Every finding on record at Jeks Healthcare Services Inc

A Relicensure/Recertification, complaint and Regional Desk Review Survey entrance conference was conducted on 02/15/2022 at 11:50 AM, with the agency Administrator present. Census: L&C - 0 LHHS - 1 PAS - 28 Complaint Intake: #330768 ROR(s): #286610 & #331735 An exit conference was conducted on 02/17/2022 with the Agency's Administrator at 5:10 PM. The preliminary findings were discussed. The agency was in substantial compliance with 42 CFR Part 484.22 Emergency Preparedness Requirements for Home Health Agencies.

A Relicensure/Recertification, complaint and Regional Desk Review Survey entrance conference was conducted on 02/15/2022 at 11:50 AM, with the agency Administrator present. Census: L&C - 0 LHHS - 1 PAS - 28 Complaint Intake: #330768 ROR(s): #286610 & #331735 An exit conference was conducted on 02/17/2022 with the Agency's Administrator at 5:10 PM. The preliminary findings were discussed. The agency is not in compliance with deficiencies cited.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on interview and record review the agency failed to ensure the patient received the services written in the Plan of Care and ordered by the physician for 1 of 2 (Patient 4) skilled patient records reviewed in that the nurse failed to report increase in the patient’s pain level greater than 6, on a 0-10 scale, to the physician. This failure placed all agency patients at risk of not receiving interventions as needed and could result in declining health status, a poor quality of life and suffering. Finding include: Review of the patient #4’s Plan of Care dated 09/12/21-11/10/21 revealed diagnoses of Essential Hypertension (high blood pressure); Type 2 Diabetes (a disease that occurs when the blood glucose, also called blood sugar, is too high; Unilateral Primary Osteoarthritis (Primary osteoarthritis is caused by the breakdown of cartilage, a rubbery material that eases the friction in the joints); Pain in Left and Right Knee and Peripheral Vascular Disease (A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs).. Review of the Plan of Care also revealed orders as follows: SN to notify physician of: Temperature greater than 101 and less than 96; Pulse greater than 120 or less than 60; Respirations greater than 30 or less than 14; Systolic BP greater than 160 and less than 90; Diastolic BP greater than 90 or less than 60; Fasting blood sugar less than 70mg/dl or greater than 300 mg/dl; Non-fasting blood sugar less than 70 mg/dl or greater than 300 mg/dl; Pain level greater than 6 on a scale of 0-10. A review of the Medication Profile dated 11/10/21 for patient #4 revealed that the physician ordered the following medications for pain: Acetaminophen 325mg/Tramadol HCL 37.5 mg oral tablet/ 1 tab PO every other day. Diclofenac Sodium 1% Topical Gel (Voltaren). Apply topical gel daily prn Lidocaine 5% Topical ointment. Apply topical ointment every 6 hrs. prn [The definition of pain by Margo McCaffery, in 1968, stated “pain is whatever the experiencing person says it is, existing whenever he says it does”. In an article by Lars Johannessen entitled “The Commensuration of Pain: How Nurses transform subjective experience into objective numbers” he wrote that the intensity of pain is a subjective measurement based on the patient’s perception of his pain and presents a unique problem in terms of measurement and suffering. Nurses measure pain by using a numeric rating scale to assess the present intensity of pain. The scale is from 0 (no pain) to 10 (the worst pain you can imagine). In the article “The Pain of Measuring Pain” by Harvard Health, pain is ranked as 0- No pain; 1-3 Mild pain; 3-5 moderate pain; 5-7 severe pain; 7-9 very severe pain and 9-10 the worst pain possible.] In a review of the Recertification Assessment dated 09/09/21 completed by the Sup Nurse it was noted that the patient reported a present pain level of 8 in a 0-10 scale in his left knee. The pain was described as aching and intermittent. Her goal for the patient was “Patient will verbalize/ demonstrate improved use of relaxation techniques and non-pharmalogical interventions for pain as evidenced by decreased events of break-through pain requiring additional medication by the end of the episode”. There was no evidence in the nursing note that the physician was notified of the pain level of 8 (very severe pain). In a further review of the patient #4 medical record, it was revealed that on 09/17/21 the patient reported a pain level of 7 (severe pain) on a 0-10 scale in his right knee. There was no evidence that the physician was contacted about this level of pain. On 09/21/21 the medical record reveled a nursing note with a recorded pain level of 9 (very severe to the worst possible pain) on a 0-10 scale in both of his lower legs. There was no evidence that the physician was contacted about this level of pain. On 10/21/21 the medical record revealed a nursing note with a recorded pain level of 8 (very severe pain) on a scale of 0-10 in his right knee. There was no evidence that the physician was notified. In an interview with the Sup Nurse (who was also the nurse who visited the patient) on 02/16/22 at 2:30 PM, she stated that she did not report the pain greater than 6 as the patient may have said his pain is 8 but he did not have the signs of severe pain. She stated that the patient did not have grimacing, guarding, rubbing, crying, restlessness or agitation that you would expect to see in someone with that kind of pain. She stated that she was aware that if the patient said his pain was 9 then it was 9. She stated that she didn’t think it necessary to report to the physician even though the orders stated, “report pain greater than 6”. The agency policy IV. 023 entitled Pain Management stated in part …. “Assessment of pain: Pain will be assessed every visit. Pain is whatever the patient believes it to be.” The agency policy VII. 022 entitled Skilled Nursing stated in part … “The nurse will make intermittent, follow-up visits after the home evaluation according to the clients’ needs as determined by the physician and the agency staff. The visits will include but not limited to the following: Noting vital signs as ordered and reporting to the physician if vital signs are not within established parameters.” [“Pain was officially declared "The Fifth Vital Sign." Henceforth the evaluation of pain became a requirement of proper patient care as important and basic as the assessment and management of temperature, blood pressure, respiratory rate, and heart rate”. NCBI, Nov-Dec 2008;8(6):417-22. Epub 2008 July 25.- The Fifth Vital Sign---What does it Mean?]