Every finding on record at Laredo Visiting Nurses Inc

Purpose of Visit: To conduct Re-Certification. On 05/14/25 at 12:00 p.m., the Surveyor conducted an unannounced visit, and an entrance conference was conducted. Census: Licensed & Certified- 153 Licensed Home Health Services – 0 PAS- 0 Total: 153 PAS- Personal Assistance Services

Purpose of Visit: To conduct Re-Certification and 1 complaint. On 05/14/25 at 12:00 p.m., the Surveyor conducted an unannounced visit, and an entrance conference was conducted. Census: Licensed & Certified- 153 Licensed Home Health Services – 0 PAS- 0 Total: 153 Adm- Administrator ADON- Alternate Director of Nurses LVN- Licensed Vocational Nurse PAS- Personal Assistance Services POC-Plan of Care RN- Registered Nurse SN-Skilled Nurse Intake # 519991

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 that services were performed only as ordered by the physician for 1 of 5 Active Patients (#3) and 1 of 2 Discharged Patients (#6) whose records were reviewed in that: 1. Patient #3’s SN frequency of 1 visit a week for 8 weeks was not followed as per physician order. Patient # 3 was not scheduled nor seen for SN visits on the week of 03/09/25 and on the week of 03/30/25. 2. Discharged Patient #6’s SN frequency of 2 visits a month for 1 month and 3 visits a month for 1 month were not followed as per physician orders. Failure of the agency's skilled nurses to follow the plan of care could place the agency's patients at risk of receiving inadequate care and services and could place the patients at risk of negative outcome. The Findings Included: 1. Review of Active Patient #3's record revealed a "Home Health Certification and Plan of Care" for the Certification Period of 02/21/25 to 04/21/25 signed by RN K with a principal diagnosis of Hypertensive chronic kidney disease with stage 1-4/unspecified chronic kidney (high blood pressure causing the heart to work harder and causing the blood vessels in the kidneys to become damage leading to kidneys being damaged and not able to flush out waste and extra fluid to the body). Continued review of the POC revealed an SN frequency of one visit a week for eight weeks. Review of Patient #3's record revealed an SN note that was scheduled and seen on 03/04/25 by LVN O. Review of Patient #3's record revealed an SN note that was scheduled and seen on 03/17/25 by LVN O. Review of Patient #3's record revealed an SN note that was signed and dated by LVN O on 03/25/25. Review of Patient #3's record revealed an SN note that was scheduled and seen on 04/09/25 by LVN O. Further review of Patient #3's record failed to reveal documented evidence that the SN frequency of 1 visit a week for 8 weeks were followed per physician orders. During an interview and record review on 05/28/25 at 11:50 a.m. with Adm and ADON present and LVN O via conference call, the surveyor presented the above and asked when Patient #3 was seen due to the visit note being dated 3/04/25 but signed and dated on 03/07/25. LVN O stated that the client was seen on 03/04/25 but was dated 03/07/25 because that is the date she completed the note. The Surveyor then asked if the patient was seen on the week of 03/09/25. LVN O stated, “no, not by me.” The ADON stated that it was a scheduling oversight. The Surveyor then asked if the nurses gave report to the next nurse. LVN O stated, “no, I just go by the last note. The patient doesn’t get seen and we don’t know what is going on with the patient.” The Surveyor then asked if there was a missed visit for the week of 03/30/25. LVN O stated, “the last day I saw her (patient #3) was the 25th of March.” During an interview and record review on 05/28/25 at 1:45 p.m. with Adm and ADON present and Schedulers CC and DD via conference call, the Surveyor asked who scheduled the visits for Patient #3. Scheduler CC stated, “Scheduler BB created the 1st visit (recertification).” The Surveyor then asked if the patient was scheduled for the week of 03/09/25 Schedular CC stated, “no, I don’t know. Oversight on all our part.” The Surveyor then asked what the process was regarding scheduling of patient’s visits. The Adm stated that there was not a current process, but that there was going to be one. The Surveyor then asked if there was a scheduled visit for the week of 03/30/25. Scheduler DD stated, “they (patient #3) were not seen on that week either, oversight. The patient could end up in the hospital, potentially lose their life.” 2. Review of Discharged Patient #6's record revealed a "Home Health Certification and Plan of Care" for the Certification Period of 12/18/23 to 02/15/25 that was signed by RN X with a principal diagnosis of Essential (primary) hypertension (abnormally high blood pressure often due to poor diet, obesity or family history). Continued review of the POC revealed an SN frequency of 2 visits a month for 1 month and 3 visits a month for 1 month. Review of Discharged Patient #6's record revealed an SN note that was signed and dated on 12/20/23 by LVN W. Review of Discharged Patient #6's record revealed an SN note that was signed and dated on 01/05/24 by Ex-Employee V. Review of Discharged Patient #6's record revealed an SN note that was signed and dated on 01/18/24 by LVN W. Review of Discharged Patient #6's record revealed an SN note that was signed and dated on 02/01/24 by LVN W. Review of Discharged Patient #6's record revealed an SN note that was signed and dated on 02/15/24 by LVN W. Review of Discharged Patient #6's record revealed an OASIS Assessment that was signed and dated on 02/15/24 by RN EE. Further review of Patient #6's record failed to reveal documented evidence that the SN frequency 2 visits a month for 1 month and 3 visits a month for 1 month were followed per physician orders. During an interview and record review on 05/23/25 at 11:22 a.m. with Adm and ADON present and RN X via conference call the surveyor presented the above and asked if the frequency of 2 visits a month for 1 month and 3 visits a month for 1 month were followed per POC. The Surveyor asked if the patient was seen twice in December. RN X stated, “no, she was only seen once every two weeks.” The Surveyor then asked if the patient was seen three times in January. RN X stated, “no she was only seen twice.” The Surveyor asked if there was a frequency order for the patient to be seen in February. RN X stated, “no. I didn’t do my frequency right. Her shot (B-12 Injection) could have been missed. She could be tired.” Review of the agency's policy manual revealed a policy titled "Plan of Care" page 80 and not dated. The policy revealed in part: "VIII. Drugs, services, and treatments are administered only as ordered by a physician."