Every finding on record at Crossroads Hospice of Oklahoma City, L.L.C.

Based on record review and interview, the agency failed to ensure emergency preparedness disaster declaration, table-top exercises, drills, community drills or plan activation events were conducted for calendar year 2022 for all patients and employees. --- Findings: A review of administrative records related to emergency preparedness showed no documentation of emergency preparedness disaster declaration, table-top exercises, drills, community drills or plan activation events for calendar year 2022. On 06/20/23 at 2:30 pm, Staff A stated: The agency had no emergency preparedness disaster declaration, table-top exercises, drills, community drills or plan activation events for calendar year 2022.

Based on record review and interview, the hospice failed to ensure: 1. Hospice aide services were provided in accordance with the plan of care for four (Patients #4, 9, 14 and #15) of 19 patients and; 2. Skilled nurse services were provided in accordance with the plan of care for five (Patients #4, 8, 13, 14 and #15) of 19 patients. --- Findings: Patient #4 A review of the plan of care dated 03/24/23 to 06/21/23 and plan of care updates dated 03/24/23, 04/04/23, 04/18/23, 05/02/23, 05/16/23, 05/30/23 and 06/13/23 ordered hospice aide visits at a frequency of two visits every week and SN visits at a frequency of one visit every week. Documentation showed during the weeks of 05/14/23 to 05/20/23 one hospice aide visit was made (2 visits ordered, one visit conducted) and no SN visit was conducted (1 visits ordered, no visit conducted), 05/21/23 to 05/27/23 no SN visit was conducted (1 visits ordered, no visit conducted). Documentation showed no patient or family refusal of missed visits and no changes in the ordered frequencies for the hospice aide or SN. Patient #8 A review of the plan of care dated 04/17/23 to 07/19/23 and plan of care updates dated 04/19/23, 05/03/23, 05/16/23 and 05/31/23 ordered SN visits one time a week. Documentation showed during the weeks of 04/30/23 to 05/06/23 no SN visits were made (1visit ordered, no visit conducted), 05/14/23 to 05/20/23 no SN visits were made (1visit ordered, no visit conducted), 05/21/23 to 05/27/23 no SN visits were made (1visit ordered, no visit conducted), 05/14/23 to 05/20/23 no SN visits were made (1visit ordered, no visit conducted), 05/28/23 to 06/03/23 no SN visits were made (1visit ordered, no visit conducted). Documentation showed no patient or family refusal of missed visits and no changes in the ordered frequency for the SN. Patient #9 A review of the plan of care dated 05/16/23 to 07/14/23 and plan of care updates dated 05/17/2 and 05/31/23 ordered hospice aide visits at a frequency of three visits every week. Documentation showed during the weeks of 05/16/23 to 05/19/23 one hospice aide visit was made (3 visits ordered, one visit conducted), 05/20/23 to 05/27/23 two hospice aide visits were made (3 visits ordered, two visit conducted), 05/28/23 to 06/03/23 two hospice aide visits were made (3 visits ordered, two visit conducted), 06/04/23 to 06/10/23 two hospice aide visits were made (3 visits ordered, two visit conducted). Documentation showed no patient or family refusal of missed visits and no changes in the ordered frequency for the hospice aide. Patient #13 A review of the plan of care dated 04/26/23 to 07/24/23 and plan of care updates dated 05/03/23, 05/16/23, 05/31/23 and 06/13/23 ordered SN visits one time a week. Documentation showed during the weeks of 06/04/23 to 06/10/23 no SN visits were made (1visit ordered, no visit conducted) and 06/11/23 to 06/17/23 no SN visits were made (1visit ordered, no visit conducted). Documentation showed no patient or family refusal of missed visits and no changes in the ordered frequency for the SN. Patient #14 A review of the plan of care dated 03/28/23 to 06/25/23 and plan of care updates dated 03/28/23, 04/05/23, 04/19/23, 05/03/23, 05/17/23, 05/30/23 and 06/13/23 ordered hospice aide visits at a frequency of two visits every week and SN visits at a frequency of two visits every week. Documentation showed during the weeks of 03/28/23 to 04/01/23 no hospice aide visit was made (2 visits ordered, no visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 03/29/23 to 04/08/23 one hospice aide visit was made (2 visits ordered, one visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 04/09/23 to 04/15/23 one hospice aide visit was declined (2 visits ordered, one visit declined) and one SN visit was conducted (2 visits ordered, one visit conducted), 04/16/23 to 04/22/23 one hospice aide visit was conducted (2 visits ordered, one visit conducted) and no SN visit was conducted (2 visits ordered, no visit conducted), 04/23/23 to 04/29/23 no hospice aide visit was conducted (2 visits ordered, no visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 04/30/23 to 05/06/23 one hospice aide visit was declined (2 visits ordered, one visit declined) and one SN visit was conducted (2 visits ordered, one visit conducted), 05/07/23 to 05/13/23 one hospice aide visit was conducted (2 visits ordered, one visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 05/14/23 to 05/20/23 no hospice aide visit was conducted (2 visits ordered, no visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 05/21/23 to 05/27/23 no hospice aide visit was conducted (2 visits ordered, no visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 05/28/23 to 06/03/23 no hospice aide visit was conducted (2 visits ordered, no visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted), 06/04/23 to 06/10/23 no hospice aide visit was conducted (2 visits ordered, no visit conducted) and one SN visit was conducted (2 visits ordered, one visit conducted). Documentation showed no patient or family refusal of missed visits and no changes in the ordered frequencies for the hospice aide or SN. Patient #15 A review of the plan of care dated 05/04/23 to 08/01/23 and plan of care updates dated 05/03/23, 05/17/23 and 05/31/23 ordered hospice aide visits at a frequency of two visits every week and SN visits at a frequency of one visit every week. Documentation showed during the weeks of 05/04/23 to 05/06/23; 05/07/23 to 05/13/23; 05/14/23 to 05/20/23; 05/21/23 to 05/27/23; 05/28/23 to 06/04/23, 06/05/23 to 06/10/23 and 06/11/23 to 06/17/23 no hospice aide visits were made (2 visits ordered per week, no visits conducted) and 05/14/23 to 05/20/23 no SN visit was conducted (1 visits ordered, no visit conducted). Documentation showed no patient or family refusal of missed visits and no changes in the ordered frequencies for the hospice aide or SN. On 06/21/23 at 4:00 p.m., Staff A stated: 1. Hospice aide frequency was not followed as ordered for Patients #4, 9, 14 and #15 and; 2. Skilled nurse frequency was not followed as ordered for Patients #4, 8, 13, 14 and #15.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include: 1. All services necessary for the palliation and management of the terminal illness for two (Patients #4 and #7) of 19 patients; 2. Include ordered interventions for the management of the urinary catheter and monthly interventional procedure to change the urinary catheter for one (Patients #5) of 19 patients and; Include ordered interventions for the care and management of wound sites for two (Patients #5 and #18) of 19 patients. --- Findings: Patient #4 A review of the plan of care dated 03/24/23 to 06/21/23 and plan of care updates dated 03/24/23, 04/04/23, 04/18/23, 05/02/23, 05/16/23, 05/30/23 and 06/13/23 failed to include ordered interventions necessary for the palliation and management of the terminal illness end stage heat failure. On 06/20/23 at 3:20 p.m., Staff A stated the POC for patient #4 failed to include interventions for the palliation and management of end stage heart failure. Patient #5 A review of the plan of care dated 06/10/23 to 09/07/23 and plan of care updates dated 06/15/23 showed a diagnosis of senile degeneration of the brain. Documentation showed the plan of care failed to include ordered interventions for the management of the urinary catheter and monthly interventional procedure to change the urinary catheter and interventions for the care and management of a stage four pressure ulcer. On 06/20/23 at 3:28 p.m., Staff A stated: 1. The POC failed to include ordered interventions for the management of the urinary catheter and; 2. Interventions for the care and management of a stage four pressure ulcer for patient #5. Patient #7 A review of the plan of care dated 05/06/23 to 07/04/23 and plan of care updates dated 05/16/23, 05/30/23 and 06/13/23 failed to include ordered interventions necessary for the palliation and management of the terminal illness atherosclerotic heat disease. On 06/20/23 at 3:30 p.m., Staff A stated the POC for patient #7 failed to include interventions for the palliation and management of atherosclerotic heart disease. Patient #18 A review of the plan of care dated 02/25/23 to 04/12/23 and plan of care update dated 03/05/23 showed a diagnosis of liver cirrhosis. Documentation showed the plan of care failed to include ordered interventions necessary for the care and management of skin tears to bilateral upper extremities. On 06/20/23 at 4:05 p.m., Staff A stated the POC for patient #18 failed to include interventions for the care and management of skin tears to bilateral upper extremities.