Every finding on record at Day-By-Day Staff Relief, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 05/31/22 to 06/02/22. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 05/31/22 to 06/02/22. An entrance conference was conducted with Staff A and B. The survey process was explained. Questions were answered. Staff A was identified as the contact person for administrative and clinical issues and Staff B was identified as an additional contact person for clinical issues Findings were discussed during an informal exit conference with Staff A, B, C, D, E, F, G, H and I. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: CHHA Certified Home Health Aide OT Occupational Therapy PT Physical Therapy POC Plan of Care SN Skilled Nurse ST Speech Therapy

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 a written notice of change in payer source and an advance beneficiary notice were provided prior to being discharged from the agency for one (Patient #13) of 17 patients. Findings: Patient #6 A review of the clinical record showed no written notice of change in payer source and no advance notice of discharge prior to discharge from the agency on 01/10/22. On 06/02/22 at 10:50 a.m., Staff A stated the clinical record for Patient #13 showed: no written notice of change in payer source and; no advance notice of discharge prior to being discharged from the agency.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD 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 two (Patient #1 and #2) of 17 patients. Findings: Patient #1 A review of a plan of care dated 05/20/22 to 07/18/22 documented a primary diagnosis of hypertension and chronic kidney disease with heart failure and showed a physician reporting parameter of weight greater than 195 pounds. Documentation showed an OT visit note dated 05/23/22 showed a weight of 206.4 pounds, the vital sign alert was auto-faxed to the physician with no follow up; an ST visit note dated on 05/25/22 showed a weight of 202 pounds, the documentation showed a telephone message was left for the physician and the vital sign alert was auto-faxed to the physician with no follow up; a SN visit note dated 05/26/22 showed a weight of 200 pounds, the vital sign alert was auto-faxed to the physician with no follow up; and an ST visit note dated on 05/27/22 showed a weight of 202.8 pounds, the vital sign alert was auto-faxed to the physician with no follow up. The documentation showed no direct physician coordination of care communications as follow up to the changes in the patient’s weight status and no changes in orders. On 06/02/22 at 10:15 a.m., Staff A stated the weight gain vital sign alerts for Patient #1 that were auto-faxed by the computer system should have had follow up coordination of care communications to ensure the physician was aware of the patient’s change in weight status. Patient #2 A review of a plan of care dated 04/10/22 to 06/08/22 documented a primary diagnosis of hypertensive heart disease with heart failure and showed a physician reporting parameter of weight greater than 140 pounds, or weight gain greater than 3 pounds in 24 hours or 5 pounds in one week and ankle circumference measurements greater than 20 centimeters. Documentation showed an SN visit note dated 05/10/22 showed a weight of 147 pounds and ankle circumference measurement of 25 centimeters, the vital sign alert was auto-faxed to the physician with no follow up; a SN visit note dated on 05/17/22 showed a weight of 150 pounds, the documentation showed a telephone message was left for the physician and the vital sign alert was auto-faxed to the physician with no follow up; a SN visit note dated 05/24/22 showed a weight of 150 pounds and ankle circumference measurement of 24 centimeters, the vital sign alert was auto-faxed to the physician with no follow up. The documentation showed no direct physician coordination of care communications as follow up to the changes in the patient’s weight status, ankle circumference measurements and no changes in orders. On 06/02/22 at 10:25 a.m., Staff A stated the weight gain and ankle circumference measurement vital sign alerts for Patient #2 that were auto-faxed by the computer system should have had follow up coordination of care communications to ensure the physician was aware of the patient’s change in weight status and ankle circumference measurements.

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 one (Patient #11) of 17 patients. Findings: Patient #11 A review of the POC dated 04/05/22 to 06/03/22 showed orders for SN to conduct an evaluation of the patient with a frequency of one week one, effective week of 04/10/22. Documentation showed no SN evaluation was conducted during the week of 04/10/22 through 04/16/22 and showed no patient/caregiver refusal of SN evaluation. A physician's order dated 04/20/22 showed documentation to discontinue SN evaluation (four days after the last date the SN evaluation was due). On 06/02/22 at 10:50 a.m., Staff A stated the SN evaluation for Patient #11 should have been conducted within the ordered date range and patient/caregiver refusal of the SN evaluation should have been documented prior to the physician’s order to discontinue the SN evaluation on 04/20/22.

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 certified home health aide supervisory visits were completed every 14 days for one (Patients #6) of 17 patients. Findings: Patient #6 A plan of care dated 05/05/22 to 07/03/22 showed a CHHA visit frequency of once a week for one week, then two times a week for eight weeks. A review of the clinical record showed CHHA visits conducted on 05/09/22, 05/12/22 and on 05/16/22 with supervisory visits completed on 04/29/22 (prior episode period) and on 05/18/22 (17 days between supervisory visits). Documentation showed no patient/caregiver refusal of the supervisory visit, physician notification, or change in orders. On 06/02/22 at 10:40 a.m., Staff A stated the CHHA supervisory visits for Patient #6 should have been completed every 14 days.