Elara Caring Xxiv

“Based on record review and interview, the hospice failed to ensure 1. hospice aide visits were provided in accordance with the plan of care for seven (Patients #2, 3, 4, 5, 7, 14 and 16) of 19 patients; 2. skilled nurse visits were provided in accordance with the plan of care for one (Patients #6) of 19 patients; and 3. social worker visits were provided in accordance with the plan of care for two (Patients #5 and 6) of 19 patients. 1. Patient #2 A review of the plan of care dated 04/03/24 to 06/01/24 and plan of care updates dated 04/05/24, 04/11/24, 04/25/24, 05/09/24 and 05/23/24 showed a hospice aide frequency of one visit per week for one week and two visits per week for eight weeks. A review of the clinical record showed the following: Hospice aide missed visit notes dated 04/16/24 and 04/18/24 documented the reason for the missed visit as did not answer phone for the week of 04/14/24 to 04/20/24 (no completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide missed visit notes dated 04/23/24 and 04/25/24 documented the reason for the missed visit as did not answer phone for the week of 04/14/24 to 04/20/24 (no completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 04/30/24 documented the reason for the missed visit as did not answer phone for the week of 04/28/24 to 05/04/24 (one of two completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/09/24 documented the reason for the missed visit as “mom has everything under control” for the week of 05/05/24 to 05/11/24 (one of two completed visits for this week). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/16/24 documented the reason for the missed visit as does not need anything today for the week of 05/12/24 to 05/18/24 (one of two completed visits for this week). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #3 A review of the plan of care dated 04/04/24 to 07/02/24 and plan of care updates dated 04/05/24, 04/19/24, 05/03/24, 05/17/24 and 05/31/24 showed a hospice aide frequency of two visits per week for one week and six visits per week for twelve weeks. A review of the clinical record showed the following: Hospice aide visits dated 04/09/24, 04/10/24 and 04/11/24 for the week of 04/17/24 to 04/18/24 (three of six completed visits). Documentation showed no family/patient refusal of visits, no attempts to reschedule the missed visits and no change in the ordered frequency. A hospice aide missed visit note dated 04/24/24 documented the reason for the missed visit as the patient was going out and completed visits dated 04/23/24 and 04/26/24 for the week of 04/21/24 to 04/27/24 (two of six completed visits). Documentation showed no family/patient refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/01/24 documented the reason for the missed visit as refused and completed visits dated 04/30/24 and 05/03/24 for the week of 04/28/24 to 05/04/24 (two of six completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/08/24 documented the reason for the missed visit as had a shower yesterday and completed visits dated 05/07/24 and 05/10/24 for the week of 04/28/24 to 05/04/24 (two of six completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide visits dated 05/14/24, 05/14/24 and 04/17/24 for the week of 05/12/24 to 05/18/24 (three of six completed visits). Documentation showed no family/patient refusal of visits, no attempts to reschedule the missed visits and no change in the ordered frequency. A hospice aide missed visit note dated 05/22/24 documented the reason for the missed visit as not home and completed visits dated 05/21/24 and 05/24/24 for the week of 05/19/24 to 05/25/24 (two of six completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #4 A review of the plan of care dated 02/15/24 to 05/14/24 and plan of care updates dated 02/15/24, 02/29/24, 03/08/24, 03/22/24 and 04/05/24 showed a hospice aide frequency of one visit per week for one week and two visits per week for twelve weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 04/04/24 documented the reason for the missed visit as “the patient stated she didn’t need a shower today” and completed visit dated 04/01/24 (one of two completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #5 A review of the plan of care dated 04/30/24 to 06/28/24 and plan of care updates dated 05/10/24 and 05/24/24 showed a hospice aide frequency of two visits per week for nine weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 05/23/24 documented the reason for the missed visit as “didn’t feel like a shower” and completed visit dated 05/02/24 (one of two completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #7 A review of the plan of care dated 05/03/24 to 07/31/24 and plan of care updates dated 05/10/24 and 05/24/24 showed a hospice aide frequency of three visits per week for twelve weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 05/13/24 for the day of 05/06/24 documented the reason for the missed visit as refused and completed visits dated 05/08/24 and 05/10/24 (two of three completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/27/24 documented the reason for the missed visit as due to a holiday and completed visits dated 05/29/24 and 05/31/24 (two of three completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #14 A review of the plan of care dated 02/24/24 to 04/23/24 and plan of care updates dated 03/01/24, 03/15/24, 03/29/24, 04/12/24 and 04/26/24 showed a hospice aide frequency of five visits per week for eight weeks. A review of the clinical record showed the following: A hospice aide missed visit note dated 04/01/24 for the day of 03/29/24 documented the reason for the missed visit as the caregiver provided care and completed visits dated 03/25/24, 03/26/24, 03/27/24 and 03/28/24 (four of five completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 04/06/24 for the day of 04/05/24 documented no reason for the missed visit and completed visits dated 04/01/24, 04/02/24, 04/03/24 and 04/04/24 (four of five completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #16 A review of the plan of care dated 02/19/24 to 05/18/24 and plan of care updates dated 03/01/24, 03/15/24 and 03/29/24 showed a hospice aide frequency of three visits per week for thirteen weeks. A review of the clinical record showed the following: Hospice aide missed visit notes dated 02/21/24 documented the reason for the missed visit as refused, 02/24/24 documented no reason and 02/26/24 documented the reason as “not home” for the week of 02/25/24 to 03/02/24 (zero of three completed visits. Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide missed visit notes dated 03/04/24 documented the reason for the missed visit as not home and 03/06/24 documented the reason as refused shower for the week of 03/03/24 to 03/09/24 (one of three completed visits. Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide missed visit notes dated 03/11/24 documented the reason for the missed visit as refused shower and 03/15/24 documented the reason for the missed visit as not home for the week of 03/10/24 to 03/16/24 (one of three completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. 2. Patient #6 A review of the plan of care dated 02/29/24 to 04/28/24 and plan of care updates dated 03/01/24, 03/15/24, 03/29/24, 04/12/24 and 04/26/24 showed a skilled nurse frequency of one visit per week for one week and two visits per week for eight weeks. A review of the clinical record showed the following: A skilled nurse missed visit note dated 03/29/24 documented the reason for the missed visit as “no answer” and a completed skilled nurse visit dated 03/27/24 for the week of 03/24/24 to 03/30/24 (one of two completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. 3. Patient #5 A review of the plan of care dated 04/30/24 to 06/28/24 and plan of care updates dated 05/10/24 and 05/24/24 showed a social worker frequency of one visit per week for one week and one visit every two weeks for six weeks. A review of the clinical record showed the following: A social worker missed visit note dated 05/28/24 documented the reason for the missed visit as schedule conflict (no visits made for the weeks of 05/12/24 to 05/18/24, 05/19/24 to 05/25/24 and 05/26/24 to 06/01/24). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #6 A review of the plan of care dated 02/29/24 to 04/28/24 with plan of care updates dated 03/01/24, 03/15/24, 03/29/24, 04/12/24 and 04/26/24 showed a social worker frequency of one visit per week for one week and one visit every two weeks for six weeks. A social worker missed visit note dated 04/22/24 documented the reason for the missed visits as “unable to make visit” (no visits were made for the week of 03/03/24 to 03/09/24, 03/10/24 to 03/16/24 and 03/17/24 to 03/27/24). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. On 06/05/24 at 1:20 pm., staff A stated: 1. the hospice aide frequencies for Patients #2, 3, 4, 5, 7, 14 and 16 were not met as ordered in the plan of care; 2. the skilled nurse frequency for Patient #6 was not met as ordered in the plan of care; and 3. the social worker frequencies for Patient #5 and 6 were not met as ordered in the plan of care.”

