Every finding on record at Five Star Home Health, Inc.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 01/23/24 to 01/26/24. 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 in conjunction with complaint (99176) at the agency on 01/23/24 to 01/26/24. An entrance conference was conducted with Staff A and by phone Staff B and C. The survey process was explained. Questions were answered. Staff A was identified as the contact person for clinical and administrative issues. Findings were discussed during an informal exit conference with Staff A, B, C, and D and by phone Staff E, F, and G. Deficiencies were cited as a result of the re-certification survey. Deficiencies were cited related to the complaint. Glossary: POC Plan of Care SN Skilled Nurse/Nursing OT Occupational Therapy/Therapist

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: 1. SN provided wound care treatment as ordered for one (Patient #1) of nineteen patients. 2. OT frequencies were followed as ordered for two (Patients #3 and #10) of nineteen patients. 3. SN frequencies were followed as ordered for four (Patients #5, #7, #8, and 14) of nineteen patients. 1. Patient #1 A review of the POC dated 10/10/23 to 12/08/23 showed an order for SN to irrigate the left lower leg with saline, pat dry, apply remedy calazime zinc oxide paste (a skin protectant), 4x4.75, apply maxorb extra alginate dressing, apply conforming stretch gauze bandage, and cover with coban bandage. A review of the clinical records showed the following: A SN visit dated 10/11/23 documented the left lower leg was irrigated with normal saline and patted dry, then SN applied maxorb extra silver alginate dressing, qwick dressing, ABD pad, conforming gauze roll, and secured with coban. A SN visit dated 10/17/23 documented no wound care was provided to the left lower leg. A SN visit dated 10/19/23 documented no wound care was provided to the left lower leg. 2. Patient # 3 A review of a POC dated 10/27/23 to 12/25/23 showed an OT frequency of one visit per week for one week, effective 10/29/23. A review of the medical records showed no OT visit was made for the week of 10/29/23 to 11/04/23. Documentation showed no refusal of visits or services from the patient or caregiver, no contact made with the patient or caregiver and no physician order for a change in services. Patient #10 A review of a POC dated 10/25/23 to 12/23/23 showed an OT frequency of one visit per week for one week, and to evaluate the patient the week of 10/22/23. A review of the medical records showed no OT visit was made for the week of 10/22/23 to 10/28/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. 3. Patient #5 A review of a POC dated 10/02/23 to 11/30/23 showed SN frequencies of one time a week for nine weeks. A review of a SN missed visit note dated 10/06/23 documented the reason for the missed visit as waiting for authorization, and no other visits were documented for the week of 10/01/23 to 10/07/23. A review of a SN missed visit note dated 10/13/23 documented the reason for the missed visit as unable to reach patient, and no other visits were documented for the week of 10/08/23 to 10/14/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. Patient #7 A review of a POC dated 11/22/23 to 01/20/23 showed SN frequencies of one time a week for nine weeks. A review of the medical records showed no SN visits were made for the week of 11/19/23 to 11/25/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. Patient #8 A review of a POC dated 11/25/23 to 01/23/24 showed SN frequencies of three times a week for eight weeks, and one time a week for one week, effective 11/26/23. A review of a SN missed visit note dated 12/24/23 documented the reason for the missed visit as patient refused, and no other visits were documented for the week of 12/24/23 to 12/30/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. Patient #14 A review of a POC dated 08/16/23 to 10/14/23 showed SN frequencies of one time a week for nine weeks. A review of a SN missed visit note dated 08/17/23 documented the reason for the missed visit as no answer, and no other visits were documented for the week of 08/13/23 to 08/19/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. On 01/26/24 at 10:20 a.m., Staff A stated: 1. the wound care treatment order for Patient #1 was not followed as ordered by the physician; 2. the OT frequencies for Patient #3 and Patient #10 were not met as ordered by the physician; and 3. the SN frequencies for Patient #3, Patient #5, Patient #7, Patient #8, and Patient #14 were not met as ordered by the physician.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the hospice on 02/23/21 - 02/24/21. 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 02/23/21 - 02/24/21. An entrance conference was conducted with Staff A, B, C, D and E. The survey process was explained. Questions were answered. Staff E was identified as the contact person for administrative issues and Staff A was identified as the contact person for clinical issues. Findings were discussed during an informal exit conference with Staff A, C, D and E and by telephone Staff F. A standard level deficiency was cited as a result of the Medicare re-certification survey. GLOSSARY: COPD Chronic Obstructive Pulmonary Disease DME Durable Medical Equipment POC Plan of Care Pt Patient Pts Patients SN Skilled Nurse

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 a plan of care was fully developed for monitoring of weight related to disease process for one (Patient #7) of 17 patients. Findings: Pt #7 A review of the POC dated 12/09/20 to 02/06/21 showed a secondary diagnoses of chronic kidney disease and chronic systolic (congestive) heart failure. A review of the POC showed orders for SN to notify the physician of a weight gain of 3 lbs or more in 24 hours. Documentation showed no instructions given by the agency for the pt to weigh daily, notify the agency of weight gain or for the agency to alert the physician of a significant weight gain outside of a 24 hour period. On 02/24/21 at 12:40 pm, Staff A stated the POC was not developed to instruct the patient to weigh daily, was not developed to instruct the patient to notify the agency of weight gain and did not have orders for the agency to notify the physician of a significant weight gain outside of a 24 hour period of time for Pt #7.

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 agency failed to ensure: 1) the POC included orders for oxygen use for two (Pt #1 and 6) of 17 patients; 2) oxygen use was included in the safety measures section of the POC for two (Pt #1 and 6) of 17 patients; 3) oxygen was listed under the DME and supplies section for two (Pt #1 and 6) of 17 patient. Findings: Pt #1 A review of the POC dated 12/28/20 - 02/25/21 showed a secondary diagnosis of COPD with an exacerbation date of 10/29/20. A review of the POC contained no orders for the use of oxygen. SN notes dated 12/22/20, 01/02/21, 01/06/21 and 01/14/21 documented the use of oxygen. Clinical documentation showed no physician orders for oxygen use. Pt #6 A review of the POC dated 01/20/21 - 03/20/21 showed a primary diagnosis of COPD with an exacerbation date of 12/22/20. A review of the POC contained no orders for the use of oxygen. A SN note dated 01/28/21 documented the use of oxygen. Clinical documentation showed no physician orders for oxygen use. On 01/20/21 at 10:52 am, Staff B stated the POC should include: 1) orders for oxygen for Pts #1 and 6; 2) oxygen documented in the safety measures section of the POC for Pts #1 and 6; 3) oxygen documented in the DME and supplies section of the PC for Pt's #1 and 6.

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 SN frequencies were followed as ordered for one (Pt #3) of 17 patients. Findings: Pt #3 A review of the POC dated 12/21/21 to 02/18/21 showed orders for a SN frequency of once a week for nine weeks. An order dated 01/07/21 instructed an increase in the SN frequency to three times a week. A review of visit notes showed SN visits continued at a frequency of once a week from 01/07/22 - 02/18/21 for routine visits. Clinical documentation showed no additional orders to reduce the SN frequency, no refusal of the additional ordered visits by the patient or family/caregiver and no notification to the ordering practitioner that orders to increase the visit frequency had not been followed. On 02/24/21 at 12:23 pm, Staff A stated: 1) the ordered SN frequency was not followed for Pt #3 and 2) the visits of three times a week for Pt#3 had not been plotted on the calendar.