Apex Hospice

“Based on record review and interview, the hospice failed to:1. ensure completion of the initial bereavement assessment no later than 5 calendar days after the election of hospice care for two (Patients #8 and 9) of 19 patients;2. ensure completion of the initial spiritual assessment no later than 5 calendar days after the election of hospice care for two (Patients #8 and 9) of 19 patients; and3. ensure completion of the initial social work assessment no later than 5 calendar days after the election of hospice care for one (Patient #16) of 19 patients. Findings:Patient #8A review of the clinical record showed an election of the hospice benefit on 04/08/25 with no completion of the initial bereavement and spiritual assessment from 04/08/25 to 04/22/25 (14 days after the election of the hospice benefit). Documentation showed no patient or caregiver refusal of the initial bereavement risk assessment or initial spiritual assessment.Patient #9A review of the clinical record showed an election of the hospice benefit on 03/22/25 with no completion of the initial bereavement and spiritual assessment from 03/22/25 to 03/31/25 (8 days after the election of the hospice benefit), Documentation showed no patient or caregiver refusal of the initial bereavement risk assessment or initial spiritual assessment.Patient #16A review of the clinical record showed an election of the hospice benefit on 04/16/25 with no completion of the social worker assessment from 04/16/25 to 04/23/25 (7 days after the election of the hospice benefit), Documentation showed no patient or caregiver refusal of the initial bereavement risk assessment or initial spiritual assessment.On 05/07/25 at 3:00 pm., Staff B stated:1. the initial comprehensive assessment was to be completed within five days of the election of the hospice benefit;2. the initial bereavement risk assessment for Patients #8 and 9 was not completed within the first five days of the election of the hospice benefit; 3. the initial spiritual assessment for Patients #8 and 9 was not completed within the first five days of the election of the hospice benefit; and4. the initial social work assessment for Patent #16 was not completed within the first five days of the election of the hospice benefit.”

“Based on record review and interview, the hospice failed to ensure imminence of death was assessed during the comprehensive assessment for six (Patients #1, 8, 9, 13, 17 and 18) of 19 patients. Findings:Patient #1A review of the Initial Assessment dated 01/16/25 showed no assessment of imminence of death.Patient #8A review of the Initial Assessment dated 04/08/25 showed no assessment of imminence of death.Patient #9A review of the Initial Assessment dated 03/22/25 showed no assessment of imminence of death.Patient #13A review of the Initial Assessment dated 10/11/24 showed no assessment of imminence of death.Patient #17A review of the Initial Assessment dated 04/11/25 showed no assessment of imminence of death.Patient #18A review of the Initial Assessment dated 04/24/25 showed no assessment of imminence of death.On 05/07/25 at 3:15 pm., Staff B stated imminence of death was not assessed on the comprehensive assessment for Patients #1, 8, 9, 13, 17 and 18.”

