Choice Health at Home - Southeastern Oklahoma Hospice

“Based on record review and interview, the hospice failed to ensure completion of an initial evaluation for hospice services within 48 hours from receipt of referral for three (Patients #4, 6 and 7) of 10 patients. Findings: Patient #4A review of the clinical record showed a referral for hospice services on 05/12/26 and showed start of care dated 05/15/26 (3 days from receipt of the referral). The clinical record showed no patient or caregiver refusal or request to delay hospice services, no communication with the physician and no change in orders. Patient #6A review of the clinical record showed a referral for hospice services on 02/11/26 and showed start of care dated 02/16/26 (5 days from receipt of the referral). The clinical record showed no patient or caregiver refusal or request to delay hospice services, no communication with the physician and no change in orders. Patient #7A review of the clinical record showed a referral for hospice services on 02/19/26 and showed start of care dated 02/25/26 (5 days from receipt of the referral). The clinical record showed no patient or caregiver refusal or request to delay hospice services, no communication with the physician and no change in orders. On 08/05/26 from 1:05 p.m. to 1:20 a.m., Staff B stated there was no documentation in the clinical records for the delay in hospice service evaluations for patients #4, 6 and #7.”

“Based on record review and interview, the hospice failed to ensure a bereavement care plan was initiated or was included as a part of the overall POC after the initial spiritual and bereavement assessments for 10 (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9 and #10) of 10 patients. Findings: Patient #1A review of the clinical record showed an election of the hospice benefit on 05/05/26, and completion of the spiritual and bereavement assessments on 05/08/26. A review of a POC dated 05/05/26 to 08/02/26 and IDG updates to the POC on 05/02/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #2A review of the clinical record showed an election of the hospice benefit on 01/07/26, and completion of the spiritual and bereavement assessments on 01/08/26. A review of a POC dated 01/07/26 to 04/06/26 and IDG updates to the POC on 01/06/26, 01/20/26, 02/03/26, 02/17/26, 03/03/26, 03/17/26 and on 03/31/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #3A review of the clinical record showed an election of the hospice benefit on 03/09/26, and completion of the spiritual and bereavement assessments on 03/11/26. A review of a POC dated 03/09/26 to 06/06/26 and IDG updates to the POC on 03/20/26, 04/03/26, 04/17/26, 04/28/26, 05/12/26 and on 05/26/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #4A review of the clinical record showed an election of the hospice benefit on 05/15/26, and completion of the spiritual and bereavement assessments on 05/18/26. A review of a POC dated 05/15/26 to 08/12/26 and IDG updates to the POC on 05/26/26, 06/09/26, 06/23/26, 07/07/26 and on 07/22/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #5A review of the clinical record showed an election of the hospice benefit on 05/09/26, and completion of the spiritual and bereavement assessments on 05/12/25. A review of a POC dated 05/09/26 to 07/25/26 and IDG updates to the POC on 06/09/26, 06/23/26, 07/07/26 and on 07/22/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #6A review of the clinical record showed an election of the hospice benefit on 02/11/26, and completion of the spiritual and bereavement assessments on 02/18/26. A review of a POC dated 06/16/26 to 08/14/26 and IDG updates to the POC on 06/23/26, 07/07/26, 07/22/26 and on 08/04/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #7A review of the clinical record showed an election of the hospice benefit on 02/25/26, and completion of the spiritual and bereavement assessments on 02/27/26. A review of a POC dated 05/26/26 to 08/23/26 and IDG updates to the POC on 05/29/26, 06/12/26, 06/26/26, 07/10/26 and on 07/24/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #8A review of the clinical record showed an election of the hospice benefit on 07/15/26, and completion of the spiritual and bereavement assessments on 07/16/26. A review of a POC dated 07/15/26 to 10/12/26 and IDG updates to the POC on 07/22/26 and on 08/04/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #9A review of the clinical record showed an election of the hospice benefit on 02/07/25, and completion of the spiritual and bereavement assessments on 02/11/25. A review of a POC dated 06/02/26 to 07/31/26 and IDG updates to the POC on 06/09/26, 06/23/26, 07/07/26, 07/22/26 and on 08/04/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. Patient #10A review of the clinical record showed an election of the hospice benefit on 12/18/25 and completion of the spiritual and bereavement assessments on 12/22/25. A review of a POC dated 06/16/26 to 08/14/26 and IDG updates to the POC on 06/23/26, 07/07/26, 07/22/26 and on 08/04/26 showed no bereavement care plan and no bereavement interventions and goals included as a part of the overall POC. The clinical record showed no changes in orders. On 08/05/26 from 12:40 p.m. to 1:30 p.m., Staff B stated:Patients #2, 4, 5, 6, 7, 8, 9 and #10 did not have bereavement care plans in place. Patients #1 and #3 had bereavement care plans initiated after the patients’ deaths.”

