Family Choice Home Care Oklahoma City

The agency failed to ensure a community-based risk assessment (All Hazards Risk Assessment) was reviewed and updated every two years for all patients and employees.

The agency failed to ensure an emergency preparedness communication plan included current employee contact information for the agency for all patients and employees.

The agency failed to ensure emergency preparedness disaster table-top exercises, drills, community drills or plan activation events were conducted in calendar year 2024 for all patients and employees.

The agency failed to ensure patient case conferences were carried out as discharge planning activities for four (Patients #1, 2, 3 and #5) of 10 patients.

The agency failed to ensure utilization of patient quality indicator data in the QAPI program for all patients and employees.

The agency failed to ensure its QAPI program performance improvement projects for calendar year 2024 and for 01/01/25 to 06/30/25 for all patients and employees.

The agency failed to ensure its infection control program surveillance monitoring was included in QAPI program reporting for calendar years 2024 and 01/01/25 to 06/30/25 for all patients and employees.

The agency failed to ensure informed consents were obtained and accessible for three (Patients #5, 8 and #10) of 10 patients.

The agency failed to ensure an initial assessment was conducted within 48 hours of referral for two (Patients #5 and #9) of 10 patients.

The agency failed to ensure individualized patient POC included: Identified wound care site for one (Patient #1) of 10 patients.

The agency failed to ensure: SN conducted weight assessments for two (Patient #1 and #6) of 10 patients.

The agency failed to ensure visit note documentation was completed for two (Patients #1 and #2) of 10 patients.

The agency failed to ensure multi-disciplined skilled professional staff participated in its QAPI program for calendar year 2024 and for 01/01/25 to 06/30/25 for all patients and employees.

The agency failed to ensure a transfer/discharge summary was provided to a receiving service provider for three (Patients #8, 9 and #10) of 10 patients.

The agency failed to ensure patients’ rights to have completed assessments, participate in the establishment and revision of a plan of care and be informed of disciplines to provide services with expected frequencies of visits for two (Patients #2 and #3) of eight patients reviewed.

The agency failed to ensure a recertification (updated comprehensive [OASIS]) assessment was completed for two (Patient #4 and #8) of eight patients.

The agency failed to ensure development of an episodic Plan of Care after a comprehensive OASIS assessment for two (Patients #2 and #3) of eight patients.

The agency failed to ensure evidence of a patient centered QAPI Program for all patients and employees.

The agency failed to ensure its infection control program included surveillance monitoring and reporting; and was included in QAPI program activities for all patients and staff.

The agency failed to ensure services were provided as ordered on the POC’s: 1. SN to perform PICC line care every visit (weekly) for one (Patient #1) of eight patients; 2. PT evaluations were conducted for one (Patient #1) of eight patients; 3. OT evaluations were conducted for two (Patients #1 and…

The agency failed to ensure governing body oversite of: 1. A patient centered QAPI Program; 2. An operating budget, capital expenditure plan and allocation of resources activities for 10/01/20 to 12/31/20, calendar year's 2021 and 2022; and 3. Agency program evaluation for 10/01/20 to 12/31/20; and…

The agency failed to ensure a community-based risk assessment (All Hazards Risk Assessment) that identified a date the assessment was developed and implemented and/or was reviewed for all patients and employees.

The agency failed to ensure development, implementation and maintenance of processes for an integrated emergency preparedness response with Federal, State, Tribal, Regional and Local emergency management officials for all patients and employees.

The agency failed to ensure emergency preparedness disaster table-top exercises, drills, community drills or plan activation events were conducted for 10/01/20 to 12/31/20; and calendar years 2021 and 01/01/22 to 12/22/22 for all patients and employees.

The agency failed to ensure a transfer/discharge summary was completed at the time of patient transfer/discharge for five (Patients #2, 3, 4, 7 and #8) of eight patients.

The agency failed to ensure development of an episodic Plan of Care after a comprehensive OASIS assessment for two (Patients #2 and #3) of eight patients.

The agency failed to ensure evidence of a patient centered QAPI Program for all patients and employees.

The agency failed to show utilization of QAPI data to improve program effectiveness, quality of patient care and overall program improvement for all patients and employees.

The agency failed to show conduction of patient centered QAPI Program activities for all patients and employees.

The agency failed to ensure the initiation and review of a PIP through their QAPI Program for 10/01/20 to 12/31/20 and in calendar years 2021 and 2022 for all patients and employees.

The agency failed to ensure governing body oversite of the conduction of patient centered QAPI Program activities for all patients and employees.

The agency failed to ensure its infection control program included surveillance monitoring and reporting; and was included in QAPI program activities for all patients and staff.

The agency failed to ensure an agency staff participation compliance rate with COVID 19 vaccination and/or exemption requirements of 100% for all patients and staff.

The agency failed to ensure governing body oversite of: 1. A patient centered QAPI Program; 2. An operating budget, capital expenditure plan and allocation of resources activities for 10/01/20 to 12/31/20, calendar year's 2021 and 2022; and 3. Agency program evaluation for 10/01/20 to 12/31/20; and…

The agency failed to ensure governing body appointment of the alternate clinical manager and/or alternate supervising RN for the agency effecting all patients and staff.

The agency failed to ensure patients’ rights to have completed assessments, participate in the establishment and revision of a plan of care and be informed of disciplines to provide services with expected frequencies of visits for two (Patients #2 and #3) of eight patients reviewed.

The agency failed to ensure an advance notice of discharge was provided prior to being discharged from the agency for five (Patients #2, 3, 4, 7 and #8) of eight patients.

The agency failed to: 1. Show documentation of the problems encountered by the HHA related to behaviors that impeded the HHA from providing care and services for one (Patient #7) of eight patients; 2. Educate the patient on potential health outcomes from discontinued HHA care and services for one…

The agency failed to ensure a recertification (updated comprehensive [OASIS]) assessment was completed for two (Patient #4 and #8) of eight patients.

The agency failed to ensure a discharge (updated [OASIS]) assessment was completed at the time of discharge prior to or by the end of the patient’s episodic certification period from agency services for three (Patients #2, 3 and #8) of eight patients.

The agency failed to ensure: 1. An individualized patient POC included pain reporting parameters for two (Patients #2 and #4) of eight patients and; 2. An individualized patient POC included weight reporting parameters for one (Patient #6) of eight patients.

The agency failed to ensure: 1. SN visits were ordered by the physician for two (Patients #2 and #3) of eight patients and; 2. CHHA visits were ordered by the physician for one (Patient #3) of eight patients.

The agency failed to ensure services were provided as ordered on the POC’s: 1. SN to perform PICC line care every visit (weekly) for one (Patient #1) of eight patients; 2. PT evaluations were conducted for one (Patient #1) of eight patients; 3. OT evaluations were conducted for two (Patients #1 and…

The agency failed to ensure: 1. CHHA visit notes were completed for one (Patients #3) of eight patients and; 2. SN visit notes were completed for one (Patients #6) of eight patients.

The agency failed to ensure multi-disciplined skilled professional staff were available to participate and provide input into the agency’s QAPI program for all patients and employees.

The agency failed to ensure governing body appointment of the administrator for the agency affecting all patients and staff.

The agency failed to ensure operational oversight of the agency by the administrator and governing body for 22 patients and all staff.

The agency failed to ensure governing body appointment of the clinical manager and/or supervising RN for the agency effecting all patients and staff.

The agency failed to ensure a completed transfer/discharge summary was provided for two (Patients #1 and #6) of eight patients.