Every finding on record at Kindful Hospice Norman Oklahoma City LLC

Based on record review and interview, the agency failed to ensure effective pain management was provided for one (Patient #19) of 20 patients. --- Findings:A review of the plan of care dated 02/10/25 to 05/10/25 showed a skilled nurse frequency of three visits per week for one week and one visit per week for twelve weeks with an intervention to monitor the pain level and report ineffective pain control to the physician.  A review of the clinical record showed the following:A skilled nurse assessment dated 02/10/25 showed a pain level of 7 (severe) on the classic 1-10 pain scale and a patient stated pain level goal of 5 with no evaluation of effectiveness of interventions provided.A skilled nurse assessment dated 02/11/25 showed a pain level of 4 (mild) on the classic 1-10 pain scale and a patient goal of 2 with no documented interventions provided.A skilled nurse assessment dated 02/14/25 showed a pain level of 7 (severe) on the classic 1-10 pain scale and a patient goal of 5 with documentation of the patient taking pan medication prior to the nurse arriving.  The assessment documented the physician was not notified of the pain level and no documentation of the effectiveness of the medication taken prior to the nurse arriving.A skilled nurse assessment dated 02/19/25 showed a pain level of 5 on the classic (moderate) on the classic 1-10 pain scale and a patient goal of 3 with no documented interventions provided.  The assessment documented no physician notification.On 08/28/25 at 2:40 pm., Staff C stated the pain level for Patient #19 was never documented as being less than the pain goal and interventions provided were not evaluated for effectiveness.

Based on record review and interview, the hospice failed to ensure hospice aide visits were provided in accordance with the plan of care for four (Patients #1, 2, 3 and 9) of 20 patients. --- Findings:Patient #1A plan of care dated 05/10/25 to 07/14/25 showed a hospice aide frequency of one visit per week for one week, three visits per week for one week, two visits per week for one week, three visits per week for four weeks, two visits per week for one week, three visits per week for one week and one visit per week for one week.  A physician's order dated 05/26/25 showed a hospice aide frequency of six visits per week for five weeks, four visits per week for one week, six visits per week for one week and two visits per week for one week.  A review of the clinical record showed the following:Hospice aide visits dated 05/27/25 and 05/30/25 with a hospice aide missed visit dated 05/25/25 for the week of 05/25/25 to 05/31/25 (two of six completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency. Hospice aide visits dated 06/02/25 and 06/04/25 with a hospice aide missed visit dated 06/03/25 (no reason given) for the week of 06/01/25 to 06/07/25 (two of six completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency. Hospice aide visits dated 06/09/25, 06/11/25 and 06/13/25 for the week of 06/08/25 to 06/14/25 (three of six completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/16/25, 06/18/25 and 06/20/25 for the week of 06/15/25 to 06/21/25 (three of six completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/23/25, 06/25/25 and 06/27/25 for the week of 06/22/25 to 06/28/25 (three of six completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/30/25 and 07/02/25 for the week of 06/29/25 to 07/05/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 07/07/25, 07/09/25 and 07/11/25 for the week of 07/06/25 to 07/12/25 (three of six completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Patient #2A review of the plan of care dated 05/10/25 to 08/07/25 and plan of care updates dated 05/23/25, 06/05/25, 06/19/25, 07/03/25 and 07/17/25 showed a hospice aide frequency of four visits per week for twelve weeks and two visits per week for one week.  A review of the clinical record showed the following:A hospice aide visit dated 05/13/25 for the week of 05/11/25 to 05/17/25 (one of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.A hospice aide visit dated 05/22/25 for the week of 05/18/25 to 05/24/25 (one of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 05/27/25 and 05/29/25 for the week of 05/25/25 to 05/31/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/03/25 and 06/05/25 for the week of 06/01/25 to 06/07/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/10/25 and 06/12/25 for the week of 06/08/25 to 06/14/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/17/25 and 06/19/25 for the week of 06/15/25 to 06/21/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 06/24/25 and 06/26/25 for the week of 06/22/25 to 06/28/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Hospice aide visits dated 07/01/25 and 07/03/25 for the week of 06/29/25 to 07/05/25 (two of four completed visits).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Patient #3A review of the plan of care dated 05/27/25 to 08/24/25 and plan of care updates dated 05/27/25, 06/11/25, 06/25/25 and 07/09/25 showed a hospice aide frequency of one visit per week for one week and two visits per week for twelve weeks.  A review of the clinical record showed the following:The week of 06/29/25 to 07/05/25 no hospice aide visits were completed (zero of two visits completed).  Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.Patient #9A review of the plan of care dated 06/18/25 to 09/15/25 and plan of care updates dated 06/25/25, 07/09/25, 07/23/25, 08/06/25 and 08/20/25 showed a hospice aide frequency of one visit per week for thirteen weeks.  A review of the clinical record showed the following:The week of 06/22/25 to 06/28/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.The week of 06/29/25 to 07/05/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.The week of 07/06/25 to 07/12/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.The week of 07/13/25 to 07/19/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.The week of 07/20/25 to 07/26/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.The week of 07/27/25 to 08/02/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.The week of 08/03/25 to 08/09/25 no hospice aide visits were completed (zero of one visit completed).   Documentation showed no patient/caregiver refusal of the visits, no attempt to reschedule the missed visit and no physician orders to change the ordered frequency.On 08/28/25 at 2:50 pm., Staff C stated the hospice aide frequencies for Patients #1, 2, 3 and 9 were not met as ordered in the plan of care.

