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

On 12/20/23 at 1:30 PM, an entrance conference was conducted with Agency Representatives. The agency was informed the purpose of the visit was to conduct a federal home health complaint investigation survey for compliance with the Conditions of Participation for Home Health, 484.50 Patient’s Rights and 484.60 Care planning, coordination of services, and quality of care. On 12/22/23 at 10:30 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. The Agency Representatives were given an opportunity to present additional information for the findings discussed. Provided complaint log updated 12/22/2023 with results of complaint investigation conducted 12/20/23-12/22/23. The complaint was substantiated with related deficiencies cited.

Investigate complaints made by patient CFR(s): 484.50(e)(1)(i) (i) Investigate complaints made by a patient, the patient's representative (if any), and the patient's caregivers and family, including, but not limited to, the following topics: This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview, the agency failed to thoroughly investigate complaints in a timely manner for 1 (#10) of 10 (#1-#10) clinical records reviewed This deficit had the potential to affect all patients currently on census. Findings include: 1. Review of clinical record #10 with a start of care date of 10/05/23 revealed a patient with a diagnosis of Sepsis Unspecified Organism. A document titled "Complaint Report" and dated 12/06/23 revealed the agency received a complaint from the patient's son. States the patient requested the urinalysis on 11/16/23 because she was known to become septic from urinary tract infection. Reports they called the agency 2 days later about the urinalysis results. Reports the results were not sent to the patient or her Primary Care Physician. Reports patient had urinalysis done at physician's office and prescribed oral antibiotics. Informed agency he would be filing complaint with state and patient's insurance. Agency documented interventions "LISTENED TO CARE GIVERS CONCERNS”. Agency staff documented update 12/08/23 "ATTEMPTED TO CALL WITH NO ASNSWER". Complaint processed 12/08/2023. There was no evidence the agency conducted an investigation, did a clinical record review or complaint log documentation. 2. During an interview on 12/21/23 at 2:30 PM, Agency Personnel #1 confirmed complaint processed but not investigated prior to patient’s discharge from the agency. Reports complaint currently being investigated and additional information to be added to the complaint report.

Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview, the Agency failed to communicate with the laboratory, physician or patient to ensure coordination of patient care in 1 (#10) of 3 (#5, #8, & #10) clinical records reviewed with orders for laboratory testing. This deficit had the potential to affect all patients currently on census. Findings include: 1. Review of clinical record #10 with a start of care date of 10/05/23 revealed a patient with a diagnosis of Sepsis Unspecified Organism. On a document titled “VISIT NOTE REPORT” and dated 11/17/2023 the skilled nurse documented “OBTAINED UA (urinalysis) AS ORDERED. SPECIMEN DROPPED OFF AT ELITE HOME HEALTH JONESBORO OFFICE”. On a document titled “VISIT NOTE REPORT” and dated 11/24/2023 the skilled nurse documented “NO PROBLEMS IDENTIFIED” and patient discharged from skilled nurse services. Urinalysis results not in clinical record. No evidence of communication between Agency, laboratory or physician to ensure coordination of care. 2. Review of a document titled “COORDINATION OF CARE, FROM ADMIT THROUGH DISCHARGE” reveals policy includes “Coordinating patient care among various disciplines to ensure that services are continuous and coordinated from admission through discharge. 3. During an interview on 12/21/23 at 2:30 PM, Agency Personnel #1 confirmed there was no documentation in the clinical record of communication with laboratory to follow up on ordered tests. Confirmed failure to coordinate patient care with laboratory.

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, the Agency failed to maintain a liaison with the laboratory, physician or patient to ensure communication of laboratory results in 1 (#10) of 3 (#5, #8, & #10) clinical records reviewed with orders for laboratory testing. This deficit had the potential to affect all patients currently on census. Findings include: 1. Review of clinical record #10 with a start of care date of 10/05/23 revealed a patient with a diagnosis of Sepsis Unspecified Organism. On a document titled “VISIT NOTE REPORT” and dated 11/17/2023 the skilled nurse documented “OBTAINED UA (urinalysis) AS ORDERED. SPECIMEN DROPPED OFF AT ELITE HOME HEALTH JONESBORO OFFICE”. On a document titled “VISIT NOTE REPORT” and dated 11/24/2023 the skilled nurse documented “NO PROBLEMS IDENTIFIED” and patient discharged from skilled nurse services. Urinalysis results not in clinical record. No evidence of communication between Agency and laboratory to request laboratory results. 2. During an interview on 12/21/23 at 2:30 PM, Agency Personnel #1 confirmed the clinical record did not contain the urinalysis results. Confirmed there was no documentation in the clinical record of communication with laboratory to see if they had completed the ordered tests.

