Every finding on record at Cmb Home Care, Inc

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 encode and electronically transmit each completed OASIS (Outcome and Assessment Information Set) within 30 days of completion date of the assessment. This deficient practice had the potential to affect all 165 total patients according to the agency’s current active census. Findings: Review of the agency’s revised policy dated 11/18/2024 and titled “Comprehensive Assessment” revealed, in part: Policy: [Provider] electronically reports all OASIS data collected in accordance with federal regulations 484.45(a) (b) (c) (1) (2) (3) (d) related to encoding and transmitting of OASIS data. Review of the Center for Medicare and Medicaid Services (CMS) update to the 2023 Home Health Prospective Payment System (PPS) Final Rule revealed a home health agency (HHA) must submit all payer OASIS data beginning 07/01/2025, with the following action items, in part: January 1, 2025-June 30, 2025: Maintain OASIS data collection and submission for all skilled Medicare and/or Medicaid patients. OASIS data collection and submission for Non-Medicare/Non-Medicaid patients is voluntary. Review of the agency’s OASIS Agency Final Validation Report revealed 1 out of 1 record, with a completion date of 06/22/2025. Further review revealed a submission date of 07/31/2025, which was more than 30 days after the date of completion. Further review revealed this beneficiary’s pay source, per the agency’s demographic record, was Veteran’s Administration (VA) Community Care primary and a Medicare-Advantage plan secondary. Review of the above beneficiary’s Recertification OASIS completed on 06/22/2025 revealed the following, in part: Section M0150: Current Payment Sources for Home Care: 2- Medicare (HMO/Managed Care/ Advantage Plan), and 7- Other Government- (VA). On 08/06/2025 at 3:45 p.m., an interview was conducted with S2DON. S2DON stated she was responsible for transmitting all OASIS data for the agency. S2DON stated OASIS should be transmitted within 30 days of the completion date. S2DON confirmed the CMS OASIS submission guidelines above and agreed only Non-Medicare and Non-Medicaid beneficiary OASIS submissions were voluntary and exempt from the OASIS data submission rule applied through 06/30/2025. S2DON confirmed the above OASIS submission date of 07/31/2025 and the beneficiary’s payer source was Medicare-Advantage secondary. S2DON confirmed the beneficiary's OASIS completed on 06/22/2025 should have been submitted within 30 days of the completion date and was not. On 08/06/2025 at 4:00 p.m., an interview was conducted with S1ADM. S1ADM stated OASIS should be transmitted within 30 days of the completion date. S1ADM confirmed the CMS OASIS submission guidelines above and agreed only Non-Medicare and Non-Medicaid beneficiary OASIS submissions were voluntary and exempt from the OASIS data submission rule applied through 06/30/2025. S1ADM confirmed the above OASIS submission date of 07/31/2025 and the beneficiary’s payer source was Medicare-Advantage secondary. S1ADM confirmed the beneficiary's OASIS completed on 06/22/2025 should have been submitted within 30 days of the completion date and was not.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on record reviews and interviews, the agency failed to have the Plan of Care (PoC) reviewed and revised by the physician no less frequently than every 60 days, beginning with the Start of Care (SOC) date for 1 (#4) of 10 (#1, #2, #3, #4, #5, #6, #7, #8, #9 and #10) sampled patients reviewed. This deficient practice had the potential to affect all 165 patients according to the agency’s current active census. Findings: Review of the agency’s revised policy, dated 11/18/2024, and titled, “Comprehensive Assessment” revealed, in part: Policy: The Comprehensive Assessment shall be updated and revised by the appropriate skilled professional to ensure the Plan of Care is individualized to meet the patient’s needs and to address changes in the patient’s clinical status in conformance with home health agency (HHA) policy, applicable state and federal laws and regulations and accrediting organization standards as often as the patient’s needs require, but no less often than every 60 days from start of care. Review of Patient #4's clinical record revealed Patient #4's SOC date was 02/22/2025. Review of Patient #4’s certification period of 04/23/2025 through 06/21/2025 revealed the patient’s physician electronically signed the PoC on 06/27/2025. Further review revealed the physician did not review the PoC within 60 days of the beginning of the certification period. On 08/05/2025 at 2:12 p.m., an interview was conducted with S2DON, and Patient #4’s PoC for certification period of 04/23/2025 through 06/21/2025 was reviewed. S2DON confirmed Patient #4’s physician did not review or sign the PoC within the required 60 day period. On 08/06/2025 at 4:00 p.m., an interview was conducted with S1ADM. Patient #4’s PoC for certification period dated 04/23/2025 through 06/21/2025 was reviewed. S1ADM confirmed Patient #4’s physician did not review or sign the PoC within the required 60 day period.

