Every finding on record at A Path of Care Home Health II, Inc

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 07/19/22 to 07/20/22. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 07/19/22 to 07/20/22.An entrance conference was conducted with Director1. The survey process was explained. Questions were answered.Admin1 was identified as the contact person for administrative issues and Director1 as the contact person for clinical issues.Findings were discussed during an informal exit conference with Admin1, Director1 and Administrative staff.Standard level deficiencies were cited as a result of the re-certification survey.GLOSSARY: Admin Administrator RN Registered Nurse SN Skilled Nurse POC Home Health Certification and Plan of Care HHA Home Health Aide SAV Supervisory Aide Visit

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure SN staff identified all medications currently taken by the patients and failed to conduct a review of all medications to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy for two ( #1 and #5) of seven (#1 - #7) records reviewed. Patient #1 A review of the record for Patient #1 with a SOC date of 11/01/21 and recertification period 06/29/22 to 08/27/22 revealed a Primary Diagnosis of Hypertensive Heart Disease with Heart Failure and a secondary diagnosis of Chronic Pain. A review of the agency form titled, "Medication List" failed to include Marijuana Salve as a current medication during review of all medications by the SN as part of the comprehensive assessment. During and interview on 07/20/22 at 10:00 am, Patient #1 stated she has a prescription for a Marijuana Salve she applies to her knee to relieve pain and also applies to "some spots on her face' which have improved. Patient #5 A review of the POC for Patient #5 for the period 06/21/22 to 08/19/22 revealed a Primary Diagnosis of Chronic Obstructive Pulmonary Disease and a secondary diagnosis of Dependence on Supplemental Oxygen. Documentation by the RN Visit Notes on 07/05/22 and 07/19/22 indicated Patient #5 had Oxygen in use and required supplemental Oxygen. Further review of the "Medication List" failed to include Oxygen as a current medication for Patient #5. During an interview on 07/20/22 at 2:10 pm, Director1 stated the SN staff did not include Marijuana Salve on the medication list for Patient #1 and did not include Oxygen on the medication list for Patients #5.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record review and interview, the RN failed to ensure development of HHA POC with specific instructions determined by patient care needs for two (#1 and #5) of two (#1and #5) records reviewed with orders for home health aide services. Patient #1 A review of the clinical record for Patient #1 re-certification period 06/29/22 - 08/27/22, revealed a principal diagnosis of Hypertensive Heart Disease with Heart Failure and orders for HHA visits one time a week for one week and two times a week for eight weeks to assist with personal care and activities of daily living. A form titled, "Aide Care Plan Report" contained instructions for the HHA to provide "Bathing- Tub Bath/Shower" every visit and "Bathing- Bed Bath" and Bathing - Partial Sponge Bath" per patient request. Further review of weekly HHA Visit notes for 07/01/22 to 07/15/22 indicated the HHA provided both a Bed Bath and Partial Sponge Bath every visit and did not provide a Tub Bath/Shower as instructed by the Aide Care Plan. During an interview on 07/20/22 at 10:00 am, Patient #1 stated she has a tall whirlpool tub she can not safely access, so she does not take a tub bath or shower and explained the HHA always gives her a sponge bath. Patient #5 A review of the clinical record for Patient #5 initial certification period 06/21/22 - 08/192/22, revealed a principal diagnosis of Chronic Obstructive Pulmonary Disease and orders for HHA visits one time a week for four weeks to assist with personal care and activities of daily living. A form titled, "Aide Care Plan Report" contained instructions for the HHA to provide "Bathing - Bed Bath", Bathing - Tub Bed/ Shower" and "Bathing - Partial Sponge Bath" per patient request and failed to provide specific bathing instructions to the HHA based on Patient #5 personal care needs. Further review of weekly HHA Visit notes for 06/23/22 to 07/14/22 indicated the HHA provided a Tub Bath every visit. On 07/20/22 at 2:10 pm, Director1 stated the Aide Care Plan is developed by the RN and instructions for Patients #1 and #5 failed to provide patient specific bathing instructions for the HHA based on patient care needs.