On 1/25/2022 at 12:40 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. On 1/31/2022 at 1:45 PM 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 2 (#5 and #11) of 17 (#1 - #17 Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for all patients on census 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 Clinical Record #5 revealed the following: A. Document titled, "Home Health Care Certification and Plan of Care" (POC) dated 10/20/21 - 12/18/21 showed "DME (durable medical equipment) and supplies - Oxygen Supplies." B. Document titled "Client Medication Report" did not list Oxygen to be included in the review for adverse effects, drug reactions, significant side effects or significant drug interactions. C. Document titled "Client Medication Report" listed Vitamin D3 as a medication Patient #5 was taking and highlighted in the color blue. The color blue indicated the Vitamin D3 was not included in the review for adverse effects, drug reactions, significant side effects or significant drug interactions. 2. A review of Clinical Record #11 revealed the following: A. Document titled "Client Medication Report", listed Oxygen as a medication Patient #11 was using and highlighed in the color blue. The color blue indicated the Oxygen was not included in the review for adverse effects, drug reactions, significant side effects or significant drug interactions. 3. During an interview on 1/31/2022 at 1:00 PM, Agency Representatives were provided an opportunity to present additional documentation. Agency Personnel #1 confirmed the Agency staff did not review all medications for adverse effects, drug reactions, significant side effects and significant drug interactions for Patients #5 and #11.

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 Clinical Record review and staff interview, it was determined the Agency staff did not follow the Attending Physician orders contained in the Plan of Care (POC) for 3 (#3, #12 and #13) of 17 (#1 - #17) Clinical Records reviewed. This failed practice if not corrected had the potential of increased risk of rehospitalizations due to disease exacerbation. 1. A review of Clinical Record #3 revealed the following: A. Document titled "Home Health Certificaiton and Plan of Care (POC)" dated 11/3/21 to 1/1/22, showed a diagnosis of "Type 2 Diabetes Mellitus with Diabetic Chronic Kideny Disease." An order contained in the POC showed Skilled Nurse (SN) to record blood sugar reading from Patient #3 log every SN visit. B. Document titled "Visit Note Report" dated 11/19/21 and 12/17/21, showed no evidence of blood sugar readings documented by the SN. 2. Review of Clinical Record #13 revealed the following: A. Document titled "Home Health Certificaiton and Plan of Care (POC)" dated 12/10/21 to 2/7/22, showed a diagnosis of "Type 2 Diabetes" An order contained in the POC showed Skilled Nurse (SN) to record blood sugar reading from Patient #13 log every SN visit. B. Document titled "Visit Note Report" dated 1/14/22 and 1/27/22, showed no evidence of blood sugar readings documented by the SN. 3. Review of clinical record #12 revealed the following: A. Document titled, "Home Health Certification and Plan of Care", showed a significant diagnosis of "Hypertensive Heart Disease with Heart Failure" and Physician orders for "SN to obtain weight every SN visit and to notify RN/MD (Registered Nurse/Medical Doctor) 0f weight gain or loss of 3 LBS [pounds] within 1 day or 5 LBS in 7 days. B. Document titled "Visit Note Report" dated 1/24/22 showed no evidence weights were obtained by the SN. 4. During an interview on 1/31/22 at 1:00 PM, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 confirmed the Agency staffs failure to provide interventions as ordered in the individualized POC for Patient #3, #12 and #13.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on Clinical Record review and Agency staff interview it was determined the Skilled Nurse (SN) failed to alert the Physician of relevant assessment findings which may have necessitated an alteration in the Plan of Care (POC) in 1 (#4) of 17 (#1 - #17) Clinical Records reviewed. This failed practice had the potential to affect all current patients on census in that Physicians may be unaware of new assessment findings resulting in missed opportunities for revision of patient goals/interventions and prevention of hospitalizations. 1. Review of Clinical Record #4 with a Plan of care dated 11/24/21 - 1/22/22 revealed the following: A. Document titled "visit note report" dated 11/24/21, showed the Skilled nurse (SN) documented the Patient weighed 200 pounds. B. Visit note report on 12/08/21 showed documentation by the SN that the Patient weighed 178 pounds, ( a difference of 22 pounds in 14 days. C There was no evidence the Physician was notified of Patient #4 22 pounds weight loss 2. During an interview on 11/31/21 at 1:00 PM, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel # 1 confirmed the SN failed to notify the Physician of the significant change in weight loss. .