Elara Caring Xxv

“Based on record review, observation and interview the RN staff failed to provide patient specific instructions on the Aide POC for four( #1, #6, #7, and #9) of nine ( #1, #2, #4 - #7, #9, #11 and #12) records reviewed with orders for Hospice Aide services. Patient #1 Review of the POC dated 06/25/26 for Patient #1 showed a re-certification period of 07/01/26 to 08/29/26 and a primary diagnosis of Moderate Protein Calorie Malnutrition with orders for Hospice Aide visits 1 time a week for 1 week and 2 times a week for 8 weeks. Review of the most current Aide POC dated 07/24/25 showed Aide visits 5 times a week for 12 weeks and 3 times a week for 1 week and included patient specific task to be conducted at each visit as well as “Oxygen Precautions”. Further review of the IDG Updated POC dated 6/30/26 showed HA visits 3 times a week and the form titled “Client Medication Report” failed to provide evidence of oxygen as a current medication and no orders were identified in the EMR for Oxygen. During an observation visit conducted at a facility on 07/08/26 at 9:00 AM, Patient #1 was not observed using oxygen during the visit and when asked if she used oxygen, she denied the need for oxygen. In addition, Patient #1 stated she had a Hospice Aide that helped with her bath 2 times a week. Review of documentation by the HA showed visits were conducted 2 times a week, however the agency POC maintained in the facility showed HA visits were to be conducted 3 times a week. Patient #6Review of the POC for Patient #6 showed a re-certification period of 05/14/26 to 07/12/26 and a primary diagnosis of Atherosclerotic Heart Disease with orders for Hospice Aide visits 2 time a week for 1 week and 5 times a week for 8 weeks. The Aide POC dated 06/15/26 included patient specific task to be conducted at each visit as well as “Oxygen Precautions”. Further review of the “Client Medication Report” failed to provide evidence of oxygen as a current medication and no orders were identified in the EMR for Oxygen. Patient #7 Review of the POC for Patient #7 showed an initial certification period of 06/10/26 to 09/07/26 and a primary diagnosis of Alzheimer’s Disease with orders for Hospice Aide visits 1 time a week for 1 week, 2 times a week for 12 weeks and 1 time a week for 1 week. The Aide POC dated 06/18/26 included patient specific task to be conducted at each visit as well as “Oxygen Precautions”. Further review of the “Client Medication Report” failed to provide evidence of oxygen as a current medication and no orders were identified in the EMR for Oxygen. Patient #9Review of the POC Patient #9 showed an initial certification period of 05/20/26 to 08/17/26 and a primary diagnosis of Hemiplegia with orders for Hospice Aide visits 1 time a week for 1 week, 3 times a week for 12 weeks and 1 time a week for 1 week . The Aide POC dated 06/15/26 included patient specific task to be conducted at each visit as well as “Oxygen Precautions”. Further review of the “Client Medication Report” failed to provide evidence of oxygen as a current medication and no orders were identified in the EMR for Oxygen. During an interview on 07/08/26 at 1:30 PM, Staff A stated the Aide POC was not patient specific regarding HA visit frequency for Patient #1 and Oxygen Precautions for Patients #1, #6, #7 and #9.”

“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 19 patients reviewed. Patient #1 A plan of care dated 01/21/24 to 03/20/24 documented a primary diagnosis of Alzheimer’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 02/06/24 to 04/05/24 documented a primary diagnosis of hypertensive heart disease with heart failure 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 02/01/24 to 03/31/24 documented a primary diagnosis of cancer of the lung 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 01/05/24 to 03/04/24 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 #5 A plan of care dated 01/26/24 to 04/24/24 documented a primary diagnosis of senile degeneration of the brain 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 03/15/24 to 06/13/24 documented a primary diagnosis of hemiplegia after cerebral infarction 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 01/16/24 to 04/14/24 documented a primary diagnosis of senile degeneration of the brain 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 01/04/24 to 05/03/24 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 02/12/24 to 04/0611/24 documented a primary diagnosis of cerebral infarction 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 04/10/24 to 07/08/24 documented a primary diagnosis of hypertensive heart disease 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 02/09/24 to 04/08/24 documented a primary diagnosis of congestive heart failure 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 04/04/24 to 07/02/24 documented a primary diagnosis of hypertensive heart with heart failure and chronic kidney disease with heart failure 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 01/25/24 to 03/24/24 documented a primary diagnosis of panlobular emphysema 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 11/16/23 to 02/13/24 documented a primary diagnosis of congestive heart failure and showed no individualized plan of care development for the services necessary for the palliation and management of the terminal illness. On 04/24/24 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 be individualized and include services necessary for the palliation and management of the terminal illness.”

“Based on record review and interview, the hospice failed to the ensure plans of care was coordinated with the long-term care facility for three (Patients #7, 8 and 9) of 19 patients reviewed. Patient #7 A plan of care dated 01/16/24 to 04/14/24 showed a primary diagnosis of senile degeneration of the brain and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #8 A plan of care dated 02/04/24 to 05/03/24 showed a primary diagnosis of atherosclerotic heart disease and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. Patient #9 A plan of care dated 02/12/24 to 04/11/24 showed a primary diagnosis of cerebral infarction and documented no patient specific interventions to be provided by the nursing home or the hospice for the palliation and management of the terminal illness. On 04/24/24 at 2:20 pm, Staff A stated the plan of care for Patients #7, 8 and 9 did not outline the patient specific interventions to be to be provided by the nursing home or the hospice for the palliation and management of the terminal illness.”

“Based on record review and interview, the hospice failed to ensure required background checks were completed by the surveyed hospice for five (Staff C, D, E, F and G) 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. Staff F 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 F. Staff G 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 G. On 04/24/24 at 2:30 pm, Staff H stated the OKSCREEN for Staff C, D, E, F and G were not completed by the surveyed hospice.”