Every finding on record at Lakes Area Medical Supply Inc

A recertification survey was conducted on 05/26/26. The census was 30 (L&C) and 0 (LHH). The agency is in compliance with no deficiencies cited. Acronyms used: L&C- Licensed and Certified LHH- Licensed Home Health

A recertification survey was conducted on 05/11/26. The census was 106 (L&C) and 0 (LHH). Acronyms used: CMS- Center for Medicare and Medicaid Services HHA- Home Health Agency iQIES- Internet Quality Improvement and Evaluation System OASIS- Outcome and Assessment Information Set L&C- Licensed and Certified LHH- Licensed Home Health

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 code and electronically transmit each completed OASIS (data collected as part of the comprehensive assessment) assessment to the CMS system within thirty days of completing the assessment of the beneficiary for 72 of 262 assessments submitted from 05/18/25 to 05/18/26 (27.48%). This failure prevented the agency’s patient OASIS data from being made available to CMS for analysis of patient care performance and could cause negative patient outcomes. Findings included: Record review of an iQIES OASIS HHA Error Summary by Agency Report dated 05/18/25 to 05/18/26 indicated the agency transmitted a total number of 262 assessments of which 72 assessments were indicated as being transmitted later than 30 days after completion of the assessment. (27.48%) During a telephone interview on 5/28/26 at 10:57 am, the Alternate Supervising Nurse said she was not sure how often the OASIS transmissions were supposed to be transmitted. The Alternate Supervising Nurse said she was not aware of any errors for OASIS assessments being transmitted late. During an interview and record review on 5/28/26 at 11:06 am, the Supervising Nurse said she has been in her role since 9/2/25, not quite a year. The Supervising Nurse said she believed the Alternate Administrator transmitted the OASIS assessments. The Supervising Nurse said OASIS assessments were supposed to be transmitted within 30 days. The Supervising Nurse said they review the iQIES error reports. The Supervising Nurse said she was not sure if the agency had any errors for late transmissions. The Supervising Nurse reviewed the iQIES HHA Error Summary by Agency report and confirmed the report indicated the agency had 72 late assessments. The Supervising Nurse said she was not sure why the assessments were transmitted late. The Supervising Nurse said if an OASIS assessment was transmitted late the patient could have future visits denied and not be able to continue care. During an interview and record review on 5/28/26 at 11:19 am, the Alternate Administrator said he was responsible for transmitting OASIS assessments. The Alternate Administrator said they tried to transmit OASIS assessments as soon as they could. The Alternate Administrator said the requirement was for OASIS assessments to the transmitted within 30 days. The Alternate Administrator said there shouldn’t be any errors for late OASIS transmissions. The Alternate Administrator reviewed iQIES HHA Error Summary by Agency report and confirmed the report indicated the agency had 72 late assessments. The Alternate Administrator said there was a process for transmitting the assessments that required everything to be validated and sometimes assessments were sent back and forth to clinicians for additional documentation. Attempted a telephone interview on 5/28/26 at 11:36 am with the Administrator. No answer. No option to leave a voicemail. Attempted a telephone interview on 5/28/26 at 11:48 am with the Administrator. No answer. No option to leave a voicemail. Record review of a “Conventions/Rules for Completing OASIS” policy dated 3/23/26 indicated, “… The Agency is required to submit all OASIS assessments to the national database specified by CMS within 30 days of the M0090 [completion] date. …”

A recertification survey entrance conference was conducted on 05/15/2023. Census: 15 Licensed & Certified - 15 Licensed Home Health – 0 The agency was in substantial compliance with 42 CFR Part 484.102, Emergency Preparedness Requirements for Home Health Agencies. Acronyms used: CFR- code of federal regulations

A recertification survey entrance conference was conducted on 05/15/2023. Census: 15 Licensed & Certified - 15 Licensed Home Health – 0 Acronyms used: eg- exempli gratia (for example) HHSC- Health and Human Services Commission mL- milliliter PL- provider letter RN- registered nurse

