Every finding on record at Hoffmeyer Tate Incorporated

A Recertification survey entrance conference was conducted on 02/07/2023 at 11:00 a.m. with the Therapy Director and by telephone with the Alternate Administrator. The census was: Waco: L&CHHS- 112 An exit conference was conducted on 02/10/23 at 11:20 a.m. with the Alternate Administrator, Therapy Director and by telephone with the Administrator. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies.” Abbreviations: L&CHHS- Licensed and Certified Home Health Services RN- Registered Nurse LVN- Licensed Vocational Nurse SN- Skilled Nurse ASN- Alternate Supervising Nurse Pt- Patient lb- pound OT- occupational therapy HEP- home exercise program ROM- range of motion IADLS- improvement in activities of daily living

A Recertification survey entrance conference was conducted on 02/07/2023 at 11:00 a.m. with the Therapy Director and by telephone with the Alternate Administrator. The census was: Waco: L&CHHS- 112 An exit conference was conducted on 02/10/23 at 11:20 a.m. with the Alternate Administrator, Therapy Director and by telephone with the Administrator. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies.” Abbreviations: L&CHHS- Licensed and Certified Home Health Services RN- Registered Nurse LVN- Licensed Vocational Nurse SN- Skilled Nurse ASN- Alternate Supervising Nurse Pt- Patient lb- pound OT- occupational therapy HEP- home exercise program ROM- range of motion IADLS- improvement in activities of daily living

