Every finding on record at Heritage Acquisition, LLC

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 four (Patients #1, 5, 11 and 13) of 14 patients. --- Findings:Patient #1A review of the clinical record showed an election of the hospice benefit on 07/14/25 with no completion of the initial spiritual assessment from 07/14/25 to 08/21/25 (38 days after the election of the hospice benefit.)  Documentation showed no patient or caregiver refusal of the initial spiritual assessment.Patient #5A review of the clinical record showed an election of the hospice benefit on 07/11/25 with no completion of the initial spiritual assessment from 07/11/25 to 07/18/25 (7 days after the election of the hospice benefit.)  Documentation showed no patient or caregiver refusal of the initial spiritual assessment.Patient #11A review of the clinical record showed an election of the hospice benefit on 06/20/25 with no completion of the initial spiritual assessment from 06/20/25 to 07/11/25 (21 days after the election of the hospice benefit.)  Documentation showed no patient or caregiver refusal of the initial spiritual assessment.Patient #13A review of the clinical record showed an election of the hospice benefit on 07/15/25 with no completion of the initial spiritual assessment from 07/15/25 to 07/24/25 (9 days after the election of the hospice benefit.)  Documentation showed no patient or caregiver refusal of the initial spiritual assessment.On 08/21/25 at 2:20 pm., Staff C stated the initial spiritual assessment for Patients #1, 5, 11 and 13 was not completed within the first five days of the election of the hospice benefit.

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. --- Findings:A review of volunteer records and hours showed the hospice volunteers provided services that equaled 0.00% of the total patient care hours of all paid hospice employees for 2024. On 08/21/25 at 2:20 pm, Staff C 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 agency failed to ensure hospice aide services were provided in accordance with the plan of care for one (Patient #6) of 11 patients. --- Patient #6 A review of the plan of care dated 11/08/22 to 01/04/23 and plan of care updates dated 11/16/22 and 11/30/22 showed a hospice aide frequency of one visit per week for one week, two visits per week for seven weeks and one visit per week for one week. A review of the medical record showed the following: A missed visit note dated 11/17/22 for the week of 11/13/22 to 11/19/22 (one of two scheduled visits documented) with no change in the ordered hospice aide frequency. A missed visit dated 11/22/22 for the week of 11/20/22 to 11/26/22 (one of two scheduled visits documented) with no changed in the ordered hospice aide frequency. A missed visit dated 11/30/22 for the week of 11/27/22 to 12/03/22 (one of two scheduled visits documented) with no change in the ordered frequency. On 01/04/23 at 2:20 pm, Staff B stated the ordered frequency was not met for Patient #6.

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 seven (Patients #1, 2, 6, 7, 8, 10 and 11) of 11 patients reviewed. --- Patient #1 A review of the plan of care dated 10/21/22 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 #2 A review of the plan of care dated 11/06/22 to 01/04/23 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 #6 A plan of care dated 11/08/22 to 01/04/23 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 #7 A review of the plan of care dated 09/28/22 to 11/26/22 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 #8 A review of the plan of care dated 10/22/22 to 12/20/22 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 #10 A plan of care dated 10/15/22 to 12/13/22 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 plan of care dated 10/23/22 to 12/21/22 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. On 01/03/23 at 2:15 pm, Staff B stated the plans of care for Patients #1, 2, 6, 7, 8, 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 wounds for two (Patient #1 and 2) of 11 patients. --- Patient #1 A review of the plan of care dated 10/21/22 to 12/19/22 with plan of care updates dated 11/02/22, 11/16/22, 11/30/22 and 12/14/22 showed a skilled nurse frequency of one visit per week for nine weeks and addressed no skin integrity issues. A review of the electronic medical records showed the following: A skilled nurse assessment dated 10/25/22 documented the presence of a Stage I pressure area to the coccyx. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/08/22 documented the presence of a Stage I pressure area to the coccyx. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 11/22/22 documented the presence of a Stage I pressure area to the coccyx. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 12/06/22 documented the presence of a Stage I pressure area to the coccyx and a Stage I pressure area to the shoulder (unspecified). No updates were made to the plan of care to reflect the presence of pressure areas. Patient #2 A review of the plan of care dated 10/01/22 to 11/29/22 with plan of care updates dated 10/12/22, 10/27/22, 11/09/22 and 11/23/22 showed a skilled nurse frequency of two visits per week for eight weeks and one visit per week for one week and showed no skin integrity issues. A review of the electronic medical record showed the following: A skilled nurse assessment dated 12/27/22 which documented a Stage II pressure ulcer to the coccyx. No updates were made to the plan of care to reflect the current wound sites. A skilled nurse assessment dated 12/29/22 which documented a Stage II pressure ulcer to the coccyx. No updates were made to the plan of care to reflect the current wound sites. On 01/04/23 at 2:35 pm, Staff B stated the plan of care for Patient's #1 and 2 should have been updated to reflect the presence of pressure ulcers.

