Every finding on record at Integris Hospice, Inc.

Based on record review and interview, the hospice failed to ensure the initial psychosocial assessment was conducted within the five-day timeframe required to complete the initial comprehensive assessment for one (Patient #10) of 19 patients. --- Findings: Patient #10A review of the clinical record showed an election of the hospice benefit/SOC on 01/08/25. Documentation showed a psychosocial assessment was conducted on 01/17/25 (9 days later) by an MSW. Documentation showed no declined MSW visits, no physician notifications, and no changes in orders.  On 08/22/25 at 11:00 a.m., Staff A stated the MSW did not conduct the initial psychosocial assessment within the five-day timeframe.

Based on record review and interview, the hospice failed to ensure a bereavement care plan was initiated or was included as a part of the overall POC after the initial and ongoing spiritual/bereavement assessments for 15 (Patients #7, 8, 9, 12, 13, 14 and #15) of 19 patients. --- Findings: Patient #7A review of the clinical record showed an election of the hospice benefit on 06/28/25 and completion of the bereavement assessment on 07/02/25. A review of a POC dated 06/28/25 to 09/25/25 and IDG updates to the POC on 06/28/25, 07/04/25, 07/18/25, 08/01/25 and on 08/15/25 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/22/25 at 10:55 a.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC. Patient #8A review of the clinical record showed an election of the hospice benefit on 01/20/25 and completion of the bereavement assessment on 01/21/25. A review of a POC dated 07/20/25 to 09/17/25 and IDG updates to the POC on 08/15/25 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/22/25 at 10:57 a.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC. Patient #9A review of the clinical record showed an election of the hospice benefit on 05/07/25 and completion of the bereavement assessment on 05/09/25. A review of a POC dated 05/07/25 to 09/25/25 and IDG updates to the POC on 05/09/25, 05/23/25, 06/06/25, 06/20/25, 07/04/25, 07/18/25 and on 08/01/25 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/22/25 at 10:58 a.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC. Patient #12A review of the clinical record showed an election of the hospice benefit on 05/09/25 and completion of the bereavement assessment on 05/12/25. A review of a POC dated 08/07/25 to 11/04/25 and IDG updates to the POC on 08/01/25 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/22/25 at 11:07 a.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC. Patient #13A review of the clinical record showed an election of the hospice benefit on 05/18/25 and completion of the bereavement assessment on 05/20/25. A review of a POC dated 05/18/25 to 08/16/25 and IDG updates to the POC on 05/09/25, 05/30/25, 06/13/25, 06/27/25, 07/11/25, 07/25/25 and on 08/08/25 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/22/25 at 11:10 a.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC. Patient #14A review of the clinical record showed an election of the hospice benefit on 11/22/24 and completion of the bereavement assessment on 11/26/24. A review of a POC dated 07/20/25 to 09/17/25 and IDG updates to the POC on 07/11/25, 07/25/25 and on 08/08/25 showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/22/25 at 11:12 a.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC. Patient #15A review of the clinical record showed an election of the hospice benefit on 02/14/24 and completion of the bereavement assessment on 02/16/24. A review of a POC dated 05/30/25 to 07/28/25 and IDG updates to the POC on 05/16/25, 05/30/25, 06/13/25, 06/27/25 and on 07/11/25showed no bereavement care plan and/or no bereavement interventions and goals included as a part of the overall POC. Documentation showed no change in orders. On 08/20/25 at 2:20 p.m., Staff A stated the patient had no BCP or bereavement interventions and goals included as a part of the POC.

Based on record review and interview, the hospice failed to ensure:1.    Aide services were provided in accordance with the plan of care for three (Patients #5, 12 and #15) of 19 patients.2.    Skilled nurse services were provided in accordance with the plan of care for seven (Patients #9 and #15) of 19 patients. --- Findings: Patient #5A review of the plan of care dated 06/26/25 to 09/23/25 and plan of care updates dated 06/27/25, 07/11/25, 07/25/25 and 08/08/25 ordered aide visits at a frequency of three times a week, effective week of 07/06/25. The clinical record showed during the weeks of 08/04/25 to 08/10/25 aide visits were conducted on 08/04/25 and 08/06/25 (three visits ordered, two visits conducted). The clinical record showed no patient or family refusal of visits and no changes in the ordered frequency for the aide. On 08/22/25 at 10:50 a.m., Staff A stated the record only showed two aide visits were made that week. Patient #9A review of the plan of care dated 05/07/25 to 08/04/25 and plan of care updates dated 05/09/25, 05/23/25, 06/06/25, 06/20/25, 07/04/25, 07/18/25 and 08/01/25 ordered SN visits at a frequency of one to two times a week, effective week of 05/07/25. The clinical record showed during the weeks of 05/18/25 to 05/24/25 no SN visits were conducted (one to two visits ordered, no visits conducted), 06/15/25 to 06/21/25 no SN visits were conducted (one to two visits ordered, no visits conducted), 06/29/25 to 07/05/25 no SN visits were conducted (one to two visits ordered, no visits conducted), 07/15/25 to 07/20/25 no SN visits were conducted (one to two visits ordered, no visits conducted) and 07/27/25 to 08/02/25 no SN visits were conducted (one to two visits ordered, no visits conducted). The clinical record showed no patient or family refusal of visits and no changes in the ordered frequency for the SN. On 08/22/25 at 10:58 a.m., Staff A stated the record did not show SN visits were made during those weeks. Patient #12A review of the plan of care dated 08/07/25 to 11/04/25 and plan of care update dated 08/01/25 ordered aide visits at a frequency of three times a week, effective week of 08/07/25. The clinical record showed during the week of 08/07/25 to 08/16/25 aide visits were conducted on 08/12/25 and 08/14/25 (three visits ordered, two visits conducted). The clinical record showed no patient or family refusal of visits and no changes in the ordered frequency for the aide. On 08/22/25 at 11:07 a.m., Staff A stated the record only showed two aide visits were made that week. Patient #15A review of the plan of care dated 05/30/25 to 07/28/25 and plan of care updates dated 05/16/25, 05/30/25, 06/13/25, 06/27/25 and 07/11/25 ordered aide visits at a frequency of three times a week, effective week of 06/27/25. The clinical record showed during the week of 06/29/25 to 07/05/25 aide visits were conducted on 06/30/25 and 07/02/25 (three visits ordered, two visits conducted). The clinical record showed no patient or family refusal of visits and no changes in the ordered frequency for the aide. On 08/22/25 at 11:14 a.m., Staff A stated the record only showed two aide visits were made that week.

