Every finding on record at Continental Home Care, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the hospice on 01/24/24 to 01/26/24. No deficiencies were cited as a result of the Medicare Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 01/24/24 to 01/26/24. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff B and C were identified as the contact persons for administrative issues and clinical issues. Findings were discussed during an informal exit conference with Staff B and C and by Zoom conference Staff E, F, G, H, I and J. A deficiency was cited as a result of the State re-licensure survey.

Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to document resolutions for three (Complaint #1, 2 and 3) of 15 agency complaints reviewed. A review of agency records showed the following: Complaint #1 A complaint dated 09/19/23 documented a complaint regarding a fall during physical therapy in which the therapist failed to use a gait belt. No resolution was made regarding the lack of use of the gait belt and only changed clinicians. Complaint #2 A complaint dated 12/05/23 which documented a complaint related to how the clinician spoke to the patient in an unprofessional manner and use of the word "cripple". No resolution was documented on the behalf of the patient other than the change of clinician as an intervention. Complaint #3 A complaint dated 12/06/23 which documented a complaint related to an inappropriate statement made by a clinician. No resolution was documented. On 01/26/24 at 1:45 pm, Staff B stated Complaints #1, 2 and 3 documented no resolutions.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the hospice failed to ensure the plan of care was fully developed to include individualized interventions in relation to the primary diagnosis for seven (Patients #1, 2, 3, 4, 5, 7 and 8) of 17 patients reviewed. Patient #1 A review of the plan of care dated 01/08/24 to 03/07/24 showed a primary diagnosis of dementia and showed interventions for the education and training of gait and balance. Patient #2 A review of the plan of care dated 12/21/23 to 02/18/24 showed a primary diagnosis of dementia and showed interventions for the education and training of gait and balance. Patient #3 A review of the plan of care dated 11/15/23 to 01/13/24 showed a primary diagnosis of diabetes type II with hyperglycemia and showed no patient specific interventions for the management of the hyperglycemia. Patient #4 A review of the plan of care dated 12/01/23 to 01/29/24 showed a primary diagnosis of chronic obstructive pulmonary disease and showed no patient specific interventions for the management of the primary diagnosis. Patient #5 A review of the plan of care dated 11/09/23 to 01/07/24 showed a primary diagnosis of diabetes type II with hyperglycemia and showed no patient specific interventions for the management of the hyperglycemia. Patient #7 A review of the plan of care dated 11/29/23 to 01/27/24 showed a primary diagnosis of hypertensive heart disease with heart failure and showed no patient specific interventions for the management of the primary diagnosis. Patient #8 A review of the plan of care dated 11/07/23 to 01/05/24 showed a primary diagnosis of hypertensive heart disease with heart failure and showed no patient specific interventions for the management of the primary diagnosis. On 01/26/24 at 1:30 pm, Staff C stated there were no patient specific interventions for the primary diagnosis for Patients #1, 2, 3, 4, 5, 7 and 8.

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 the agency failed to ensure the physician was notified of fasting blood sugar levels outside of ordered parameters for two (Patient #3 and 5) of 17 patients. Patient #3 A review of the plan of care dated11/15/23 to 01/13/24 showed a primary diagnosis of type II diabetes mellitus with hyperglycemia and documented the physician be notified of fasting and random blood glucose levels greater than 180. A review of the clinical record showed the following: A skilled nurse assessment dated 12/06/23 showed a fasting blood glucose level of 217 and documented the physician was not notified. A skilled nurse assessment dated 12/11/23 showed a fasting blood glucose level of 250 and documented the physician was not notified. A skilled nurse assessment dated 12/21/23 showed a fasting blood glucose level of 211 and documented the physician was not notified. A skilled nurse assessment dated 12/28/23 showed a fasting blood glucose level of 274 and documented the physician was not notified. A skilled nurse assessment dated 01/04/24 showed a fasting blood glucose level of 274 and documented the physician was not notified. Patient #5 A review of the plan of care dated11/09/23 to 01/07/24 showed a primary diagnosis of type II diabetes mellitus with hyperglycemia and documented the physician be notified of fasting and random blood glucose levels greater than 180. A review of the clinical record showed the following: A skilled nurse assessment dated 11/28/23 showed a fasting blood glucose level of 188 and documented the physician was not notified. A skilled nurse assessment dated 12/07/23 showed a fasting blood glucose level of 272 and documented the physician was not notified. On 01/26/24 at 2:30 pm, Staff C stated the skilled nurse assessments for Patients #3 and 5 documented the physician was not notified of fasting blood sugar reading outside of the ordered parameters.