Every finding on record at Bgm Group, LLC

This entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey

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 record review and interviews, the agency failed to ensure each OASIS (Outcome and Assessment Information Set) was successfully transmitted to the CMS system within 30 days of completion. This deficient practice had the potential to affect all 470 patients, according to the agency’s current active census reported on 02/24/2025. Findings: Review of the agency’s undated policy titled, “Reporting of Oasis Information” revealed the following, in part: Procedure: 1. Agency must encode and have capability of transmitting OASIS data for each patient within thirty (30) days of completing any required OASIS data set collection. Agency staff will ensure the accuracy of OASIS data reflects the patient’s status at time of assessment and data collection. Review of the agency’s OASIS Final Validation Report with a submission date of 01/02/2025 revealed 33 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. Review of the agency’s OASIS Final Validation Report with a submission date of 01/03/2025 revealed 8 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. Review of the agency’s OASIS Final Validation Report with a submission date of 01/13/2025 revealed 27 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. Review of the agency’s OASIS Final Validation Report with a submission date of 01/28/2025 revealed 20 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. Review of the agency’s OASIS Final Validation Report with a submission date of 02/04/2025 revealed 20 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. Review of the agency’s OASIS Final Validation Report with a submission date of 02/17/2025 revealed 13 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. Review of the agency’s OASIS Final Validation Report with a submission date of 02/17/2025 revealed 52 records were processed with 1 record receiving a message the record was submitted late due to a submission date of more than 30 days after date on the record. An interview was conducted with S4ADON on 02/26/2025 at 3:30 p.m. S4ADON stated she was responsible for all OASIS submissions. S4ADON confirmed the above records were submitted late. S4ADON stated OASIS Assessments should have been submitted within 30 days of completion and were not. An interview was conducted with S1ADM on 02/26/2025 at 3:35 p.m. S1ADM confirmed the above records were submitted late. S1ADM confirmed OASIS Assessments should be submitted within 30 days of completion and were not.

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 record reviews, observations, and interviews, the agency failed to maintain an accurate medication profile for 1 (#4) of 7 (#1, #2, #3, #4, #5, #6, and #7) sampled patients reviewed who received home visits. This deficient practice had the potential to affect all 470 patients, according to the agency’s current active census reported on 02/24/2025. Findings: Review of the agency’s undated policy titled “Medication Reconciliation” revealed, in part: Procedure: Medications ordered while patient is receiving care will be compared to the medication list/ profile. The medication list/ profile will be updated with each new or changed medication. Clinicians will assess patient’s home medications on an ongoing basis. Review of Patient #4’s clinical record revealed a start of care date of 02/21/2025. The patient's primary diagnosis was Other Generalized Epilepsy, Not Intractable, without Status Epilepticus. A review of the Home Health Certification and Plan of Care/485 for the Certification Period of 02/21/2025 through 04/21/2025 revealed orders which included Skilled Nurse 1w1, 2w1, 1w5, Physical Therapy 1w4, and Occupational Therapy 1w1, 2w2. Review of the agency’s current medication profile for Patient #4 dated 02/24/2025 revealed the following, in part: Plaquenil (Hydroxychloroquine) 200mg 1 tablet twice daily. Oxybutynin Chloride 5mg 1 tablet daily. Pilocarpine HCL 5mg tablet twice daily. Omeprazole 40mg capsule daily. Gabapentin 800mg (0.5 tab) half-tablet three times daily. On 02/25/2025 at 10:00 a.m., a home visit was conducted in the home of Patient #4 with S3OT. Review of the patient's current medication profile list provided by the agency was reviewed with S3OT and Patient #4. Patient #4 stated she managed her own medications and verified she took the following medications: 1. Zolpidem 5 milligrams (mg) 1 tablet at bedtime as needed for insomnia. This medication was not listed on the patient’s current medication profile list provided by the agency. 2. Pravastatin 40mg 1 tablet by mouth daily. This medication was not listed on the patient’s current medication profile list provided by the agency. 3. Gabapentin 800mg 1 tablet by mouth three times daily. A bottle of the medication with a fill date of 09/24/2024 was observed in the home, instructions stated one-half (0.5) tablet by mouth three times daily. 4. Oxybutynin Chloride 5 mg 1 tablet by mouth every morning and evening. A bottle of the medication with a fill date of 01/23/2025 was observed in the home, instruction stated one tablet by mouth daily. An interview was conducted with Patient #4 on 02/25/2025 at 10:45 a.m. Patient #4 reported she no longer took the following medications: Plaquenil (Hydroxychloroquine) 200mg 1 tablet twice daily. Pilocarpine HCL 5mg tablet twice daily. Omeprazole 40mg capsule daily. An interview with S3OT was conducted on 02/25/2025 at 11:00 a.m. S3OT verified Patient #4's agency and home medication profile lists had not been updated to reflect her current medications. An interview was conducted with S2DON on 02/27/2025 at 1:40 p.m. S2DON was made aware of the medication discrepancies found during the home visit with Patient #4. S2DON verified Patient #4’s agency and home medication profile lists were not current and should have been. An interview was conducted with S1ADM on 02/27/2025 at 1:43 p.m. S1ADM confirmed Patient #4’s agency and home medication profile lists should have accurately reflected the medications Patient #4 was currently prescribed and did not.

The entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey Abbreviations: CG- Caregiver DON- Director of Nursing ER- Emergency Room HHA- Home Health Aide IV- Intravenous LPN- Licensed Practical Nurse LLE- Left Lower Extremity MD- Medical Doctor PCP- Primary Care Physician PO- By Mouth PRN- As needed POC- Plan of Care Q- Every RN- Registered Nurse SN- Skilled Nurse UTI- Urinary Tract Infection

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to comply with accepted professional standards and principles by failing to have a Registered Nurse assess a patient's pressure wound, including the size and stage, weekly for 1 (#15) of 5 (#6, #10, #13, #15 and #16) patients reviewed with pressure ulcers out of a total of 17 sampled patients. Findings: Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management adapted 02/1999 revealed the following in part: Registered nurses render care that is directed towards the prevention and treatment of wounds. Wounds are a common health care challenge that often occur with or result from Chronic disorders such as impaired circulation and malnutrition. Nursing care of skin/wound conditions involves the identification, assessment, management, and ongoing evaluation of patients with alterations in skin/tissue integrity that includes but is not limited to draining wounds, pressure ulcers, and vascular ulcers, and conditions resulting from incontinence, surgical procedures, and/or trauma. Scope of Practice - The Louisiana State Board of Nursing recognizes that assessment, planning, intervention, teaching, evaluation, and supervision are the major responsibilities of the registered nurse in the practice setting. The registered nurse is responsible for performing a nursing assessment and physical examination for preventative and restorative nursing and for providing patient/family teaching. Recognizing that the physician must always prescribe wound care, the following roles are defined to delineate the scope of practice for each member of the nursing team members. The registered nurse initiates appropriate wound preventative measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by an authorized prescriber. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following: Pressure Ulcer Assessment 1. Assess the pressure ulcer initially and re-assess it at least weekly. 1.1. Document the results of all wound assessments. Assess and document physical characteristics including: location, Category/Stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Review of the clinical record for Patient #15 revealed a start of care date of 06/06/2020. Review of the plan of care for the current certification period 06/06/2020 to 08/04/2020 revealed diagnoses which included Obstructive and Reflux Uropathy and Right Buttock Pressure Ulcer Stage II. Further review of the plan of care revealed orders for the following Frequency/Duration of Visits: SN effective week of 06/18/2020 1wk1, 2wk3. Review of the Orders of Discipline and Treatment section of the plan of care for Patient #15 included the following: Cleanse with normal saline and pat dry with gauze. Apply thin layer of antibiotic ointment with sterile Q-tip then cover with border foam. Wound care to be performed daily. Review of the skilled nursing notes revealed only an LPN conducted visits for the following weeks: 07/13/2020, 07/20/2020 and 07/27/2020. Further review of the skilled nurse visit documentation revealed there were no weekly pressure wound assessments completed by an RN for Patient #15. An interview was conducted on 04/21/2022 at 10:45 am with S1DON. She reviewed Patient #15's clinical record and confirmed there was no documentation an RN assessed the patient’s pressure wound for the weeks of 07/13/2020, 07/20/2020 and 07/27/2020. She confirmed the expectation was the Registered Nurse should assess and stage pressure wounds once a week.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on interviews and record review, the agency failed to communicate with the physician for 2 (#6, #11) of 17 patients reviewed. The agency failed to ensure: 1.) the nurse contacted the physician when Patient #6’s caregiver reported they were running low on pain medication; and 2.) a follow-up was conducted with the physician when Patient #11’s caregiver reported the patient was having concerns with urinary incontinence. Findings: Patient #6 Review of the clinical record for Patient #6 revealed the patient began receiving services with the agency on 04/09/2022. The patient had diagnoses that included Aphasia following Cerebral infarction, Pressure Ulcer of Left Buttock Stage 2, Pressure Ulcer of the Right Buttock Stage 2, Pressure Ulcer of Sacral Region Stage 2, Chronic Kidney Disease. Review of the current Plan of Care for Patient #6 revealed she was certified to receive services from 04/09/2022-06/07/2022. She received SN services 2wk2, 1wk7 and HHA 2wk2, 1w9. Review of Patient #6’s current medication profile last reviewed by S3RN on 04/19/2022 revealed the patient was ordered to receive Tramadol 50 mg Q 8 hours as needed for pain. Review of the SN visit documentation conducted by S2RN for Patient #6 dated 04/18/2022 revealed the following, in part: The patient complains of LLE pain. Physically there is no obvious reason for the patient to have pain. The patient’s husband also says that she is getting low on her medications. SN instructed him to call the pharmacy and request