Based on interview and record review, the hospice failed to ensure the plan of care was developed to include the treatment and presence of a stage II pressure ulcer for one (Patient #10) of 20 patients. --- Findings:A review of the plan of care dated 05/29/25 to 07/27/25 showed a primary diagnosis of other frontotemporal neurocognitive disorder with a skilled nurse frequency of one visit per week for one week and two visits per week for eight weeks with no interventions provided for the care and management of stage II pressure ulcer to the lower right buttocks.  A review of the clinical record showed the following:A skilled nurse assessment dated 05/29/25 for the week of 05/29/25 to 05/31/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.Skilled nurse assessments dated 06/02/25 and 06/05/25 for the week of 06/01/25 to 06/07/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.Skilled nurse assessments dated 06/09/25 and 06/12/25 for the week of 06/08/25 to 06/14/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.Skilled nurse assessments dated 06/17/25 and 06/19/25 for the week of 06/15/25 to 06/21/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.Skilled nurse assessments dated 06/22/25 and 06/28/25 for the week of 06/01/25 to 06/07/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.Skilled nurse assessments dated 07/01/25 and 07/03/25 for the week of 06/29/25 to 07/05/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.Skilled nurse assessments dated 07/07/25 and 07/10/25 for the week of 07/06/25 to 07/12/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressingSkilled nurse assessments dated 07/14/25 and 07/17/25 for the week of 07/13/25 to 07/19/25 showed the presence of a stage II pressure ulcer to the right lower buttock with a treatment of cleansing the wound, patting dry with gauze and applying Optifoam dressing and no assessment of the wound status.On 08/28/25 at 2:45 pm., Staff C stated there was no documentation of the presence of a stage II pressure ulcer to the right lower buttocks and no interventions developed for the care and management of the pressure ulcer on the plan of care.

