Every finding on record at Neighborhood Hospice, 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 19 patients reviewed. --- Patient #1 A plan of care dated 05/29/24 to 08/26/24 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 #2 A review of the plan of care dated 07/08/24 to 10/05/24 documented a primary diagnosis of cirrhosis of liver 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 04/23/24 to 07/21/24 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 #4 A plan of care dated 06/11/24 to 08/09/24 documented a primary diagnosis of senile degeneration of the brain 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 05/11/24 to 07/09/24 documented a primary diagnosis of cerebral infarction 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 07/18/24 to 10/15/24 documented a primary diagnosis of cerebral infarction 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 05/18/24 to 07/17/24 documented a primary diagnosis of heart failure 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 06/13/24 to 08/11/24 documented a primary diagnosis of acute kidney failure 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 06/27/24 to 09/24/24 documented a primary diagnosis of unifocal Langerhans-cell histiocytosis 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 07/25/24 to 10/22/24 documented a primary diagnosis of senile degeneration of the brain 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 05/17/24 to 07/15/24 documented a primary diagnosis of unspecified sever protein calorie malnutrition 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 05/23/24 to 07/21/24 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 #13 A plan of care dated 05/14/24 to 07/12/24 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 #14 A plan of care dated 08/12/24 to 11/09/24 documented a primary diagnosis of senile degeneration of the brain and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 08/21/24 at 2:40 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 services necessary for the palliation and management of the terminal illness.

Based on record review and interview, the hospice failed to the ensure plans of care was coordinated with the long-term care facility for two (Patients #5 and 7) of 19 patients reviewed. --- Patient #5 A plan of care dated 05/11/24 to 07/09/24 showed a primary diagnosis of cerebral infarction and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #7 A plan of care dated 05/19/24 to 07/17/24 showed a primary diagnosis of heart failure and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. On 08/21/24 at 2:50 pm., Staff A stated the plan of care for Patients #5 and 7 did not outline the patient specific interventions to be to be provided by the nursing home or the hospice for the palliation and management of the terminal illness.

Based on record review and interview, the agency failed to ensure required background checks were completed by the surveyed hospice for five (Staff C, E, F, G and H) of five employees. --- A review of 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 hospice whose employment began after 06/01/14. Staff D A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff D. Staff E A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff E. Staff F A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff F. Staff G A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff G. Staff H A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff H. On 08/21/24 at 1:30 pm., Staff A stated the OKSCREEN for Staff D, E, F, G and H were not completed by the surveyed hospice.

Based on record review and interview, the hospice failed to ensure skin assessments were provided in accordance with the plan of care frequency for one (Patient #8) of 11 patients. Findings: Patient #8 A review of the plan of care dated 01/19/21 to 03/19/22 showed a skilled nurse frequency of two visits per week and documented orders to monitor wounds weekly for size/measurements, color changes, redness, swelling, warmth and pain. A review of the electronic medical record showed the following: Skilled nurse assessments dated 01/25/22 and 01/27/22 for the week of 01/23/22 to 01/29/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 01/31/22, 02/01/22 and 02/04/22 for the week of 01/30/22 to 02/05/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 02/08/22 and 02/10/22 for the week of 02/06/22 to 02/12/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 02/15/22 and 02/17/22 for the week of 02/13/22 to 02/19/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. A skilled nurse assessments dated 02/22/22 for the week of 02/20/22 to 02/26/22 (one of one assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessment dated 03/01/22 and 03/03/22 for the week of 02/27/22 to 03/05/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 03/08/22 and 03/10/22 for the week of 03/06/22 to 03/12/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 03/15/22 and 03/17/22 for the week of 03/13/22 to 03/19/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. On 04/19/22 at 12:30 pm, Staff B stated wound assessments were not followed as ordered for Patient #8.

Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include services provided for the management of wounds for one (Patient #5) of 11 patients reviewed. Findings: Patient #5 A plan of care dated 03/22/22 to 05/20/22 documented no care or services to be provided to shearing wound to buttocks and a stage II wound to the ball of the left outer foot and showed a skilled nurse frequency of two visits per week. A review of the electronic medical record showed the following: A comprehensive skilled nurse assessment dated 03/08/22 (prior to the plan of care dated 03/22/22 to 05/20/22) documented the presence and wound treatment provided to buttocks and a stage II wound to the ball of the left outer foot. A skilled nurse assessment dated 03/22/22 documented the presence of and wound care provided to buttocks and left foot. A skilled nurse assessment dated 03/24/22 documented the presence of and wound care provided to buttocks and left foot. A skilled nurse assessment dated 03/29/22 documented the presence of and wound care provided to buttocks and left foot. A skilled nurse assessment dated 03/30/22 documented the presence of and wound care provided to buttocks and left foot. A skilled nurse assessment dated 03/31/22 documented the presence of and wound care provided to buttocks and left foot. A skilled nurse assessment dated 04/01/22 documented the presence of and wound care provided to buttocks and left foot. A skilled nurse assessment dated 04/02/22 documented the presence of and wound care provided to buttocks and left foot. On 04/19/22 at 12:17 pm, Staff B stated the plan of care for Patient #1 failed to include care and services provided to documented wounds to buttocks and a stage II wound to bal of the left outer foot.

Based on record review and interview, the hospice failed to ensure skilled nursing services met the needs of the patient for the management of wounds for two (Patients #5 and 8) of 11 patients. Findings: Patient #5 A plan of care dated 03/22/22 to 05/20/22 documented a skilled nurse frequency of two visits per week. A review of the electronic medical record showed the following: Skilled nurse assessments dated 03/29/22, 03/30/22, 03/31/22, 04/01/22 and 04/02/22 (four of four assessments) during the week of 03/27/22 to 04/02/22 documented the presence of and wound care provided to buttocks and left foot with no assessment of the wounds provided. Patient #8 A review of the plan of care dated 01/19/21 to 03/19/22 showed a skilled nurse frequency of two visits per week and documented orders to monitor wounds weekly for size/measurements, color changes, redness, swelling, warmth and pain. A review of the electronic medical record showed the following: Skilled nurse assessments dated 01/25/22 and 01/27/22 for the week of 01/23/22 to 01/29/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 01/31/22, 02/01/22 and 02/04/22 for the week of 01/30/22 to 02/05/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 02/08/22 and 02/10/22 for the week of 02/06/22 to 02/12/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 02/15/22 and 02/17/22 for the week of 02/13/22 to 02/19/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. A skilled nurse assessments dated 02/22/22 for the week of 02/20/22 to 02/26/22 (one of one assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessment dated 03/01/22 and 03/03/22 for the week of 02/27/22 to 03/05/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 03/08/22 and 03/10/22 for the week of 03/06/22 to 03/12/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. Skilled nurse assessments dated 03/15/22 and 03/17/22 for the week of 03/13/22 to 03/19/22 (two of two assessments) documented no precise measurements and no assessment of the wound/wounds in accordance with the plan of care. On 04/19/22 at 12:40 pm, Staff B stated skilled nurse assessments for Patients #5 and 8 failed to documented wound assessments.