Every finding on record at Health Watch Health Care of Altus, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program at the Agency 12/09/25 - 12/10/25. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare Recertification survey at the agency on 12/09/25 - 12/10/25. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff B was identified as the contact person for administrative issues and Staff A for clinical issues. Standard level deficiencies were cited as a result of the Medicare recertification survey. Glossary: POC - Plan of Care Pt - Patient PT - Physical Therapy RN - Registered Nurse SN - Skilled Nurse

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure that an order was obtained for newly identified wounds for one (Pt #1) of seven patients. Findings: A policy titled Physician Communication read in part, the agency will establish and maintain communication with the physician or allowed practitioner to ensure safe and appropriate care for the patient/client... when there are significant changes in the patient's/client's medical condition, vital signs out of parameter. Pt #1 A review of the clinical record showed a SN assessment dated 11/07/25 identified new wounds to the right buttock (#4) and left buttock (#5). Wound care was provided as follows: cleansed with wound wash, patted dry with 4x4 gauze. Applied Triad cream to red areas. The SN assessment showed no physician notification of new wounds and no orders were obtained for wound care. On 12/10/25 at 1:58 pm, Staff B stated the physician for Pt #1 was not notified of the new wounds.

Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure that a physician was notified of: 1) a change in skin integrity for one (Pt #1) of seven patients; 2) a pain level above acceptable level in a timely manner for one (Pt #1) of seven patients. Findings: A policy titled Coordination of Services with Other Clinicians read in part, Coordination includes but is not limited to: ... Initiation of communication with other organizations/individuals when there are changes in the patient's/client's overall care. A policy titled Physician Communication read in part, the agency will establish and maintain communication with the physician or allowed practitioner to ensure safe and appropriate care for the patient/client... when there are significant changes in the patient's/client's medical condition, vital signs out of parameter. Pt #1 A review of the clinical record for the certification period of 09/28/25 - 11/26/25 showed a SN assessment dated 11/07/25 identified two new wounds as #4 right buttock and #5 left buttock. The SN visit note showed no physician notification of new wounds sites and showed no orders were obtained for wound care. On 12/10/25 at 1:58 pm, Staff B stated the physician for Pt #1 was not notified of the additional wounds. Pt #2 A review of a POC for the certification period dated 07/03/25 - 08/31/25 showed an order to notify the physician if pain greater than 8. A nurse assessment dated 07/17/25 showed the patient reported a pain level of 10 out of 10 and showed no physician notification at the time of the assessment and no further follow up was noted. On 12/10/25 at 2:05 pm, Staff B stated the nursing assessment showed no physician notification the patient reported a pain level of 10 of 10 at the time of the visit.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the ordered visit frequency was followed for one (Pt #2) of four patients. Findings: Pt #2 A review of a POC dated 07/03/25 - 08/31/25 showed a PT ordered frequency beginning the week of 07/06/25 twice a week for three weeks. The following PT visits were noted during the week of 07/06/25 - 07/12/25 a PT visit dated 07/07/25, no other visit, no patient refusal, and no missed visit was completed (two visits ordered, one visit conducted). On 12/10/25 at 2:05 pm, Staff B stated there was only one PT visit during the week of 07/06/25.

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 in the POC for one (Pt #4) of four patients. Findings: Pt #4 A review of a POC dated 10/31/25 - 12/29/25 showed orders for a physical therapist to evaluate. The clinical record showed no PT evaluation was conducted, showed no physician's order to cancel the PT evaluation, and no patient refusal of a PT evaluation. On 12/10/25 at 2:18 pm, Staff B stated no PT evaluation was conducted.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 11/15/22 to 11/16/22. Standard level deficiencies were cited as a result of the Emergency Preparedness Program survey.

Names and Contact Information CFR(s): 484.102(c)(1) §403.748(c)(1), §416.54(c)(1), §418.113(c)(1), §441.184(c)(1), §460.84(c)(1), §482.15(c)(1), §483.73(c)(1), §483.475(c)(1), §484.102(c)(1), §485.68(c)(1), §485.625(c)(1), §485.727(c)(1), §485.920(c)(1), §486.360(c)(1), §491.12(c)(1), §494.62(c)(1). [(c) The [facility must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following:] (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [facilities]. (v) Volunteers. *[For Hospitals at §482.15(c) and CAHs at §485.625(c)] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians (iv) Other [hospitals and CAHs]. (v) Volunteers. *[For RNHCIs at §403.748(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Next of kin, guardian, or custodian. (iv) Other RNHCIs. (v) Volunteers. *[For ASCs at §416.45(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For Hospices at §418.113(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Hospice employees. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Other hospices. *[For HHAs at §484.102(c):] The communication plan must include all of the following: (1) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Patients' physicians. (iv) Volunteers. *[For OPOs at §486.360(c):] The communication plan must include all of the following: (2) Names and contact information for the following: (i) Staff. (ii) Entities providing services under arrangement. (iii) Volunteers. (iv) Other OPOs. (v) Transplant and donor hospitals in the OPO's Donation Service Area (DSA). This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure an Emergency Preparedness Communication Plan included updated required staff contact information for the agency. Findings: A review of administrative records showed documentation the Emergency Preparedness Communication Plan included staff contact information for former staff members who no longer worked for the agency. On 11/16/22 at 9:30 a.m., Staff A stated the active staff member call list was not updated with current staff contact information in the Emergency Preparedness Communication Plan for the agency.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 11/15/22 to 11/16/22. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff A and Staff B were identified as the contact persons for administrative and 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: POC plan of care SN skilled nurse

