Every finding on record at Healthcare Innovations of Oklahoma, LLC

Based on record review and interview, the hospice failed to ensure emergency preparedness disaster declaration, table-top exercises, drills, community drills or plan activation events were conducted as required for 05/12/2023 to 12/31/23, and 01/01/24 to 12/31/24 for 49 patients, seven volunteers, and 26 employees. --- Findings: A review of emergency preparedness records showed winter weather advisories were emailed out to staff on 01/14/24 and again on 02/17/25. Documentation showed no after action summary reporting, table-top exercises, drills, community drills or plan activation events for 05/12/23 to 12/31/23, and 01/01/24 to 12/31/24.On 04/03/25 at 3:00 p.m., Staff B stated the hospice had no emergency preparedness disaster declarations, table-top exercises, drills, community drills or plan activation events for 05/12/23 to 12/31/23, and 01/01/24 to 12/31/24.

Based on record review and interview, the hospice failed to ensure it completed an initial assessment within 48 hours of election of the hospice benefit for five (Patients #1, 6, 8, 10, and 11) of 14 patients. --- Findings: Patient #1A review of the clinical record showed a referral date of 09/13/24 with election of the hospice benefit and SOC on 09/19/24 (6 days later). Documentation showed no declined visits, no physician notifications, and no changes in orders.  On 04/03/25 at 2:56 p.m., Staff B stated the initial comprehensive assessment was not completed within five days for patient #1. Patient #6A review of the clinical record showed a referral date of 06/03/24 with election of the hospice benefit and SOC on 08/23/24 (81 days later). Documentation showed no declined visits, no physician notifications, and no changes in orders.  On 04/03/25 at 3:55 p.m., Staff B stated the initial comprehensive assessment was not completed within five days for patient #6.  Patient #8A review of the clinical record showed a referral date of 03/14/25 with election of the hospice benefit and SOC on 03/20/25 (6 days later). Documentation showed no declined visits, no physician notifications, and no changes in orders.  On 04/03/25 at 4:05 p.m., Staff B stated the initial comprehensive assessment was not completed within five days for patient #8.  Patient #10A review of the clinical record showed a referral date of 06/14/24 with election of the hospice benefit and SOC on 07/20/24 (36 days later). Documentation showed no declined visits, no physician notifications, and no changes in orders.  On 04/03/25 at 4:15 p.m., Staff B stated the initial comprehensive assessment was not completed within five days for patient #10.  Patient #11A review of the clinical record showed a referral date of 11/15/24 with election of the hospice benefit and SOC on 11/21/24 (6 days later). Documentation showed no declined visits, no physician notifications, and no changes in orders.  On 04/03/25 at 4:20 p.m., Staff B stated the initial comprehensive assessment was not completed within five days for patient #11.

Based on record review and interview, the hospice failed to ensure initial psychosocial assessments were conducted by the MSW within the five-day for two (Patients #1 and #6) of 14 patients. --- Findings: Patient #1A review of the clinical record showed an election of the hospice benefit and SOC on 09/19/24. Documentation showed no psychosocial assessment conducted and showed no follow up care and services were offered or provided by an MSW. Documentation showed no declined MSW visits, no physician notifications, and no changes in orders.  On 04/03/25 at 2:56 p.m., Staff B stated:1.    The MSW had not conducted the initial psychosocial assessment for patient #1 within the five-day timeframe and2.    The hospice didn’t have a MSW available at that time and was utilizing a social worker out of Denton, Texas that was licensed in Oklahoma.  Patient #6A review of the clinical record showed an election of the hospice benefit and SOC on 08/23/24. Documentation showed no psychosocial assessment conducted and showed no follow up care and services were offered or provided by an MSW. Documentation showed no declined MSW visits, no physician notifications, and no changes in orders.  On 04/03/25 at 3:55 p.m., Staff B stated:1.    On 04/03/25 at 2:56 p.m., Staff B stated:1.    The MSW had not conducted the initial psychosocial assessment for patient #1 within the five-day timeframe and2.    The hospice didn’t have a MSW available at that time and was utilizing a social worker out of Denton, Texas that was licensed in Oklahoma.

