Every finding on record at Arkansas Home Health Providers, LLC

The complaint was investigated during a Federal Recertification Survey from 12/09/2024-12/12/2024. An entrance conference was conducted with Agency Representatives at 1:40 PM. The Agency Representatives were informed the purpose of the visit was to conduct a complaint survey. At that time the complaint was reviewed. An exit conference was conducted with Agency Representatives on 12/12/2024 at 2:00 PM. Preliminary findings of the survey were discussed with the Agency Representatives.

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 patient interview, it was determined the Agency failed to assure all medications were included in a comprehensive medication review 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 in one (#1) of 14 (#1-#14) records reviewed. Findings: Review of Record #1 revealed a diagnosis of Malignant Neoplasm of stomach (growing cancer of stomach).During a home visit on 12/11/2025 at 10:10 AM, surveyor asked patient if they were under care of an oncologist (A doctor specializing in the treatment of cancer). Patient #1 replied, "Yes. I go for chemo (chemotherapy infusions) every two weeks right now." A review of a document titled "Patient Medication Record" showed no evidence of the chemotherapy medications listed. Agency Representatives were given an opportunity to provide additional information. Agency Representative #1 stated, "We will contact the oncologist and get them (the chemotherapy medications added to medication record)."

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on clinical record review and staff interview, it was determined the agency failed to ensure the assessment for the Physician ordered weight goal was completed as ordered in 1 (#2) of 14 (#1-#14) clinical records reviewed. This failed practice had the potential to affect all patients on census that have Congestive Heart Failure in that a patients weight changes and fluctuations over the course of a few days to a week can profoundly impact early care interventions and the ability to manage the condition in the patients home instead of readmission to hospital for treatment or complications. Findings: Review of a document titled "Home Health Certification And Plan of Care" with certification dates from 10/16/2024 through 12/14/2024 showed a diagnosis of Heart Failure. On the same document, an order to report to physician for "weight gain of three pounds in 24 hours or five pounds in a week." and a SN (Skilled Nurse) Goal of "Patient weight will be maintained between 232 pounds and 237 pounds during episode" Further review of Skilled Nurse Visit Note revealed the following weight entries10/16/2024-no weight entry, 10/17/2024-no weight entry, 10/18/2024-no weight entry, 10/21/2024- no weight entry, 10/22/2024- no weight entry, 10/23/2024- no weight entry, 10/24/2024- 232 pounds, 10/25/2025-232 pounds, 10/28/2024-no weight entry, 10/29/2024-no weight entry but SN (Skilled Nurse) documented "edema BLE" (swelling to both lower extremities),11/01/2024-no weight entry, 11/04/2024-no weight entry, 11/06/2024-no weight entry, 11/08/2024-no weight entry, 11/12/2024- no weight entry, 11/15/2024-221 pounds, 11/18/2024-no weight entry, 11/20/2024-no weight entry, 11/25/2024-no weight entry, 11/27/2024-no weight entry, 11/29/2024- no weight entry. Agency Representatives were given an opportunity to provide additional information. None was provided.

On 06/28/2022 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 Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 07/01/2022 at 11:15 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

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 physicians orders contained in the Plan of Care (POC) for 4 (#6, #10, #11 and #12) of 13 (#1-#13) clinical records reviewed. This failed practice had the potential of increased risk of hospitalization and obtaining treatment goals, the patient's personal goals and aspects of patient's independence Review Clinical Record #6 revealed the following: 1. A document titled “Home Health Certification and Plan of Care (POC)” dated 5/27/22 to 7/25/22 which contained orders for SN (Skilled Nurse) “to eval/monitor pain including pain level, frequency, location, quality, precipitating factors and report to SN/MD any pain level that is >7 relieved by medication.” 2. A document titled" Physical Therapy (PT) visits" dated 5/14/22, 5/16/22, 5/23/22, 6/1/22, 6/6/22, 6/8/22, 6/17/22, 6/22/22, and 6/24/22, showed patient levels were reported at 8 and above on a scale of 1-10 with 10 being the worst pain. 3. A document titled:" Occupational Therapy (OT) visits" dated on 5/31/22, 6/6/22 6/24/22 showed pain levels at 8 and above. 4. A document titled" SN visits" dated 5/19/22, 5/25/22, 6/17/22, and 6/22/22 showed pain levels at 8 and above. 5. There was no evidence that PT, OT, SN reported pain levels above 7 as ordered on the POC. Review of Clinical Record #10 revealed the following: 1. A primary diagnosis of “Spinal Stenosis Cervical Region”. 2. A Document titled "Home Health Certification and Plan of Care (POC)" dated 4/02/22 to 5/31/22, showed an order for Medical Social Worker to evaluate and treat 4/04/22 to 4/08/22. 3. There was no evidence the Medical Social Worker completed an evaluation as ordered in the POC. Review of Clinical Record #11 revealed the following: 1. A primary diagnosis of “Atherosclerotic Heart disease of Native Coronary Artery with Unspecific Angina Pectoris”. 2. A Document titled "Home Health Certification and Plan of Care (POC)" dated 4/28/22 to 6/27/22, showed an order for SN (Skilled Nurse) to assess blood pressure, temperature, and weekly weight measurement 1wk9wk (once a week for 9 weeks) and 6 PRN (whenever needed). 3. A Document titled "Med-Pass Skilled Visit Note" dated 5/19/2022, showed no documentation of weight measurement, blood pressure and temperature. There were no other SN visits made for the week of May 29, 20022 through June 04, 2022. 4. There was no evidence the Agency staff completed blood pressure, temperature, and weight measurement on 5/19/2022 as ordered in the POC Review of Clinical Record #12 revealed the following: 1. A primary diagnosis of “Multiple Sclerosis”. 2. A Document titled "Home Health Certification and Plan of Care (POC)" dated 4/15/22 to 6/13/22, showed an order for OT (Occupational Therapy) to evaluate and treat 4/15/22 to 4/19/22 and PT (Physical Therapy) to evaluate and treat 4/15/22 to 4/19/22. 3. There was no evidence the OT and PT completed an evaluation as ordered in the POC. 4. During an interview on 7/01/2022 at 11:15 AM, Agency Personnel were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 confirmed the Agency staff’s failure to follow POC for Patient #6, #10, #11 and #12.