Based on record review and interview, the agency failed to ensure care was coordinated between the IDG members and the physician for one (Patient #18) of 19 patients. --- Findings: Patient #19A review of the POC dated 12/31/24 to 03/08/25 and plan of care updates dated 12/31/24, 01/03/25, 01/17/25, 01/31/25, 02/14/25 and 02/28/25 showed orders for an aide visit frequency and duration of three times a week for 14 weeks. The clinical record showed between 01/01/25 to 03/07/25 aide visits were missed on 01/01/25, 01/03/25, 01/08/25, 01/13/25, 01/17/25, 01/20/25, 01/22/25, 01/24/25, 01/27/25, 01/29/25, 01/31/25, 02/03/25, 02/12/25, 02/14/25, 02/17/25, 02/19/25, 02/24/25, 02/26/25, 02/28/25, 03/04/25 and on 03/07/25 (30 visits ordered, 6 visits conducted). The clinical record showed no discussion of aide missed visits by the IDG, patient or family refusal of visits and showed no changes in the ordered visit frequency for the aide. On 08/22/25 at 11:20 a.m., Staff A stated the IDG did not discuss the aide missed visits or update the patient’s POC.

Based on record review and interview, the agency failed to ensure required background checks were completed for one (Volunteer #3) of three volunteers reviewed. --- Findings: The "Long-Term Care Security Act Title 63 of the Oklahoma Statutes" documented requirement for an OKSCREEN national background check with fingerprinting for all employees of a home care agency whose employment began after 07/01/14. Volunteer #3A review of the personnel record showed no documentation of a background check through OKSCREEN for employment that began 07/22/25. On 08/22/25 at 9:00 a.m., Staff D stated Volunteer #3 had no background check through OkScreen.

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 two (Patient #2 and 8) of 13 patients. --- Patient #2A review of the clinical record showed an election of the hospice benefit on 08/30/22 with no completion of the initial spiritual assessment from 08/30/22 to 11/27/22 (90 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. Patient #8A review of the clinical record showed an election of the hospice benefit on 12/12/22 with no completion of the initial spiritual assessment from 12/12/22 to 12/19/22 with no documentation of attempts to contact the patient made by the Chaplain and no patient or caregiver refusal of Chaplain visits until 12/19/22 (7 days after the election of the hospice benefit.. On 01/18/23 at 3:10 pm, Staff B stated the initial psychosocial assessments were not completed within the first five days after the election of the hospice benefit for Patients #2 and 8.