Based on record review and interview, the hospice failed to ensure development of a bereavement POC for four (Patients #2, 4, 6 and #13) of 14 patients. --- Findings: Patient #2A review of the clinical record showed an election of the hospice benefit/SOC on 02/27/25. Documentation showed a spiritual assessment on 03/03/25, and a psychosocial assessment was conducted 03/04/25. Documentation showed a bereavement POC dated 04/03/25 (35 days later). Documentation showed no patient or caregiver refusal of a bereavement POC and showed no change in orders. Patient #4A review of the clinical record showed an election of the hospice benefit/SOC on 03/26/25. Documentation showed a spiritual assessment on 03/27/25, and a psychosocial assessment was conducted 03/28/25. Documentation showed no bereavement POC. Documentation showed no patient or caregiver refusal of a bereavement POC and showed no change in orders. Patient #6A review of the clinical record showed an election of the hospice benefit/SOC on 08/23/24. Documentation showed a spiritual assessment on 08/26/24, and showed no psychosocial assessment was conducted. Documentation showed no bereavement POC. Documentation showed no patient or caregiver refusal of a bereavement POC and showed no change in orders. Patient #13A review of the clinical record showed an election of the hospice benefit/SOC on 03/03/23. Documentation showed a spiritual assessment on 03/07/23, and a psychosocial assessment was conducted 03/06/24. Documentation showed no bereavement POC. Documentation showed no patient or caregiver refusal of a bereavement POC and showed no change in orders.    On 04/03/25 at 4:40 p.m., Staff C stated patients #2, 4, 6 and #13 had no bereavement POCs.

Based on record review and interview, the hospice failed to ensure the IDG developed and updated the plans of care four (Patients #4, 5, 8 and #12) of 14 patients. --- Findings: Patient #4A review of the clinical record showed no POC for the certification period of 03/26/25 to 05/24/25. IDG update meetings on 03/17/25 and on 03/31/25 showed no documentation of an identified wound care site on the POC for subsequent recertification period starting on 03/26/25. Documentation showed no IDG communications and no physician notifications for wound site care.  On 04/03/25 at 3:33 p.m., Staff B stated the recertification plan of care for patient #4 was not updated with an identified wound care site prior to the beginning of the patient’s subsequent recertification period. Patient #5A review of the clinical record showed no POC for the certification period of 03/04/25 to 05/02/25. IDG update meetings on 03/03/25, 03/17/25 and on 03/31/25 showed no interventions and goals related to the hospice diagnosis of sarcopenia on the POC for the subsequent recertification period starting on 03/04/25. Documentation showed no IDG communications, no IDG review of the patients care and services provided by the hospice and no physician notifications for wound site care.  On 04/03/25 at 3:50 p.m., Staff B stated the recertification plan of care for patient #5 did not include interventions and goals for the hospice diagnosis of sarcopenia.  Patient #8A review of the clinical record showed no POC for the certification period of 03/20/25 to 06/17/25. IDG update meetings on 03/17/25 and on 03/31/25 showed no interventions and goals related to the hospice diagnosis of heart failure on the POC for the subsequent recertification period starting on 03/04/25. Documentation showed no IDG communications, no IDG review of the patients care and services provided by the hospice and no physician notifications for wound site care.  On 04/03/25 at 3:50 p.m., Staff B stated the recertification plan of care for patient #8 did not include interventions and goals for the hospice diagnosis of heart failure.  Patient #12A review of the clinical record showed no POC for the certification period of 08/25/24 to 10/23/24. IDG update meetings on 08/19/24, 09/02/24, 09/16/24, 09/30/24, 10/14/24 showed no interventions and goals related to the hospice diagnosis of heart failure on the POC for the certification period starting on 08/25/24. Documentation showed no IDG communications, no IDG review of the patients care and services provided by the hospice and no physician notifications for wound site care.  On 04/03/25 at 4:35 p.m., Staff B stated the recertification plan of care for patient #12 did not include interventions and goals for the hospice diagnosis of heart failure.

Based on record review and interview, the hospice failed to ensure urinary catheter management was included in the POC for one (Patient #9) of 14 patients. --- Findings: Patient #9A review of a POC dated 02/10/25 to 05/10/25 showed IDG updates during the weeks of 02/17/25, 03/03/25, 03/17/25 and 03/31/25. SN visit notes dated 02/26/25, 03/04/25, 03/11/25, 03/18/25, 03/25/25 and 04/01/25 showed the patient had an indwelling Foley catheter in place but showed no orders for SN to perform urinary catheter management monthly. Documentation showed no communications between the IDG and showed no changes in the POC.  On 04/03/25 at 4:12 p.m., Staff B stated there were no orders SN to perform urinary catheter management monthly.

