Health Watch Hospice of Guymon, LLC

“Based on record review and interview, the hospice failed to ensure initial spiritual or bereavement assessment and psychosocial assessment were not conducted in the five-day period for two (pt #6, 7) of 16 patients. Findings:Pt #6A review of the clinical record showed an election of benefits on 03/19/26 and showed: 1. The completion of the spiritual assessment on 05/13/26 (55 days after the election of the hospice benefit and initial assessment) per patient request and showed no physician notification or changes in orders. 2. The completion of the psychosocial assessment on 03/31/26 (12 days after the election of the hospice benefit and initial assessment) per patient request and showed no physician notification or changes in orders.Pt #7A review of the clinical record showed an election of benefits on 07/04/26 and showed: 1. The completion of the spiritual assessment was not completed and showed no patient or caregiver refusal, physician notification or changes in orders. 2. The completion of the psychosocial assessment on 07/23/26 (19 days after the election of the hospice benefit and initial assessment) and showed no patient or caregiver refusal, physician notification or changes in orders.On 08/28/2026 from 11:16 a.m. to 11:46 a.m., Staff B stated the initial spiritual assessments, and psychosocial assessments were not completed on time as a part of the comprehensive assessment for patient #6 and 7.”

“Based on record review and interview, the hospice failed to ensure: 1. Aide visits were provided in accordance with the plan of care for two (pt #5, 6) of 16 patients. 2. SN visits were provided in accordance with the plan of care for three (pt #2, 5, 16) of 16 patients. Findings:Pt #2A review of a POC dated 07/22/26 to 09/19/26 and IDG updates to the POC on 07/28/26, 08/11/260and 08/25/26 showed a SN frequency of two times a week.A review of the SN visit notes showed during the week of 07/19/26 to 07/25/26 a SN visit was missed (two visits ordered, one visit conducted and showed no communications between the IDG and no changes in the ordered SN visit frequencies.On 08/28/26 at 10:44 a.m., Staff B stated SN frequencies were not conducted as ordered.Pt #5A review of a POC dated 08/06/26 to 11/03/26 and IDG updates to the POC on 08/13/26 showed orders for the SN frequency to be three times a week for one week.A review of the SN visit notes showed during the week of 08/16/26 to 08/22/26 a SN visit was missed 08/20/26 (three visits ordered, two visits conducted) and showed no communication between the IDG and no changes in the ordered SN visit frequencies.On 08/28/26 at 11:34 a.m., Staff B stated SN visits were not conducted as ordered.Pt #16A review of a POC dated 02/09/26 to 05/09/26 and IDG updates to the POC on 02/17/26, 03/03/26 and 03/17/26 showed orders for SN frequency of two times a weekA review of the SN visit notes showed during the weeks of 02/22/26 to 02/28/26, 02/29/26 to 03/07/26 and 03/15/26 to 03/21/26, one SN visit was missed per week (two visits ordered, one visit conducted) and showed no communication between the IDG and no changes in the ordered SN visit frequencies.On 08/28/26 at 12:13 p.m., Staff B stated SN visits were not conducted as ordered.Pt #5A review of a POC dated 08/06/26 to 11/3/26 with an IDG update to the POC on 08/13/26 showed an HHA frequency of one time a week.A review of visit notes showed during the week of 08/17/26 to 08/22/26, one HHA visit was missed (one visit ordered, no visits conducted) and showed no communication between the IDG and no changes in the ordered HHA visit frequencies.On 08/28/26 at 11:34 a.m., Staff B stated HHA visits were not conducted as ordered.Pt #6A review of a POC dated 06/17/26 to 09/14/26 with IDG updates to the POC on 07/02/26, 07/14/26, 07/29/26 and 08/13/26 showed orders for HHA frequency of twice per week.A review of visit notes showed:1. During the week of 07/05/26 to 08/22/26 an HHA visit was missed (two visits ordered, one visit conducted) and showed no communication between the IDG and no changes in the ordered HHA visit frequencies.2. During the week of 08/02/26 to 08/08/26 two HHA visits were missed (two visits ordered, no visits conducted) and showed no communication between the IDG and no changes in the ordered HHA visit frequencies.On 08/28/26 at 11:16 a.m., Staff B stated HHA visits were not conducted as ordered.”

