Every finding on record at Interim Healthcare of Tulsa, Inc.

Based on record review and interview, the hospice failed to ensure effective pain management was provided for two (Patients #3 and 6) of 11 patients. Findings: Patient #3 A review of the plan care dated 04/20/22 to 07/18/22 showed a skilled nurse frequency of two visits per week. A review of the medical record showed the following: A skilled nurse assessment dated 04/20/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale and a pain of 5 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/04/22 documented the patient pain upon arrival as a 8 out of 10 on the classic 1-10 pain scale and a pain of 6 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/11/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale and a pain of 5 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/13/22 documented the patient pain upon arrival as a 10 out of 10 on the classic 1-10 pain scale and a pain of 6 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. Patient #6 A review of the plan care dated 05/20/22 to 08/17/22 showed a skilled nurse frequency of two visits per week. A review of the medical record showed the following: A skilled nurse assessment dated 05/24/22 documented the patient pain upon arrival as a 8 out of 10 on the classic 1-10 pain scale and a pain of 8 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/02/22 documented the patient pain upon arrival as a 6 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/05/22 documented the patient pain upon arrival as a 6 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/06/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. On 08/02/22 at 11:30 am, Staff C stated the pain for Patients #3 and 6 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 two (Patient #4 and 7) of 11 patients. Findings: Patient #4 A review of the clinical record showed an election of the hospice benefit on 04/08/22 with no completion of the initial psychosocial assessment from 04/08/22 to 04/19/22 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. Patient #7 A 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 07/04/22 (60 days after 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 08/02/22 at 11:10 am, Staff C stated the initial psychosocial assessments were not completed within the first five days after the election of the hospice benefit for Patients #4 and 7.

Based on record review and interview, the hospice failed to ensure imminence of death was assessed during the comprehensive assessment for four (Patients #2, 4, 6 and 7 ) of eleven patients. Findings: Patient #2 A review of the Initial Assessment dated 06/28/22 showed no assessment of imminence of death. Patient #4 A review of the Initial Assessment dated 04/08/22 showed no assessment of imminence of death. Patient #6 A review of the Initial Assessment dated 05/20/22 showed no assessment of imminence of death. Patient #7 A review of the Initial Assessment dated 05/06/22 showed no assessment of imminence of death. On 08/02/22 at 11:15 am, Staff C stated imminence of death was not assessed on the comprehensive assessment for Patients #2, 4, 6 and 7.

Based on record review and interview, the hospice failed to ensure the comprehensive assessment included data elements (with the exception of pain) that allowed for measurement of outcomes for four (Patients #2, 4, 6 and 7) of 11 patients. Findings: Patient #2 A review of the Initial Assessment dated 06/28/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. Patient #4 A review of the Initial Assessment dated 04/08/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. Patient #6 A review of the Initial Assessment dated 05/20/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. Patient #7 A review of the Initial Assessment dated 05/06/22 showed no data elements (with the exception of pain) included in the comprehensive assessment. On 08/02/22 at 11:15 am, Staff C stated pain was the only data element which was documented on the initial comprehensive assessments for Patients #2, 4, 6 and 7.

Based on record review and interview, the hospice failed to ensure skilled nursing services were provided in accordance with the plan of care frequency for one (Patients #11) of 11 patients. Findings: Patient #11 A review of the plan of care updates dated 03/30/22 and 04/13/22 ordered skilled nurse visits at a frequency of five times per week. A review of the clinical record showed the following: Skilled nurse visits dated 05/05/22 and 05/07/22 for the week of 05/02/22 to 05/08/22 (two of five completed visits). Skilled nurse visits dated 05/12/22 and 05/14/22 for the week of 05/09/22 to 05/15/22 (two of five completed visits). Skilled nurse visits dated 05/19/22 and 05/21/22 for the week of 05/16/22 to 05/22/22 (two of five completed visits). Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. On 06/02/22 at 9:50 am, Staff C stated the ordered skilled nurse frequency for Patient #11 was 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 seven (Patients #1, 2, 3, 4, 6, 8 and 11) of 11 patients reviewed. Findings: Patient #1 A review of the plan of care dated 05/13/22 to 07/11/22 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 06/28/22 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 #3 A review of the plan of care dated 04/20/22 to 07/18/22 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 #4 A review of the plan of care dated 04/08/22 to 07/06/22 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 #6 A plan of care dated 05/20/22 to 08/17/22 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 #8 A review of the plan of care dated 05/10/22 to 07/08/22 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 03/22/22 to 06/19/22 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. On 08/02/22 at 11:05 am, Staff C stated the plans of care for Patients #1, 2, 3, 4, 6, 8 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 physician notification of elevated pain levels for two (Patients # and 6) of 11 patients reviewed. Findings: Patient #3 A review of the plan care dated 04/20/22 to 07/18/22 showed a skilled nurse frequency of two visits per week. A review of the medical record showed the following: A skilled nurse assessment dated 04/20/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale and a pain of 5 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/04/22 documented the patient pain upon arrival as a 8 out of 10 on the classic 1-10 pain scale and a pain of 6 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/11/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale and a pain of 5 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/13/22 documented the patient pain upon arrival as a 10 out of 10 on the classic 1-10 pain scale and a pain of 6 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. Patient #6 A review of the plan care dated 05/20/22 to 08/17/22 showed a skilled nurse frequency of two visits per week. A review of the medical record showed the following: A skilled nurse assessment dated 05/24/22 documented the patient pain upon arrival as a 8 out of 10 on the classic 1-10 pain scale and a pain of 8 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/02/22 documented the patient pain upon arrival as a 6 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/05/22 documented the patient pain upon arrival as a 6 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/06/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. On 08/02/22 at 11:30 am, Staff C stated the physician should have been notified of the elevated pain ratings for Patients #3 and 6.

Based on record review and interview, the hospice failed to ensure skilled nursing services met the needs of the patient for the management of pain for two (Patients #3 and 6) of 11 patients. Findings: Patient #3 A review of the plan care dated 04/20/22 to 07/18/22 showed a skilled nurse frequency of two visits per week. A review of the medical record showed the following: A skilled nurse assessment dated 04/20/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale and a pain of 5 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/04/22 documented the patient pain upon arrival as a 8 out of 10 on the classic 1-10 pain scale and a pain of 6 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/11/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale and a pain of 5 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 05/13/22 documented the patient pain upon arrival as a 10 out of 10 on the classic 1-10 pain scale and a pain of 6 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. Patient #6 A review of the plan care dated 05/20/22 to 08/17/22 showed a skilled nurse frequency of two visits per week. A review of the medical record showed the following: A skilled nurse assessment dated 05/24/22 documented the patient pain upon arrival as a 8 out of 10 on the classic 1-10 pain scale and a pain of 8 out of 10 on the classic 1-10 pain scale after pain medication was administered with. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/02/22 documented the patient pain upon arrival as a 6 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/05/22 documented the patient pain upon arrival as a 6 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. A skilled nurse assessment dated 06/06/22 documented the patient pain upon arrival as a 7 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 3 on the classic 1-10 pain scale. Documentation showed no physician notification of the elevated pain levels and no documented follow up for the effectiveness of interventions provided. On 08/02/22 at 11:30 am, Staff C stated the pain was not properly managed by the skilled nurse for Patients #3 and 6.