Every finding on record at Ok4 Hospice, LLC

Based on record review and interview, the hospice failed to ensure a timely review of medications for one (Patient #8) of 13 patients. Findings: Patient #8 A review of clinical records showed a skilled nurse assessment dated 04/25/22 which documented the use of oxygen. Documentation showed no addition of oxygen to the medication profile. On 08/10/22 at 11:35 am, Staff B stated oxygen was not added to the medication profile for Patient #8.

Based on record review and interview, the hospice failed to ensure: 1. Hospice aide services were provided in accordance with the plan of care frequency for four (Patients #5, 10, 12 and 13) of 13 patients; 2. Psychosocial (social worker) services were provided in accordance with the plan of care frequency for three (Patients #1, 8 and 9) of 13 patients; and 3. Volunteer services were provided in accordance with the plan of care frequency for one (Patient #4) of 13 patients. Findings: 1. Patient #5 A review of the plan of care dated 05/04/22 to 07/02/22 and plan of care updates dated 05/11/22, 05/25/22, 06/08/22 and 06/22/22 ordered hospice aide visits at a frequency of two visits per week. A review of the clinical record showed the following: Hospice aide missed visits due to lack of staff dated 06/07/22 and 06/09/22 (two of two scheduled visits) for the week of 06/05/22 to 06/11/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. A hospice aide missed visit due to lack of staff dated 06/16/22 (one of two scheduled visits) for the week of 06/12/22 to 06/18/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Patient #10 A review of the plan of care dated 05/16/22 to 07/14/22 and plan of care updates dated 05/25/22, 06/08/22, 06/22/22 and 07/06/22 ordered hospice aide visits at a frequency of five visits per week. A review of the clinical record showed the following: Hospice aide missed visits due to lack of staff dated 05/31/22 and 06/02/22 (two of five scheduled visits) for the week of 05/29/22 to 06/04/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Patient #12 A review of the plan of care dated 05/18/22 to 07/16/22 and plan of care updates dated 05/25/22, 06/08/22, 06/22/22 and 07/06/22 ordered hospice aide visits at a frequency of five visits per week. A review of the clinical record showed the following: Hospice aide missed visits due to lack of staff dated 05/20/22 (one of five scheduled visits) for the week of 05/18/22 to 05/21/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. A hospice aide missed visit due to a holiday dated 05/30/22 (one of five scheduled visits) for the week of 05/29/22 to 06/04/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. A hospice aide missed visit due to a holiday dated 07/04/22 (one of five scheduled visits) for the week of 07/03/22 to 07/09/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Patient #13 A review of the plan of care dated 05/19/22 to 07/17/22 and plan of care updates dated 05/25/22, 06/08/22, 06/22/22 and 07/06/22 ordered hospice aide visits at a frequency of two visits per week. A review of the clinical record showed the following: Hospice aide missed visits due to lack of staff dated 06/07/22 and 06/09/22 (two of two scheduled visits) for the week of 06/05/22 to 06/11/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. A hospice aide missed visit due to lack of staff dated 06/16/22 (one of two scheduled visits) for the week of 06/12/22 to 06/18/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. A hospice aide missed visit due to lack of staff dated 07/12/22 (one of two scheduled visits) for the week of 07/10/22 to 07/16/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. 2. Patient #1 A review of the plan of care dated 04/19/22 to 07/17/22 and plan of care updates dated 04/27/22, 05/11/22, 05/25/22 and 06/08/22 ordered social worker visits at a frequency of one time per month. A review of the clinical record showed a no social worker visits for the month of May. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. Patient #8 A review of the plan of care dated 04/23/22 to 06/21/22 and plan of care updates dated 04/27/22, 05/11/22, 05/25/22 and 06/08/22 ordered social worker visits at a frequency of one time per month. A review of the clinical record showed a social worker missed visit dated 05/02/22 with a documented reason of the social worker being ill. Documentation showed no patient or family refusal of visits, no further attempts for social worker visits and no changes in the ordered frequency. Patient #9 A review of the plan of care dated 04/18/22 to 07/16/22 and plan of care updates dated 04/27/22, 05/11/22, 05/25/22 and 06/08/22 ordered social worker visits at a frequency of one time per month. A review of the clinical record showed a social worker missed visit dated 05/09/22 with a documented reason of the social worker being ill. Documentation showed no patient or family refusal of visits, no further attempts for social worker visits and no changes in the ordered frequency. 3. Patient #4 A review of the plan of care dated 05/02/22 to 06/30/22 and plan of care updates dated 05/11/22, 05/25/22, 06/08/22 and 06/21/22 ordered volunteer visits at a frequency of one visit per week. A review of the clinical record showed no volunteer visits from 05/02/22 to 06/30/22. Documentation showed no patient or family refusal of visits and no changes in the ordered frequency. On 08/10/22 at 11:35 am, Staff B stated: 1. The ordered hospice aide frequency for Patients #5, 10, 12 and 13 was not met. 2. The ordered social worker frequency for Patients #1, 8 and 9 was not met. 3. The ordered volunteer frequency for Patient #4 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 four (Patients #5, 8, 9 and 13) of 13 patients reviewed. Findings: Patient #5 A plan of care dated 05/04/22 to 07/02/22 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 04/23/22 to 06/21/22 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 04/18/22 to 07/16/22 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 #13 A plan of care dated 05/19/22 to 07/17/22 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. On 08/10/22 at 11:35 am, Staff B stated the plans of care for Patients #5, 8, 9 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 increased hospice aide services for one (Patient #1) of 13 patients. Findings: Patient #1 A review of the clinical record showed a plan of care dated 04/19/22 to 07/17/22 and plan of care updates dated 04/27/22, 05/11/22, 05/25/22 and 06/08/22 which showed orders for a hospice aide frequency of three visits per week. A review of the clinical record showed: Hospice aide visits dated 04/25/22, 04/26/22, 04/27/22, 04/28/22 and 04/29/22 (five total visits) for the week of 04/24/22 to 04/30/22. Hospice aide visits dated 05/02/22, 05/03/22, 05/05/22 and 05/06/22 (four total visits) for the week of 05/01/22 to 05/07/22. Hospice aide visits dated 05/09/22, 05/10/22, 05/11/22, 05/12/22 and 05/13/22 (five total visits) for the week of 05/08/22 to 05/14/22. Hospice aide visits dated 05/23/22, 05/24/22, 05/25/22 and 05/26/22 (four total visits) for the week of 05/15/22 to 05/21/22. Hospice aide visits dated 05/31/22, 06/01/22, 06/02/22 and 06/03/22 (four total visits) for the week of 05/29/22 to 06/05/22. Hospice aide visits dated 06/06/22, 06/07/22, 06/08/22, 06/09/22 and 06/10/22 (five total visits) for the week of 06/05/22 to 06/11/22. Hospice aide visits dated 06/13/22, 06/14/22, 06/15/22, 06/16/22 and 06/17/22 (five total visits) for the week of 06/12/22 to 06/18/22. On 08/10/22 at 11:55 am, Staff B stated the plan of care should have been updated to reflect the increased hospice aide services provided for Patient #1.

