Every finding on record at Amedisys Oklahoma L.L.C.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 07/07/25 - 07/09/25. 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 07/07/25 - 07/09/25. An entrance conference was conducted with the Staff A and Staff B. The survey process was explained. Questions were answered. The Staff A was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff A, Staff C, and other administrative staff. Deficiencies were cited as a result of the Medicare re-certification survey. Glossary: SN Skilled Nurse RN Registered Nurse SOC Start of Care POC Plan of Care PT Physical Therapy OT Occupational Therapy

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the Physical Therapist failed to conduct a PT evaluation timely as part of the comprehensive assessment for two (#3 and #4) of eight (#1-#7 and #10) records reviewed with orders for PT services. Patient #3 Review of the POC for initial certification period 06/28/25- 08/26/25 showed a primary diagnosis of Hypo-osmolarity and Hyponatremia with referral orders of 06/26/25 for SN and PT evaluations. Further review failed to provide evidence a PT evaluation was completed as of the date of this survey and no documentation as to the reason for the delay. Patient #4 Review of the POC for initial certification period 06/04/25- 08/02/25 showed a primary diagnosis of Acute Cystitis and Hematuria with SOC orders of 06/04/25 for a PT evaluation. Further review showed a PT evaluation was completed as part of the comprehensive assessment on 06/10/25, 1 day late with no documentation as to the reason for the delay. During an interview on 07/09/25 at 9:45 AM, Staff C stated the PT failed to conduct the evaluations timely.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide an individualized POC based on the assessed needs of the patient for three (#5, #6 and #10) of ten (#1 - #10) records reviewed. Patient #5 Review of the POC for initial certification period 06/20/25 - 08/18/25 showed a primary diagnosis of Type 2 Diabetes Mellitus with Hyperglycemia and Polyneuropathy and long-term use of oral Hypoglycemic drugs with orders for "Diabetes Management". "Diabetes Management specified by the POC included orders for RN/LVN/LPN "to...assess, observe and teach ... instructions of diabetic care to include: ...to observe and teach patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician. ...RN/LVN/LPN may perform blood glucose test as needed. ... to report to physician blood glucose readings greater than 300 or less than 70 mg/dl...instruct patient on importance of HCBA1C monitoring". Review of SOC RN Visit note 06/20/25 stated " Patient's A1C on 6/11/25 was at 7.7 which is up from 7.1 6 months prior...placed on new med Sitagliptin. No current orders to monitor daily blood glucose levels as patient is not on insulin, no glucometer in home, knowledge deficit of T2DM". Further record review failed to provide evidence of DME/ Supplies for CBG testing or orders for testing frequency on the POC and no documentation the SN staff notified the physician of the need for CBG testing supplies and orders for testing frequency. The Vital Signs Record showed no CBG results documented for SN visits conducted 6/20/25, 6/27/25, 7/2/25 and 7/9/25 Patient #6 Review of the POC for initial certification period 05/20/25 - 07/18/25 showed a primary diagnosis of Orthopedic Aftercare and secondary diagnosis of Type 2 Diabetes Mellitus with Neuropathy with orders for SN "Diabetes Management" Further review of the POC failed to include DME /Supplies for CBG testing. Patient #10 Review of the POC for re-certification period 04/08/25 - 06/06/25 showed a primary diagnosis of Chronic Obstructive Pulmonary Disease and secondary diagnosis of Hypertensive Heart Disease with Heart Failure and Type II Diabetes Mellitus with orders for SN "Oxygen Therapy' and "Diabetes Management." Further review of the POC failed to include DME /Supplies for CBG testing or Safety Measures for Oxygen Precautions. During an interview on 07/09/25 at 9:45 AM, Staff C stated the POC for Patients #5, #6 and #10 were not individualized to meet the patients' needs based on the documented assessments.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record review, observation and interview the SN failed to provide wound care as ordered for one (#2) of two (#2 and #3) wound care procedures observed. Patient #2 Review of the POC for SOC period 06/06/25 - 08/04/25 showed a primary diagnosis of Metabolic Encephalopathy and Malignant Neoplasm of the Tongue with wound care orders of 06/27/25 for SN to perform wound care 2 times a week to the left forearm graft site and the left thigh graft site. On 07/08/25 at 10:30, the SN was observed performing wound care: Current wound care orders to the left forearm specified: Cleanse with wound cleanser, pat dry, apply hydrofera blue to hyper granulated area, apply Aquaphor to dry skin of forearm, wrap with kerlix, secure with coban. The SN applied an opened single-use Xeroform dressing to the wound instead of hydrofera blue as ordered, did not apply Aquaphor to forearm and informed the patient she would contact the physician to get wound care orders changed. Current wound care orders to the left thigh specified: Cleanse with wound cleanser, pat dry, apply Xeroform to the wound, cover with meplix. The SN applied Xeroform to the wound and covered with a bordered dressing the patient had ordered to use for comfort. The SN informed the patient she would contact the physician to get orders for a new dressing. During an interview on 07/09/25 at 09:45 AM, Staff A stated the SN did not provide wound care as ordered for Patient #2.