Every finding on record at Homecare Clinicians, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 02/13/25 to 02/14/25. No deficiencies were cited related to the complaint, standard level deficiencies were cited as a result of the survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 02/13/25 to 02/14/25. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff A was identified as a contact person for administrative issues and Staff B was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff A, B, C, D and E. Standard level deficiencies were cited as a result of the survey. Glossary: ABN advance beneficiary notice HHA Home Health Agency HHCOC home health change of care Mg milligrams POC Plan of Care SN skilled nurse

Patient/payer will no longer pay for services CFR(s): 484.50(d)(2) The patient or payer will no longer pay for the services provided by the HHA; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure advance beneficiary notice and/or HHCOC notice was provided to a patient prior to discharge from agency services for one (Patient #13) of 13 patients. Findings: Patient #13 A review of the clinical record showed no advance notice of discharge or home health change of care notice prior to discharge from the agency on 09/13/24 for insurance payor denial of services. On 02/14/25 at 3:10 p.m., Staff B stated: 1. There were no ABN or HHCOC notices in the clinical record for patient #13 and; 2. Patient #13 should have received an ABN and/or HHCOC notices prior to being discharged from the agency for insurance payor denial of services.

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, the agency failed to ensure a medication profile was reviewed and updated with ordered medications for two (Patients #5 and #7) of 13 patients. Findings: Patient #5 A review of a POC dated 01/24/25 to 03/24/25 showed orders for Trulicity (a diabetic medication) 0.75 mg subcutaneous injection weekly and Trulicity 1.5 mg subcutaneous injection weekly. A SN visit note dated 01/28/25 documented the patient did not have the medication (Trulicity) available to administer in the residential care facility and the medical provider ordered Glipizide 5 mg by mouth be increased to two times a day. A review of the medication profile showed no communication with the medical provider regarding dual doses of the medication and showed no update to the medication profile. On 02/14/25 at 2:13 p.m., Staff B stated: 1. The Trulicity 0.75 mg dose should have been discontinued at the recertification on or before 01/24/25 and increased to the 1.5 mg weekly dose and; 2. The SN should have clarified with the medical provider if the Trulicity should be discontinued, as it was not available for administration. Patient #7 A review of a POC dated 01/04/25 to 03/04/25 showed a verbal order dated 01/24/25 for Doxycycline 100 mg twice a day starting on 01/20/25. The medication profile showed no end date (duration) for the medication and showed no notifications or changes in orders. On 02/14/25 at 2:20 p.m., Staff B stated the medication profile will not update medication until the 485 (POC, orders) are approved (signed and returned by the medical provider).

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 ordered placement of compression stockings for one (Patient #4) of 13 patients. Findings: Patient #4 A review of the POC dated 12/14/24 to 02/11/25 showed orders for SN to assess, instruct and perform blood sugar testing every visit for diabetes management. Documentation showed during SN visits conducted on 01/11/25, 01/17/25 and on 01/31/25 SN applied compression stockings to the bilateral lower extremities. Documentation showed no physician notification and no changes in orders. On 02/14/25 at 2:11 p.m., Staff B stated the POC for patient #4 did not include application of compression stockings to bilateral lower extremities for patient #4.

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: SN notified the physician for weight readings outside of reporting parameters as ordered on the POC for one (Patient #1) of 13 patients. SN notified the physician for blood pressure reading outside of reporting parameters as ordered on the POC for two (Patients #2 and #8) of 13 patients and. SN conducted wound site care ordered on the POC for one (Patients #7) of 13 patients. Findings: Patient #1 A review of a POC dated 01/17/25 to 03/17/25 showed orders for SN to assess, monitor patient’s weight every visit and notify physician of weight gain of 2 to 5 pounds in 1 week. Documentation showed that during SN visits on 01/20/25 patient’s weight was 141 pounds (4-pound gain in 3 days). Documentation showed no physician notifications and no change in orders. On 02/14/25 at 2:00 p.m., Staff B stated the SN should have notified the physician of the patient’s weight gain outside of reporting parameters. Patient #2 A review of a POC dated 01/06/25 to 03/06/25 showed orders for SN to assess, monitor patient’s blood pressure every visit and notify physician of diastolic blood pressure less than 50. Documentation showed during SN visits on 01/20/25 the patient’s diastolic blood pressure was 46. Documentation showed the physician was not notified until 01/28/25 (eight days later) of the patient’s diastolic blood pressure and showed no change in orders. On 02/14/25 at 2:05 p.m., Staff B stated the SN should have notified the physician of the diastolic blood pressure that was outside of reporting parameters at the time of the SN visit. Patient #7 A review of the POC dated 01/04/25 to 03/04/25 showed orders for SN to assess, instruct caregiver and perform wound site care to gluteal skin fold with wound cleanser, apply calcium alginate to wound bed and cover with Opti foam dressing every visit. Documentation showed during SN visits conducted on 01/10/25, 01/24/25, 01/31/25 and on 02/07/25 SN documentation showed no wound site care to gluteal skin fold was conducted during the SN visits. Documentation showed no physician notification and no changes in orders. On 02/14/25 at 2:20 p.m., Staff B stated SN should have completed wound site care to the gluteal skin fold for patient #7 each visit. Patient #8 A review of a POC dated 01/09/25 to 03/09/25 showed orders for SN to assess, monitor patient’s blood pressure every visit and notify physician of diastolic blood pressure less than 50. Documentation showed during ST visits on 01/23/25 the patient’s diastolic blood pressure was 48. Documentation showed no physician notification and showed no change in orders. On 02/14/25 at 2:30 p.m., Staff B stated the ST should have notified the physician of the diastolic blood pressure that was outside of reporting parameters at the time of the ST visit.