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure home health aide supervisory visits were completed every 14 days for three (Patients #7, 8 and 12) of 17 patients. Patient #7 A plan of care dated 11/06/23 to 01/04/24 ordered home health aide visits twice per week for four weeks and a physician order dated 12/03/23 ordered home health aide visits twice per week for five weeks. A review of the clinical record showed the following: A home health aide visit was performed on 11/27/23 and 11/30/23 for the week of 11/26/23 to 12/02/23. A home health aide visit was performed on 12/04/23 and 12/07/23 for the week of 12/03/23 to 12/09/23. A home health aide visit was performed on 12/11/23 and 12/14/23 for the week of 12/10/23 to 12/16/23. A skilled nurse assessment dated 11/29/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 12/15/23 documented a supervisory aide visit was conducted (16 days after the last supervisory visit). Patient #8 A plan of care dated 11/07/23 to 01/05/24 ordered home health aide visits twice per week for nine weeks.. A review of the clinical record showed the following: A home health aide visit was performed on 11/08/23 and 11/10/23 for the week of 11/07/23 to 11/11/23. A home health aide visit was performed on 11/15/23 and 11/18/23 for the week of 11/12/23 to 11/18/23. A home health aide visit was performed on 11/22/23 and 11/24/23 for the week of 11/19/23 to 11/25/23. A home health aide visit was performed on 11/29/23 and 12/02/23 for the week of 11/26/23 to 12/02/23. A home health aide visit was performed on 12/05/23 and 12/08/23 for the week of 12/03/23 to 12/09/23. A skilled nurse assessment dated 11/14/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 12/12/23 documented a supervisory aide visit was conducted (27 days after the last supervisory visit). Patient #12 A plan of care dated 11/15/23 to 01/13/24 ordered home health aide visits once per week for one week and twice per week for eight weeks. A review of the clinical record showed the following: A home health aide visit was performed on 11/28/23 and 12/01/23 for the week of 11/26/23 to 12/02/23. A home health aide visit was performed on 12/05/23 and 12/08/23 for the week of 12/03/23 to 12/09/23. A skilled nurse assessment dated 11/29/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 12/14/23 documented a supervisory aide visit was conducted (15 days after the last supervisory visit). A home health aide visit was performed on 12/12/23 and 12/15/23 for the week of 12/10/23 to 12/16/23. A home health aide visit was performed on 12/19/23 and 12/21/23 for the week of 12/17/23 to 12/23/23. A home health aide visit was performed on 12/29/23 for the week of 12/24/23 to 12/30/23. A home health aide visit was performed on 01/02/24 and 01/06/24 for the week of 12/31/23 to 01/06/24. A home health aide visit was performed on 01/09/24 and 01/12/24 for the week of 01/07/24 to 01/13/24. A skilled nurse assessment dated 12/14/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 01/11/24 documented a supervisory aide visit was conducted (28 days after the last supervisory visit). On 01/26/24 at 2:45 pm, Staff C stated supervisory aide visits exceeded 14 days for Patient #7, 8 and 12.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 03/09/21 through 03/11/21. A standard deficiency was cited as a result of the Emergency Preparedness Program survey.

Plan Based on All Hazards Risk Assessment CFR(s): 484.102(a)(1)-(2) §403.748(a)(1)-(2), §416.54(a)(1)-(2), §418.113(a)(1)-(2), §441.184(a)(1)-(2), §460.84(a)(1)-(2), §482.15(a)(1)-(2), §483.73(a)(1)-(2), §483.475(a)(1)-(2), §484.102(a)(1)-(2), §485.68(a)(1)-(2), §485.625(a)(1)-(2), §485.727(a)(1)-(2), §485.920(a)(1)-(2), §486.360(a)(1)-(2), §491.12(a)(1)-(2), §494.62(a)(1)-(2) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following:] (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.* (2) Include strategies for addressing emergency events identified by the risk assessment. * [For Hospices at §418.113(a):] Emergency Plan. The Hospice must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach. (2) Include strategies for addressing emergency events identified by the risk assessment, including the management of the consequences of power failures, natural disasters, and other emergencies that would affect the hospice's ability to provide care. *[For LTC facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents. (2) Include strategies for addressing emergency events identified by the risk assessment. *[For ICF/IIDs at §483.475(a):] Emergency Plan. The ICF/IID must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following: (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing clients. (2) Include strategies for addressing emergency events identified by the risk assessment. This STANDARD is not met as evidenced by: Based on record review, and interview the agency failed to ensure an all hazard risk assessment identified the agency and was dated when completed effecting 607 patients and all staff members. Finding: A review of administrative records related to emergency preparedness showed an undated risk analysis with no agency identification. On 03/11/21 at 1:25 p.m., Staff B stated the risk assessment did not identify the agency and was undated.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 03/09/21 through 03/11/21. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff B was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff B, C, D, E and F. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: ABN advance beneficiary notice OT Occupational Therapy PT Physical Therapy POC Plan of Care SN Skilled Nurse

Patient/payer will no longer pay for services CFR(s): 484.50(d)(2) The patient or payer will no longer pay for the services provided by the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure advance beneficiary notices were provided to one (Patient #14) of 17 patients. Findings: Patient #14 A review of the clinical record showed no advance notice of discharge prior to discharge from the agency on 12/30/20. On 03/11/21 at 12:20 p.m., Staff B stated there was no ABN notice in the clinical record for Patient #14.