“Based on record review and interview, the hospice failed to ensure1. hospice aide visits were provided in accordance with the plan of care for four (Patients #1, 3, 5 and 7) of 19 patients and2. volunteer visits were provided in accordance with the plan of care for seven (Patients #1, 3, 5, 7, 11, 12 and 14) of 19 patients. Findings:Patient #1A review of the plan of care dated 01/16/25 to 03/16/25 showed a hospice aide frequency of three visits per week and a volunteer frequency of one visit per month. A review of the clinical record showed the following:Hospice aide visit notes dated 02/18/25 and 02/20/25 showed a hospice aide missed visit note (inclimate weather family able to assist) dated 02/19/25 for the week of 02/16/25 to 02/22/25 (two of three 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 visit notes dated 02/25/25 and 02/26/25 showed a hospice aide missed visit note (had certified medication aide class) dated 02/27/25for the week of 02/23/25 to 03/01/25 (two of three 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 visit notes dated 03/11/25 and 03/12/25 showed a hospice aide missed visit note (throwing up unable to work) dated 03/13/25for the week of 03/09/25 to 03/15/25 (two of three 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.No volunteer visits were conducted from 01/16/25 to 03/16/25. 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 01/31/25 to 03/31/25 showed a hospice aide frequency of two visits per week and a volunteer frequency of one visit per month. A review of the clinical record showed the following:A hospice aide visit note dated 02/25/25 showed a hospice aide missed visit note (due to having class) dated 02/27/25 for the week of 02/23/25 to 03/01/25 (one of two 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 visits note dated 03/11/25 showed a hospice aide missed visit note (due to throwing up and could not work) dated 03/13/25 for the week of 03/09/25 to 03/15/25 (one of two 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.No volunteer visits were conducted from 01/31/25 to 03/31/25. 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 #5A review of the plan of care dated 02/15/25 to 04/15/25 showed a hospice aide frequency of three visits per week and a volunteer frequency of one visit per month. A review of the clinical record showed the following:Hospice aide visit notes dated 02/18/25 and 02/20/25 showed a hospice aide missed visit note (roads slick) dated 02/19/25 for the week of 02/16/25 to 02/22/25 (two of three 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 visit notes dated 03/10/25 and 03/12/25 showed a hospice aide missed visit note (not completed, took vacation day) dated 03/14/25for the week of 03/09/25 to 03/15/25 (two of three 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 visit notes dated 03/19/25 and 03/21/25 showed a hospice aide missed visit note (took some paid time off) dated 03/17/25 for the week of 03/16/25 to 03/22/25 (two of three 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.No volunteer visits were conducted from 02/15/25 to 04/15/25. 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 #7A review of the plan of care dated 02/23/25 to 04/23/25 showed a hospice aide frequency of two visits per week and a volunteer frequency of one visit per month. A review of the clinical record showed the following:Hospice aide missed visits notes dated 04/07/25 (sick unable to see patient) and 04/09/25 (due to sick unable to see patient) for the week of 04/06/25 to 04/12/25 (no completed visits this week). 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.No volunteer visits were conducted from 02/23/25 to 04/23/25. 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 #11A review of the plan of care dated 02/22/25 to 04/22/25 showed a volunteer frequency of one visit per month. A review of the clinical record showed the following:No volunteer visits were conducted from 02/22/25 to 04/22/25. 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 #12A review of the plan of care dated 02/12/25 to 04/12/25 showed a volunteer frequency of one visit per month. A review of the clinical record showed the following:No volunteer visits were conducted from 02/12/25 to 04/12/25. 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 #14A review of the plan of care dated 02/28/25 to 04/28/25 showed a volunteer frequency of one visit per month. A review of the clinical record showed the following:No volunteer visits were conducted from 02/28/25 to 04/28/25. 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 05/07/25 at 2:50 p.m., Staff B stated:1. the hospice aide frequency was not followed as ordered for Patients #1, 3, 5 and 7 and2. the volunteer frequency was not followed as ordered for Patients #1, 3, 5, 7, 11, 12 and 14.”

“Based on record review and interview, the hospice failed to ensure the care plan included an individualized range of skilled nurse visits for eight (Patients #1, 3, 5, 7, 8, 9, 10 and 13) of 19 patients. Findings:Patient #1A review of the plan of care dated 01/16/25 to 03/16/25 showed a skilled nurse frequency of one to seven visits per week.Patient #3A review of the plan of care dated 01/31/25 to 03/31/25 showed a skilled nurse frequency of one to seven visits per week.Patient #5A review of the plan of care dated 02/15/25 to 04/15/25 showed a skilled nurse frequency of one to seven visits per week.Patient #7A review of the plan of care dated 02/23/25 to 04/23/25 showed a skilled nurse frequency of one to seven visits per week.Patient #8A review of the plan of care dated 04/08/25 to 06/06/25 showed a skilled nurse frequency of one to seven visits per week.Patient #9A review of the plan of care dated 03/22/25 to 05/20/25 showed a skilled nurse frequency of one to seven visits per week.Patient #10A review of the plan of care dated 01/15/25 to 03/15/25 showed a skilled nurse frequency of one to seven visits per week.Patient #13A review of the plan of care dated 10/11/24 to 01/07/25 showed a skilled nurse frequency of one to seven visits per week.On 05/07/25 at 3:10 pm., Staff B stated the hospice was unaware long frequencies were not acceptable.”

