Every finding on record at Cowboy Cares Inc Dba/Cowboy Cares Home Health

A complaint survey was conducted by Healthcare Licensing and Surveys from 2/24/26 to 2/26/26. The survey was prompted by complaint intake #2710939.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and policy review, the agency failed to provide services as directed in the plan of care for 1 of 5 sample clients (#3). The findings were: 1.Review of the Plan of Care for client #3 dated 12/29/25 to 2/26/26 showed the Home Health Aide (HHA) patient-specific orders for discipline and treatments: Frequency and Duration: 6 hours weekly times 9 weeks. Review of the HHA visit notes showed the last home visit was done on 12/31/25. 2. Interview with the DON (Director of Nursing) on 2/25/26 at 3:46 PM revealed the agency failed to get the discontinue order for the HHA services for client #3. She stated the agency stopped the visits for the HHA services. 3. Review of the policy "Home Health Aide Service" hand delivered on 2/25/26 at 2:33 PM by the DON showed "...1. b. A Home Health Aide provides services that are: i. Ordered by the physician; ii. Included in the plan of care; iii. Permitted to be performed under state law; and iv. Consistent with the home health aide training..."

A complaint survey was conducted by Healthcare Licensing and Surveys from 10/11/23 to 10/12/23. The survey was prompted by complaint intakes IQ 101417 and IQ 101821.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, review of the complaints, and policy review the facility failed to ensure services were provided as outlined in the plan of care for 1 of 5 clients (#5). The findings were: Review of the 9/1/23 "Request for Prior Authorization of Skilled Nursing Services" for client #5 showed the principal diagnosis was neuropathy of bilateral limbs. The other pertinent diagnoses included cardiovascular disease, peripheral vascular disease, impaired mobility, and chronic pain. The activities permitted showed client up as tolerated and wheelchair. The mental status showed oriented, forgetful and depressed. Review of the complaints showed the client filed 3 different complaints. The agency address each complaint. Review of a warning letter to the client dated 6/15/23 showed the warning was given due to profane language, physical and verbal aggression towards staff by clint and/or family members. Review of the "Service Review" form showed the request "...Part-time or intermittent assistance with personal care and other daily living needs...". The service request to be provided 3 hour(s) every day from 9/1/23 to 8/31/24. The following concerns were identified: Review of the schedule, aide visits showed the visits were 1 time a day for 1 to 2 hours. The skilled nurse was visiting 1 time a week. Review of the 10/6/23 at 2:13 PM complaint showed the family was concerned with the agency lack of following the plan of care. Further, they stated the client was approved for services for both AM and PM care. The client was dependent on others for assistance. Interview with the director of nursing (DON) on 10/12/23 at 10 AM revealed the client had a bad drinking problem and was unable to stand or assist with the transfer. The agency stopped providing the PM visits at the beginning of July. The family hired a person from the community to put the client to bed. Further, she stated the agency notified the case worker. However, the agency did not notify the client with the change of service. Review of the policy titled "Patient Rights and Responsibilities" hand delivered on 10/11/23 at 2:38 PM showed "...The Patient has the right: 1. To be fully informed in writing and knowledgeable of all rights and responsibilities before providing pre-planned care and to understand that these right can be exercised at any time. ...5. To be informed in advance about care to be furnished and of any changes in the care to be furnished before the change is made... 13. To receive and access services consistently and in a timely manner from the agency to his/her request for service..."

