Every finding on record at Healthcare Innovations of Oklahoma, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 06/02/25 - 06/04/25. 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 Complaint #105390 at the agency on 06/02/25 - 06/04/25. An entrance conference was conducted with the Staff A and Staff B. The survey process was explained. Questions were answered. The Staff A was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff A, Staff B, and other administrative staff. Deficiencies were cited as a result of the Medicare re-certification survey. No deficiencies were cited related the complaint. Glossary: SN Skilled Nurse RN Registered Nurse SOC Start of Care POC Plan of Care HHA Home Health Aide SAV Supervisory Aide Visit OASIS Outcome Assessment and Information Set

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on record review and interview, the Agency failed to transmit completed Outcome and Assessment Information Set (OASIS) assessment to the CMS system within the required 30 days. Pre-survey review of OASIS Error Summary Report for the year 01/01/2024 to 12/31/2024 showed a total of 33 Late Submission Error -3330 Warning messages for 1.11% error rate. During an interview on 06/02/25 at 2:15 PM, Staff A stated the Agency began a new review process in January 2025 and this new process has resulted in a higher error rate for late submissions. Review of an agency HHA Error Summary Report provided by Staff A for the previous year of 06/02/2024 - 06/02/2025 showed 119 Warning Messages for Late Submission for a total 3.59% error rate. A second review of the Current Year-To Date 01/01/2025 - 05/31/2025 showed 99 Warning Messages for a total 6.66% error rate. During an interview on 06/02/25 at 3:00 PM, Staff A stated Agency's failure to submit assessments after completion within the required 30-day period.

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 the RN conducted onsite Supervisory Aide Visits (SAV) at least every 14 days for three (#1, #6 and #12) of five (#1, #3, #5, #6 and #12) patients records reviewed with orders for Home Health Aide (HHA) services. Patient #1 A review of the POC for Patient #1 for recertification period 04/13/25 to 06/11/25 showed a Primary Diagnosis of Urinary Tract Infection and orders for HHA services two time a week for eight weeks and one time a week for one week. Review of HHA Visit notes showed HHA visit were conducted weekly as ordered. Further review of SN Visit notes for the same time period showed the RN conducted a SAV on 05/06/25 and next on 05/21/25 (1 day late). Patient #6 A review of the POC for Patient #6 for recertification period 05/14/25 to 07/12/25 showed a Primary Diagnosis of Pressure Ulcer to Right and Left Heels and orders for HHA services one time a week for one week and two times a week for eight weeks. Review of HHA Visit notes showed HHA visit were conducted weekly as ordered. Further review of SN Visit notes for the same time period showed the RN conducted a SAV on 05/12/25 and next on 06/02/25 (7 days late). Patient #12 A review of the POC for Patient #12 for recertification periods 03/29/25 to 05/27/22 and 05/28/25 to 07/26/25 showed a Primary Diagnosis of Chronic Kidney Disease with Heart Failure and orders for HHA services one time a week for nine weeks. Review of HHA Visit notes showed HHA visit were conducted weekly as ordered. Further review of SN Visit notes for the same time period showed the RN conducted a SAV on 04/08/25 and next on 04/24/25 (2 days late), 05/06/25, 05/20/25 and no SAV was documented when due on 06/03/25. During an interview on 06/04/25 at 2:45 PM, Staff A stated the Supervisory Visits were not completed timely for patients #1, #6 and #12.

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 review and interview, the Agency failed to send a completed transfer summary to the facility within 2 business days for one (#17) of two (#15 and #17) records reviewed for patients transferred to short term general hospitals. Patient #17 Record review for certification period 03/03/25 to 05/04/25 showed a Primary Diagnosis of Pressure Ulcer to Sacral Region and included a 04/23/25 Client Coordination Note titled "Hospital Hold" and Transfer Summary with documentation the patient was transferred to a local hospital due to Sepsis on 04/22/25. Further record review failed to provide evidence the Transfer Summary was sent to the facility. During an interview on 06/04/25 at 2:45 PM, Staff A stated a Transfer Summary was not sent to the facility for patient #17.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 07/27/22 to 07/28/22. 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 07/27/22 to 07/28/22.An entrance conference was conducted with Admin1 and Director1. The survey process was explained. Questions were answered.Admin1 was identified as the contact person for administrative issues and Director1 as the contact person for clinical issues. Findings were discussed during an informal exit conference with Admin1, Director1 and Administrative staff.Standard level deficiencies were cited as a result of the re-certification survey.GLOSSARY: Admin Administrator RN Registered Nurse SN Skilled Nurse POC Home Health Certification and Plan of Care HHA Home Health Aide SAV Supervisory Aide Visit

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record review and interview, the RN failed to ensure development of HHA POC with specific instructions determined by patient care needs for one (#3) of four (#2, #3, #5 and #10) records reviewed with orders for home health aide services. Patient #3 A review of the clinical record for Patient #3 re-certification period 07/11/22 - 09/08/22, revealed a principal diagnosis of a Fractured Femur and orders for HHA visits one time a week for nine weeks to assist with bathing. A form titled, "Aide Care Plan Report" contained instructions for the HHA to provide "Bathing -Shower" every visit and "Bathing- Bed Bath" every visit. Further review of weekly HHA Visit notes for 07/15/22, 07/19/22 and 07/26/22 indicated the HHA provided a Shower and no Bed Bath as instructed by the Aide Care Plan. During an interview on 07/28/22 at 9:30 am, Patient #3 stated she always takes a shower with the help of her Aide. On 07/28/22 at 12:30 pm, Director1 stated the Aide Care Plan instructions by the RN for Patients #3 failed to provide patient specific bathing instructions for the HHA based on patient care needs.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(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 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 §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the RN conducted onsite Supervisory Aide Visits at least every 14 days for one (#5) of four (#2, #3, #5 and #10) patients records reviewed with orders for Home Health Aide (HHA) services. Patient#5 A review of the POC for Patient #5 for recertification period 06/05/22 to 08/03/22 with a Primary Diagnosis of Essential Hypertension included orders for Home Health Aide (HHA) services one time a week for eight weeks. Review of HHA Visit notes revealed HHA visit were conducted weekly as ordered on 06/08/22 through 07/27/22. Further review of SN Visit notes for the same time period indicated the RN conducted a SAV on 06/21/22 and next on 07/06/22 (1 day late). On 07/28/22 at 12:30 PM, Director1 stated the Supervisory Aide Visit was not conducted every 14 days by the RN as required.