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

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 02/10/26 to 02/11/26. 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 02/10/26 to 02/11/26. 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 clinical issues. Findings were discussed during an informal exit conference with Staff B and C. Standard level deficiencies were cited as a result of the survey. Glossary: CBC complete blood count CMP comprehensive metabolic panel FSBS fingerstick blood sugar PT INR fingerstick prothrombin timed test international normalized ratio (related to blood clotting) HHA Home Health Agency POC Plan of Care PT physical therapy PT INR prothrombin timed test international normalized ratio 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 individualized patient POC's included: 1. Fingerstick blood sugar reporting parameters for four (Patients #3, 4, 5 and #7) of 10 patients. 2. Fingerstick blood sugar intervention goals for two (Patients #4 and #5) of 10 patients. Findings: Patient #3 A review of a POC dated 01/16/26 to 03/16/26 showed orders for SN to assess and perform FSBS for signs and symptoms of hypoglycemia (low blood sugar). SN visits dated: 01/22/26 showed a FSBS of 15801/29/26 showed a FSBS of 15602/06/26 showed a FSBS of 157 The POC showed no FSBS reporting parameters and showed no physician notifications and no changes in orders. On 02/11/26 at 9:42 a.m., Staff B stated the POC did not include an FSBS reporting parameter for when to notify the physician. Patient #4 A review of a POC dated 01/13/26 to 03/13/26 showed orders for SN to assess and perform FSBS for signs and symptoms of hypoglycemia (low blood sugar). A SN visit dated 01/16/26 showed no FSBS result. The POC showed no FSBS reporting parameters, no intervention goals, no physician notifications and no changes in orders. On 02/11/26 at 9:46 a.m., Staff B stated the POC did not include FSBS reporting parameter for when to notify the physician and had no goals for FSBS’s. Patient #5 A review of a POC dated 12/31/26 to 02/28/26 showed orders for SN to assess and perform FSBS for signs and symptoms of hypoglycemia (low blood sugar). SN visits dated 01/05/26, 01/13/26, 01/20/26, 01/26/26 and on 02/02/26 showed no FSBS results. The POC showed no FSBS reporting parameters, no intervention goals, no physician notifications and no changes in orders. On 02/11/26 at 9:51 a.m., Staff B stated the POC did not include FSBS reporting parameter for when to notify the physician and had no goals for FSBS’s. Patient #7 A review of a POC dated 10/19/25 to 12/17/25 showed orders for SN to assess and perform FSBS for signs and symptoms of hypoglycemia (low blood sugar). A SN visit dated 10/21/25 showed an FSBS of 158. The POC showed no FSBS reporting parameters and showed no physician notifications and no changes in orders. On 02/11/26 at 9:57 a.m., Staff B stated the POC did not include an FSBS reporting parameter for when to notify the physician.

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 physician orders for SN to perform fingerstick PT INR instead of venipuncture PT INR for one (Patient #3) of 10 patients. Findings: Patient #3 A review of a POC dated 01/16/26 to 03/16/26 showed orders for SN to perform venipuncture lab draws every week for PT INR, CBC and CMP. A review of a SN visit note dated 01/26/26 showed the SN performed a fingerstick PT INR. The clinical record showed no physician orders for a fingerstick PT INR, no physician notifications and no changes in orders. On 02/11/26 at 9:42 a.m., Staff B stated the there were no orders for the fingerstick PT INR.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure timely individualized POC every 60 days for one (Patient #3) of 10 patients. Findings: Patient #3 A review of the clinical record showed a SOC date of 01/16/24. The POC for certification period 01/16/26 to 03/16/26 was not completed and sent to the physician for review and signature as of 02/11/26 (26 days from the start of care date). A review of the plan of care dated 01/16/26 to 03/16/26 showed a PT frequency of two times a week for three weeks from PT evaluation on 01/18/26 and an additional PT frequency of one time a week for four weeks from re-evaluation on 02/04/26 (19 days from the start of care). On 02/11/26 at 9:42 a.m., Staff B stated: The agency added additional PT visit frequency from the re-evaluation to the POC because it had not been completed and sent to the physician.The POC was not completed from the start of care on January 16th.