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, the agency failed to ensure medications were included in the review of medications for potential/adverse effects, drug reactions, side effects, interactions and duplicate drug therapy for one (Patient #1) of 17 patients. Findings: Patient #1 A review of a clinical coordination note dated 02/11/21 documented clotrimazole and Lisinopril medications were ordered by the physician. A review of the medication profile showed no documentation the clotrimazole and Lisinopril medications were added to the medication profile or reviewed for potential/adverse effects, drug reactions, side effects, interactions and duplicate drug therapy. On 03/11/21 at 11:23 a.m., Staff B stated the medications ordered by the physician were not documented on the patient medication profiles or reviewed for potential/adverse effects, drug reactions, side effects, interactions and duplicate drug therapy.

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 record review and interview the agency failed to ensure: 1. SN visits were conducted as ordered by the physician for 11 (Pt's #2, 3, 6, 7, 8, 9, 10, 11, 12, 13 and #14) of 17 patients and; 2. PT visits were conducted as ordered by the physician for three (Pt's #3, 12 and #17) of 17 patients and; 3. OT visits were conducted as ordered by the physician for one (Patient #13) of 17 patients. Findings: Patient #2 A review of the POC dated 01/10/21 to 03/16/21 showed a SN frequency of one time a week for nine weeks. Documentation showed no SN visit conducted during the week 02/07/21 through 02/13/21 (one missing SN visit.) Documentation showed late physician notification of the missed visit on 02/22/21 and no change in orders, and no patient or caregiver refusal of the SN visit. Patient #3 A review of the POC dated 01/29/21 to 03/29/21 showed a SN frequency of one time a week for nine weeks and a PT frequency of two times a week for eight weeks. Clinical documentation showed during the week of 02/14/21 through 02/20/21 no SN visit was conducted (one missing SN visit) and no PT visits were conducted (two missing PT visits; and during the week of 02/28/21 through 03/06/21 a PT visit was conducted on 03/01/21 (one missing PT visit). Documentation showed late physician notification of the missed visits on 03/02/21 and no change in orders, and no patient or caregiver refusal of the SN or PT visits. Patient #6 A review of the POC dated 02/13/21 to 04/13/21 showed a SN frequency of one time a week for eight weeks. Clinical documentation showed during the week of 02/17/21 through 02/20/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visits on 03/02/21, no change in orders, and no patient or caregiver refusal of the SN visits. Patient #7 A review of the POC dated 01/27/21 to 03/27/21 showed a SN frequency of one time a week for one week, one time every two weeks times two weeks, one time a week for one week, one time every two weeks times two weeks and then one time a week for two weeks. Clinical documentation showed during the week of 02/07/21 through 02/13/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visits on 03/01/21 and no change in orders, and no patient or caregiver refusal of the SN visits. Patient #8 A review of the POC dated 01/13/21 to 03/13/21 showed a SN frequency of one time a week for nine weeks. Clinical documentation showed during the week of 01/31/21 through 02/06/21 no SN visit was conducted (one missing SN visit.) Documentation showed late physician notification of the missed visit on 02/17/21 and no change in orders, and no patient or caregiver refusal of the SN visit. During the week of 02/14/21 through 02/20/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visit on 03/09/21, no change in orders, and no patient or caregiver refusal of the SN visit. Patient #9 A review of the POC dated 02/07/21 to 04/07/21 showed a SN frequency of one time a week for three weeks and then one time every two weeks for six weeks. Clinical documentation showed during the week of 02/14/21 through 02/20/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visits on 03/02/21 and no change in orders, and no patient or caregiver refusal of the SN visits. Patient #10 A review of the POC dated 02/03/21 to 04/03/21 showed a SN frequency of two times a week for two weeks, then one time a week for seven weeks and a PT frequency of two times a week for three weeks, then one time a week for three weeks. Clinical documentation showed during the week of 02/07/21 through 02/13/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visit on 02/23/21 and no change in orders, and no patient or caregiver refusal of the SN visit. During the week of 02/14/21 through 02/20/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visit on 03/09/21 and no change in orders, and no patient or caregiver refusal of the SN visit. During the week of 02/21/21 through 02/27/21 one PT visit was conducted (one missing