“Based on record review and interview, the hospice failed to ensure:Aide visits were provided in accordance with the plan of care for one (Patient #2) of 10 patients.The hospice aide did not obtain a patient weight weekly in accordance with the plan of care for one (Patient #5) of 10 patients. Findings: Patient #2A review of a POC dated 01/07/26 to 04/06/26 and IDG updates to the POC on 01/06/26, 01/20/26, 02/03/26, 02/17/26, 03/03/26, 03/17/26 and on 03/31/26 showed an aide visit frequency of two times a week. During the week of 05/24/26 to 05/30/26 an aide visit was conducted on 05/25/26 (one visit conducted, two visits ordered). The clinical record showed no communication between the IDG and showed no refused or missed visit and no changes in the ordered aide visit frequency. On 08/05/26 at 12:50 p.m., Staff B stated the aide visits were not conducted as ordered. Patient #5A review of a POC dated 05/09/26 to 07/25/26 and IDG updates to the POC on 06/09/26, 06/23/26, 07/07/26 and on 07/22/26 showed an aide visit frequency of two times a week and showed orders for the aide to weigh the patient weekly. The clinical records showed no patient weights were obtained by the aide during the aide visits from 05/28/26 to 07/24/26. On 08/05/26 at 1:12 p.m., Staff B stated the patient was not weighed during the aide visits.”

“Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include services necessary for:The palliation and management of the terminal illness (hospice diagnosis) for four (Patients #2, 4, 7 and #9) of 10 patients. Aide services interventions and goals for nine (Patients #2, 3, 4, 5, 6, 7, 8, 9 and #10) of 10 patients.Interventions and goals related to the management of pain for three (Patients #3, 4 and #9) of 10 patients. Findings: Patient #2A review of a POC dated 01/07/26 to 04/06/26 and IDG updates to the POC on 01/06/26, 01/20/26, 02/03/26, 02/17/26, 03/03/26, 03/17/26 and on 03/31/26 did not include interventions and goals necessary for the palliation and management of the terminal illness breast cancer and did not include hospice aide interventions and goals.Patient #3A review of a POC dated 03/09/26 to 06/06/26 and IDG updates to the POC on 03/20/26, 04/03/26, 04/17/26, 04/28/26, 05/12/26 and on 05/26/26 did not include hospice aide or pain management interventions and goals. Patient #4A review of a POC dated 05/15/26 to 08/12/26 and IDG updates to the POC on 05/26/26, 06/09/26, 06/23/26, 07/07/26 and on 07/22/26 did not include interventions and goals necessary for the palliation and management of the terminal illness dementia and did not include hospice aide or pain management interventions and goals.Patient #5A review of a POC dated 05/09/26 to 07/25/26 and IDG updates to the POC on 06/09/26, 06/23/26, 07/07/26 and on 07/22/26 did not include hospice aide interventions and goals.Patient #6A review of a POC dated 06/16/26 to 08/14/26 and IDG updates to the POC on 06/23/26, 07/07/26, 07/22/26 and on 08/04/26 did not include hospice aide interventions and goals. Patient #7A review of a POC dated 05/26/26 to 08/23/26 and IDG updates to the POC on 05/29/26, 06/12/26, 06/26/26, 07/10/26 and on 07/24/26 did not include did not include interventions and goals necessary for the palliation and management of the terminal illness of heart failure and did not include hospice aide interventions and goals. Patient #8A review of a POC dated 07/15/26 to 10/12/26 and IDG updates to the POC on 07/22/26 and on 08/04/26 did not include hospice aide interventions and goals. Patient #9A review of a POC dated 06/02/26 to 07/31/26 and IDG updates to the POC on 06/09/26, 06/23/26, 07/07/26, 07/22/26 and on 08/04/26 did not include did not include interventions and goals necessary for the palliation and management of the terminal illness atrial fibrillation and did not include hospice aide or pain management interventions and goals. Patient #10A review of a POC dated 06/16/26 to 08/14/26 and IDG updates to the POC on 06/23/26, 07/07/26, 07/22/26 and on 08/04/26 did not include hospice aide interventions and goals. On 08/05/26 from 12:50 p.m. to 1:27 p.m., Staff B stated the POCs did not include interventions and goals related to their hospice diagnoses for patients #2, 4, 7 and #9. On 08/05/26 from 12:40 p.m. to 1:30 p.m., Staff B stated the care plans for:Patients #2, 4, 7 and #9 did not include interventions and goals related to their hospice diagnoses.Patients #2, 3, 4, 5, 6, 7, 8, 9 and #10 did not include interventions and goals for the hospice aide services.Patients #3, 4 and #9 did not include interventions and goals related to management of the patients’ pain.”