“Based on record review and interview, the hospice failed to ensure plans of care were fully developed to include:1. Volunteer service prn order frequencies to meet individualized patient care for nine (pt #3, 4, 7, 8, 9, 12, 13, 14, 15) of 16 patients.2. PT/OT/ST/Dietary Services prn frequencies to meet individualized patient care for eight (pt# #8, 9, 10, 11, 12, 13, 14, 15) of 16 patients.3. Wound care orders for no identified wound site for 13 (pt # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13) of 16 patients.4. Order for placement of straight or indwelling catheter for five (pt #1, 2, 4, 12, 16) of 16 patients.5. Service frequencies to meet individualized patient care for two (pt # 12, 14) of 16 patients. Findings:Pt #1A review of a POC dated 06/30/26 to 08/28/26 with IDG updates on 06/30/2026, 07/14/2026, 07/28/26, 08/11/26 and 08/25/26 showed prn wound care orders for no identified wound site and prn orders for placement of straight or indwelling catheter that did not indicate foley catheter size or interventions for foley catheter management and showed no communication between the IDG and physician with no changes in orders.Pt #2A review of a POC dated 07/22/26 to 09/19/26 with IDG updates on 07/28/26, 08/11/26, and 08/25/26 showed prn wound care orders for no identified wound site and prn orders for placement of straight or indwelling catheter that did not indicate foley catheter size or interventions for foley catheter management and showed no communication between the IDG and physician with no changes in orders.Pt #3A review of a POC dated 07/10/26 to 09/07/26 with IDG updates on 07/14/26, 07/28/26, 08/11/26 and 08/25/26 showed prn volunteer visits with no visit frequencies; prn wound care orders with no identified wound site and showed no communication between the IDG and physician with no changes in orders.Pt #4A review of a POC dated 07/10/26 to 09/07/26 with IDG updates on 07/28/26, 08/11/26 and 08/25/26 showed prn volunteer visits with no visit frequencies; prn wound care orders with no identified wound site and showed no communication between the IDG and physician with no changes in orders.Pt #5A review of a POC dated 08/06/26 to 11/03/26 with IDG update on 08/13/26 showed prn wound care orders with no identified wound site and showed no communication between IDG and physician with no changes in orders.Pt #6A review of a POC dated 06/17/26 to 09/14/26 with IDG updates on 07/02/26, 07/14/26, 07/29/26 and 08/13/26 showed prn wound care orders with no identified wound site and showed no communication between IDG and physician with no changes in orders.Pt #7A review of a POC dated 07/05/26 to 09/02/26 with IDG updates on 07/14/26, 07/29/26 and 08/13/26 showed prn volunteer visits with no visit frequencies; prn wound care orders with no identified wound site and showed no communication between the IDG and physician with no changes in orders. Pt #8A review of a POC dated 08/17/26 to 10/15/26 with no IDG updates showed prn volunteer visits with no visit frequencies; prn wound care orders with no identified wound site and showed no communication between the IDG and physician with no changes in orders.Pt #9A review of a POC dated 06/26/26 to 09/23/26 with IDG updates on 07/14/26, 07/29/26, 08/13/26 and 08/27/26 showed prn volunteer visits with no visit frequencies; prn wound care orders with no identified wound site and showed prn PT/OT/ST/Dietary with no discipline frequencies and showed no communication between the IDG and physician with no changes in orders.Pt #10A review of a POC dated 07/11/26 to 10/08/26 with IDG updates 07/14/26, 07/28/26, 08/11/26 and 08/25/26 showed orders for prn PT/OT/ST/Dietary service with no visit frequencies; wound care orders for no identified wound site and showed no communication between the IDG and physician with no changes in orders.Pt #11A review of a POC dated 03/09/26 to 04/08/26 with IDG updates on 03/24/26, 04/07/26 and 04/21/26 showed orders for prn PT/OT/ST/Dietary service with no visit frequencies; wound care orders for no identified wound site and showed no communication between the IDG and physician with no changes in orders.Pt #12A review of a POC dated 03/31/26 to 05/19/26 with IDG updates on 04/07/26, 04/20/26, 05/05/26 and 05/20/26 showed orders for prn volunteer visits with no visit frequencies, prn wound care orders with no identified wound site, prn PT/OT/ST/Dietary service disciplines with no visit frequencies, prn orders for placement of straight or indwelling catheter that did not indicate foley catheter size or interventions for foley catheter management and prn Chaplain and MSW visits with no visit frequencies and showed no communication between the IDG and physician with no changes in orders.Pt #13A review of a POC dated 02/05/26 to 05/05/26 with IDG updates on 02/03/26, 02/17/26, 03/03/26 and 03/17/26 showed orders for prn volunteer visits with no visit frequencies, prn wound care orders with no identified wound site, prn PT/OT/ST/Dietary service disciplines with no visit frequencies and showed no communication between the IDG and physician with no changes in orders.Pt #14A review of a POC dated 02/25/26 to 05/25/26 with IDG update on 03/09/26 showed orders for prn volunteer visits with no visit frequencies, prn wound care orders with no identified wound site, prn PT/OT/ST/Dietary service disciplines with no visit frequencies, prn Chaplain and MSW service disciplines with no visit frequencies and showed no communication between the IDG and physician with no changes in orders.Pt #15A review of a POC dated 07/22/26 to 09/19/26 with IDG update on 07/08/26 showed orders for prn volunteer visits with no visit frequencies, prn PT/OT/ST/Dietary service disciplines with no visit frequencies and showed no communication between the IDG and physician with no changes in orders.Pt #16A review of a POC dated 02/09/26 to 05/09/26 with IDG updates on 02/17/26, 03/03/26 and 03/17/26 prn orders for placement of straight or indwelling catheter that did not indicate foley catheter size or interventions for foley catheter management and showed no communication between the IDG and physician with no changes in orders.On 08/28/26 from 10:40 a.m. to 12:13 p.m., Staff B stated there were no visit frequencies for the prn service disciplines and orders for the nursing interventions were incomplete for patients #1 through 16.”

