Every finding on record at Arkansas Home Health Providers-III, LLC

On 07/08/24 at 2:35 PM, an entrance conference was conducted with Agency Representatives. The agency was informed the purpose of the visit was to conduct a Medicare recertification survey for compliance with the Conditions of Participation for Home Health. The general nature of the survey process and expected length of survey were explained. On 07/11/24 at 10:15 AM, an exit survey was conducted with Agency Representatives. Preliminary findings of the survey were discussed. The Agency Representatives were given the opportunity to present additional information for the findings discussed. No additional information was presented.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on pre-survey review of the Agency's reports it was determined the Agency failed to encode and transmit Outcome and Assessment Information Set (OASIS) patient data within the required 30 days of the assessment completion date. This failed practice, if not corrected, could result in late submission of all assessments. Findings follow: Review of the "HHA (Home Health Agency) Error Summary by Agency Report" revealed a total of 97 assessments with error -3330 (Record Submitted Late) for the prior calendar year. An interview on 07/09/24 at 12:05 PM with Agency Personnel #2 confirmed failure to submit assessments after completed within the required 30-day period.

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 clinical record review and staff interview, it was determined the Agency failed to ensure a process was in place for checking all medications for actual or potential drug interactions in 2 (#5 and #9) of 10 #1-#10) clinical records reviewed. This failed practice by the Agency presented a risk to all patients on census as the failure to conduct a complete medication review potentially delayed decisions regarding the patient’s medication regimen. Findings follow: Review of clinical record #5 revealed a patient with a start of care (SOC) of 06/13/24 and a diagnosis of Malignant Neoplasm of Head of Pancreas. A document titled “HOME HEALTH CERTIFICATION AND PLAN OF CARE” with a certification period of 06/13/2024-08/11/2024 revealed orders for THC (marijuana) Gummy. A document titled "Client Medication Report" (the form the agency used to document the patient’s medications) lists “THC GUMMY 10MG 1gummy WEEKLY BY MOUTH.” Medication was highlighted in blue indicating it was not included in the review of all medications. No documentation in the clinical record to indicate THC Gummy had been checked for potential side effects or interactions. Review of clinical record #9 revealed a patient with a SOC of 4/29/24 and a diagnosis of Chronic Obstructive Pulmonary Disease with Acute Lower Respiratory Infection. A document titled “HOME HEALTH CERTIFICATION AND PLAN OF CARE” with a certification period of 04/29/2024-06/27/2024 revealed orders for oxygen. A document titled "Client Medication Report" lists “OXYGEN 3 liter PRN (as needed) NASAL CANNULA.” Oxygen was highlighted in blue indicating it was not included in the review of all medications. No documentation in the clinical record to indicate oxygen had been checked for potential side effects or interactions. An interview on 07/11/24 at 9:45 AM with Agency Personnel #1confirmed the failure to check all medications for actual or potential drug side effects or interactions.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (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) 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 paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview, it was determined the Registered Nurse (RN) failed to supervise and assess the quality of care and services provided through on-site supervisory aide visits (SAV) every 14 days in 1 (#1) of 1 (#1) current clinical record reviewed with Home Health Aide (HHA) services. This lack of supervision by the RN had the potential to place all patients receiving HHA services at risk for adverse outcomes due to possible delays in the discovery of noncompliance with the aide plan of care by the HHA or possible changes in the needs of the patient. Findings follows: Review of clinical record #1 with a SOC of 06/03/24 revealed a patient with a diagnosis of Hypertensive Heart Disease with Heart Failure. A document titled "HOME HEALTH CERTIFICATION AND PLAN OF CARE" revealed orders for "HHA 2wk9" (2 times a week for 9 weeks). On a document titled "Visit Note Report" and dated 06/24/2024 the RN documented a SAV. There were no other SAVs performed as of the record review date 07/09/24 (1 day late). An interview on 07/11/24 at 9:45 AM with Agency Personnel #1 and #2 confirmed the failure to conduct supervisory aide visits within the required 14-day period.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview, it was determined the Agency failed to obtain orders for and include all medications utilized by the patient on the medication list in 2 (#5 and #9) of 10 #1-#10) clinical records reviewed. This failed practice by the Agency resulted in an inaccurate and incomplete clinical record and presented a risk to all patients on census as the failure to include all medications could potentially inhibit the patient's attending physician from making an informed decision regarding the patient's medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. Findings follow: Review of clinical record #5 revealed a patient with a start of care (SOC) of 06/13/24 and a diagnosis of Malignant Neoplasm of Head of Pancreas.On a document titled “MedOnc Follow-up Note” and dated 05/31/2024 the Physician documented “patient’s current treatment plan is 5 FU plus Onivyde (chemotherapy drugs).”On a document titled “CLIENT COORDINATION NOTE REPORT” and dated 07/02/2024 the Registered Nurse (RN) documented the patient “WAS AT INFUSION CLINIC RECEIVING CHEMOTHERAPY.”A document titled "Client Medication Report" (the form the agency used to document the patient’s medications) failed to include chemotherapy drugs. Review of clinical record #9 revealed a patient with a SOC of 4/29/24 and a diagnosis of Chronic Obstructive Pulmonary Disease with Acute Lower Respiratory Infection. On a form titled “Visit Note Report” and dated 05/10/2024 the Physical Therapist documented the patient “WAS PLACED ON PREDNISONE WHICH WAS ADDED BY NHRSING [sic] YESTERDAY.”On a form titled “Visit Note Report” and dated 05/09/2024 the RN documented “MED RECON (reconciliation) PERFOMED. NO CHANGES NOTED.”A document titled "Client Medication Report" failed to include the medication prednisone. An interview on 07/11/24 at 9:45 AM with Agency Personnel #1 confirmed the failure to include all medications on the patient's medication list.

. On 01/04/2022 at 11:15 AM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 01/07/2022 at 9:30 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. .

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 Clinical Record review and staff interviews, it was determined the Skilled Nurse (SN) failed to include all medications during the review of the patients medications in 1 (#2) of 17 (#1 - #17) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for patients on census receiving Oxygen therapy by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. 1. A review of Patient #2 Medical Record contained a document titled "Home Health Certification and Plan of Care (POC), dated 12/15/2021 to 02/12/2022." Interventions and goals listed in the POC were for SN "to assess home environment for any hazards related to Oxygen therapy," and goals that the "Patient/Caregiver will verbalize/demonstrate understanding of Oxygen precautions and care of equipment by 01/02/2022." Further review of Patient #2 Medical Record contained a document titled "Client Medication Report." Oxygen was listed on the report and was highlighted in the color blue. 2. During an interview on 01/06/2022 at 3:00 PM with Agency Personnel #3, questions were asked by the surveyor as to why the Oxygen was highlighted in the color blue on the "Client Medication Report." Agency Personnel #3 stated that medications highlighted in the color blue were not reviewed for potential side effects and interactions for all medications verifying oxygen was not reviewed for Patient #2 with all other medications the patient was taking. Agency Personnel #3 further stated that "the electronic medical record software program being utilized by the Agency did not include Oxygen when running the reports for potential adverse effects, drug reactions, significant side effects or significant drug interactions further confirming Oxygen was not assessed for Patient #2.