Every finding on record at Carter Healthcare of Oklahoma, LLC

The Oklahoma State Department of Health conducted an unannounced Emergency Preparedness Program survey at the agency on 12/09/25 to 12/10/25. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 12/09/25 to 12/10/25. An entrance conference was conducted with RN1. The survey process was explained. Questions were answered. RN1 was identified as the contact person for administrative issues and the contact person for clinical issues. Findings were discussed during an informal exit conference with RN1. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: RN Registered Nurse SN Skilled Nurse POC Plan of Care SOC Start of Care PT Physical Therapist

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on record review and interview, PT staff failed to conduct initial evaluations timely as part of the comprehensive assessment for four (#2, #3, #4 and #7) of seven (#1-#7) records reviewed. Patient #2 Review of Patient #2 record for SOC certification period 10/30/25 to 12/283/25 revealed a primary diagnosis of Pneumonia and referral for SN and PT services. Further review revealed a SOC OASIS was completed by the SN on 10/30/25 and a PT initial evaluation was completed on 11/8/25 (9 days later). A communication note titled "Provider Notification" dated 10/31/25 documented, "PT eval will not be performed within 48 hrs. of referral. PT eval has been scheduled for the week of 11/03/25". The record failed to provide the reason the initial PT evaluation was not completed within 5 days of the SOC as part of the comprehensive assessment. Patient #3 Review of Patient #3 record for SOC certification period 10/08/25 to 12/06/25 revealed a primary diagnosis of Type II Diabetes Mellitus with Foot Ulcer and referral for SN and PT services. Further review revealed a SOC OASIS was completed by the SN on 10/08/25 and a PT initial evaluation was completed on 10/20/25 (12 days later). A Provider Notification dated 10/14/25 documented, "PT eval will not be performed within 48 hrs. of referral. PT eval has been scheduled for the week of 10/20/25". The record failed to provide the reason the initial PT evaluation was not completed within 5 days of the SOC as part of the comprehensive assessment. Patient #4 Review of Patient #4 record for SOC certification period 11/14/25 to 01/12/26 revealed a primary diagnosis of Malignant Neoplasm of Rectum and referral for SN and PT services. Further review revealed a SOC OASIS was completed by the SN on 11/14/25 and a PT initial evaluation was completed on 11/20/25 (6 days later). A Provider Notification dated 11/17/25 documented, "PT eval will not be performed within 48 hrs. of referral. PT eval has been scheduled for the week of 11/17/25". The record failed to provide the reason the initial PT evaluation was not completed within 5 days of the SOC as part of the comprehensive assessment. Patient #7 Review of Patient #7 record for SOC certification period 09/30/25 to 11/28/25 revealed a primary diagnosis of Acute Respiratory Failure and referral for SN and PT services. Further review revealed a SOC OASIS was completed by the SN on 09/30/25 and a PT initial evaluation was completed on 10/17/25 (17 days later). The SOC assessment indicated multiple falls and that Pt #7 would benefit from PT. The record failed to provide the reason the initial PT evaluation was not completed within 5 days of the SOC as part of the comprehensive assessment. During an interview on 12/10/25 at 2:15 PM, RN1 stated the PT initial evaluations were not completed timely as part of the comprehensive assessment for Patient #2, #3, #4 and #7.