Based on record review and interview, the hospice failed to ensure hospice aide frequencies were provided within the scope of practice for two (Patients #4 and 8) of 13 patients. Findings: Patient #4 A review of the plan of care dated 05/02/22 to 6/30/22 and plan of care updates dated 05/11/22, 05/25/22, 06/08/22 and 06/21/22 showed a hospice aide frequency range of one to five times per week. Documentation showed no instructions on how to determine the number of visits. Patient #8 A review of the plan of care dated 04/23/22 to 6/21/22 and plan of care updates dated 04/27/22, 05/11/22, 05/25/22 and 06/08/22 showed a hospice aide frequency range of one to five times per week. Documentation showed no instructions on how to determine the number of visits. On 08/10/22 at 11:10 am, Staff B stated the ranged hospice aide frequencies were inappropriate for the scope of practice of hospice aides.

Based on record review and interview, the hospice failed to ensure wound assessments were coordinated with the long term care facility for two (Patients #6 and 7) of 13 patients reviewed. Findings: Patient #6 A plan of care dated 06/09/22 to 08/07/22 showed a skilled nurse frequency of one to one visit per week. A review of the electronic medical record showed the following: A skilled nurse visit dated 06/15/22 documented the presence of a wound to the right foot and right calf with no documented assessment of the wounds. A skilled nurse visit dated 06/20/22 documented the presence of a wound to the right foot and right calf with no documented assessment of the wounds. A skilled nurse visit dated 06/29/22 documented the presence of a wound to the right foot and right calf with no documented assessment of the wounds. Patient #7 A plan of care dated 05/25/22 to 08/22/22 showed a skilled nurse frequency of one to one visit per week. A review of the electronic medical record showed the following: A skilled nurse visit dated 06/01/22 documented the presence of a wound to the buttock with no documented assessment of the wound. A skilled nurse visit dated 06/08/22 documented the presence of a wound to the buttock with no documented assessment of the wound. A skilled nurse visit dated 06/15/22 documented the presence of a wound to the buttock with no documented assessment of the wound. A skilled nurse visit dated 06/22/22 documented the presence of a wound to the buttock with no documented assessment of the wound. A skilled nurse visit dated 06/29/22 documented the presence of a wound to the buttock with no documented assessment of the wound. On 08/10/22 at 11:45 am, Staff B stated the hospice failed to show coordination with the nursing home regarding wound assessment.