“Based on record review and interview, the hospice failed to ensure physicians orders were entered into the patients’ clinical records upon receipt for two (Patients #1 and #3) of 10 patients. Findings: Patient #1A review of the clinical record showed a POC dated 05/05/26 to 08/02/26 and IDG updates to the POC on 05/02/26 showed an entry into the patient’s medication profile morphine sulfate 20mg per ml every two hours as needed for pain on 05/12/26 and showed no physicians order for the medication. A SN visit note dated 05/08/26 documented the nurse requested an order from the hospice physician during the visit for morphine sulfate 20mg per ml every two hours as needed for increased pain. A review of SN visit notes dated 05/09/26, 05/10/26 and 05/12/26 documented the patient was taking morphine sulfate for pain management. On 08/05/26 at 12:40 p.m., Staff B stated the clinical record showed no entry of the 05/08/26 physician’s order for morphine sulfate. Patient #3A review of the clinical record showed a POC dated 03/09/26 to 06/06/26 and IDG updates to the POC on 03/20/26, 04/03/26, 04/17/26, 04/28/26, 05/12/26 and on 05/26/26 showed a physician’s order dated 05/14/26 for wound care: cleanse with normal saline, apply Xeroform and cover with bordered foam dressing two times a week. The order did not document the wound site location for the wound care. On 08/05/26 at 1:00 p.m., Staff B stated the clinical record showed no location site for the wound 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 fourteen (Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 14) of 14 patients reviewed. Patient #1 A plan of care dated 04/24/24 to 06/22/24 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. Patient #2 A review of the plan of care dated 05/16/24 to 08/13/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #3 A plan of care dated 04/19/24 to 06/17/24 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 #4 A plan of care dated 05/11/24 to 07/09/24 documented a primary diagnosis of prostate cancer 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 04/28/24 to 06/26/24 documented a primary diagnosis of atherosclerotic heart disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #6 A plan of care dated 06/12/24 to 09/09/24 documented a primary diagnosis of chronic combined systolic and diastolic heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #7 A plan of care dated 02/21/24 to 05/18/24 documented a primary diagnosis of breast cancer 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 04/17/24 to 07/15/24 documented a primary diagnosis of atherosclerotic heart disease 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 03/31/24 to 05/29/24 documented a primary diagnosis of chronic obstructive pulmonary disease and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #10 A plan of care dated 03/15/24 to 06/12/24 documented a primary diagnosis of cerebral ischemia and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #11 A plan of care dated 03/20/24 to 06/17/24 documented a primary diagnosis of lung cancer 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 03/17/24 to 05/15/24 documented a primary diagnosis of colon cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. Patient #13 A plan of care dated 03/25/24 to 06/22/24 documented a primary diagnosis of liver cancer 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 05/21/24 to 08/18/24 documented a primary diagnosis of pancreatic cancer and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 07/02/24 at 2:15 pm, Staff A stated the plans of care for Patients #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 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: 1. ensure the plan of care was revised to reflect the presence of wounds for two (Patients #1 and 5) of 14 patients; and 2. ensure the plan of care was revised to reflect changes in the services for a change in the primary diagnosis for one (Patient #2) of 14 patients. 1. Patient #1 A review of the plan of care dated 04/24/24 to 06/22/24 and plan of care updates dated 04/30/24, 05/14/24, 05/28/24 and 06/11/24 showed a skilled nurse frequency of one visit per week for nine weeks and documented no presence of wounds or impaired skin integrity. A review of the clinical record showed the following: A skilled nurse assessment dated 06/05/24 documented the presence of a diabetic ulcer which was reported to the interdisciplinary group, with no documentation of physician notification or update to the plan of care. A skilled nurse assessment dated 06/12/24 documented the presence of a diabetic ulcer to the 4th left toe, with no update to the plan of care. A physician’s order dated 06/12/24 documented facility staff to paint the diabetic ulcer with Betadine daily, with no update to the plan of care. A skilled nurse assessment dated 06/19/24 documented the presence of a diabetic ulcer to the 4th left toe, with no update to the plan of care. Patient #5 A review of the plan of care dated 04/28/24 to 06/26/24 and plan of care updates dated 05/03/24, 05/17/24, 05/31/24 and 06/14/24 showed a skilled nurse frequency of one visit per week for nine weeks and documented no presence of wounds or impaired skin integrity. A review of the clinical record showed the following: A skilled nurse assessment dated 05/01/24 documented the presence of a lesion to the upper left back, with no update to the plan of care. A skilled nurse assessment dated 06/19/24 documented the presence of a lesion to the upper left back, with no update to the plan of care. 2. Patient #2 A review of the plan of care dated 05/16/24 to 08/13/24 and plan of care updates dated 05/28/24 and 06/11/24 documented a primary diagnosis of chronic obstructive pulmonary disease. A physician’s order dated 06/14/24 showed the primary diagnosis was to be changed to hypertensive heart disease with heart failure. A plan of care update dated 06/25/24 showed no changes in the services necessary for the management and palliation of the updated primary diagnosis. On 07/02/24 at 2:00 pm., Staff A stated: 1.the plan of care for Patients #1 and 6 were not updated to reflect the changes in skin integrity; and 2.. the plan of care for Patient #2 was no updated to reflect changes in the services necessary for the management and palliation of the updated primary diagnosis.”

“Based on record review and interview, the hospice failed to analyze quality indicators. This failed practice had the potential to place 21 current patients and any new patient admitted to the hospice at risk for repeated hospice mishaps due to failure of the hospice to self-identify problem areas. A review of administrative records showed no analysis of quality indicators for 2023 and from January 1st, 2024, to March 31st, 2024. On 07/02/24 at 1:45 pm, Staff A stated the QAPI for 2023 and from January 1st, 2024, to March 31st, 2024, not contain an analysis of quality indicators.”