Every finding on record at Kpar Investments, LLC

The Oklahoma State Department of Health conducted an unannounced Emergency Preparedness Program survey at the agency on 12/13/22 to 12/14/22, No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Health Department conducted an unannounced Medicare re-certification survey at the agency on 12/13/22 to 12/14/22. An entrance conference was conducted with Admin1 and RN1. The survey process was explained. Questions were answered. Admin1 was identified as the contact person for administrative issues and RN1 was identified as the contact person for clinical issues. Findings were discussed during an informal exit conference with Admin1 and RN1. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: Admin Administrator RN Registered Nurse SN Skilled Nurse HHA Home Health Aide POC Plan of Care

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on record review and interview, SN staff failed to ensure SN Visit Notes provided current and accurate assessments for two (#2 and #4) of three (#2, #4 and #7) records reviewed with orders for SN to assess signs and symptoms of Congestive Heart Failure. Patient #2 Review of the POC for Patient #2 certification period 11/05/22 - 01/03/23 with Primary Diagnosis of Hypertensive Chronic Kidney Disease with Heart Failure included orders for SN visits one time a week for four weeks and "SN to obtain weight every visit ... report abnormal to MD weight +5 lbs or -5 lbs in 1 -2 weeks". Review of weekly SN Visit Notes failed to provide evidence weights were obtained as ordered for the period of 11/0722 through 11/28/22. Patient #4 Review of the POC for Patient #4 for certification period 11/01/22 - 12/30/22 with Primary Diagnosis of Hypertensive Chronic Kidney Disease with Heart Failure included orders for SN visits one time a week for nine weeks and "SN to obtain weight or calf circumference every visit ... report abnormal to MD weight or cm growth +5 lbs or -5 lbs in 1 -2 weeks". Review of weekly SN Visit Notes failed to provide evidence weights or calf circumference measurements were obtained as ordered for the period of 11/07/22 through 12/09/22. On 12/14/22 at 12:00 PM, Admin1 stated the SN staff confirmed weights were obtained as ordered for each visit, but SN failed to document in SN Visit Note as required to ensure the clinical record provided current and accurate assessments for Patients #2 and #4.

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, RN failed to conduct Supervisory Aide Visits at least every 14 days for two (#1 and #6) of three (#1, #4 and #6) records reviewed with orders for Home Health Aided (HHA) services. Patient #1 Review of the POC for Patient #1 certification period 10/29/22 - 12/27/22 with Primary Diagnosis of Hypertensive Chronic Kidney Disease included orders for HHA services two times a week for eight weeks. Review of HHA Visit Notes revealed HHA visits were conducted weekly as ordered for 7 weeks of 10/31/22 through 11/12/22. Further review of SN Visit Notes revealed the RN failed to conduct any Supervisory Aide Visits (SAV) during the same 7week period of 10/31/22 through 11/12/22. Patient #6 Review of the POC for Patient #6 for certification period 09/12/22 - 11/10/22 with Primary Diagnosis of Type II Diabetes Mellitus included orders for HHA services two times a week for nine weeks. Review of HHA Visit Notes revealed HHA visits were conducted weekly as ordered for 5 weeks of 09/12/22 through 10/10/22. Further review of SN Visit Notes revealed the first SAV conducted by the RN was during week 5 and no SAV RN visits were conducted for the first 4week period of 09/12/22 through 10/10/22. On 12/14/22 at 12:00 PM, Admin1 stated the Supervisory Aide Visits were not conducted by the RN at least every 14 days as required for Patients #1 and #6.