Based on interview and record review, the hospice failed to update to the plan of care to reflect the presence of wounds for two (Patient #10 and 12) of 20 patients. --- Findings:Patient #10A review of the plan of care dated 05/29/25 to 07/27/25 with plan of care updates dated 06/19/25, 06/30/25, 07/03/25 and 07/17/25 showed a primary diagnosis of other frontotemporal neurocognitive disorder with a skilled nurse frequency of one visit per week for one week and two visits per week for eight weeks with no documentation of the presence of pressure ulcers.A skilled nurse assessment dated 05/29/25 for the week of 05/29/25 to 05/31/25 showed the presence of a stage II pressure ulcer to the right lower buttock.Skilled nurse assessments dated 06/02/25 and 06/05/25 for the week of 06/01/25 to 06/07/25 showed the presence of a stage II pressure ulcer to the right lower buttock.Skilled nurse assessments dated 06/09/25 and 06/12/25 for the week of 06/08/25 to 06/14/25 showed the presence of a stage II pressure ulcer to the right lower buttock.Skilled nurse assessments dated 06/17/25 and 06/19/25 for the week of 06/15/25 to 06/21/25 showed the presence of a stage II pressure ulcer to the right lower buttock and the development of a stage II pressure ulcer to the proximal left dorsum.Skilled nurse assessments dated 06/22/25 and 06/28/25 for the week of 06/01/25 to 06/07/25 showed the presence of a stage II pressure ulcer to the right lower buttock and a stage II pressure ulcer to the proximal left dorsum.Skilled nurse assessments dated 07/01/25 and 07/03/25 for the week of 06/29/25 to 07/05/25 showed the presence of a stage II pressure ulcer to the right lower buttock and a stage II pressure ulcer to the proximal left dorsum.Skilled nurse assessments dated 07/07/25 and 07/10/25 for the week of 07/06/25 to 07/12/25 showed the presence of a stage II pressure ulcer to the right lower buttock and a stage II pressure ulcer to the proximal left dorsum.Skilled nurse assessments dated 07/14/25 and 07/17/25 for the week of 07/13/25 to 07/19/25 showed the presence of a stage II pressure ulcer to the right lower buttock and a stage II pressure ulcer to the proximal left dorsum.Patient #12A review of the plan of care dated 05/28/25 to 08/25/25 with plan of care updates dated 05/05/25, 06/19/25, 07/03/25 and 07/17/25 showed a skilled nurse frequency of one visit per week for one week and two visits per week for twelve weeks and the presence of a partial thickness wound to the right buttock with a treatment to cleanse the wound apply collagen powder to the wound bed and cover with calcium alginate and secure with a dressing.  A review of the clinical record showed the following:A physician's order for the week of 06/01/25 to 06/07/25 showed the skilled nurse frequency was decreased to one visit per week.A skilled nurse assessment dated 06/02/25 for the week of 06/01/25 to 06/07/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 06/10/25 for the week of 06/08/25 to 06/14/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 06/17/25 for the week of 06/15/25 to 06/21/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 06/24/25 for the week of 06/22/25 to 06/28/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 07/01/25 for the week of 06/29/25 to 07/05/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 07/08/25 for the week of 07/06/25 to 07/12/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 07/15/25 for the week of 07/13/25 to 07/19/25 documented no presence of a wound and no wound care provided.A skilled nurse assessment dated 07/22/25 for the week of 07/20/25 to 07/26/25 documented no presence of a wound and no wound care provided.On 08/28/25 at 2:45 pm., Staff C stated:1. the plan of care was not updated to reflect of the presence of a stage II pressure ulcer to the right lower buttocks and a stage II pressure ulcer to the proximal left dorsum to the plan of care and plan of care updates for Patient #10 and2. the plan of care was not updated to reflect the wound was healed in the month of April 2025 for Patient #12.

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 1.56% of the total patient care hours of all paid hospice employees for 2024.On 08/28/25 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 observation, interview and record review, the hospice failed to ensure a branch location provided the services of the parent location. --- Findings:On 08/26/25 at 10:00 am., a sign was observed at the branch location which stated staff were providing care to patents and provided a contact phone number.  At 10:17 am., a phone call was placed to the number provided on the posted note at the branch location.  A staff member stated the location was not going to have any staff present within the building for the day.At 10:20 am., the surveyor was informed staff were on the way to the branch location and were 40 minutes away.At 11:10 am., Staff A arrived and stated there were to be no staff members at the branch location that day.

