Every finding on record at Ross Hospice of Enid, LLC

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 4.46% of the total patient care hours of all paid hospice employees for 2024.On 07/23/25 at 1:45 pm., Staff A stated the hospice volunteer services did not provide 5% of the total patient care hours of all paid hospice employees for 2024.

Based on record review and interview, the hospice failed to ensure effective pain management was provided for one (Patient #2) of 11 patients. Findings: Patient #2 A review of the plan care dated 06/19/22 to 08/17/22 showed a primary diagnosis of malignant neoplasm of laryngeal cartilage and documented a skilled nurse frequency of two visits per week for eight weeks. A review of the medical record showed the following: A skilled nurse assessment dated 06/21/22 documented the patient pain as a 5 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 06/28/22 documented the patient pain as a 5 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/06/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/20/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. An as needed skilled nurse assessment dated 07/20/22 documented the patient pain as a 5 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/26/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/28/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed the nurse instructed the patient and caregiver of medication changes. The electronic medical record showed no documented follow up related to the pain level documented above the patient stated goal or effectiveness of changes to the patient's pain medications until 08/01/22 (four days later). A skilled nurse assessment dated 08/05/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 08/09/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. On 08/23/22 at 11:25 am, Staff B stated the pain for Patient #2 was not properly managed.

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 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11) of 11 patients reviewed. Findings: Patient #1 A review of the plan of care dated 05/08/22 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 #2 A review of the plan of care dated 06/19/22 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 #3 A review of the plan of care dated 05/11/22 to 07/09/22 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 05/28/22 to 07/26/22 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 #5 A plan of care dated 08/01/22 to 10/29/22 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 04/30/22 to 06/28/22 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 #7 A review of the plan of care dated 11/30/21 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 review of the plan of care dated 04/01/22 to 05/30/22 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 07/27/22 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 #10 A plan of care dated 06/08/22 to 08/06/22 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 #11 A plan of care dated 05/14/22 to 07/12/22 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. On 08/23/22 at 11:20 am, Staff B 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 ensure skilled nursing services met the needs of the patient for the management of pain for one (Patient #2) of 11 patients. Findings: Patient #2 A review of the plan care dated 06/19/22 to 08/17/22 showed a primary diagnosis of malignant neoplasm of laryngeal cartilage and documented a skilled nurse frequency of two visits per week for eight weeks. A review of the medical record showed the following: A skilled nurse assessment dated 06/21/22 documented the patient pain as a 5 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 06/28/22 documented the patient pain as a 5 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/06/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/20/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. An as needed skilled nurse assessment dated 07/20/22 documented the patient pain as a 5 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/26/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 07/28/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed the nurse instructed the patient and caregiver of medication changes. The electronic medical record showed no documented follow up related to the pain level documented above the patient stated goal or effectiveness of changes to the patient's pain medications until 08/01/22 (four days later). A skilled nurse assessment dated 08/05/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. A skilled nurse assessment dated 08/09/22 documented the patient pain as a 10 out of 10 on the classic 1-10 pain scale. The patient's pain goal was documented as 0 on the classic 1-10 pain scale. Documentation showed no interventions provided, no direct physician notification of the elevated pain level and no documented follow up related to the pain level documented above the patient stated goal. On 08/23/22 at 11:25 am, Staff B stated the skilled nurse did not properly manage the pain for Patient #2.