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

Recertification Survey. Abbreviations: DON- Director of Nursing LPN- Licensed Practical Nurse RN- Registered Nurse SN- Skilled Nurse

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 interview and record reviews, the home health agency failed to ensure the RN provided home health agency services in accordance with current clinical practice guidelines and accepted professional standards for 2 of 2 (#8, #10) patients reviewed for pressure ulcers. The agency failed to ensure: 1. A Registered Nurse assessed and staged Patient #8 and Patient #10’s pressure wounds on a weekly basis; 2. A Registered Nurse assessed three new pressure wounds identified by the LPN for Patient #10. Findings: Review of the Louisiana State Board of Nursing, Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management revealed, in part, the following: Registered nurses render care that is directed towards the prevention and the treatment of wounds. 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 initiates appropriate wound prevention measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by the authorized prescriber. Wound care management requires the registered nurse to collaborate with other members of the interdisciplinary team to ensure that the individual's nutritional and psychosocial needs are being met and to provide for preventive and therapeutic measures. The Registered Nurse should consult with the physician and/or CWCN (certified wound care nurse) to assure safe, quality nursing measures that facilitate appropriate skin and wound management. 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. Patient #8 Review of the Clinical Record for Patient #8 revealed the patient began receiving services with the agency on 05/03/2021 and certification period of 08/31/2021- 10/29/2021. Patient #8 had diagnoses, which included, Stage 2 Pressure Ulcer to Right Upper Buttock and Stage 2 Pressure Ulcer to Lumbar Spine, The patient was ordered to receive SN services 1 time a week for 9 weeks. Review of the current Physician’s Orders for Patient #8 revealed the following, in part: 10/06/2021 Spinal and Buttock Decubiti: Clean wounds with Normal Saline and pat dry and Apply Duoderm to wound each visit. Review of the nursing visits conducted for Patient #8 for the certification period of 08/31/2021- 10/29/2021 revealed she was seen by an LPN on the following weeks: 09/05/2022 and 09/19/2022. Patient #8’s Sacral Pressure Ulcer was not assessed by a RN on the weeks of 09/05/2022 and 09/19/2022. An interview was conducted on 10/11/2022 at 1:30 p.m. with S1DON. She confirmed there were no weekly RN pressure ulcer assessments for Patient #8 on the weeks of 09/05/2022 and 09/19/2022. She said a RN should assess pressure ulcers weekly. Patient #10 Review of the clinical record for Patient #10 revealed the patient began receiving services with the agency on 08/25/2021 with the most recent certification period of 06/21/2022-08/19/2022. Diagnoses included Pressure Ulcer of the Sacral Region, Left Lower Back Stage 2 and Sacral Region, Stage 2. The patient was ordered to receive SN services 2 times a week for 9 weeks. Review of the current Physician’s Orders for Patient #10 revealed the SN was to perform wound care to pressure ulcers to the Left Lower Extremity, Left Heel, Right Lower Extremity, Right Heel, Lower Back and Sacral Area 2 times a week and as needed. The patient’s caregiver was to perform wound care when skilled nurse not present in the home. Review of the LPN Skilled nursing visit documentation for Patient #10 on 06/28/2022 revealed the following documentation for wounds addressed during this visit: Onset Date- 06/24/2022- Left Heel, Open wound, Pressure Injury, Stage 2 Onset Date- 06/24/2022- Right Heel, Open Wound, Pressure Injury, Stage 1 Onset Date- 06/24/2022- Right Lower Leg, Open Wound, Pressure Injury, Stage 2 Review of the nursing visits conducted for Patient #10 revealed the LPN assessed the patient on the following dates: 06/21/2022, 06/24/2022, 06/28/2022, 07/01/2022, 07/05/2022, 07/08/2022, 07/12/2022, 07/15/2022, 07/19/2022, 07/22/2022 and 07/26/2022. Further review of the nursing visit notes revealed a Registered Nurse did not assess Patient #10’s pressure wounds until 07/28/2022. An interview was conducted with S1DON on 10/12/2022 at 12:00 p.m. She verified a Registered Nurse should have assessed Patient #10’s pressure wounds at least weekly. She also confirmed when the LPN identified three new pressure wounds on 06/24/2022 the RN should have gone out to assess the wounds on the next visit.