Every finding on record at Louisiana Homecare of North Louisiana, LLC

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

Recertification Survey Abbreviations: ADA-American Diabetes Association FBS-Fasting Blood Sugar LPN-Licensed Practical Nurse RN-Registered Nurse RBS-Random Blood Sugar SN-Skilled Nurse

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 ensure the patient’s written individualized plan of care was followed for 1 ( #5) of 10 (#1, #2, #3, #4, #5, #6, #7, #8, #9, and #10) sampled patients as evidenced by: Patient #5 was not seen by a skilled nurse or registered nurse twice weekly as ordered on Plan of Care for 4 weeks. Findings: Review of the clinical record for Patient #5 revealed a Start of Care date of 11/21/2024. Patient #5 had a primary diagnosis of Paraplegia, Pressure Ulcer, stage 3, Fracture of Vertebra, and Anxiety Disorder for the Certification Period from 01/22/2025 to 03/21/2025. Review of the orders/POC revealed Patient #5 was ordered to have skilled nurse visits twice weekly. Review of Patient #5’s calendar and visit notes revealed Patient #5 had missed visits on the following dates: 02/17/2025, 02/21/2025, 02/24/2025, 02/28/2025, 03/03/2025, 03/07/2025, 03/20/2025 and 03/14/2025. Interview with Patient #5 on 03/18/2025 at 10:10 a.m. revealed he is currently still living with a family member in Mansura. Patient #5 stated when he went to his family member’s house several weeks ago. He said he has had several conversations with staff calling to schedule visits but he notified them he was not at his home in Alexandria at the time but planned to return. Patient #5 stated he was not made aware that he could have been provided care at his family member’s home until 03/13/2025 and had he known that he would have had them come out as scheduled. Interview on 03/18/2025 at 11:45 a.m. with S2 RN revealed she notified S1 ED that Resident #5 was in Mansura with his sister in the beginning of 03/2025. S2 RN stated she asked Resident #5 if he wanted to move to another home health agency to be seen but Resident #5 stated he wanted to stay with his current agency. S2 RN stated this agency does not see clients in Mansura and that the sister branch sees those patients. S2 RN stated because Patient #5 was living in Mansura and told her that he would be moving back to Alexandria soon was the reason the visits were not provided. Interview on 03/18/2025 at 10:29 a.m. with S1 ED acknowledged Patient #5 was not seen twice weekly for 4 weeks by a skilled nurse, as ordered. S1 ED revealed she was unaware of the amount of missed visits Patient #5 had until the week of 03/13/2025. S1 ED stated once she was notified, she spoke to Patient #5 and he stated he would like to have services where he was currently living in Mansura. S1 ED stated she set him up with the Bunkie office to provide visits until he moved back to Alexandria. S1 ED stated that Mansura was within the 50 miles radius and Patient #5 should have been offered to be seen by staff in the Alexandria office. S1 ED stated she has some new nurses who probably did not realize that Patient #5 was still in the 50-mile radius.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient’s physician was promptly notified when the patient’s pain level and blood glucose levels were high and outside of the physician ordered parameters for 1 (#2) of 10 (#1, #2, #3, #4, #5, #6, #7, #8, #9 and #10) sampled patients reviewed. Findings: Review of the agency’s policy on 03/19/2025 titled “Vital Signs” last revised on 09/01/2024 revealed in part…4. The clinician shall collaborate with the other clinicians and/or Patient Care Manager/Case Manager and notify the physician or authorized practitioner for deviations per the plan of care. Review of the clinical record for Patient #2 revealed a Start of Care date of 12/26/2024. Patient #2’s diagnoses included in part…Pressure Ulcer of Sacral Region, Stage 3 and Type 2 Diabetes Mellitus for the Certification Period from 02/24/2025 to 04/24/2025. Physician’s orders included the following: When vital signs are obtained, licensed professional to report vital signs falling outside the following established parameters…Pain greater than 6, FBS250, and RBS300. Review of SN visit note dated 02/25/2025 revealed S4 LPN documented Patient #2’s random blood sugar level was 317 at 1:43 p.m. S4 LPN documented Patient was asymptomatic and does not follow ADA diet as directed. Physician contacted was marked as no. Review of SN visit note dated 03/02/2025 revealed Patient #2’s blood glucose level was 330 at 10:00 a.m. S5 RN documented in part…Physician was not contacted, no new orders, and Patient asymptomatic. Review of SN visit note dated 03/06/2025 revealed S4 LPN documented in part…Patient #2 says her sugar has been reading “Hi” and she is out of her Tresiba (insulin) ; Sitter to pick up at Pharmacy; Patient asymptomatic. Review of the visit note revealed no documentation of S4 LPN notifying Patient #2’s physician of elevated blood glucose level. Review of SN visit note dated 03/08/2025 revealed Patient #2’s random blood glucose was 300 at 11:48 a.m. S4 LPN documented in part…Patient’s sitter just picked up Tresiba today. Review of the visit note revealed no documentation of S4 LPN notifying Patient #2’s physician of elevated blood glucose level. Review of SN visit note dated 03/10/2025 revealed S6 LPN documented Patient #2’s blood glucose level as 396, asymptomatic. Review of the visit note revealed no documentation of S6 LPN notifying the patient’s physician of elevated blood glucose level. Review of SN visit note dated 03/12/2025 revealed S5 RN documented in part…Patient #2’s random blood glucose was 400 at 10:10 a.m., physician contacted-no. Review of the visit note revealed no documentation of S5 RN notifying the patient’s physician of elevated blood glucose level. Review of SN visit note dated 03/16/2025 revealed S7 LPN documented Patient #2’s pain level as 7 and fasting blood glucose as 276 at 10:44 a.m. S7 LPN documented low back pain in the comments and physician contacted as no. Review of the visit note revealed no documentation of S7 LPN notifying Patient #2’s physician of pain and blood glucose levels above parameters. In an interview on 03/17/2025 at 1:27 p.m., S1 Executive Director, who reviewed Patient #2’s clinical record at that time, confirmed Patient #2’s physician was not notified until the following day when her pain and blood glucose levels were high and above the parameters outlined in the plan of care. S1 Executive Director confirmed the nurses should have called the doctor before leaving the patient’s home and if unable to reach him, they should have faxed the notification to the doctor on the same day, but had not.