a refill. SN also instructed the patient’s husband to make an appointment with the PCP. He said that it is hard to get her to the appointments. SN instructed him to go the same route that he went through (ambulance) to get her to the gynecologist office. A home visit was conducted for Patient #6 on 04/20/2022 at 09:10 a.m. Patient #6 was resting quietly and the patient’s husband was available to answer questions. Patient #6’s husband stated she was up all night hollering in pain. He stated the patient took tramadol for pain and only had two pills left. He stated he finally managed to get her to take one a few hours ago. He stated he informed S2RN when she came to visit the patient they were low on Tramadol. He stated she informed him he needed to make an appointment with the patient’s PCP to obtain more pain medication. He stated he was unable to drive Patient #6 to the doctor and she had to go to her appointments via ambulance. He stated the patient would tell him she hurt all over and he would only give her one tramadol a day because he did not have a lot. An observation was made of the patient’s medication bottle for Tramadol at that time. The medication was filled with 15 tablets on 04/09/2022 and there were only two pills left in the bottle. There were no refills ordered on the bottle of Tramadol. Patient #6’s husband verbalized it was very difficult to get in touch with the patient’s PCP. He confirmed this was the only medication the patient was receiving for pain. He stated he needed more pain medication for her. An interview was held with Patient #6 on 04/20/2022 at 9:30 a.m. She confirmed she had pain all over her body and she wanted to receive pain medication more than once a day. An interview was held with S2RN on 04/20/2022 at 10:30 a.m. She confirmed she was the nurse that saw Patient #6 on 04/18/2022. She confirmed the patient’s husband informed her they needed more pain medication. She stated she told him he needed to make an appointment with the patient’s PCP to obtain a new prescription for the Tramadol. She stated the patient required an ambulance for transportation to MD appointments. She stated Patient #6 went to the gynecologist a few weeks ago and could use the ambulance to see the PCP. She confirmed she did not contact Patient #6’s PCP to assist with obtaining more pain medication. Review of a Communication Log for Patient #6 revealed on 04/20/2022, S3RN documented the following, in part: Family also reported need for more pain medication, Patient needs prescription for Tramadol 50 mg 1 PO Q8H PRN pain. Please advise. Further review of the communication log for Patient #6 revealed there was no communication documentation with the MD prior to 04/20/2022 regarding obtaining more Tramadol for Patient #6. An interview was held with S1DON on 04/21/2022 at 10:45 a.m. She reviewed the communication log for Patient #6 and verified there was no communication prior to 04/20/2022 to assist the patient with obtaining more Tramadol for pain. She confirmed when the nurse was made aware of the husbands concerns with the medication; she should have communicated this on 04/18/2022. Patient #11 Review of the clinical record for Patient #11 revealed the patient began receiving services with the agency on 03/18/2022. The patient had diagnoses that included Unspecified Dementia with Behavioral Disturbance, Major Depressive Disorder, Diabetes Mellitus with Hyperglycemia and Presence of Cardiac Pacemaker. Review of the current Plan of Care for Patient #11 revealed she was certified to receive services from 03/18/2022-05/16/2022. She received SN services 1wk1, 2wk1, 1w7 and HHA 2wk8. Review of Communication Log for Patient #11 revealed on 04/11/2022, S4RN documented the following, in part: CG reports concern over patient with increased urinary incontinent episodes; states that patient changed pants 5 times in 1 day due to “accidents.” Patient’s urine does have a strong ammonia odor to it; Patient denies any burning, stinging, or painful urination/voiding. This communication was faxed to the MD on 04/12/2022. Further review of the communication documentation for Patient #11 revealed no follow-up with the MD regarding the patient’s urinary status after 04/12/2022. Review of the ER record for Patient #11 on 04/18/2022 at 1:42 p.m. revealed the following, in part: Chief Complaint: Altered Mental Status. Patient’s children reports that he was having trouble dressing himself. The patient presents with, he had a history of progressive dementia with intermittent worsening days of confusion. Today the episode of confusion this morning was worse than usual. Patient’s confusion has improved since this morning. Completed: Rocephin IV piggyback 2 grams 100 ml/hour once Reevaluation: We will transfer to local hospital for UTI, Altered Mental Status. Diagnosis: Altered Mental Status, Acute UTI. An interview was conducted on 04/21/2022 with S1DON. She confirmed a fax was sent on 04/12/2022 to the MD regarding urinary incontinence for Patient #11. She stated if they did not get a response from the MD that day, she would expect a follow-up the next day. She said on 04/18/2022, the doctor was notified because Patient #6 was showing facial drooping and confusion. She verified the patient was sent to the hospital with diagnosis of UTI. She confirmed there was no follow-up with the MD regarding urinary incontinence after 04/12/2022 but there should have been.