to 11/19/22 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 #8A review of the plan of care dated 09/04/22 to 11/02/22 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 #9A plan of care dated 11/02/22 to 01/30/23 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 #10A plan of care dated 08/08/22 to 10/06/22 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 #11A plan of care dated 06/02/22 to 08/30/22 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. On 11/18/22 at 10:50 am, Staff C stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11 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 skilled nursing services met the needs of the patient for the management of blood pressure for one (Patient #11) of 11 patients. --- Patient #11 A review of the plan of care dated 06/02/22 to 08/30/22 showed a primary diagnosis of breast cancer and documented a skilled nurse frequency of two visits for one week and one visit for twelve weeks. A review of the medical record showed the following: A skilled nurse assessment dated 06/16/22 documented a blood pressure out of parameters of 184/101 which documented the physician was not notified. A skilled nurse assessment dated 06/21/22 documented a blood pressure outside of parameters of 181/98 which documented the physician stated if the blood pressure were elevated the following week a hypertensive medication would likely be started. A skilled nurse assessment dated 06/28/22 documented a blood pressure outside of parameters of 181/105 which documented the physician stated if the blood pressure were elevated the following week a hypertensive medication would likely be started. A skilled nurse assessment dated 07/05/22 documented a blood pressure outside of parameters of 181/104. No interventions were documented. A skilled nurse assessment dated 07/21/22 documented a blood pressure outside of parameters of 240/108. No interventions or patient teaching were documented. A skilled nurse assessment dated 07/27/22 documented a blood pressure outside of parameters of 240/108 and documented the nurse informing the patient a blood pressure medication may be needed no patient teaching provided. A skilled nurse assessment dated 08/02/22 documented a blood pressure outside of parameters of 189/102. No interventions or patient teaching were documented. A skilled nurse assessment dated 08/09/22 documented a blood pressure outside of parameters of 189/110. No interventions or patient teaching were documented. A skilled nurse assessment dated 08/18/22 documented a blood pressure outside of parameters of 200/110. No interventions or patient teaching were documented. A skilled nurse assessment dated 08/23/22 documented a blood pressure outside of parameters of 210/111. No interventions or patient teaching were documented. On 11/18/22 at 12:10 pm, Staff C stated the blood pressure for Patient #11 was not properly managed.

Based on record review and interview, the hospice failed to ensure the hospice aide notified the supervising nurse of a significant weight change for one (Patient #1) of 11 patients. --- Patient #1 A review of the plan of care dated 06/24/22 to 09/21/22 showed hospice aide frequency of three visits for one week, five visits for one week, three visits for ten weeks and two visits for one week. A review of the clinical record showed: A hospice aide note dated 07/18/22 documented a weight of 148.6 pounds. A hospice aide note dated 07/25/22 documented a weight of 118 pounds (a 29.4-pound weight loss) with no notification to the supervising nurse. On 11/18/22 at 11:29 am, Staff C stated the hospice aide should have notified the supervising nurse of the significant weight loss.