“Based on record review and interview, the hospice failed to ensure:1. the plan of care was updated to reflect the presence of a wound for one (Patient #4) of 19 patients; and2. the plan of care was revised to reflect increased hospice aide services for one (Patient #12) of 19 patients Findings:Patient #4A review of the plan of care dated 03/17/25 to 05/15/25 showed a diagnosis of cancer of the brain and a skilled nurse frequency of three visits per week. A review of the clinical record showed the following:A skilled nurse assessment dated 03/31/25 showed the presence of a stage II pressure area to the posterior scalp and the presence of a stage III pressure area to the right side of scalp.A skilled nurse assessment dated 04/07/25 showed the presence of a stage II pressure area to the posterior scalp and the presence of a stage III pressure area to the right side of scalp.A skilled nurse assessment dated 04/14/25 showed the presence of a stage III pressure area to the right side of scalp.A skilled nurse assessment dated 04/21/25 showed the presence of a stage III pressure area to the right side of scalp.Plan of care updates dated 04/03/25 and 04/21/25 showed no presence of pressure ulcers or wounds.On 05/07/25 at 3:25 pm., Staff B stated there was no documentation of pressure ulcers or wounds to the plan of care updates for Patient #4.Patient #12A review of the plan care dated 02/12/25 to 04/12/25 showed a hospice aide frequency of one visit per week with plan of care updates dated 02/20/25, 03/06/25, 03/20/25 and 04/03/25. A review of the clinical record showed the following:Hospice aide visits dated 02/25/25 and 02/27/25 for the week of 02/23/25 to 03/01/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.Hospice aide visits dated 03/04/25 and 03/06/25 for the week of 03/02/25 to 03/08/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.Hospice aide visits dated 03/11/25 and 03/13/25 for the week of 03/09/25 to 03/15/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.Hospice aide visits dated 03/18/25 and 03/20/25 for the week of 03/16/25 to 03/22/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.Hospice aide visits dated 03/25/25 and 03/27/25 for the week of 03/23/25 to 03/29/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.Hospice aide visits dated 04/01/25 and 04/03/25 for the week of 03/30/25 to 04/05/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.Hospice aide visits dated 04/08/25 and 04/10/25 for the week of 04/06/25 to 04/12/25 (two completed visits, one ordered). Documentation showed no physician orders for a change in the ordered frequency.On 05/07/25 at 3:30 pm., Staff B stated the plan of care was not updated to reflect the increased hospice aide visits for Patient #12.”

“Based on record review and interview, the hospice failed to ensure it provided the most recent plan of care to a skilled nursing facility for two (Patients #2 and 5) of 19 patients. Findings:Patient #2A review of the hospice clinical record for skilled nursing facility #1 showed no current hospice plan of care.On 05/08/25 at 10:00 am., skilled nursing facility staff #1 stated the last plan of care in the hospice clinical record was in the year 2023.Patient #5A review of the hospice clinical record for skilled nursing facility #1 showed no current hospice plan of care.On 05/08/25 at 11:45 am., skilled nursing facility staff #1 stated the last plan of care in the hospice clinical record was in the year 2024.On 05/08/25 at 2:00 pm., Staff B stated the hospice was not aware the current plan of care for Patients #2 and 5 were not provided to the facility.”

“Based on record review and interview, the agency failed to ensure required background checks were completed by the surveyed hospice for one (Staff F) of five employees. Findings:A review of the “Long-Term Care Security Act Title 63 of the Oklahoma Statutes” documented requirement for an OKSCREEN (an Oklahoma based background check program) national background check with fingerprinting for all employees of a home care agency whose employment began after 07/01/14.Staff FA review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed hospice through OKSCREEN for Staff F.On 05/08/25 at 12:30 pm, Staff B stated the OKSCREEN for Staff D was not completed by the surveyed hospice.”