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 the individualized patient POCs included: 1. SN intervention for patient weight monitoring was documented for one (Patient #2) of seven patients and; 2. Patient ankle circumference monitoring reporting parameters were documented for one (Patient #4) of seven patients. Findings: Patient #2 A review of the plan of care dated 09/26/22 to 11/24/22 documented a principal diagnosis of chronic obstructive pulmonary disease. POC showed documentation of patient weight reporting parameters of 125 to 135 pounds but showed no SN treatment interventions for monitoring of the patient’s weight. On 11/16/22 at 10:02 a.m., Staff A stated the POC for patient #2 showed no SN treatment interventions for monitoring of the patient’s weight. Patient #4 A review of the plan of care dated 09/30/22 to 11/28/22 documented a principal diagnosis of Parkinson’s disease. POC showed orders for SN treatment interventions to monitor the patient’s weight or alternatively measure the patient’s ankle circumference every visit but showed no documentation of ankle circumference reporting parameters. On 11/16/22 at 10:06 a.m., Staff A stated the POC for patient #4 showed no SN treatment interventions reporting parameters for monitoring of the patient’s ankle circumference.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT 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 (Patients #1 and #6) of seven patients. Findings: Patient #1 A review of a plan of care dated 10/24/22 to 12/22/22 documented a primary diagnosis of Diabetes Mellitus Type II with foot ulcer and documented SN to assess the wound site and perform wound site care every visit. Documentation showed SN visit note dated 11/09/22 documented the wound site was healed and showed no wound site care was performed. Documentation showed no physician coordination of care communications to notify of changes to the wound site and showed no changes in orders. On 11/16/22 at 9:57 a.m., Staff A stated the agency failed to notify the physician of changes in the wound status and obtain orders to discontinue wound site care for patient #1. Patient #6 A review of the plan of care dated 09/30/22 to 11/28/22 documented a principal diagnosis of chronic obstructive pulmonary disease. The POC showed orders for SN to assess, evaluate and intervene on conditions that present themselves during the course of the episode to identify and report changes to the physician to minimize complications and SN to obtain the patient’s weight or obtain ankle circumference measurements every visit and report to nurse practitioner or physician weight gain or loss of five pounds. Documentation showed a SN visit note dated 09/15/22 documented a weight loss of nine pounds accompanied with patient report of daily episodes of nausea and vomiting. Documentation showed no physician coordination of care communications to inform the physician of a patient weight loss of nine pounds accompanied with patient report of daily episodes of nausea and vomiting and showed no changes in orders. On 11/16/22 at 10:15 a.m., Staff A stated the physician for patient #6 should have been informed the patient had a weight loss of nine pounds accompanied with daily episodes of nausea and vomiting.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the 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) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record reviews and interview, the agency failed to ensure a completed transfer and/or discharge summary was provided to the receiving service providers for two (Patients #6 and #7) of seven patients. Findings: Patient #6 A review of the clinical record documented transfer from the agency on 09/28/22 to in-patient hospital provider services. Documentation showed no transfer summary was provided to the in-patient hospital service provider. Documentation showed the patient was resumed on agency services on 10/04/22 and was then subsequently discharged from agency services on 10/06/22 to hospice provider services. Documentation showed no discharge summary was provided to the hospice service provider. Additional documentation related to the coordination of care and/or receipt of patient care summaries by the receiving service providers was requested, none was provided. Patient #7 A review of the clinical record documented transfer from the agency on 09/22/22 to in-patient hospital provider services. Documentation showed no transfer summary was provided to the in-patient hospital service provider. Additional documentation related to the coordination of care and/or receipt of the patient care summary by the receiving service provider was requested, none was provided. On 11/16/22 at 11:00 a.m., Staff B stated the agency failed to ensure transfer and/or discharge summaries were sent to the receiving service providers for patients #6 and #7.