Based on record review and interview, the hospice failed to ensure: 1. Completion of the initial bereavement assessment no later than 5 calendar days after the election of hospice care for three (Patients #1, 5 and 11) of 13 patients; and 2. Completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for one (Patient #1) of 13 patients. --- Patient #1 A review of the clinical record showed an election of the hospice benefit on 08/30/22 with no completion of the initial bereavement assessment from 08/30/22 to 11/27/22 (90 days after election of the hospice benefit) and no completion of the initial spiritual assessment from 08/30/22 to 11/27/22 (90 days after the 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 #5 A review of the clinical record showed an election of the hospice benefit on 11/15/22 with no completions of the initial bereavement assessment from 11/15/22 to 11/14/23 (14 days after the 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 #11 A review of the clinical record showed an election of the hospice benefit on 09/14/22 with no completions of the initial bereavement assessment from 09/14/22 to 09/23/22 (8 days after the 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. On 11/30/22 at 10:20 am, Staff B stated the initial bereavement assessments for were not completed within the first five days after the election of the hospice benefit for Patients #1, 5 and 11. Staff B stated the initial spiritual assessment was not completed within the first five days after the election of the hospice benefit for Patients #1.

Based on record review and interview, the hospice failed to ensure imminence of death was assessed during the comprehensive assessment for four (Patients #1, 2, 5 and 6) of thirteen patients. --- Patient #1 A review of the Initial Assessment dated 08/30/22 showed no assessment of imminence of death. Patient #2 A review of the Initial Assessment dated 07/13/22 showed no assessment of imminence of death. Patient #5 A review of the Initial Assessment dated 11/25/22 showed no assessment of imminence of death. Patient #6 A review of the Initial Assessment dated 08/20/22 showed no assessment of imminence of death. On 11/30/22 at 11:20 am, Staff B stated imminence of death was not assessed on the comprehensive assessment for Patients #1, 2, 5 and 6.

Based on record review and interview, the hospice failed to ensure a timely review of medications for one (Patient #1) of 13 patients. --- Patient #1 A review of clinical records showed a skilled nurse assessment dated 10/10/22 which documented the patient utilizing Mirialx for constipation. This medication was not added to the medication profile. On 11/30/22 at 10:35 am, Staff B stated the medication profile for Patient #1 was not updated to reflect medication changes.