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on record review, observation and interview, the staff failed to adhere to current infection control standards of practice for three (#1, #2 and #3) of four (#1 - #4) patients observed during home visits. Patient #1 Review of POC for SOC period 06/27/25 - 08/25/25 showed primary diagnosis of Osteoporosis and Fractured Right Femur with orders for PT and OT services. During a home visit on 07/08/25 at 9:30 AM, the OT was observed to place the clinician bag directly on the patients dining table without a protective barrier to prevent transmission of infections. Patient #2 Review of the POC for SOC period 06/06/25 - 08/04/25 showed a primary diagnosis of Metabolic Encephalopathy and Malignant Neoplasm of the Tongue with wound care orders of 06/27/25 for SN to perform wound care 2 times a week to the left forearm graft site and the left thigh graft site. On 07/08/25 at 10:30 AM, the SN was observed to place the clinician bag directly on the patients dining table without a protective barrier. During the wound care procedure, the SN failed to sanitize hands between glove changes, failed to change gloves between removing old dressing to new dressing, reused opened single-use products on the wounds and entered clinician bag with gloves on. Patient #3 Review of the POC for initial certification period 06/28/25- 08/26/25 showed a primary diagnosis of Hypo-osmolarity and Hyponatremia with orders for SN to provide wound care 2 times a week. During a home visit on 07/08/25 at 2:30 PM, the SN was observed during the procedure to place the clinician bag and wound care supplies on a barrier directly on the floor. During an interview on 07/09/25 at 9:45 AM, Staff A stated the clinicians failed to follow infection control practices for Patients #1, #2 and #3.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 08/22/22 to 08/23/22. 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 08/22/22 to 08/23/22.An entrance conference was conducted with Director1. The survey process was explained. Questions were answered.Director1 was identified as the contact person for administrative issues and for clinical issues.Findings were discussed during an informal exit conference with Director1 and Administrative staff members.Standard level deficiencies were cited as a result of the re-certification survey.GLOSSARY: SN Skilled Nurse POC Home Health Certification and Plan of Care

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the SN staff failed to provide services as ordered by the physician in the plan of care for two (#4 and #7) of three ( #2, #4 and #7) records reviewed with orders to assess and report blood glucose readings outside parameters. Patient #4 A review of the POC for Patient #4 for certification periods 06/10/22 to 10/07/22 revealed a primary diagnosis of Type II Diabetes Mellitus with bilateral foot ulcers. The POC included orders for "SN to assess...blood glucose testing as ordered ...report to physician blood glucose readings greater than 160 or less than 60." A review of SN Visit Notes failed to provide evidence the SN reported the following blood glucose results falling outside the established parameters as ordered for visits on 07/13/22 (193), 07/15/22 (193), 07/29/22 (184), 08/12/22 (200) and 08/17/22 (190). Patient #7 A review of the POC for Patient #7 for certification period 07/28/22 revealed a primary diagnosis of Hypertensive Heart Disease with Heart Failure and a secondary diagnosis of Type II Diabetes Mellitus. The POC included orders for SN to assess...blood glucose testing as ordered...report to physician blood glucose readings greater than 160 or less then 60". A review of SN Visit Notes failed to provide evidence the SN reported the blood glucose results outside the established parameters for the recertification SN Visit conducted on 07/25/22 (162) and there was no evidence the SN assessed blood glucose results for SN Visit on 08/03/22. On 08/23/22 at 11:15 am, Director1 stated the SN staff failed to assess and report blood glucose results outside parameters as ordered on the POC for Patients #4 and #7.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interviews, the SN staff failed to provide wound care in accordance with current clinical practice guidelines and accepted standards of practice for three (#2, #4 and #9) of three (#2, #4 and #9) records reviewed with orders for wound care services. Patient #2 A review of the POC for Patient #2 for recertification period 06/29/22 to 08/27/22 revealed a primary diagnosis of Type II Diabetes Mellitus with foot ulcer. The POC included orders for SN Visits 2 times a week for 2 weeks, 1 time a week for 7 weeks and "SN to perform/teach...wound care to left heel pressure ulcer: ...twice a week and prn ...". A review of SN Visit Notes for 06/29/22 - 08/19/22 failed to provide evidence of weekly wound measurements for 5 weeks (07/10/22, - 07/31/22 and 08/14/22). Patient #4 A review of the POC for Patient #4 for recertification periods 06/10/22 to 10/07/22 revealed a primary diagnosis of Type II Diabetes Mellitus with Foot Ulcers. The POC included orders for SN Visits 2 times a week for 8 weeks,1 time a week for 1 week and "SN to perform/teach...wound care to bilateral feet:.. Change dressing every day and prn...Patient will change in absence of SN Visits". A review of SN Visit Notes for 06/10/22 - 08/19/22 failed to provide evidence of weekly wound measurements for 7 weeks (06/12/22, 07/03/22-07/31/22 and 08/14/22) Patient #9 A review of the POC for Patient #9 for recertification period 05/23/22 - 06/17/22 revealed a primary diagnosis of Dehiscence of Amputation Stump and a secondary diagnosis of Type II Diabets Mellitus. The POC included orders for SN Visits 1 time a week for 5 weeks, 1 every other week for 4 weeks and for "SN to perform/teach...wound care to left stump incision dehiscence area: Change dressing every day and prn. Patient to perform in absence of SN". A review of SN Visit Notes failed to provide evidence of weekly wound measurements for 3 weeks (05/26/22 - 06/05/22). Further review of Agency policy entitled, "The Provision of Wound and Skin Care" provided by Director1, stated under General Guidance: Measuring: "In accordance with best practice and standard of care, wounds will be measured a minimum of one time a week...". On 08/23/22 at 11:15 AM, Director1 stated the SN staff failed to obtain weekly wound measurements as required for Patients #2, #4 and #9.