Every finding on record at Harmony Home Care Inc

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 01/06/25 to 01/08/25. 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 a Medicare complaint (94903) survey at the agency on 01/06/25 to 01/08/25. An entrance conference was conducted with Staff A. Staff A was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff A. Deficiencies were cited as a result of the re-certification survey. No deficiencies were cited as a result of the complaint survey.

Written notice of patient's rights CFR(s): 484.50(a)(1)(i) (i) Written notice of the patient's rights and responsibilities under this rule, and the HHA's transfer and discharge policies as set forth in paragraph (d) of this section. Written notice must be understandable to persons who have limited English proficiency and accessible to individuals with disabilities; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure written notice of patient rights was provided to two (Patients #3 and 7) of 7 patients. A review of the clinical record showed no indication the agency provided the patient with a copy of their patient rights documents at admission. On 01/08/25 at 10:05 am., Patient #3 stated they had no written notification of Patient Rights from the agency and had not been provided with a copy of their Patient Rights at admission. At 10:10 am Patient #3 spouse stated the patient was not provided a written notification of Patient Rights. At 11:35 am., Patient #7 stated they had no written notification of Patient Rights. At 1:35 pm., Staff A stated there was no written notification of Patient Rights provided on paper and had to be accessed by a "portal" which Patient #3 and 7 may have not known how to access.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure patient involvement in the establishment of a patient care plan was provided for one (Patient #3) of 7 patients. A review of the patient record showed no indication of patient participation in the plan of care. On 01/08/25 at 10:15 am., Patient #3 stated they were not provided the opportunity to participate in the development of their plan of care. At 1:38 pm., Staff A stated she was not aware Patient #3 was not involved in the development of their plan of care.

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 an individualized plan of care was developed for seven (Patients #1, 2, 3, 4, 5, 6 and 7) of 7 patients. Patient #1 A review of the plan of care dated 10/25/24 to 12/23/24 showed a primary diagnosis of irritable bowel syndrome with constipation with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. Patient #2 A review of the plan of care dated 10/16/24 to 12/14/24 showed a primary diagnosis of encounter for surgical aftercare following surgery on the circulatory system with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. Patient #3 A review of the plan of care dated 11/15/24 to 01/13/25 showed a primary diagnosis of displaced bimalleolar fracture of right lower leg with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. Patient #4 A review of the plan of care dated 11/05/24 to 01/03/25 showed a primary diagnosis of unspecified atrial fibrillation with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. Patient #5 A review of the plan of care dated 10/21/24 to 12/19/24 showed a primary diagnosis of infection and inflammatory reaction due to internal right hip prosthesis with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. Patient #6 A review of the plan of care dated 10/08/24 to 12/06/24 showed a primary diagnosis of cervical disc disorder with myelopathy, high cervical region with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. Patient #7 A review of the plan of care dated 10/10/24 to 12/08/24 showed a primary diagnosis of spinal stenosis, cervical region with no patient specific individualized interventions or goals developed for the management of the primary diagnosis. On 01/08/25 at 1:25 pm, Staff A stated the plan of care for Patients #1, 2, 3, 4, 5, 6 and 7 were not individualized for the management of the primary diagnosis.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (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) 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 paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a home health aide supervisory visit was completed every 14 days for one (Patient #6) of 7 patients. Patient #6 A review of a plan of care dated 10/08/24 to 12/06/24 showed a skilled nurse frequency of one visit per week for one week, two visits per week for one weed and one visit per week for seven weeks and a home health aide frequency of two visits per week for nine weeks. A review of the clinical record showed the following: Home health aide visits dated 10/08/24 and 10/11/24 for the week of 10/08/24 to 10/12/24 (two of two completed visits). Home health aide visits dated 10/14/24 and 10/18/24 for the week of 10/13/24 to 10/19/24 (two of two completed visits). Home health aide visits dated 10/21/24 and 10/25/24 for the week of 10/20/24 to 10/26/24 (two of two completed visits). Home health aide visits dated 10/28/24 and 11/01/24 for the week of 10/27/24 to 11/02/24 (two of two completed visits). Home health aide visits dated 11/04/24 and 11/08/24 for the week of 11/03/24 to 11/09/24 (two of two completed visits). Home health aide visits dated 11/11/24 and 11/15/24 for the week of 11/10/24 to 11/16/24 (two of two completed visits). Home health aide visits dated 11/18/24 and 11/22/24 for the week of 11/17/24 to 11/23/24 (two of two completed visits). Home health aide visits dated 11/25/24 and 11/30/24 for the week of 11/24/24 to 11/30/24 (two of two completed visits). A supervisory aide visit was performed on 11/07/24. No supervisory aide visits were conducted from 10/08/24 to 11/06/24 (30 days with no supervisory aide visit). No supervisory aide visits were conducted from 11/08/24 to 11/30/24 (23 days with no supervisory aide visit). On 01/08/25 at 1:50 pm., Staff A stated supervisory aide visits were not completed every 14 days for Patient #6.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency from 01/12/22 to 01/13/22. 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 01/12/22 to 01/13/22.An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered.Staff A was identified as the contact person for administrative and clinical issues.Findings were discussed during an informal exit conference with Staff A.Deficiencies were cited as a result of the re-certification survey.GLOSSARY:QAPI Quality Assessment and Performance Improvement

Improvements are sustained CFR(s): 484.65(c)(3) The HHA must take actions aimed at performance improvement, and, after implementing those actions, the HHA must measure its success and track performance to ensure that improvements are sustained. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a patient centered QAPI Program measured and tracked agency performance strategies to ensure improvements were sustained for all 18 patients and employees. A review of administrative records showed no ongoing QAPI program activities which measured and tracked agency performance strategies to ensure improvements were sustained to improve the care, services, and operations of the agency for calendar years 2019, 2020 and 2021.On 01/13/22 at 11:10 am, Staff A stated they had no QAPI documentation which measured and tracked agency performance strategies to ensure improvements were sustained for calendar years 2019, 2020 and 2021.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the Infection Control Program included comprehensive infection control surveillance activities and interventions to reduce future infections and promote learning and preventative measures throughout the agency for all 18 patients and staff. A review of administrative records showed no ongoing infection control surveillance data for calendar year's 2020 and 2021. On 01/13/22 at 11:00 am, Staff A stated the agency had no comprehensive infection surveillance program in place.