“Based on record review and interview, the hospice failed to ensure orders in the POC were updated after an IDG meeting for one (pt #3) of 16 patients. Findings:A review of a POC dated 07/10/26 to 09/07/26 with IDG updates on 07/14/26, 07/28/26, 08/11/26 and 08/25/26 showed orders for HHA visits with no hospice aide visit frequency and no hospice aide visit were conducted.A review of an Aide Care Plan dated 07/10/26 to 09/07/26 showed a visit frequency of once a week for 12 weeks.On 08/28/26 at 10:47 a.m., Staff B stated the hospice aide visits were declined by the patient, and the orders were not updated after the IDG meeting on 07/14/26.”

“Based on record review and interview, the hospice failed to ensure review of the QAPI program for the 2nd, 3rd, and 4th quarters of calendar year 2024 and in calendar year 2025. Findings:A review of Governing Body meeting minutes for calendar years 2024 and 2025 showed no review and approval of the QAPI program by the Governing body during the 2nd, 3rd, and 4th quarter of 2024 and the 1st through 4th quarter of 2025.On 08/28/26 at 11:45 a.m., Staff B stated that the Governing Body minutes did not include review and approval of the QAPI program.”

“Based on record review and interview, the hospice failed to ensure governing body appointments of the person responsible for the management of the program and designation of the supervising nurse (patient care coordinator) for the hospice program for all patients, employees and volunteers. Findings:A review of governing body records showed no appointment of the person responsible for the management of the program (administrator) and designation of the patient care coordinator (supervising RN) for the hospice program in 2025.On 08/28/26 at 11:45 p.m., Staff B stated the governing board did not designate the current administrator and supervising RN for the hospice.”