Based on record review and interview, the hospice failed to: 1. ensure skilled nursing services were provided in accordance with the plan of care frequency for one (Patient #9) of 13 patients and 2. ensure hospice aide services were provided in accordance with the plan of care frequency for three (Patients #3, 5 and 12) of 13 patients. --- 1. Patient #9 A review of the plan of care dated 11/06/22 to 01/04/23 with plan of care updates dated 11/18/22, 12/02/22, 12/16/22 and 12/30/22 showed a skilled nurse frequency of 1 to 2 visits per week for 7 weeks. A review of the clinical record showed the following; No skilled nurse visits made for the week of 11/20/22 to 11/26/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. 2. Patient #3 A review of the plan of care dated 09/05/22 to 12/03/22 with plan of care updates dated 09/15/22, 09/26/22, 09/30/22, 10/14/22, 10/28/22 and 11/08/22 showed a hospice aide frequency of one visit per week for 14 weeks. A review of the clinical record showed the following: No hospice aide visits made for the week of 09/11/22 to 09/17/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits made for the week of 09/18/22 to 09/24/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits made for the week of 09/25/22 to 10/01/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits made for the week of 10/02/22 to 10/08/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits made for the week of 10/09/22 to 10/15/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits made for the week of 10/16/22 to 10/22/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits made for the week of 10/23/22 to 10/29/22 (no completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Patient #5 A review of the plan of care dated 12/14/22 to 03/13/23 with plan of care updates dated 12/16/22, 12/30/22 and 01/13/23 showed a hospice aide frequency of one visit per day for one day and three visits per week for 13 weeks. A review of the clinical record showed the following: Hospice aide visits dated 12/28/22 and 12/30/22 for the week of 12/25/22 to 12/31/22 (two of three visits completed). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Hospice aide visit dated 01/06/23 and a hospice aide missed visit dated 01/04/23 for the week of 01/01/23 to 01/0723 (two of three visits completed and attempted). Documentation showed no other patient or family refusal of visits and no changes in the ordered frequency. Patient #12 A review of the plan of care dated 10/14/22 to 01/11/23 with plan of care updates dated 10/21/22 and 11/04/22 showed a hospice aide frequency of one visit per day for one day and three visits per week for 14 weeks. A review of the clinical record showed the following: No hospice aide visits completed the week of 10/16/22 to 10/22/22 (no completed visits). Documentation showed no other patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits completed the week of 10/23/22 to 10/29/22 (no completed visits). Documentation showed no other patient or family refusal of visits and no changes in the ordered frequency. No hospice aide visits completed the week of 10/30/22 to 11/05/22 (no completed visits). Documentation showed no other patient or family refusal of visits and no changes in the ordered frequency. On 01/19/23 at 12:50 pm, Staff B stated: 1. the ordered skilled nurse frequency for Patient #9 was not met and 2. the ordered hospice aide frequency for Patients #3, 5 and 12 were not met.

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 thirteen (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13) of 13 patients reviewed. --- Patient #1A review of the plan of care dated 11/08/22 to 01/06/23 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 #2A review of the plan of care dated 08/30/22 to 11/27/22 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 #3A review of the plan of care dated 09/05/22 to 12/03/22 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 #4A review of the plan of care dated 10/25/22 to 12/23/22 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 12/14/22 to 03/13/23 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 #6A plan of care dated 12/28/22 to 02/25/23 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 #7A review of the plan of care dated 11/14/22 to 02/11/23 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 #8A review of the plan of care dated 12/12/22 to 03/11/23 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 #9A 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 #10A plan of care dated 11/17/22 to 02/14/23 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 #11A plan of care dated 10/26/22 to 01/23/23 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 #12A plan of care dated 10/14/22 to 01/11/23 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 #13A plan of care dated 11/01/22 to 01/29/23 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. On 01/19/23 at 1:30 pm, Staff B stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 and 13 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 hospice aide frequencies were provided within the scope of practice for one (Patient #11) of 13 patients. --- Patient #11A review of the plan of care dated 10/26/22 to 01/23/23 and plan of care updates dated 11/04/22, 11/18/22, 12/02/22 and 12/16/22 showed a hospice aide frequency range of two to three times per week for 13 weeks. Documentation showed no instructions on how to determine the number of visits. On 01/19/23 at 1:10 pm, Staff B stated the ranged hospice aide frequencies for Patient #11 were inappropriate for the scope of practice of hospice aides.

Based on record review and interview, the hospice failed to ensure the hospice aide notified the supervising nurse of missed visits for four (Patients #2, 5, 6 and 11) of 13 patients. --- Patient #2 A review of the plan of care dated 08/30/22 to 11/27/22 and plan of care updates dated 08/30/22, 09/09/22, 09/23/22, 10/07/22 and 10/21/22 showed a hospice aide frequency of three visits every four days for four days and three visits per week for 12 weeks. A review of the clinical record showed the following: A hospice aide missed visit dated 08/31/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 09/02/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 09/07/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 10/07/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 10/14/22 which documented the supervising nurse was not notified. Patient #5 A review of the plan of care dated 12/14/22 to 03/13/23 and plan of care updates dated 12/16/22, 12/30/22 and 01/13/23 showed a hospice aide frequency of one visit every one day for one day and three visits per week for 13 weeks. A review of the clinical record showed the following: A hospice aide missed visit dated 12/16/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 12/21/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 01/11/23 which documented the supervising nurse was not notified. Patient #6 A review of the plan of care dated 12/28/22 to 02/25/23 and plan of care updates dated 12/28/22, 12/30/22 and 01/13/23 showed a hospice aide frequency of two visits per week for 8 weeks. A review of the clinical record showed the following: A hospice aide missed visit dated 12/29/22 which documented the supervising nurse was not notified. Patient #11 A review of the plan of care dated 110/26/22 to 01/23/23 and plan of care updates dated 10/27/22, 11/06/22, 11/18/22, 12/02/22 and 12/16/22 showed a hospice aide frequency of two to three times per week for 13 weeks. A review of the clinical record showed the following: A hospice aide missed visit dated 11/02/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 12/02/22 which documented the supervising nurse was not notified. A hospice aide missed visit dated 12/16/22 which documented the supervising nurse was not notified. On 01/19/23 at 1:20 pm, Staff B stated the hospice aide failed to notify the supervising nurse of missed visits for Patients #2, 5, 6 and 11.