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the agency failed to ensure the plan of care contained the required elements to cover all medications and treatments, and patient specific interventions and education for 1 of 7 patients reviewed for plans of care. (Patient #2) This failure could place patients at risk of medication errors or adverse reactions, and not receiving proper care/instruction leading to complications and hospitalization. Findings included: During an observation and interview on a home visit on 05/16/23 at 8:42 a.m., Patient #2 said she had not taken her blood sugar yet. Patient #2’s blood sugar was 101 when the Supervising Nurse checked it. Patient #2 said she did not check her blood sugar every day. Patient #2 said she takes her insulin, and her son tells her after she takes her insulin she needs to eat. Record review of Patient #2’s Plan of Care dated 03/22/23 to 05/20/23 indicated a Start of Care date of 12/02/20 and indicated she was 74 years old with diagnoses including Type 2 Diabetes Mellitus (disease in which your blood sugar levels are too high) and Long term (current) use of insulin (a medication used to control blood sugar levels). The Plan of Care indicated Patient #2 indicated skilled nurse to perform fingerstick for fasting blood sugar/ random blood sugar during visit if it had not been done or if the patient reported symptoms of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). Further review revealed there was no documented evidence that patient teaching for insulin was included in the Plan of Care. Record review of Patient #2’s Medication Profile dated 03/22/23 to 05/20/23 indicated Patient #2 had orders for Insulin Lispro (fast-acting insulins used to control high blood sugar) 100 units/mL 12 units subcutaneous (injected into the fatty tissue just under the skin) three times daily and Insulin Detemir (long-acting insulin that can be taken once or twice daily to control high blood sugar) 100 units/mL 36 units subcutaneous (injected into the fatty tissue just under the skin) at bedtime. During an interview on 05/16/23 at 3:39 p.m., the Supervising Nurse reviewed Patient #2’s Plan of Care. The Supervising Nurse said Patient #2’s Plan of Care did not include patient education on insulin use or signs and symptoms of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). The Supervising Nurse said the Plan of Care for Patient #2 probably needed to be updated to include patient education on insulin use or signs and symptoms of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). The Supervising Nurse said the RN that does the certification or recertification was responsible for entering in patient specific interventions and education on the Plan of Care. The Supervising Nurse said she was the RN that completed the Plan of Care for Patient #2 on 03/21/23. During an interview on 05/17/23 at 3:30 p.m., the Supervising Nurse said if patient teaching was not completed for insulin use, checking blood sugar, and signs and symptoms of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) it could cause the patient not to be educated and could cause complications including hospitalization. During an interview on 05/17/23 at 4:45 p.m., the Alternate Administrator said his expectation was for the Plan of Care to include patients’ medications, treatments, and patient specific interventions and education. Review of Insulin Lispro (subcutaneous (injected into the fatty tissue just under the skin) precautions dated 05/18/23 and accessed at https://www.mayoclinic.org/drugs-supplements/insulin-lispro-intravenous-route-subcutaneous-route/precautions/drg-20064334 indicated “... Too much insulin lispro can cause hypoglycemia (low blood sugar). Low blood sugar can also occur if you use insulin lispro with another antidiabetic medicine, changes in insulin regimen (eg, insulin strength, type of insulin, injection site), delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting or have diarrhea. Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms of low blood sugar. It is important that you learn which symptoms you usually have so that you can treat it quickly. Talk to your doctor about the best way to treat low blood sugar. Symptoms of low blood sugar include anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, depression, difficulty in thinking, dizziness or lightheadedness, drowsiness, excessive hunger, fast heartbeat, headache, irritability or abnormal behavior, nervousness, nightmares, restless sleep, shakiness, slurred speech, and tingling in the hands, feet, lips, or tongue. … Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine or insulin, changes in insulin regimen, you overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual. High blood sugar can be very serious and must be treated right away. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat high blood sugar. Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination, ketones in the urine, loss of appetite, stomachache, nausea or vomiting, tiredness, troubled breathing (rapid and deep), unconsciousness, and unusual thirst. If these symptoms occur, check your blood sugar level and then call your doctor for instructions. …” Record review of the agency’s Plan of Care policy dated 12/10/21 indicated “… The individualized plan of care must include the following: … all medications and treatments; safety measures to protect against injury; a description of the patient’s/ client’s risk for emergency department visits and hospital re-admissions, and all necessary interventions to address the underlying risk factors. Patient/ client-specific interventions and education …”