Based on a record review and interview, the hospice failed to ensure multi-disciplined skilled professional staff (PT, OT, MSW and SLP) were available to participate and provide input into the agency’s QAPI program for 49 patients, 26 employees and seven volunteers. --- Findings:A review of QAPI records showed no multi-disciplined skilled professional staff (PT, OT, MSW and SLP) participation in QAPI activities for calendar years 2023 and 2024. On 04/03/25 at 3:00 p.m., Staff C stated no multi-disciplined skilled professional staff participated in the QAPI program activities for the hospice.

Based on record review and interview, the hospice failed to ensure continued review and update of the hospice aide care plan for six (Patients #3, 5, 7, 9, 10 and #12) of 14 patients. --- Findings: Patient #3A recertification plan of care dated 03/19/25 to 06/16/25 and IDG updates to the POC on 03/17/25 and 03/31/25 showed no physician orders for hospice aide visits. Documentation showed a hospice aide care plan dated 03/19/25 with an aide visit frequency and duration of two times a week for six weeks, then one time a week for one week effective 12/22/24 (prior certification period) and showed no review or update to the hospice aide care plan for the 03/19/25 to 06/16/25 certification period. Documentation showed no communication between the IDG, no physician notifications and showed no ordered aide visit frequency. Patient #5A recertification plan of care dated 03/04/25 to 05/02/25 and IDG update meetings on 03/03/25, 03/17/25 and on 03/31/25 showed no physician orders for hospice aide visits. Documentation showed a hospice aide care plan dated 03/04/25 with an aide visit frequency and duration of one time a week for one week, three times a week for eight weeks, then one time a week for one week effective 01/03/25 (prior certification period) and showed no review or update to the hospice aide care plan for the 03/04/25 to 05/02/25 certification period. Documentation showed no communication between the IDG, no physician notifications and showed no ordered aide visit frequency. Patient #7A recertification plan of care dated 03/23/25 to 06/20/25 and IDG updates to the POC on 03/17/25 and 03/31/25 showed no physician orders for hospice aide visit. A hospice aide care plan dated 03/23/25 showed no aide visit frequency and showed no review or update to the hospice aide care plan for the 03/23/25 to 06/20/25 certification period. Documentation showed no communication between the IDG, no physician notifications and showed no ordered aide visit frequency. Patient #9A recertification plan of care dated 02/10/25 to 05/10/25 and IDG updates to the POC on 02/17/25, 03/03/25, 03/17/25 and 03/31/25 showed no physician orders for hospice aide visits. Documentation showed a hospice aide care plan dated 02/10/25 with an aide visit frequency and duration of one time a week for 13 weeks, effective 11/12/24 (prior certification period) and showed no review or update to the hospice aide care plan for the 02/10/25 to 05/10/25 certification period. Documentation showed no communication between the IDG, no physician notifications and showed no ordered aide visit frequency. Patient #10A recertification plan of care dated 03/17/25 to 05/15/25 and IDG updates to the POC on 03/17/25 and 03/31/25 showed no physician orders for hospice aide visits. Documentation showed a hospice aide care plan dated 03/17/25 with an aide visit frequency and duration of two times a week for 12 weeks, then one time a week for one week effective 07/21/24 (prior certification period) and showed no review or update to the hospice aide care plan for the 03/17/25 to 05/15/25 certification period. Documentation showed no communication between the IDG, no physician notifications and showed no ordered aide visit frequency. Patient #12A recertification plan of care dated 08/25/24 to 10/23/24 and IDG updates to the POC on 08/19/24, 09/02/24, 09/16/24, 09/30/24, 10/14/24 documented no physician orders for hospice aide visits. The documentation showed a hospice aide care plan dated 08/25/24 which showed no aide visit frequency and duration and showed no review or update to the hospice aide care plan for the 08/25/24 to 10/23/24 certification period. Documentation showed no communication between the IDG, no physician notifications and showed no ordered aide visit frequency. On 04/03/25 at 3:30 p.m., Staff B stated the clinical record documentation for patients #3, 5, 7, 9, 10 and #12 showed no review or update to the hospice aide care plans.

Based on record review and interview, the hospice failed to ensure volunteer orientation and training included hospice care and philosophy for three (Volunteer #1, 2 and #3) of three volunteers. --- Findings: Volunteer #1, 2, and #3A review of volunteer personnel records showed no orientation or training for hospice care and philosophy.  Additional request for personnel records yielded no results. On 04/03/25 at 2:30 p.m., Staff C stated the hospice had no documentation that showed Volunteers #1, 2, and #3 were provided hospice care and philosophy training.