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 a completed discharge summary was provided for two (Patients #12 and #13) of 13 patients. Findings: Patient #12 A review of the clinical record showed discharge from the agency on 12/05/24 to the hospice service provider. Documentation showed no discharge summary was provided to the hospice service provider and was not provided to the physician service provider until 12/12/24 (7 days later). Patient #13 A review of the clinical record documented discharge from the agency on 09/13/24 due to no authorization of payment from insurance payor source. Documentation showed no discharge summary was provided to the physician service provider until 09/20/24 (7 days later). On 02/14/25 at 3:05 p.m., Staff B stated no discharge summaries should have been provided to the receiving service providers for patients #12 and #13 within 48 hours of discharge from the agency.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 04/11/22 to 04/12/22. 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 04/11/22 through 04/12/22 An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff B and Staff C were identified as the contact persons for administrative 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 Medicare re-certification survey. Glossary: mg milligram POC Plan of Care QAPI Quality Assessment Performance Improvement SN skilled nurse

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, the agency failed to ensure a medication profile was reviewed and updated with dose instruction for an ordered medication for one (Patient #5) of 10 patients. Findings: Patient #5 A review of a POC dated 03/03/22 to 05/01/22 showed an order dated 04/06/22 for furosemide 60 mg once daily. The documentation showed the medication profile was changed from furosemide 40 mg (one tablet) once daily to furosemide 60 mg (one 40 mg tablet) once daily (for a continued 40 mg dose once daily). Documention showed no division of tablet dose or instructions on how to administer 60 miligrams with a 40 miligram table. On 04/12/22 at 11:50 a.m., Staff B stated the medication profile should have been updated to reflect and included direction for a 1 ½ tablet dose instruction of furosemide 40 mg to equal a furosemide 60 mg dose once daily.

At discharge CFR(s): 484.55(d)(3) At discharge. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a discharge oasis assessment was completed for two (Patients #1 and #2) of 10 patients. Findings: Patient #1 A review of the clinical record documented discharge from the agency on 01/04/22 to other home health agency provider services. Documentation showed no discharge visit, and no discharge oasis assessment was completed. Patient #2 A review of the clinical record documented discharge from the agency on 02/23/22 to hospice provider services. A communication note dated 02/23/22 documented a post hospital resumption of care assessment had been conducted. An order dated 02/25/22 showed documentation to discontinue speech therapy and physical therapy evaluations and refer patient to hospice services. Documentation showed no discharge visit, and no discharge oasis assessment was completed. On 04/12/22 at 11:40 a.m., Staff B stated discharge oasis assessments had not been conducted for Patients #1 and #2.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the Infection Control Program was included in QAPI activities for all patients and staff. Findings: An agency policy titled, Infection Control Surveillance, stated information will be reported and included in the quality assessment performance improvement plan. A review of QAPI administrative records showed no infection control surveillance data for calendar year's 2020, 2021 and 01/01/22 to 04/12/22. On 04/12/22 at 2:00 p.m., Staff B stated infection surveillance activities were not reported through the agency's QAPI program.

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 discharge summary was provided for two (Patients #1 and #2) of 10 patients. Findings: Patient #1 A review of the clinical record documented discharge from the agency on 01/04/22 to other home health agency provider services. Documentation showed no discharge summary provided to the other home health service provider. Patient #2 A review of the clinical record documented discharge from the agency on 02/23/22 to hospice provider services. Documentation showed no discharge summary provided to the hospice service provider. On 04/12/22 at 11:40 a.m., Staff B stated no discharge summary was sent to the receiving service providers for Patients #1 and #2.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure clinical records were complete timely for one (Patient #6) of 10 patients. Findings: Patient #6 A review of the clinical record showed a SN visit conducted on 02/04/22 was not completed until 03/01/22, almost a month after the visit occurred. On 04/12/22 at 12:00 p.m., Staff B stated the SN visit note dated 02/04/22 was completed on 03/01/22 but should have been completed within two days of the visit.