“Based on record review and interview, the IDG failed to ensure the comprehensive assessment was completed within 5 days of the election of hospice care for three (#1, #13 and #14) of fourteen (#1 -#14) records reviewed. Patient #1 Review of clinical record #1 for initial certification period 05/02/24 - 07/30/24 revealed a primary diagnosis of Chronic Obstructive Pulmonary Disease and a SOC date of 05/02/24. Further review of Clinical Visit Notes indicated a Chaplain Spiritual Evaluation was conducted on 05/10/24 (3 days late). Patient #13 Review of clinical record #13 for initial certification period 09/28/23 - 12/15/23 revealed a primary diagnosis of Malignant Neoplasm of the Rectum and a SOC date of 09/28/23. Further review of Clinical Visit Notes indicated a Chaplain Spiritual Evaluation was conducted on 10/04/23 (1 day late). Patient # 14 Review of clinical record #14 for initial certification period 01/31/24 - 04/29/24 revealed a primary diagnosis of Chronic Kidney Disease with Heart Failure and a SOC date of 01/31/24. Further review of Clinical Visit Notes indicated the Chaplain Spiritual and Social Worker Psychosocial Evaluations were conducted on 02/06/24 (1 day late). During an interview on 05/15/24 at 2:45 PM, the Administrator stated the IDG members failed to ensure the comprehensive assessment was completed within 5 days as required for Patients #1, #13 and #14.”

“Based on record review and interview, the IDG failed to ensure an Initial Bereavement Risk Assessment was conducted as part of the Comprehensive Assessment to identify needs of the patient and family and to incorporate that information into the hospice bereavement plan of care for eight (#3, #4, #8, #9, #11, #12, #13 and #14) of fourteen (#1 -#14) records reviewed. Patient #3 Review of clinical record #3 with a SOC date of 05/19/23 revealed the initial Bereavement Risk Assessment was completed 06/19/23. (27 days late). Patient #4 Review of clinical record #4 with a SOC date of 09/29/23 revealed the initial Bereavement Risk Assessment was completed 05/10/24. (220 days late). Patient #8 Review of clinical record #8 with a SOC date of 06/07/23 revealed the initial Bereavement Risk Assessment was completed 09/21/23. (102 days late). Patient #9 Review of clinical record #9 with a SOC date of 01/13/24 revealed the initial Bereavement Risk Assessment was completed 05/07/24. (111 days late). Patient #11 Review of clinical record #11 with a SOC date of 10/04/23 revealed the initial Bereavement Risk Assessment was completed 04/30/24. (205 days late). Patient #12 Review of clinical record #12 with a SOC date of 10/24/23 revealed the initial Bereavement Risk Assessment was completed 04/30/24. (185 days late). Patient #13 Review of clinical record #13 with a SOC date of 09/08/23 revealed the initial Bereavement Risk Assessment was completed 11/29/23. (77 days late). During an interview on 05/15/24 at 2:45 PM, the Administrator stated the IDG members failed to ensure the Initial Bereavement Risk Assessments for Patients #3, #4, #8, #9, #11, #12, #13 and #14 were completed timely as part of the Comprehensive Assessment.”

“Based on clinical record review, administrative IDG schedule document and interview, the IDG failed to complete plan of care updates at least every 15 days for seven (#3-#8 and #11) of nineteen (#1 -#19) records reviewed. Patient #3 Review of clinical record #3 with a SOC date of 05/19/23 revealed the IDG completed a plan of care update on 03/26/24 and next on 04/16/24. (6 days late) Patient #4 Review of clinical record #4 with a SOC date of 09/29/23 revealed the IDG completed a plan of care update on 01/28/24 and next on 03/10/24. No IDG meetings were documented for the month of February 2024. Patient #5 Review of clinical record #5 with a SOC date of 03/12/24 revealed the IDG completed a plan of care update on 04/16/24 and next on 05/06/24. (5 days late) Patient #6 Review of clinical record #6 with a SOC date of 04/26/24 revealed the IDG completed the initial plan of care update on 05/13/24. (2 days late) Patient #7 Review of clinical record #7 with a SOC date of 10/10/23 revealed the IDG completed plan of care updates on 02/08/24 and next on 03/07/24. (13 days late) Patient #8 Review of clinical record #8 with a SOC date of 06/07/23 revealed the IDG completed plan of care updates on 02/05/24 and next on 03/04/24. (13 days late) Patient #11 Review of clinical record #11 with a SOC date of 10/04/23 revealed the IDG completed plan of care updates on 10/10/23 and next on 11/09/23 (15 days late) and next on 12/08/23. (14 days late). During an interview on 05/15/24 at 2:45 PM, the Administrator stated the IDG members failed to ensure plan of care updates were completed every 15 days as required for Patients #3- #8 and #11.”