Every finding on record at Country Style Health Care, Inc X

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 10/16/23 to 10/17/23. Deficiencies were cited as a result of the Emergency Preparedness Program survey.

Names and Contact Information CFR(s): 484.22(c)(1) [(c) The [facility, except RNHCIs, hospices, transplant centers, and HHAs] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least annually. The communication plan must include all of the following:] (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [facilities]. (v) Volunteers. *[For RNHCIs at §403.748(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Next of kin, guardian, or custodian. (iv) Other RNHCIs. (v) Volunteers. *[For ASCs at §416.45(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For Hospices at §418.113(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Hospice employees. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Other hospices. *[For OPOs at §486.360(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Volunteers. (iv) Other OPOs. (v) Transplant and donor hospitals in the OPO's Donation Service Area (DSA). This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure an Emergency Preparedness Communication Plan included updated required information related to the staff contact information for the agency for all patients and staff. Findings: A review of administrative records showed an Emergency Preparedness Communication Plan included staff contact information for staff who no longer worked for the agency and was not updated to include staff contact information for current staff who worked for the agency. On 10/17/23 at 9:45 a.m., Staff B stated the active Emergency Preparedness Communication Plan staff member call list included staff contact information for staff who no longer worked for the agency and was not updated to include staff contact information for current staff who worked for the agency.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 10/16/23 to 10/17/23. 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 and Staff C was identified as the contact person for clinical issues. Findings were discussed during an informal exit conference with Staff B and C. Standard level deficiencies were cited as a result of the survey. Glossary: cc cubic centimeter EP Emergency Preparedness HHA Home Health Agency POC Plan of Care SN skilled nurse

Patient refuses services CFR(s): 484.50(d)(4) The patient refuses services, or elects to be transferred or discharged; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient was educated on potential health outcomes related to refusal of SN visits prior to discharge from agency services for one (Patient #6) of eight patients. Findings: Patient #6 A review of a POC for 05/19/23 to 07/05/23 showed a SN visit frequency of one time a week for one week, three times a week for one week then two times a week for seven weeks. A review of visit notes showed a declined/missed SN visit on 07/03/23. A discharge summary dated 07/05/23 showed the patient was discharge from agency services for refusal of care. Documentation showed no communication or education attempts to the patient for potential health outcomes related to refusal of SN visits prior to the patient’s imminent discharge from agency services. On 10/17/23 at 10:00 a.m., Staff B stated there was no documentation of attempts to educate the patient of potential health outcomes related to refusal of SN visits prior to the patient’s discharge from agency services.

Advise the patient of discharge for cause CFR(s): 484.50(d)(5)(i) (i) Advise the patient, representative (if any), the physician(s) or allowed practitioner(s), issuing orders for the home health plan of care, and the patient's 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) that a discharge for cause is being considered; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure physician notification of the patient's refusal of SN visits and notification of the patient’s pending discharge from agency services for one (Patient #6) of eight patients. Findings: Patient #6 A review of a POC for 05/19/23 to 07/05/23 showed a SN visit frequency of one time a week for one week, three times a week for one week then two times a week for seven weeks. A review of visit notes showed a declined/missed SN visit on 07/03/23. A discharge summary dated 07/05/23 showed patient discharge from agency for refusal of care. Documentation showed no physician notification of the patient's continued refusal of SN visits and no notification of the patient’s pending discharge from agency services. On 10/17/23 at 10:00 a.m., Staff B stated there was no physician notification of the patient's refusal of SN visits and no notification of the patient’s pending discharge from agency services.

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 reviews and interview, the agency failed to ensure SN performed wound care as ordered by the physician for one (Patient #3) of eight patients. Findings: Patient #3 A review of a POC dated 09/15/23 to 11/11/23 showed wound care orders for SN to perform wound care every visit to bilateral lower extremities of: cleanse site with normal saline, dry with 4x4 gauze and apply Unna boot dressings. Clinical documentation showed during SN visit on 10/02/23 SN identified new blister formations to the left lower extremity and cleansed the site with normal saline and applied gentamycin ointment. Documentation showed no physician notification of the new blister formations to the left lower extremity and showed no orders for gentamycin ointment. On 10/17/23 at 9:55 a.m., Staff B stated physician should have been notified of new blister formations to the left lower extremity and physician orders should have been obtained prior to the SN applying gentamycin ointment.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure care was coordinated between the agency and physician for one (Patient #5) of eight patients. Findings: Patient #5 A review of a plan of care dated 08/24/23 to 10/22/23 documented a primary diagnosis of congestive heart failure and showed orders for SN to weight the patient every visit and report to the physician patient weight less than 260 pounds or greater than 270 pounds. A review of clinical notes showed on SN visits dated 08/28/23, 09/08/23, 09/11/23, 09/18/23, 09/25/23, 10/06/23 and on 10/13/23 the patient was unable to be weighed. Documentation showed no physician coordination of care notifying the physician the patient was unable to be weighed and showed no patient refusal of weight and no changes in orders. On 10/17/23 at 9:55 a.m., Staff B stated the SN should have notified the physician the patient was unable to be weighed during SN visits.

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 and interview, the agency failed to ensure services were provided as ordered on the POC for: 1. SN to conduct visit frequencies as ordered by the physician for one (Patient #3) of eight patients; 2. SN to perform suprapubic catheter change every month using a 16 French/10 cc sized catheter for one (Patient #4) of eight patients and; 3. SN to conduct assessment of patient pain level every visit and notify the physician of patient reported pain levels greater than 4 of 10 for one (Patients #6) of eight patients. Findings: Patient #3 A review of a POC dated 09/15/23 to 11/11/23 showed SN visit frequency orders of one time a week for one week, three times a week for eight weeks, and then one time a week for one week. During the week of 09/17/23 to 09/22/23 SN visits were conducted on 09/18/23 and on 09/21/23 (three visits ordered, one visit missed). Documentation showed no patient/caregiver refusal of the SN visit, no physician notification and no change in orders. Patient #4 A review of the POC dated 08/06/23 to 10/04/23 showed orders for SN to change suprapubic catheter 16 French/10 cc every month. Documentation showed during SN visit dated 09/08/23 SN changed the suprapubic catheter using a 22 French/30 cc catheter. Documentation showed no physician notification of different suprapubic catheter size and showed no change in orders. Patient #6 A review of the POC dated 05/19/23 to 07/05/23 showed orders for SN to assess changes in the patient’s pain level every visit and report to physician patient reported pain levels greater 4. Documentation showed during SN visits patient reported pain levels were: 05/19/23 pain level of 5; 05/22/23 pain level of 5; 05/26/23 pain level of 5; 05/30/23 pain level of 5; 06/06/23 pain level of 5; 06/08/23 pain level of 5; 06/15/23 pain level of 5; 06/27/23 pain level of 5 and 06/29/23 pain level of 5. Documentation showed no physician notification of patient reported pain levels greater 4 and showed no change in orders. On 10/17/23 at 9:50 a.m. to 10:00 a.m., Staff B stated: 1. SN should have conducted SN visit frequency as ordered by the physician patient #3; 2. SN to should have used the ordered suprapubic catheter size as ordered by the physician for patient #4 and; 3. SN should have notified the physician of the patient’s reported pain level greater than 4 of 10 every visit as ordered for patient #6.