Based on record review and interview, the hospice failed to ensure orientation and training of hospice care and philosophy for five (Staff E, F, G, H and I) of five employees. --- Findings: Staff E, F, G, H, and I A review of personnel records showed no training for hospice care and philosophy. Additional request for personnel records yielded no results. On 04/03/25 at 2:00 p.m., Staff A stated the hospice had no documentation that showed Staff E, F, G, H and I were provided training on hospice care and philosophy.

Based on record review and interview, the hospice failed to ensure effective pain management was provided for one (Patient #9) of 11 patients. --- Patient #9 A review of the plan care dated 08/12/22 to 10/10/22 showed a primary diagnosis of chronic obstructive pulmonary disease and documented a skilled nurse frequency of one visit per week for one week and two visits per week for eight weeks with orders to notify the physician of a pain rating greater than 5 out of 10 on the classic 1-10 pain scale. A review of the medical record showed the following: A skilled nurse assessment dated 08/15/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 08/28/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 08/22/22 documented the patient pain as a 7 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 08/25/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 08/29/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/01/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/08/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/12/22 documented the patient pain as a 7 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/15/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/22/22 documented the patient pain as an 7 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/26/22 documented the patient pain as an 8 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. A skilled nurse assessment dated 09/29/22 documented the patient pain as a 9 out of 10 on the classic 1-10 pain scale. Documentation showed no interventions provided and no documented follow up related to the pain level documented above the elevated parameter. On 08/23/22 at 11:25 am, Staff B stated the pain for Patient #2 was not properly managed.

Based on record review and interview, the hospice failed to ensure completion of the initial psychosocial assessment no later than 5 calendar days after the election of hospice care for one (Patient #1) of 11 patients. --- Patient #1A review of the clinical record showed an election of the hospice benefit on 05/06/22 with no completion of the initial psychosocial assessment from 05/06/22 to 06/20/22 (45 days after the election of the hospice benefit) with no documentation of attempts to contact the patient made by the Medical Social Worker and no patient or caregiver refusal of Medical Social Worker visits. On 10/04/22 at 2:40 pm, Staff B stated the initial psychosocial assessment was not completed within the first five days after the election of the hospice benefit for Patient #1.

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 05/06/22 to 08/03/22 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 09/14/22 to 11/12/22 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 09/26/22 to 12/24/22 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 07/20/22 to 09/17/22 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 07/02/22 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. Patient #6A plan of care dated 07/18/22 to 09/15/22 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 06/30/21 to 09/27/22 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 07/06/22 to 10/03/22 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 08/12/22 to 10/10/22 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 #10A plan of care dated 07/22/22 to 09/19/22 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 #11A plan of care dated 07/10/22 to 10/07/22 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 10/04/22 at 2:11 pm, Staff B 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 the plan of care was revised to reflect the development of a pressure ulcer for one (Patient #1) of 11 patients. --- Patient #1A review of the clinical record showed a plan of care dated 05/06/22 to 08/03/22 and plan of care updates dated 05/19/22, 06/02/22, 06/16/22 and 06/30/22 which showed orders for a skilled nurse frequency of two visits per week for two weeks, on visit per week for two weeks, two visits per week for one week, one visit per week for six weeks, two visits per week for one week and one visit per week for one week. A review of the clinical record showed: A skilled nurse assessment dated 06/13/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/15/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/17/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/18/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/20/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/22/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/24/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/27/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 06/29/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A skilled nurse assessment dated 07/01/22 which documented the presence of an unstageable pressure ulcer to the left and right heels. A review of the clinical record showed no update to the plan of care to include the presence, care and services provided to the pressure ulcers documented to the left and right heels of the patient. On 10/04/22 at 2:35 pm, Staff B stated the plan of care should have been updated to reflect the presence and care provided to the pressure ulcers located to Patient #1 right and left heel.

Based on record review and interview, the hospice failed to ensure wound assessments were coordinated with the long-term care facility for one (Patient #10) of 11 patients reviewed. --- Patient #10A plan of care dated 07/22/22 to 09/19/22 showed a skilled nurse frequency of two visits per week for eight weeks and one visit per week for one week. A review of the electronic medical record showed the following: A skilled nurse assessment dated 07/26/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 07/28/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/02/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/04/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/09/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/11/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/15/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/17/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/22/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/24/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. A skilled nurse assessment dated 08/26/22 documented the presence of a pressure ulcer to the right buttocks with no measurements of the wound. Documentation showed no coordination with the nursing home regarding the wound. On 10/04/22 at 2:25 pm, Staff B stated the hospice failed to show coordination with the nursing home regarding wound assessment.