Every finding on record at Louisiana Homecare of Kenner, LLC

The entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey, Re-licensing Survey, and Covid-19 Focused Infection Control Survey. Tag# 572 and #702 were cited as a result of the Recertification Survey. COVID-19 Focused Infection Control Survey with no related 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 record review and interview the agency failed to: Provide occupational therapy services per the plan of care for 1 of 14 sampled patients (Patient #12) who received occupational therapy services; Provide skilled nurse services per the plan of care for 1 of 16 sampled patients (Patient #12) who received skilled nursing services; and Obtain a weight for a patient with congestive heart failure per the plan of care for 1 of 2 sampled patients (Patient #13) who had an order for obtaining weights and/or ankle circumference measurements per the plan of care.The total investigative sample was 17. Findings: Patient #12 Review of Patient #12’s Home Health Referral dated 10/14/2021 revealed an order for in part, skilled nursing services and occupational therapy services. Review of Patient #12’s Home Health Certification and Plan of Care for certification period of 10/15/2021 to 12/13/2021 revealed skilled nursing services were to be provided once a week for one week, twice a week for two weeks; and occupational therapy services effective 10/17/2021 once a week for one week. Review of Patient #12’s record revealed on week three a skilled nurse visit was made on 10/28/2021. Review revealed no documented evidence of a second skilled nurse visit having ever been completed for week three. Further review revealed the first scheduled occupational therapy visit was to be completed for 10/30/2021. In an interview on 11/04/2021 at 10:19am, S2Clinical Director stated the scheduler had sent the occupational therapist (OT) the request at admission, but the OT had sent it back due to his workload being high, and we did not ensure OT visit was made in a timely manner. S2Clinical Director further stated the agency did not have a second skilled nurse home visit for another day for 10/24/2021 thru 10/30/2021. Patient #13 Review of Patient #13’s Home Health Certification and Plan of Care for certification period of 05/19/2021 to 07/17/2021 revealed a diagnosis of congestive heart failure (heart condition which may cause fluid buildup). Review of Patient #13’s Resumption of Care order dated 07/02/2021 revealed order for, in part, skilled nurse to obtain weight every visit and notify the physician of a weight gain or loss of 2-3 pounds overnight or 4-6 pounds in a week. Further review revealed if the patient is unable to stand, the skilled nurse may obtain bilateral ankle measurements. Review of Patient #13’s Nurses Note dated 07/09/2021 and Patient #13’s record revealed no documented evidence and the agency did not present any documented evidence of a weight having been obtained on 07/09/2021 to assess for fluid retention. In an interview on 11/04/2021 at 10:23am, S2Clincial Director stated the agency had no documented evidence to present of Patient #13’s weights having been obtained as ordered.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure a Registered Nurse (RN) assessed and staged a pressure ulcer weekly for 1 of 5 sampled patients (Patient #1) reviewed for pressure ulcer care and services in a total investigative samle of 17. Findings: Review of the Louisiana State Board of Nursing Declaratory Statement Scope of Practice for Registered Nurses Wound Care Management revealed, in part: the registered nurse may delegate to a LPN (Licensed Practical Nurse) wound care if the RN had deemed the wound stable; and provides appropriate supervision. Review of the National Pressure Ulcer Advisory Panel’s Pressure Ulcer Stage definitions revealed, in part, and unstageable pressure injury is an obscured full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar. Review of Patient #1’s Resumption of Care orders dated 10/03/2021 revealed Patient #1 was to receive skilled nursing services twice a week for three weeks. Review of Patient #1’s Home Health Wound Record Report dated 10/14/2021 revealed Patient #1 had an unstageable wound to the left heel due to slough/eschar (non-viable tissue) measuring 2.5cm (centimeters) by 2.5 cm by depth unable to be determined due to necrotic tissue. There was no documented evidence and the agency did not present any documented evidence of Patient #1’s wound being assessed by a RN weekly since identification of the unstageable wound to the left heel on 10/14/2021, until a Registered Nurse assessed the wound again on 10/27/2021. Review of Patient #1’s record revealed the patient was seen by a LPN (Licensed Practical Nurse) on 10/19/2021 and 10/21/2021, however no documented evidence and the agency did not present any documented evidence of a registered nurse having assessed the wound from 10/15/2021 to 10/26/2021. In an interview on 11/04/2021 at 2:00pm, S2Clinical Director stated the agency did not have any documented evidence of a Registered Nurse having assessed Patient #1’s unstageable left heel pressure ulcer from 10/14/2021 to 10/26/2021.