Every finding on record at Healthcare Innovations In-Home Services of Hugo, LLC

The Oklahoma State Department of Health conducted and unnounced Medicare Emergency Preparedness Program survey at the agency on 09/20/22 to 09/21/22. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannouced Medicare re-certification survey at the agency on 09/20/22 to 09/21/22. An entrance conference was conducted with Admin1. The survey process was explained. Questions were answered. Admin1 was indentified as the contact person for Administative issues and the contact person for clinical issues. Findings were discussed during an informal exit conference with Admin1. Standard level deficiencies were cited as a result of the re-certification survey. Glossary: Admin Administrator POC Plan of Care SN Skilled Nurse PT Physical Therapist

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, SN staff failed to include all medications the patient was currently using during a review of medications for one (#3) of seven (#1 - #7) records reviewed. Patient #3 A review of the record for Patient #3 for certification period 09/06/22 - 11/04/22 revealed a primary diagnosis of Chronic Obstructive Pulmonary Disease with Lower Respiratory Infection. SN and PT Visit notes indicated Patient #3 was currently using Oxygen per nasal cannula on a continuous basis. Further review of the agency form entitled "Client Medication Report" failed to identify Oxygen as a current medication for Patient #3. During an interview on 09/21/22 at 1:45 PM, Admin1 stated the SN failed to include Oxygen as a current medication on the medication profile for Patient #3.

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 provide an individualized POC to include patient-specific interventions and measurable outcomes and goals for one (#3) of seven (#1 - #7) records reviewed. Patient #3 A review of the POC for certification period 09/06/22 - 11/04/22 revealed a primary diagnosis of Chronic Obstructive Pulmonary Disease with Lower Repiratory Infection and secondary diagnosis of Type II Diabetes Mellitus with Long Term use of Insulin. The POC included orders for "SN for O/A and teaching of Endocrine System to identify changes associated with exacerbation of DMII for early interention of complications". The POC failed to provide evidence of patient-specific blood glucose parameters or interventions or measurable outcomes and goals for Diabetes Managment. Further review of SN Visit Note for 09/14/22 indicated Patient' #3's normal blood glucose range was 100 - 200. The SN documented a fasting blood glucose reading of "69" for that visit. No documentation indicated the SN provided any intervention or notified the physician of the blood glucose result. During an interview on 09/21/22 at 01:45 PM, Admin1 stated the agency failed to include individualized interventions and measureable goals in the POC specific to patient assessed needs for Diabetes Mellitus for Patients #3.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interview, the SN staff failed to provide wound care in accordance with current clinical practice guidelines and accepted standards of practice for one (#7) of three (#1, #4 and #7) records reviewed with orders for wound care services. Patient #7 A review of the POC for Patient #7 for certification periods 06/18/22 to 09/01/22 revealed a primary diagnosis of Nonsurgical Wound Dressing change and included orders for SN visits 1 time a week for 8 weeks and "SN or trained caregiver to perform wound care using aseptic technique to apply Unna Boot compression system...every 7 days..." Further reveiw of Agency policy and procedure entitled, "Unna Boot" provided by Admin1 stated under "Documentation Guidelines ... wound measurements at least weekly". Review of SN Visit Notes failed to provide evidence of weekly wound measurements for 6 weeks (07/16/22 - 08/29/22). On 09/21/22 at 01:45 PM, Admin1 stated the SN staff failed to obtain weekly wound meaurements as required for Patient #7.