PT visit). Documentation showed late physician notification of the missed visit on 03/10/21 and no change in orders, and no patient or caregiver refusal of the PT visit. Patient #11 A review of the POC dated 02/01/21 to 04/01/21 showed a SN frequency of two times a week for eight weeks, then one time a week for one week. Clinical documentation showed no SN visits were conducted during the week 02/14/21 through 02/20/21 (two missing SN visits.) Documentation showed late physician notification of the missed visits on 03/03/21 and no change in orders, and no patient or caregiver refusal of the SN visits. Patient #12 A review of the POC dated 01/25/21 to 03/25/21 showed a SN frequency of two times a week for two weeks, one time a week for five weeks, then one time every two weeks for two weeks and a PT frequency of one time a week for one week and two times a week for six weeks. A review of clinical documentation showed: 1. during the week of 01/25/21 through 01/30/21 one SN visit was conducted (one missing SN visit.) During the week of 01/31/21 through 02/06/21 no SN visits were conducted (two missing SN visits) and one PT visit was conducted (one missing PT visit); 2. during the week of 02/07/21 through 02/13/21 one PT visit was conducted (one missing PT visit); 3. during the week of 02/14/21 through 02/20/21 no SN visit was conducted (one missing SN visit). Documentation showed late physician notification of the missed visits on 03/02/21 and no change in orders and no patient or caregiver refusal of the SN or PT visits; and 4. during the week of 02/21/21 through 02/27/21 one PT visit was conducted (one missing PT visit.) Documentation showed no physician notification of the missed visit and no change in orders and no patient or caregiver refusal of the PT visit. Patient #13 A review of the POC dated 10/31/20 to 12/29/20 showed a PT frequency of two times a week for eight weeks and a OT frequency of two times a week for eight weeks and then one time a week for one week. A review of clinical documentation showed: 1. during the week of 11/01/20 through 11/07/20 no OT visits were conducted (two missing OT visits). Documentation showed late physician notification of the missed visits on 12/03/21 and no change in orders, and no patient or caregiver refusal of the OT visits; 2. during the week of 11/29/20 through 12/05/20 one PT visit was conducted (one missing PT visit) and one OT visit was conducted (one missing OT visit.); 3. during the week of 12/06/20 through 12/12/20 no PT (two missing PT visits) or OT visits (two missing OT visits) were conducted. Documentation showed no physician notification of the missed PT and OT visits, no change in orders, and no patient or caregiver refusal of the PT or OT visits. Patient #14 A review of the POC dated 11/15/20 to 12/30/20 showed a SN frequency of one time a week for one week, one time every two weeks for two weeks, one time a week for one week, one time every two weeks for two weeks, one time a week for one week and then one time every two weeks for two weeks. A review of clinical documentation showed during the week of 12/20/20 through 12/26/20 no SN visit was conducted (one missing SN visit). Documentation showed no physician notification of the missed visit, no change in orders, and no patient or caregiver refusal of the SN visits. On 03/11/21 at 11:30 a.m., Staff B stated: 1. Visits were not completed as ordered; 2. SN visits should have been conducted as ordered by the physician for Pt's #2, 3, 6, 7, 8, 9, 10, 11, 12, 13 and #14 and; 3. PT visits should have been conducted as ordered by the physician for Pt's #3, 12 and #17 and; 4. OT visits should have been conducted as ordered by the physician for Patient #13 and the physicians should have been notified by Friday of the next week after the visits were missed.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record reviews and interview, the agency failed to ensure a completed discharge summary was provided for three (Pt's #15, 16 and#17) of five patients. Findings: Patient #15 A review of the clinical record showed the patient was discharged from the agency on 01/18/21 to hospice care services. Documentation showed no discharge summary was provided to the hospice care service provider. Patient #16 A review of the clinical record showed the patient was discharged from the agency on 09/24/20 to hospice care services. Documentation showed no discharge summary was provided to the hospice care service provider. Patient #17 A review of the clinical record showed the patient was discharged from the agency on 12/05/20 to in-patient hospital care services. Documentation showed no discharge summary was provided to the in-patient hospital care service provider. On 03/11/21 at 1:30 p.m., Staff B stated no discharge summary was sent to the hospice service provider for Pt's #15 and #16; and no discharge summary was sent to the hospital service provider on Patient #17.