Every finding on record at Kindful Hospice Ada, LLC

Based on record review and interview, the hospice failed to ensure an individualized plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for fourteen (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14) of 14 patients reviewed. --- Patient #1 A plan of care dated 04/24/24 to 06/22/24 documented a primary diagnosis of Parkinson's disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #2 A review of the plan of care dated 05/16/24 to 08/13/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #3 A plan of care dated 04/19/24 to 06/17/24 documented a primary diagnosis of sarcopenia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #4 A plan of care dated 05/11/24 to 07/09/24 documented a primary diagnosis of prostate cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #5 A plan of care dated 04/28/24 to 06/26/24 documented a primary diagnosis of atherosclerotic heart disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #6 A plan of care dated 06/12/24 to 09/09/24 documented a primary diagnosis of chronic combined systolic and diastolic heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #7 A plan of care dated 02/21/24 to 05/18/24 documented a primary diagnosis of breast cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #8 A plan of care dated 04/17/24 to 07/15/24 documented a primary diagnosis of atherosclerotic heart disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #9 A plan of care dated 03/31/24 to 05/29/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #10 A plan of care dated 03/15/24 to 06/12/24 documented a primary diagnosis of cerebral ischemia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #11 A plan of care dated 03/20/24 to 06/17/24 documented a primary diagnosis of lung cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #12 A plan of care dated 03/17/24 to 05/15/24 documented a primary diagnosis of colon cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #13 A plan of care dated 03/25/24 to 06/22/24 documented a primary diagnosis of liver cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #14 A plan of care dated 05/21/24 to 08/18/24 documented a primary diagnosis of pancreatic cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 07/02/24 at 2:15 pm, Staff A stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14 failed to include individualized services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to: 1. ensure the plan of care was revised to reflect the presence of wounds for two (Patients #1 and 5) of 14 patients; and 2. ensure the plan of care was revised to reflect changes in the services for a change in the primary diagnosis for one (Patient #2) of 14 patients. --- 1. Patient #1 A review of the plan of care dated 04/24/24 to 06/22/24 and plan of care updates dated 04/30/24, 05/14/24, 05/28/24 and 06/11/24 showed a skilled nurse frequency of one visit per week for nine weeks and documented no presence of wounds or impaired skin integrity. A review of the clinical record showed the following: A skilled nurse assessment dated 06/05/24 documented the presence of a diabetic ulcer which was reported to the interdisciplinary group, with no documentation of physician notification or update to the plan of care. A skilled nurse assessment dated 06/12/24 documented the presence of a diabetic ulcer to the 4th left toe, with no update to the plan of care. A physician's order dated 06/12/24 documented facility staff to paint the diabetic ulcer with Betadine daily, with no update to the plan of care. A skilled nurse assessment dated 06/19/24 documented the presence of a diabetic ulcer to the 4th left toe, with no update to the plan of care. Patient #5 A review of the plan of care dated 04/28/24 to 06/26/24 and plan of care updates dated 05/03/24, 05/17/24, 05/31/24 and 06/14/24 showed a skilled nurse frequency of one visit per week for nine weeks and documented no presence of wounds or impaired skin integrity. A review of the clinical record showed the following: A skilled nurse assessment dated 05/01/24 documented the presence of a lesion to the upper left back, with no update to the plan of care. A skilled nurse assessment dated 06/19/24 documented the presence of a lesion to the upper left back, with no update to the plan of care. 2. Patient #2 A review of the plan of care dated 05/16/24 to 08/13/24 and plan of care updates dated 05/28/24 and 06/11/24 documented a primary diagnosis of chronic obstructive pulmonary disease. A physician's order dated 06/14/24 showed the primary diagnosis was to be changed to hypertensive heart disease with heart failure. A plan of care update dated 06/25/24 showed no changes in the services necessary for the management and palliation of the updated primary diagnosis. On 07/02/24 at 2:00 pm., Staff A stated: 1.the plan of care for Patients #1 and 6 were not updated to reflect the changes in skin integrity; and 2.. the plan of care for Patient #2 was no updated to reflect changes in the services necessary for the management and palliation of the updated primary diagnosis.

Based on record review and interview, the hospice failed to analyze quality indicators. This failed practice had the potential to place 21 current patients and any new patient admitted to the hospice at risk for repeated hospice mishaps due to failure of the hospice to self-identify problem areas. --- A review of administrative records showed no analysis of quality indicators for 2023 and from January 1st, 2024, to March 31st, 2024. On 07/02/24 at 1:45 pm, Staff A stated the QAPI for 2023 and from January 1st, 2024, to March 31st, 2024, not contain an analysis of quality indicators.

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 (Patient #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11) of eleven patients reviewed. Findings: Patient #1 A review of the plan of care dated 01/06/22 to 03/03/22 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 #2 A plan of care dated 11/28/21 to 02/25/22 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 plan of care dated 11/22/21 to 01/20/22 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 #4 A plan of care dated 11/08/21 to 02/05/22 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 #5 A plan of care dated 10/30/21 to 01/27/22 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 #6 A plan of care dated 12/11/21 to 02/08/22 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 #7 A plan of care dated 12/30/21 to 02/27/22 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 #8 A plan of care dated 02/26/22 to 05/26/22 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 #9 A plan of care dated 12/29/21 to 03/28/22 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 02/10/22 to 05/10/22 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 #11 A plan of care dated 02/01/22 to 04/01/22 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 03/11/22 at 4:20 pm, Staff C 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 maintain evidence of the use of quality indicator in the design of the QAPI program for all 35 current patients and any new patients admitted to the hospice. A review of QAPI records showed no use of quality indicator data in the QAPI program documentation for 2020 and 2021. On 03/11/22 at 3:30 pm, Staff C stated the QAPI program did not include the use of quality indicator data.