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 record review and interview, SN staff failed to promptly notify the physician of a patient fall with injuries and increased pain for one (#5) of seven (#1-#7) records reviewed. Patient #5 Review of Patient #5 record for certification period 10/18/25 to 12/16/252 revealed a primary diagnosis of Type II Diabetes Mellitus with Chronic Kidney Disease with orders for SN visits 1 time a week for 9 weeks. Further review revealed a SN Visit Note on 12/02/25 documented Patient #5 had a fall and skin tear on right forearm, bruising on ribs and complained of shoulder, hip and back pain of "10". A picture of the right forearm skin tear was identified but no documentation provided evidence the physician was notified of the fall with injuries or the pain level of "10". During an interview on 12/10/25 at 2:15 PM, RN1 stated there was no evidence the SN notified the physician of the patients fall, injuries or reported pain level of "10" as required.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review, observations and interview, SN staff failed to provide services and interventions as ordered in the POC for three (#2, #3 and #6) of seven (#1-#7) records reviewed. Patient #2 Review of Patient #2 record for SOC certification period 10/30/25 to 12/28/25 revealed a primary diagnosis of Pneumonia, Chronic Obstructive Pulmonary Disease and Dependance on Supplemental Oxygen. The POC contained orders for SN visits 1 time a week for 7 weeks and for the "SN to educate on use of oxygen sign to help first responders and provide sign and secure to exterior door as needed". During a home visit conducted on 12/10/25 at 10:00 AM, a portable oxygen tank and concentrator were visible in the living room but no "Oxygen Sign" was observed on the exterior or interior of the home. When this Surveyor asked the CG if an Oxygen Sign was posted in the home, the CG stated, "No". The SN retrieved an Oxygen Sign from the patient's Admission packet and provided to the CG to post in the home. Patient #3 Review of Patient #3 record for SOC certification period 10/08/25 to 12/06/25 revealed a primary diagnosis of Type II Diabetes Mellitus with Foot Ulcer. The POC contained orders for SN visits 2 times a week for 9 weeks and PT visits 2 times a week for 4 weeks and 1 time a week for 3 weeks. Further record review failed to provide evidence a SN visit or PT visit was conducted the week of 10/12/25. There was no documentation the physician was notified of a Missed Visit, or the reason visits were not conducted as ordered. Patient #6 Review of Patient #6 record for SOC certification period 08/13/25 to 10/11/25 revealed a primary diagnosis of Hypertensive Heart Failure and Type II Diabetes Mellitus. The POC contained orders for SN visits 1 time a week for 9 weeks, orders for the "SN to assess patient's weight log every visit" and parameters to notify the physician for "Fasting Blood Sugar >300 or 350 or <60". Further record review failed to provide evidence the SN assessed weights for visits conducted from 09/09/25,09/19/25 or 10/06/25 and no blood sugar results were documented for SN visits 08/13/25 or 10/06/25. During an interview on 12/10/25 at 2:15 PM, RN1 stated the SN failed to provide interventions as ordered on the POC for Patient #2, #3 and #6.

The Oklahoma State Department of Health conducted an unannounced Emergency Preparedness Program survey at the agency on 10/17/22 to 10/18/22. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 10/17/22 to 10/18/22. An entrance conference was conducted with RN1. The survey process was explained. Questions were answered. RN1 was identified as the contact person for administrative issues and the contact person for clinical issues. Findings were discussed during an informal exit conference with RN1. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: RN Registered Nurse SN Skilled Nurse POC Plan of Care SOC Start of Care PT Physical Therapist

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on record review and interview, the PT failed to conduct the initial assessment within 48 hours of the referral as required for one (#7) of seven (#1-#7) records reviewed. Patient #7 A review of the record for Patient #7 for certification period 07/06/22 to 09/03/22 revealed a primary diagnosis of Aftercare for Laminectomy surgery and a referral on 06/29/22 for Physical Therapy services. Further review revealed a SOC OASIS completed by the PT on 07/06/22 (7 days later) but failed to provide documentation as to the reason the initial SOC assessment was not completed within 48 hours of the referral as required. During an interview on 10/18/22 at 12:30 PM, RN1 stated the PT failed to conduct the initial assessment as required and there was no evidence or documentation as to the reason for the delayed initial SOC assessment.

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 review and interview, SN staff failed to review all medications the patient was currently using as part of the comprehensive assessment in order to identify possible side effects and drug interactions for one (#7) of seven (#1-#7) records reviewed. Patient #7 A review of the record for Patient #7 for certification period 07/06/22 to 09/03/22 revealed a primary diagnosis of Aftercare for Laminectomy surgery and a referral for Physical Therapy services. A SOC OASIS note completed by the PT on 07/06/22 provided a list of current medications for Patient #7. Further review of the agency form titled, "Medication Profile" revealed a list of medications provided by the PT but failed to provide evidence a SN conducted a review of all the medications to identify possible side effects or drug interactions. During an interview on 10/18/22 at 12:30 PM, RN1 stated the SN failed to conduct a drug regimen review as required for Patient #7.

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 record review and interview, SN staff failed to provide service as ordered in the POC for one (#2) of seven (#1-#7) records reviewed. Patient #2 A review of the POC for Patient #2 for certification period 08/15/22 to 10/13/22 revealed a primary diagnosis of Chronic Obstructive Pulmonary Disease. The POC contained orders for SN visits 1 time every other week for 8 weeks and for the "SN to assess patient's weight log every visit" and "notify physician of weight greater than 280 lbs. or less than 250 lbs". Further record review failed to provide evidence the SN assessed weights for visits conducted from 08/18/22 to 10/03/22 and a weight of "292 lbs" documented by the SN on 10/13/22 failed to provide evidence the physician was notified as ordered. During an interview on 10/18/22 at 12:30 PM, RN1 stated the SN failed to assess weights as ordered and failed to notify the physician of a weight outside the parameters as ordered.