Every finding on record at Crowley Home Health Services, Inc

Professional HHS of SW LA is in compliance with federal emergency preparedness requirements.

Recertification Survey.

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 home health agency failed to provide evidence of the measures taken to investigate why the patient was refusing to keep wound care clinic appointments; in an attempt to provide interventions for patient to be compliant with plan of care (POC) prior to discharge from the agency for 1 (Patient #6) out of 7 (#1-#7) sampled patients. Patient #6. Review of the patient’s electronic clinical records revealed the start of care date was 12/29/2024. The patient’s diagnosis included Cellulitis of Left Lower Limb and Heart Failure. The certification period reviewed was 12/29/2024 to 02/26/2025. Review of the patient’s POC for certification period 12/29/2024 to 02/26/2025 revealed an order for “SN 2w1, 1w8 (skilled nurse visit two times a week for one week, one visit a week for eight weeks).” Review of the patient’s Oasis Discharge Summary note dated 01/10/2025 revealed, “…Patient being discharged for noncompliance due to not seeing MD (Medical Doctor) for wound care orders. Patient made several appointments but refuses to go to MD or wound care clinic…” There was no evidence in the clinical records the agency staff asked the patient why she was refusing to go to the wound care clinic for her appointments prior to discharge from the agency. On 04/07/2025 at 12:30 p.m., an interview was conducted with S1CS (Clinical Supervisor). S1CS reviewed the patient’s electronic clinical record and confirmed there was no evidence the agency staff asked the patient why she was not going to the wound care clinic prior to discharging her from the agency. On 04/09/2025 at 9:25 a.m., an interview was conducted with S2Admin (Administrator). S2Admin reviewed the patient’s electronic clinical record and confirmed there was no evidence the agency staff asked the patient why she was not going to the wound care clinic prior to discharging her from the agency.

Professional HHS of Southwest Louisiana is in compliance with federal emergency preparedness requirements.

Recertification Survey

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 observation, interview and record review; the agency failed to ensure that medicine reconciliations were accurately performed during skilled nurse visits for 1 (Patient #3) out of 7 sampled patients. Patient #3 had a start of care date of 11/17/21. His diagnosis included Heart Failure, Atrial Fibrillation and Hypothyroidism. The certification period reviewed was 3/17/22 to 5/15/22. On 5/2/22 at 2:30 pm, a home visit conducted at the assisted living facility where Patient #3 resided with S2RN. During the visit, S2RN conducted a medication reconciliation of the medication the patient was receiving. She compared a printed copy of the medication against the medication listed in her electronic tablet. The surveyor also compared the assisted living facility’s medication list against the medication listed in the patient’s POC (plan of care) for the certification period of 3/17/22 to 5/15/22. The assisted living facility’s medication list included an order for Isosorbide Mononitrate ER (extended release) Oral Tablet Extended Release 24 hour 30 mg (milligram), take one table once a day with a start/end date of 4/13/22. This medication was not listed on the patient’s POC. S2RN was unable to find Isosorbide Mononitrate on the medication listed in her tablet and confirmed Isosorbide was listed has having been started on 4/13/2021. Review of skilled nursing visit note dated 4/13/22 revealed “assisted living facility manages medication, no change noted.” Review of skilled nursing visit note dated 4/19/22 revealed “assisted living facility manages medication, no change noted.” Review of skilled nursing visit note dated 4/26/22 revealed “assisted living facility manages medication, no change noted.” Review of skilled nursing visit note dated 5/2/22 revealed “Upon assessing MAR (medication administration record) at facility it was found that the patient was placed on Isosorbide 30 mg. Updated MAR and medication reconciliation performed to be sent to MD”… Review of the agency’s policy titled “Patient Medication Information/Reconciliation” read, in part, the following: …The patient’s medications are reviewed and assessed during each skilled visit… On 5/2/22 at 3:15 pm, an interview was conducted with S1Admin along with a review of the patient’s medication listed on his current plan of care and a copy of the medication list from the assisted living facility. She stated that medication reconciliations should be performed on every skilled nursing visit. She stated that the medication change should have been identified before 5/2/2022 since the medication was started on 4/13/22.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient's written individualized POC (plan of care) was followed as evidenced by the skilled Nurse (SN) failing to make visits as ordered per the POC for patient (#2) for 1 out of 7 sampled patients. Patient #2. Review of the patient's electronic clinical record revealed the start of care date was 2/11/2022. The patient's diagnoses included Hypertension and Diabetes. The certification period reviewed was 4/12/2022 to 6/10/2022. Review of the patient's Plan of Care (POC) revealed the following order “SN 1w9 (skilled nurse visit one time a week for nine weeks). Review of the patient’s clinical record revealed no evidence that a SN visit was made for the week of 4/12/2022. On 5/2/2022 at 1:02 pm, an interview was conducted with S1Admin (Administrator). S1Admin reviewed the patient’s electronic clinical record and confirmed that there was no evidence that a SN visit was made for the week of 4/12/2022 per the POC orders.

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure that services were integrated to assure the identification of patient needs and factors that could affect patient treatment and the coordination of care provided by all disciplines for 1 patient when PT (Physical Therapy) failed to inform the nurse/physician of patient’s pain during the PT visit for 1 (#2) out of 7 sampled patients. Patient #2. Review of the patient's electronic clinical record revealed the start of care date was 2/11/2022. The patient's diagnoses included Hypertension and Diabetes. The certification period reviewed was 4/12/2022 to 6/10/2022. Review of the patient’s PT order revealed an order to evaluate and treat effective 4/20/2022 and revealed PT orders 2w4 effective 4/24/2022 (physical therapy visits two times a week for four weeks). Review of the patient’s PT visit note dated 4/26/2022 revealed, “Pt states that she is having more pain today. She rates it 9/10…” There was no evidence that the PT notified the physician or nurse of the patient’s increased pain. On 5/3/2022 at 10:25 am, an interview was conducted with S1Admin (Administrator). S1Admin reviewed the patient’s clinical record and confirmed that there was no evidence that PT notified the nurse or the physician of the patient’s increased pain.

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on record review and interview the facility failed to ensure medical exemptions for the COVID-19 vaccines identified which COVID-19 vaccine was clinically contraindicated for 4 (S3PT, S4PT, S5PT, S6PTA) (Physical Therapy and Physical Therapy Assistant) of the 4 employees who had medical exemptions. Review of the agency’s policy and procedure for COVID-19 Vaccination Program for Healthcare Staff revealed, “… For staff members who request a medical exemption from vaccination… Such documentation must contain all information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member…” Review of the facility's COVID-19 Vaccination Status roster matrix revealed that S3PT, S4PT, S5PT, and S6PTA had medical exemptions. Review of S3PT medical exemption dated 11/22/2022, S4PT medical exemption dated 2/7/2022, S5PT medical exemption dated 9/19/2021, and S6PTA medical exemption dated 12/7/2021 revealed that the medical exemptions did not identify which COVID-19 vaccine was clinically contraindicated. There was no evidence that the physicians identified which COVID-19 vaccine was clinically contraindicated for the employees. On 5/3/2022 at 2:50 pm, a review of the vaccination medical exemptions was conducted with S1Admin (Administrator). S1Admin confirmed that the medical exemptions did not identify the COVID-19 vaccine that was contraindicated for the employees.