Every finding on record at Suncrest Hospice Tulsa, LLC

It is required that each patient’s individualized written plan of care reflects patient and family goals; and identifies planned interventions based on problems identified in the initial and updated comprehensive assessments. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure the individualized written plan of care included planned interventions based on problems identified in the initial and updated comprehensive assessments. Clinical Record 3: The patient elected the hospice benefit on 12/06/2023. A clinical record review revealed a physician's order dated 12/06/2023 that read in part, "Warfarin 7.5mg tablet by mouth three times weekly." The plan of care dated 12/06/2023 through 03/04/2024 did not include interventions for the patient being at risk for bleeding. In a joint record review on 12/17/2024, the Administrator and Senior Director of Clinical Quality confirmed that the plan of care did not include interventions for the patient being at risk for bleeding.

It is required that hospice aides are supervised by a registered nurse who makes an on-site visit to the patient’s home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide; and ensure that services ordered by the hospice Interdisciplinary Group (IDG) meet the patient’s need. The hospice aide does not need to be present. This standard was not met as evidenced by clinical record review and interview. In 4 of 18 (22%) clinical records reviewed of patients who received Hospice Aide (HHA) services, the agency did not ensure that HHA supervisory visits were completed no less frequently than every 14 days. Clinical Record 5: The patient elected the hospice benefit on 03/22/2024. The plans of care dated 03/22/2024 through 06/19/2024 and 06/20/2024 through 09/18/2024 ordered: "Aide 5x/week." Aide supervisory visits were documented as completed on 04/02/2024 and 05/17/2024, with 45 days outstanding, and 05/17/2024 and 08/27/2024, with 102 days outstanding. Clinical Record 6: The patient elected the hospice benefit on 05/15/2024. The plan of care dated 05/15/2024 through 08/13/2024 ordered: "Aide 2x/week." Aide supervisory visits were documented as completed on 06/03/2024 and 06/18/2024, with 15 days outstanding, and 07/15/2024 and 08/06/2024, with 22 days outstanding. Clinical Record 7: The patient elected the hospice benefit on 06/12/2024. The plan of care dated 07/08/2024 through 09/06/2024 ordered: "Aide 2x/week." Aide supervisory visits were documented as completed on 07/15/2024 and 08/05/2024, with 21 days outstanding. Clinical Record 11: The patient elected the hospice benefit on 09/24/2024. The plan of care dated 09/24/2024 through 12/22/2024 ordered: "Aide 5x/week." Aide supervisory visits were documented as completed on 12/02/2024 and 12/18/2024, with 16 days outstanding. In a joint record review on 12/18/2024, the Administrator and Senior Director of Clinical Quality confirmed that the supervisory visits were not completed at least every 14 days.

It is required that a patient clinical record containing past and current findings is maintained for each hospice patient. The record contains correct clinical information that is available to the patient’s attending physician and hospice staff. The record may be maintained electronically or on paper. Each patient’s record includes, at a minimum: physician orders. This standard was not met as evidenced by clinical record review and interview. In 1 of 19 (5%) clinical records reviewed, the agency did not ensure that the patient's clinical record included all physician's orders. Clinical Record 11: The patient elected the hospice benefit on 09/24/2024. On 10/30/2024, the physician ordered "Oxygen via nasal cannula at 2 liters continuously." A clinical record review revealed a nursing visit note dated 12/12/2024 documenting, "The patient's oxygen was increased to 3 liters." The clinical record did not include documentation of a physician's order for oxygen to be increased to 3 liters. During a joint record review on 12/18/2024, the Administrator and Senior Director of Clinical Quality confirmed that the oxygen order was not updated from 2 liters to 3 liters.