Based on record review and interview, the hospice failed to ensure hospice aide services were provided in accordance with the plan of care frequency for three (Patients #4, 8 and 13) of 13 patients. --- Patient #4 A review of the plan of care dated 09/30/22 to 11/28/22 and plan of care updates dated 10/06/22, 10/20/22, 11/03/22 and 11/17/22 ordered hospice aide visits at a frequency of six visits per week. A review of the clinical record showed the following: Hospice aide visits were made on 10/03/22, 10/05/22 and 10/07/22 for the week of 10/02/22 to 10/08/22 (three of six ordered visits completed). Hospice aide visits were made on 10/09/22, 10/12/22 and 10/14/22 for the week of 10/09/22 to 10/15/22 (three of six ordered visits completed). Hospice aide visits were made on 10/17/22, 10/19/22 and 10/21/22 for the week of 10/16/22 to 10/22/22 (three of six ordered visits completed). Hospice aide visits were made on 10/24/22, 10/26/22 and 10/28/22 for the week of 10/23/22 to 10/29/22 (three of six ordered visits completed). Hospice aide visits were made on 10/31/22, 11/02/22 and 11/04/22 for the week of 10/30/22 to 11/05/22 (three of six ordered visits completed). Hospice aide visits were made on 11/07/22, 11/09/22 and 11/11/22 for the week of 11/06/22 to 11/12/22 (three of six ordered visits completed). Hospice aide visits were made on 11/14/22, 11/16/22 and 11/18/22 for the week of 11/13/22 to 11/19/22 (three of six ordered visits completed). Hospice aide visits were made on 11/21/22, 11/23/22 and 11/25/22 for the week of 11/20/22 to 11/26/22 (three of six ordered visits completed). Patient #8 A review of the plan of care dated 09/29/22 to 11/27/22 and plan of care updates dated 10/04/22, 10/18/22, 11/01/22 and 11/15/22 ordered hospice aide visits at a frequency of six visits per week. A review of the clinical record showed the following: Hospice aide visits were made on 10/03/22, 10/05/22 and 10/07/22 for the week of 10/02/22 to 10/08/22 (three of six ordered visits completed). Hospice aide visits were made on 10/09/22, 10/12/22 and 10/14/22 for the week of 10/09/22 to 10/15/22 (three of six ordered visits completed). Hospice aide visits were made on 10/17/22, 10/19/22 and 10/21/22 for the week of 10/16/22 to 10/22/22 (three of six ordered visits completed). Hospice aide visits were made on 10/24/22, 10/26/22 and 10/28/22 for the week of 10/23/22 to 10/29/22 (three of six ordered visits completed). Hospice aide visits were made on 10/31/22, 11/02/22 and 11/04/22 for the week of 10/30/22 to 11/05/22 (three of six ordered visits completed). Hospice aide visits were made on 11/07/22, 11/09/22 and 11/11/22 for the week of 11/06/22 to 11/12/22 (three of six ordered visits completed). Hospice aide visits were made on 11/14/22, 11/16/22 and 11/18/22 for the week of 11/13/22 to 11/19/22 (three of six ordered visits completed). Hospice aide visits were made on 11/21/22, 11/23/22 and 11/25/22 for the week of 11/20/22 to 11/26/22 (three of six ordered visits completed). Patient #13 A review of the plan of care dated 09/21/22 to 11/19/22 and plan of care updates dated 10/06/22, 10/20/22, 11/03/22 and 11/17/22 ordered hospice aide visits at a frequency of four visits per week. A review of the clinical record showed the following: Hospice aide visits were made on 09/27/22 and 09/29/22 for the week of 10/02/22 to 10/08/22 (two of four ordered visits completed). Hospice aide visits were made on 10/04/22 and 10/06/22 for the week of 10/02/22 to 10/08/22 (two of four ordered visits completed). Hospice aide visits were made on 10/11/22 and 10/13/22 for the week of 10/09/22 to 10/15/22 (two of four ordered visits completed). Hospice aide visits were made on 10/18/22 and 10/20/22 for the week of 10/16/22 to 10/22/22 (two of four ordered visits completed). Hospice aide visits were made on 10/25/22 and 10/27/22 for the week of 10/23/22 to 10/29/22 (two of four ordered visits completed). Hospice aide visits were made on 11/01/22 and 11/03/22 for the week of 10/30/22 to 11/05/22 (two of four ordered visits completed). Hospice aide visits were made on 11/08/22 and 11/10/22 for the week of 11/06/22 to 11/12/22 (two of four ordered visits completed). Hospice aide visits were made on 11/15/22 and 11/17/22 for the week of 11/13/22 to 11/19/22 (two of four ordered visits completed). On 11/30/22 at 11:15 am, Staff B stated the hospice aide frequencies for Patients #4, 8 and 13 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 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 #2A review of the plan of care dated 07/13/22 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 #3A review of the plan of care dated 08/26/22 to 10/24/22 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 09/30/22 to 11/28/22 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 #5A plan of care dated 11/15/22 to 02/12/23 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 08/20/22 to 11/17/22 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 #7A review of the plan of care dated 08/17/21 to 11/14/22 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 09/29/22 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 #9A plan of care dated 09/17/22 to 11/15/22 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 #10A plan of care dated 04/26/22 to 07/24/22 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 #11A plan of care dated 09/14/22 to 12/12/22 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 #12A plan of care dated 10/20/22 to 01/17/23 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 09/21/22 to 11/19/22 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 11/30/22 at 10:11 am, 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 the plan of care was revised to reflect the presence of wounds for two (Patients #12 and 13) of 13 patients. --- Patient #12 A review of a plan of the care dated 10/20/22 to 01/17/23 with plan of care updates dated 11/03/22, 11/15/22 and 11/29/22 showed no presence of wounds. A review of the clinical record showed the following: A skilled nurse assessment dated 11/11/22 showed the presence of redness to the buttock with "sheering". A skilled nurse assessment dated 11/14/22 showed the presence of redness to the buttock with "sheering". A skilled nurse assessment dated 11/25/22 documented the presence of redness to the buttocks with "sheering" and treatment to the wound using a "hydrocellular" dressing. A skilled nurse assessment dated 11/28/22 documented the presence of a red/purple colored wound to the coccyx which measured 10 centimeters by 13 centimeters by and unknown depth. Patient #13 A plan of care dated 09/21/22 to 11/19/22 with plan of care updates dated 10/06/22, 10/20/22, 11/03/22 and 11/17/22 showed no presence of wounds. A review of the electronic medical record showed the following: A skilled nurse assessment dated 10/12/22 documented the presence of a stage Ii pressure ulcer to the buttocks measuring 1 centimeter long by 1 centimeter wide by 0.3 centimeters deep. A skilled nurse assessment dated 10/14/22 documented the presence of a stage Ii pressure ulcer to the buttocks measuring one centimeter long by 1 centimeter wide by 0 centimeters deep. A skilled nurse assessment dated 10/19/22 documented the presence of a stage Ii pressure ulcer to the buttocks measuring 1.4 centimeters long by one centimeter wide by 0.3 centimeters deep. Skilled nurse visits dated 10/25/22 and 10/28/22 for the week of 10/23/22 to 10/29/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. Skilled nurse visits dated 11/02/22 and 11/04/22 for the week of 10/30/22 to 11/05/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. Skilled nurse visits dated 11/07/22 and 11/11/22 for the week of 11/06/22 to 11/12/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. Skilled nurse visits dated 11/16/22 and 11/18/22 for the week of 11/13/22 to 11/19/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. On 11/30/22 at 11:15 am, Staff B stated the plan of care for Patient #12 and 13 should have been updated to reflect the presence of wounds.