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 patient care was communicated with the patient’s physician for 2 of 10 patients (Patient #1 and #7) for which records were reviewed. This failure caused the physician/practitioner to be unaware of the noncompliance of Patient #1 with the plan of care for and that OT services were not provided to Patient #7. Findings Included: Review of the clinical record for Patient #1 revealed a start of care date of 01/03/22. Diagnosis included: Cellulitis of left lower limb, Lymphedema, Diabetes Mellitus Type II, Hypertensive Heart Disease, Diastolic Congestive Heart Failure and Morbid Obesity. Review of the plan of care for the time period 10/30/22 – 12/28/22 revealed orders: SN (Skilled Nursing) 3WK8 (3 times per week for 8 weeks), 2W1 (2 times per week for 1 week) starting 10/30/22 with 3 PRN visits for soiled dressing. HHA 2W8 (2 times per week for 8 weeks), 1W1 (1 time per week for 1 week) starting 10/30/22. Further review of the POC revealed orders: SN to perform finger stick for fasting blood sugar/random blood sugar during visit if it has not been done or if patient reports signs and symptoms of hypo/hyperglycemia. SN to instruct patient on daily weight self-monitoring program where the patient utilizes the same scales on a hard, flat surface each morning before breakfast and after urination. Report to SN weight gain of 3 lb/1day, 5 lb/1 week. SN to assess patient’s week log every week. Review of all SN visit notes for the time period 10/30/22 – 12/28/22 revealed no documentation regarding the patient’s blood glucose levels or weights. Review of physician/practitioner orders revealed an order dated 11/1/22 which read in part, “New Renal Insufficiency on 10/31/22 labs. Hold all routine medications until I can adjust her doses for renal insufficiency.” An interview was conducted on 02/07/23 @ 12:45 PM with the ASN (Alternate Supervising Nurse). The clinical record for Patient #1 was reviewed. Surveyor requested documentation for review that orders in the plan of care were followed in that blood glucose levels and weights were monitored. The Alternate Supervising Nurse reviewed the SN visit notes and acknowledged the patient’s blood glucose levels and weights were not documented during any of the SN visits. The Alternate Supervising Nurse stated, “She refused to check her blood sugar.” Surveyor requested for review documentation that the patient’s physician/practitioner was notified orders in the plan of care were not followed due to the patient’s noncompliance. No documentation regarding coordination of care with the patient’s physician/practitioner was provided for review. An interview was conducted on 02/08/23 @ 10:30 AM with the ASN. The ASN stated she spoke with RN-A. The ASN stated the RN indicated she thought she had seen a weight log at the patient’s home. The Surveyor asked to review documentation that the patient’s weight was assessed/recorded in the patient’s record for the time period 10/30/22 – 12/28/22. The ASN acknowledged the patient’s weights were not documented. Surveyor requested documentation for review that the physician/practitioner was notified that the patient’s weights were not assessed. No documentation was provided. A home visit was conducted on 02/08/2023 at 3:00 PM with Patient #1 and LVN- D. Surveyor interviewed Patient #1 and asked if she regularly checks her glucose levels. Patient #1 stated she does not have a glucometer and doesn’t check her blood sugar levels. Surveyor asked if a glucometer was provided would she check her blood sugars. Patient #1 stated, “No. I don’t like needles and I don’t care what my blood sugars are.” Surveyor did not observe a weight log in the patient’s folder and asked if the patient kept a daily weight log. LVN- D stated she doesn’t assess her weight. Patient #1 stated, “I don’t weigh myself. I don’t have a scale.” Surveyor asked if a scale were provided would she weigh herself daily as ordered by her physician. Patient #1 stated, “No. I don’t care what I weigh. I probably weigh 300 lbs.” During the visit Patient #1 complained of a headache, dizziness, and sweating. LVN- D asked the patient if she could check her blood sugar because a high or low level may be causing her symptoms. Patient #1 declined. Patient #1 also reported to LVN- D she was taking medication that was placed on hold by the physician/practitioner. Review of the clinical record for Patient #7 revealed a start of care date of 10/26/22. Diagnosis included Encounter for Attention to Tracheostomy, Encounter for Attention to Gastrostomy, Bacteremia, Review of a physician’s order dated 11/30/22 read, “Occupational therapy to evaluate and treat for strengthening and (HEP) and IADLs (improvement in activities of daily living) and improve ROM. Further review of physician’s orders revealed an order dated 12/17/22 which read, “Order for OT to Evaluate and treat. Occupational therapy for assessment of functional deficits and home safety evaluation; (HEP) for upper body to restore strength and endurance, to increase independence with transfers, patient restore activity tolerance, instruction on non-pharmacological pain management as appropriate.” No evidence was found in the record that an OT evaluation was conducted, or OT was provided. Further review of the record revealed no documentation that the physician was notified that an OT evaluation was not completed. An interview was conducted on 02/09/23 @ 1:15 PM with the Alternate Administrator. Surveyor discussed what occurred during the home visit with Patient #1 on 02/08/2023.Surveyor requested to review evidence that the physician/practitioner was notified regarding the patient’s noncompliance with blood glucose monitoring, weight checks as well as her taking medications that the physician/practitioner ordered to be held. The Alternate Administrator stated the physician/practitioner was not notified, and coordination of care “Needs to be better.” Surveyor reviewed the clinical record for Patient #7 with the Alternate Administrator and asked if there was any documentation regarding OT services. The Alternate Administrator acknowledged the agency failed to coordinate care and services with the patient’s physician. An interview was conducted on 02/08/22 @ 12:50 PM with the Therapy Director. Documentation was requested for review that an OT evaluation was completed for Patient #7 as ordered. The Therapy Director stated the agency did not have an OT at that time to conduct the assessment. Surveyor requested to review documentation that the patient’s physician was notified that the agency could not provide OT services. The Therapy Director stated the physician was not notified. Review of the agency’s policy and procedure manual revealed a policy entitled “Monitoring Patient Care/Coordination of Care, PC.45”, which read in part “Policy: I. The agency will monitor, evaluate, and report to the patient’s/patient’s physician and/or non-physician practitioner regarding the patient’s/patient’s progress toward achieving goals established on the plan of care. II. The agency will collaborate with other organizations providing services (i.e., medical equipment, other home health agencies, out-patient clinics, etc.), the patient/patient, and their representative (if applicable) to ensure appropriate coordination of care.“