“Based on record review and interview, the hospice failed to ensure an individualized plan of care was fully developed to include all services necessary for the palliation and management of the terminal illness for six (Patients #2, 5, 8, 9, 12 and 14) of 19 patients reviewed. Patient #2 A review of the plan of care dated 04/03/24 to 06/01/24 documented a primary diagnosis of cancer of the cecum and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #5 A plan of care dated 04/30/24 to 06/28/24 documented a primary diagnosis of cancer of the anus and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #8 A plan of care dated 03/16/24 to 05/14/24 documented a primary diagnosis of cancer upper left lobe left bronchus and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #9 A plan of care dated 02/13/24 to 05/12/24 documented a primary diagnosis of sarcopenia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #12 A plan of care dated 05/10/24 to 08/07/24 documented a primary diagnosis of cancer upper left lobe left bronchus and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #14 A plan of care dated 02/24/23 to 04/23/24 documented a primary diagnosis of Parkinson’s disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 06/05/24 at 12:45 pm, Staff A stated the plans of care for Patients #2, 5, 8, 9, 12 and 14 failed to include individualized 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 decreased hospice aide services for three (Patient #2, 3 and 16) of 19 patients. Patient #2 A review of the plan of care dated 04/03/24 to 06/01/24 and plan of care updates dated 04/05/24, 04/11/24, 04/25/24, 05/09/24 and 05/23/24 showed a hospice aide frequency of one visit per week for one week and two visits per week for eight weeks. A review of the clinical record showed the following: Hospice aide missed visit notes dated 04/16/24 and 04/18/24 documented the reason for the missed visit as did not answer phone for the week of 04/14/24 to 04/20/24 (no completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide missed visit notes dated 04/23/24 and 04/25/24 documented the reason for the missed visit as did not answer phone for the week of 04/14/24 to 04/20/24 (no completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 04/30/24 documented the reason for the missed visit as did not answer phone for the week of 04/28/24 to 05/04/24 (one of two completed visits for this week). Documentation showed no patient or family refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/09/24 documented the reason for the missed visit as “mom has everything under control” for the week of 05/05/24 to 05/11/24 (one of two completed visits for this week). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/16/24 documented the reason for the missed visit as does not need anything today for the week of 05/12/24 to 05/18/24 (one of two completed visits for this week). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #3 A review of the plan of care dated 04/04/24 to 07/02/24 and plan of care updates dated 04/05/24, 04/19/24, 05/03/24, 05/17/24 and 05/31/24 showed a hospice aide frequency of two visits per week for one week and six visits per week for twelve weeks. A review of the clinical record showed the following: Hospice aide visits dated 04/09/24, 04/10/24 and 04/11/24 for the week of 04/17/24 to 04/18/24 (three of six completed visits). Documentation showed no family/patient refusal of visits, no attempts to reschedule the missed visits and no change in the ordered frequency. A hospice aide missed visit note dated 04/24/24 documented the reason for the missed visit as the patient was going out and completed visits dated 04/23/24 and 04/26/24 for the week of 04/21/24 to 04/27/24 (two of six completed visits). Documentation showed no family/patient refusal of visits, no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/01/24 documented the reason for the missed visit as refused and completed visits dated 04/30/24 and 05/03/24 for the week of 04/28/24 to 05/04/24 (two of six completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. A hospice aide missed visit note dated 05/08/24 documented the reason for the missed visit as had a shower yesterday and completed visits dated 05/07/24 and 05/10/24 for the week of 04/28/24 to 05/04/24 (two of six completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide visits dated 05/14/24, 05/14/24 and 04/17/24 for the week of 05/12/24 to 05/18/24 (three of six completed visits). Documentation showed no family/patient refusal of visits, no attempts to reschedule the missed visits and no change in the ordered frequency. A hospice aide missed visit note dated 05/22/24 documented the reason for the missed visit as not home and completed visits dated 05/21/24 and 05/24/24 for the week of 05/19/24 to 05/25/24 (two of six completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Patient #16 A review of the plan of care dated 02/19/24 to 05/18/24 and plan of care updates dated 03/01/24, 03/15/24 and 03/29/24 showed a hospice aide frequency of three visits per week for thirteen weeks. A review of the clinical record showed the following: Hospice aide missed visit notes dated 02/21/24 documented the reason for the missed visit as refused, 02/24/24 documented no reason and 02/26/24 documented the reason as “not home” for the week of 02/25/24 to 03/02/24 (zero of three completed visits. Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide missed visit notes dated 03/04/24 documented the reason for the missed visit as not home and 03/06/24 documented the reason as refused shower for the week of 03/03/24 to 03/09/24 (one of three completed visits. Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. Hospice aide missed visit notes dated 03/11/24 documented the reason for the missed visit as refused shower and 03/15/24 documented the reason for the missed visit as not home for the week of 03/10/24 to 03/16/24 (one of three completed visits). Documentation showed no attempts to reschedule the missed visit and no change in the ordered frequency. On 06/05/24 at 1:25 pm., Staff A stated the plan of care for Patients #2, 3 and 16 should have been updated to reflect the decreased need of hospice aide services.”

“Based on record review and interview, the agency failed to ensure required background checks were completed by the surveyed hospice for three (Staff C, D and E) of five employees. A review of the “Long-Term Care Security Act Title 63 of the Oklahoma Statutes” documented requirement for an OKSCREEN national background check with fingerprinting for all employees of a home care agency whose employment began after 07/01/14. Staff C A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff C. Staff D A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff D. Staff E A review of the personnel record showed a background check performed by another agency license number. No background check was performed for the surveyed agency through OKSCREEN for Staff E. On 06/05/24 at 12:30 pm, Staff H stated the OKSCREEN for Staff C, D and E were not completed by the surveyed hospice.”