Based on record review and interview, the hospice failed to ensure physician notification of decline in skin integrity for one (Patient #1) of 13 patients reviewed. --- Patient #12 A review of a plan of the care dated 10/20/22 to 01/17/23 with plan of care updates dated 11/03/22, 11/15/22 and 11/29/22 showed no presence of wounds. A review of the clinical record showed the following: A skilled nurse assessment dated 11/11/22 showed the presence of redness to the buttock with "sheering" with no documentation of notification to the physician of decline in skin integrity. A skilled nurse assessment dated 11/14/22 showed the presence of redness to the buttock with "sheering" with no documentation of notification to the physician of decline in skin integrity. A skilled nurse assessment dated 11/25/22 documented the presence of redness to the buttocks with "sheering" and treatment to the wound using a "hydrocellular" dressing with no documentation of notification to the physician of decline in skin integrity. A skilled nurse assessment dated 11/28/22 documented the presence of a red/purple colored wound to the coccyx which measured 10 centimeters by 13 centimeters by and unknown depth with no documentation of notification to the physician of decline in skin integrity. On 11/30/22 at 11:20 am, Staff B stated the physician should have been notified of the decline in skin integrity.

Based on record review and interview, the hospice failed to ensure wound assessments were coordinated with the long-term care facility for one (Patient #13) of 13 patients reviewed. --- Patient #7 A plan of care dated 09/21/22 to 11/19/22 showed a skilled nurse frequency of two visits per week for nine weeks. A review of the electronic medical record showed the following: Skilled nurse visits dated 10/25/22 and 10/28/22 for the week of 10/23/22 to 10/29/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. Skilled nurse visits dated 11/02/22 and 11/04/22 for the week of 10/30/22 to 11/05/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. Skilled nurse visits dated 11/07/22 and 11/11/22 for the week of 11/06/22 to 11/12/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. Skilled nurse visits dated 11/16/22 and 11/18/22 for the week of 11/13/22 to 11/19/22 (two of two assessments) documented the presence of stage II pressure ulcer to the buttocks with no documented assessment of the wound. On 11/30/22 at 11:15 am, Staff B stated the hospice failed to show coordination with the nursing home regarding wound assessment.