Every finding on record at Arken Healthcare Services Inc

The following reflects the findings of the California Department of Public Health during a Complaint Validation Survey authorized by Centers for Medicare and Medicaid Services (CMS) for intake number 108756. The inspection was limited to the specific Condition of Participation investigated and does not represent the findings of a full inspection of the agency. The following Condition of Participation was surveyed: CFR 484.60 Care Planning/Coordination/Quality of Care. One standard level of deficiency was issued.

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 interview and record review, the agency failed to follow the physician's order for one of three patients reviewed (Patient A) when Registered Nurse (RN) 1 removed Patient 1's dressing (a type of bandage that covers a wound) two days after the surgery. This failure had the potential to place Patient A at risk for delayed wound healing and other complications. On September 10, 2024, Patient A's record was reviewed. Patient A was admitted to the agency with the Start of Care (SOC) date of July 24, 2024, with diagnoses which included dislocation of the internal right hip prosthesis (a condition when the ball of the artificial hip implant slips out of the socket) and a right total hip revision arthroplasty (a procedure to replace previously implanted hip joint with a new one). Patient A had surgery on July 22, 2024. The Physician's order dated July 23, 2024, indicated "...Dressing to be remove at 5 - 7 days post op..." The POC for the certification period from July 24, 2024 to September 21, 2024, indicated "...SN (Skilled Nurse) to instruct Patient/Caregiver not to change the patient's bandage on right hip surgical wound for the first 7-10 days after surgery. After 7-10 day period, wound may be left open to air, or a new dressing can be applied..." The agency's document titled, "Journal Notes," indicated the following: "...On 07/24/2024, 01:41 PM...Received report from RN (Registered Nurse)...Patient was adament (someone who formed an opinion) that RN removed surgical dressing and look at the site. RN advise patient, she does not have the original dressing that was applied and only has basic wound care supplies. RN reported she put on a ABD (a type of dressing) pad...and On 07/24/2024, 02:32 PM...CM (Case Manager - a healthcare professional who helps patients and families receive the care they need) received message from NP (Nurse Practitioner - a Registered Nurse with advanced training who provides patient care) of the physician (name of the doctor)...stated patient was suppose to keep dressing on for a week...Dressing applied to hip surgical site, is only given at surgery center..." During a concurrent interview and record review, on September 10, 2024, at 11:09 a.m., with the CM, the CM stated the physician order for Patient A's dressing was to remove the dressing five to seven days after surgery. The CM acknowledged the dressing was removed on July 24, 2025, two days after surgery. The CM stated the physician order was not followed. During a concurrent interview and record review with the Director Of Nursing (DON) on September 10, 2024, at 11:51 a.m., The DON stated the RN should have followed the physician's order to remove the dressing 5-7 days after surgery. The DON stated the RN should have contacted the physician before she removed the dressing and took the picture of of Patient A's right hip surgery site. The DON stated the RN did not follow the physician's order. She acknowledged the POC for Patient A was not followed. A review of the agency's policy and procedure titled, "Monitoring Patient's Response/Reporting To Physician," dated November 2022, indicated, "...During home visits, the clinician will monitor the patient's response to care against the establish goals. including...care interventions and treatments...The patient's physician...will be contacted on the same day when...there is any problem implementing the plan of care..."