Every finding on record at Always Better Care of Oklahoma, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 06/27/22 to 06/28/22. 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 06/27/22 to 06/28/22.An entrance conference was conducted with Admin1 and 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 and Director1.Standard level deficiencies were cited as a result of the re-certification survey.GLOSSARY: Admin Administrator SN Skilled Nurse POC Home Health Certification and Plan of Care HHA Home Health Aide SAV Supervisory Aide Visit

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record review and interviews, the agency failed to ensure SN staff assessed the patient's weight to ensure timely reporting of changes to the physician as ordered for two (#1 and #5) of four (#1,#4, #5 and #6) records with orders to assess and report weights outside parameters. Patient #1 A review of the POC for Patient #1 for the period 06/09/22 to 08/07/22 with a Primary Diagnosis of Urinary Tract Infection with a secondary diagnosis of Chronic Kidney Disease included orders for "SN to instruct patient on daily weight... report to SN weight gain of 3 pounds/1 day, 5 pounds /1 week". Further review of SN visit notes revealed the SN failed to assess weights for SN visits conducted 06/16/22, 06/17/22, 06/23/22 and 06/24/22. Patient #5 A review of the POC for Patient #5 for the period 05/18/22 to 07/16/22 with a Primary Diagnosis of Heart Failure included orders to "Notify physician of: Weight greater than 147 pounds or less than 137 pounds". Additional orders included "SN to instruct patient on daily weight... report to SN weight gain of 3 pounds/1 day, 5 pounds /1 week". SN to assess patient's weight log every visit". Further review of SN visit notes revealed the SN failed to assess weight for the SN visits conducted 06/03/22, 06/16/22 and 6/23/22. During an interview on 06/28/22 at 1:30 pm, Director1 stated the SN staff did not assess weights for Patients #1and #5 as ordered.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure RN conduction of onsite Supervisory Aide Visits at least every 14 days for three (#2, #4 and #7) of three (#2, #4 and#7) patients records reviewed with orders for Home Health Aide (HHA) services. Patient#2 A review of the POC for Patient #2 for the period 05/05/22 to 07/03/22 with a Primary Diagnosis of Hypertensive Heart Disease and Heart Failure included orders for Home Health Aide (HHA) services 2 times a week for 8 weeks. Further review of SN Visit notes revealed SAVs were conducted by the RN on 05/2/22 and next 05/17/22 (1 day late), 05/27/22 and next 06/13/22 (3 days late). Patient#4 A review of the POC for Patient #4 for the period 06/07/22 to 08/05/22 with a Primary Diagnosis of Type 2 Diabetes Mellitus included orders for HHA services 2 times a week for 9 weeks. Further review of SN Visit notes revealed SAVs were conducted by the RN on 06/02/22 and next 06/23/22 (7 days late). Patient#7 A review of the POC for Patient #7 for the period 03/18/22 to 05/13/22 with a Primary Diagnosis of Hemiplegia included orders for HHA services 1 time a week for 9 weeks. Further review of SN Visit notes revealed SAVs were conducted by the RN on 03/14/22 and next 03/30/22 (2 days late), 04/12/22 and next 04/27/22 (1 day late). On 06/28/22 at 1:30 PM, Director1 stated the Supervisory Aide Visits for Pt#2, Pt#4 and Pt#7 had not been conducted every 14 days by the RN as required.