A complaint survey was conducted by Healthcare Licensing and Surveys from 1/20/2022 to 1/21/22. The survey was prompted by complaint intake #61688. It was determined, based upon the findings of the survey team, that no deficiencies were identified pertaining to the complaint investigation. In addition, a COVID-19 focused infection control survey, which included a review of emergency preparedness requirements, was conducted by Healthcare Licensing and Surveys from 1/20/2022 to 1/21/22.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, staff interview and manufacturer's instructions, the agency failed to implement measures to prevent infection and maintain clean equipment for 3 of 3 home visit observations (Pt #1, Pt #2, Pt #4). The findings were: 1. Observation during a home visit on 1/20/22 at 3:00 PM showed RN #2 took Pt #1's vital signs with equipment from the nursing bag. Prior to returning the used equipment to the nursing bag, RN #1 quickly wiped the equipment with a disinfectant wipe. Interview of RN #1 at that time revealed the equipment only needed wiped for "1 minute" to disinfect. Review of the instructions on the disinfectant wipe package showed "...allow to remain wet for 10 minutes. Allow to air dry". 2. Observation during a home visit on 1/20/22 at 4:10 PM showed RN #2 took Pt #2's vital signs with equipment from the nursing bag. Prior to returning the used equipment to the nursing bag, RN #1 quickly wiped the equipment with a Bactive wipe. Interview of RN #1 at that time revealed the Bactive wipes were retrieved immediately prior to the home visit and used because they had a "1 minute dry time". Review of the instructions on the Bactive wipe package showed "...allow to remain wet for 4 minutes". 3. Observation during a home visit 1/21/22 at 10:00 AM showed RN #3 took Pt #4's vital signs with equipment from the nursing bag. Prior to returning the used equipment to the nursing bag, RN #3 quickly wiped the equipment with a disinfectant wipe. Interview of RN #3 at that time revealed RN #3 was unable to describe how to ensure that the equipment was properly disinfected after use. Interview with the administrator and RN #3 on1/21/22 at 10:40 AM confirmed there was confusion related to "wet time" and "dry time", for disinfectant wipes, and wet times have not been properly observed.

A complaint survey was conducted by Healthcare Licensing and Surveys on 8/31/21 to 9/1/21. The survey was prompted by complaint intake WY00003279. In addition, a COVID-19 focused infection control survey, which included a review of emergency preparedness requirements, was conducted by Healthcare Licensing and Surveys on 8/31/21 to 9/1/21. It was determined, based upon the findings of the survey team, that no deficiencies were identified pertaining to the infection control survey.

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 medical record review, and staff and patient interviews, the facility failed to notify the patient and the physician that the home health agency (HHA) was considering discharge for cause for 1 of 5 sample patients (#1). The findings were: 1. Review of a letter issued to patient #1 on 8/20/21 showed the HHA issued a 30-day notice to terminate services. The letter stated "This termination is due to your extremely verbal abuse to our staff, and non-compliance to stop the verbal abuse..." The following concerns were identified: a. Review of the medical record showed no evidence, prior to the issuance of the 30-day notice, that the patient or the patient's physician was notified the HHA was considering discharging the patient. b. Interview on 9/1/21 at 9:15 AM with the patient revealed s/he was not aware the HHA was considering discharge until s/he was told they were issuing a 30-day notice. c. During an interview on 9/1/21 at 11:57 AM the administrator stated the physician had not been contacted because she was unaware that needed to be done. In addition, she confirmed there was no documentation to show the patient had been informed that the HHA was considering discharge.

Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient's behavior, the behavior of other persons in the patient's home, or situation; This ELEMENT is not met as evidenced by: Based on medical record review, and staff and patient interviews, the facility failed to make efforts to resolve issues caused by the patient's behavior for 1 of 1 sample patients (#1) who was discharged due to behaviors. The findings were: 1. Review of the medical record showed on 7/9/21 staff at the home health agency (HHA) spoke to patient #1 about treating the weekend aides with respect. On 8/15/21 it was documented that home health aide #1 requested the HHA not accept the patient back into services (after discharge from the hospital) because s/he was "awful" and "rude" to staff. Review of a letter issued to patient #1 on 8/20/21 showed the HHA issued a 30-day notice to terminate services. The letter stated "This termination is due to your extremely verbal abuse to our staff, and non-compliance to stop the verbal abuse..." The following concerns were identified: a. Review of the medical record showed no evidence the facility attempted to resolve issues caused by the patient's behaviors. There lacked evidence HHA staff met with the patient to discuss his/her behaviors in an attempt to resolve the issues. b. On 9/1/21 at 9:15 AM the patient stated s/he was concerned that some of the aides didn't have proper training, and so they did things "wrong" when they provided care. The patient stated s/he has been blamed for aides quitting, but stated the HHA had not talked to him about his/her behaviors or made any attempt to resolve the situation. The patient stated his/her current case manager stated she had not been contacted about any behavior issues until the facility issued the 30-day notice. c. During an interview on 9/1/21 at 11:57 AM the administrator stated she believed the previous case manager had spoken to the patient about his behavior, but she stated there was no documentation. The administrator confirmed there was no documentation to show the facility had attempted to resolve the issues caused by the patient's behavior.