Based on record review and interview, the hospice failed to ensure governing body oversight of ongoing operations of the patient care delivery systems for the specified hospice effecting all 26 patients and staff. --- A review of administrative records showed no governing body oversight of ongoing operations of the patient care delivery systems specific to the hospice in the calendar years of 2021 and 2022. On 01/04/22 at 12:55 p.m., Staff B stated there was no documentation which showed evidence of governing body oversight of ongoing operations of the patient care delivery systems specific to the hospice in calendar years 2021 and 2022.

Based on record review and interview, the hospice failed to ensure the certification of terminal illness completed by the nurse practitioner accurately reflected the primary diagnosis listed on the plan of care for one (Patient #1) of 11 patients. --- Patient #1 A plan of care dated 10/21/22 to 12/19/22 showed a primary diagnosis of Alzheimer's disease. A review of the electronic medical record showed a certification of terminal illness, completed by the nurse practitioner and signed by the physician, dated 10/21/22 which documented the primary diagnosis as no-specific abnormal findings of lung fields. On 01/04/22 at 2:25 pm, Staff B stated the primary diagnosis on the certification of terminal illness completed by the nurse practitioner and signed by the physician were incorrect in accordance with the plan of care.

Based on record review and interview, the hospice failed to ensure wound assessments were coordinated with the long-term care facility for two (Patients #1 and 2) of 11 patients reviewed. --- Patient #1 A review of the plan of care dated 10/21/22 to 12/19/22 with plan of care updates dated 11/02/22, 11/16/22, 11/30/22 and 12/14/22 showed a skilled nurse frequency of one visit per week for nine weeks and addressed no skin integrity issues. A review of the electronic medical records showed the following: A skilled nurse assessment dated 10/25/22, the week of 10/23/22 to 10/29/22, documented the presence of a Stage I pressure area to the coccyx with no documented assessment of the wound. A skilled nurse assessment dated 11/01/22, the week of 10/30/22 to 11/05/22, showed no documentation of a Stage I pressure ulcer to the coccyx. A skilled nurse assessment dated 11/08/22, the week of 11/06/22 to 11/12/22, documented the presence of a Stage I pressure area to the coccyx with no documented assessment of the wound. A skilled nurse assessment dated 11/15/22, the week of 11/13/22 to 11/19/22, showed no documentation of a Stage I pressure ulcer to the coccyx. A skilled nurse assessment dated 11/22/22, the week of 11/20/22 to 11/26/22, documented the presence of a Stage I pressure area to the coccyx with no documented assessment of the wound. A skilled nurse assessment dated 11/30/22, the week of 11/27/22 to 12/03/22, showed no documentation of a Stage I pressure ulcer to the coccyx. A skilled nurse assessment dated 12/06/22, the week of 12/04/22 to 12/10/22, documented the presence of a Stage I pressure area to the coccyx and a Stage I pressure area to the shoulder (unspecified) with no documented assessment of the wounds. Patient #2 A review of the plan of care dated 10/01/22 to 11/29/22 with plan of care updates dated 10/12/22, 10/27/22, 11/09/22 and 11/23/22 showed a skilled nurse frequency of two visits per week for eight weeks and one visit per week for one week and showed no skin integrity issues. A review of the electronic medical record showed the following: A skilled nurse assessment dated 12/23/22, the week of 12/18/22 to 12/24/22, documented the initial development of a Stage II pressure ulcer to the coccyx with no documented assessment of the wound. Skilled nurse assessments dated 12/27/22 and 12/29/22, the week of 12/25/22 to 12/31/22, documented a Stage II pressure ulcer to the coccyx with no documented assessment of the wound. On 01/04/23 at 2:35 pm, Staff B stated the hospice failed to show coordination with the nursing home regarding wound assessments for Patients #1 and 2.

Based on record review and interview, the agency failed to ensure completion and maintenance of the OKSCREEN background check completed by the hospice for two (Staff C and D) of five employees. --- The "Long-Term Care Security Act Title 63 of the Oklahoma Statutes" documented requirement for an OKSCREEN national background check with fingerprinting for all hospice employees whose employment began after 06/01/14. Staff C A review of personnel records showed an OKSCREEN background check completed by another provider with no OKSCREEN background check completed by the hospice for Staff C. Staff D A review of personnel records showed an OKSCREEN background check completed by another provider with no OKSCREEN background check completed by the hospice for Staff D. On 01/04/23 at 1:50 pm, Staff B stated the OKSCREEN background check had not been completed by the hospice for Staff C and D.