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: The SN notified the physician of oxygen saturation percentages outside of the reporting parameter for one (Patient #1) of 10 patients. The SN notified the physician of blood pressure levels outside of the reporting parameter for two (Patients #2 and #4) of 10 patients. The SN notified the physician of weight readings outside of the reporting parameter for three (Patients #4, 5 and #8) of 10 patients. The SN notified the physician of heart rates outside of the reporting parameter for two (Patients #5 and #8) of 10 patients. The SN notified the physician of blood sugar levels outside of the reporting parameter for one (Patient #8) of 10 patients. A PT visit frequency was conducted as ordered for one (Patient #10) of 10 patients. Findings: Patient #1 A review of the POC dated 01/16/26 to 03/16/26 showed orders for SN to assess and report to the physician pulse oximeter readings less than 90 % every visit. A SN visit note dated 01/29/26 showed a pulse oximeter reading of 88% and showed no physician notification until an auto-system notification was sent by fax on 02/02/26 (4 days later). On 02/11/26 at 9:36 a.m., Staff B stated the nurse did not notify the physician of the pulse oximeter reading. Patient #2 A review of the POC dated 01/06/26 to 03/06/26 showed orders for SN to assess and report to the physician diastolic blood pressure level less than 60 every visit. A SN visit note dated 01/15/26 showed a diastolic blood pressure of 58 and showed no physician notification. On 02/11/26 at 9:42 a.m., Staff B stated the nurse did not notify the physician of the diastolic blood pressure reading. Patient #4 A review of the POC dated 01/13/26 to 03/13/26 showed orders for SN to assess and report to the physician blood pressure level greater than 140/90 and to weigh the patient every visit. A SN visit note dated 01/16/26 showed a blood pressure reading of 205/98 and showed no weight assessment was conducted, and no physician notification until an auto-system notification was sent by fax on 01/19/26 (3 days later). On 02/11/26 at 9:46 a.m., Staff B stated: The nurse did not notify the physician of the blood pressure reading.The nurse did not assess the patient’s weight. Patient #5 A review of the POC dated 12/31/25 to 02/28/26 showed orders for SN to assess and report to the physician pulse level greater than 80 and report weight less than 120 pounds every visit. A SN visit note dated 01/26/26 showed a pulse rate of 82, a patient weight of 119 pounds and showed no physician notification. On 02/11/26 at 9:51 a.m., Staff B stated the nurse did not notify the physician of the pulse reading or weight. Patient #8 A review of the POC dated 12/07/25 to 02/04/26 showed orders for SN to assess and report to the physician random blood sugar level greater than 250, fasting blood sugar greater than 200, pulse level greater than 100 and report weight less than 195 pounds every visit. A SN visit notes dated: 12/11/25 showed a random blood sugar reading of 500 and a weight of 189 pounds and showed no physician notification until an auto-system notification was sent by fax on 12/15/25 (4 days later) and no change in orders. 12/18/25 showed a random blood sugar reading of 275 and a weight of 190 pounds and showed no physician notification until an auto-system notification was sent by fax on 12/22/25 (4 days later) and no change in orders. 01/02/26 showed a fasting blood sugar reading of 204 and a weight of 188 pounds and showed no physician notification until an auto-system notification was sent by fax on 01/05/25 (3 days later) and no change in orders. 01/08/26 showed a weight of 188 pounds and showed no physician notification until an auto-system notification was sent by fax on 01/09/25 (1 day later) and no change in orders. 01/15/26 showed a weight of 189 pounds and showed no physician notification showed a random blood sugar reading of 275 and a weight of 190 pounds and showed no physician notification and no change in orders. 01/22/26 showed a random blood sugar reading of 289, a weight of 184 pounds and a pulse of 113 and showed no physician notification until an auto-system notification was sent by fax on 01/25/26 (3 days later) and no change in orders. On 02/11/26 at 10:00 a.m., Staff B stated the nurse did not notify the physician of the assessment findings during the visits. Patient #10 A review of the POC dated 08/23/25 to 10/21/25 showed orders for a PT frequency of one time a week for two weeks. A review of PT visit notes showed during the week of 08/31/25 to 09/06/25 no PT visit was conducted (one visit ordered). The clinical record showed no patient refusal of visit, physician notification and no change in orders. On 02/11/26 at 10:09 a.m., Staff B stated a PT visit should have been made that week.

Governing body CFR(s): 484.105(a) Standard: Governing body. A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency's overall management and operation, the provision of all home health services, fiscal operations, review of the agency's budget and its operational plans, and its quality assessment and performance improvement program. This STANDARD is not met as evidenced by: Based on record reviews and interviews, the agency failed to ensure governing body oversite of budget and capital expenditure planning and annual program evaluation in calendar years 2024 and 2025 for all patients and employees. Findings: A review of governing body meeting minutes dated 05/02/24, 08/15/24, 11/25/24, 02/27/25, 04/30/25 and on 08/08/25 showed no governing body oversite of budget and capital expenditure planning and no annual program evaluation for the agency. Additional governing body meeting minutes dated after the 08/08/25 governing body meeting were requested, yielding no results. On 02/11/26 at 11:00 a.m., Staff B stated the governing body meeting minutes showed no budget and program evaluations specific to the agency.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure SN visit notes showed documentation of interventions conducted for two (Patients #4 and #7) of 10 patients. Findings: Patient #4 A review of the POC dated 01/13/26 to 03/13/26 showed orders for SN to assess and perform wound care interventions to left below the knee amputation wound site each visit. SN visit note dated 01/16/26 showed no wound site interventions during the visit and showed no physician notifications and no changes in orders. On 02/11/26 at 9:46 a.m., Staff B stated SN visit note did not document the wound site interventions that were performed. Patient #7 A review of the POC dated 10/19/25 to 12/17/25 showed orders for SN to assess and perform wound care interventions to left and right buttock wound sites weekly. SN visit note dated 10/21/25 showed no wound site interventions during the visit and showed no physician notifications and no changes in orders. On 02/11/26 at 9:46 a.m., Staff B stated SN visit note did not document the wound site interventions that were performed.

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 interviews, the agency failed to ensure transfer and discharge summaries were provided to the receiving service providers for three (Patients #7, 9 and #10) of 10 patients. Findings: Patient #7 A review of the clinical record showed a discharge to hospice on 10/23/25 and showed no discharge summary was provided to the hospice. On 02/11/26 at 9:57 a.m., Staff B stated the discharge summary was not sent to the hospice. Patient #9 A review of the clinical record showed a discharge to hospice on 11/15/25 and showed no discharge summary was provided to the hospice. On 02/11/26 at 10:06 a.m., Staff B stated the discharge summary was not sent to the hospice. Patient #10 A review of the clinical record showed a transfer to in-patient hospital care on 10/14/25 and showed a transfer summary was provided to the physician on 10/21/25 (7 days later). On 02/11/26 at 10:09 a.m., Staff B stated the transfer summary was not sent to the physician until a week after the transfer.