The entity is in compliance with federal emergency preparedness requirements.

Recertification Survey Abbreviations: a.m. - morning ED - executive director hrs. - hours LPN - licensed practical nurse mg - milligram p.m. - evening po - per oral prn - as needed ppe - personal protective equipment q - every RN - registered nurse SN - skilled nurse

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on observation, interview, and record review the agency failed to ensure a patient's medication regimen was reviewed and updated for accuracy for 1 (#2) of 5 (#2, #4, #7, #8, and #9) patient home visits requiring medication monitoring. Findings: Observation on 03/22/2022 at 9:30 a.m. during a home visit with Patient #2 revealed S2 RN asked Patient #2 to look at his medications. S2 RN retrieved Patient #2's medications from a bag on the patient’s sofa. Upon review of these medications, there were 3 medications that were not on the client's Plan of Care for the 03/13/2021 through 05/11/2022 certification period. These medications were: Allopurinol 300mg po daily, Furosemide 40mg po daily, and an Albuterol inhaler with instructions to take 2 puffs q 4hrs prn, which were not on the patients medication list. Further observation revealed the medications had been filled on 03/13/2022. Interview with Patient #2 on 03/22/2022 at the time of observation revealed he had been using the Albuterol inhaler for years and had begun taking the Allopurinol and Furosemide when his brother picked the medications up from the pharmacy for him on 03/14/2022. Interview on 03/22/2022 at 9:35 a.m. with S2 RN confirmed the above medications were not on the patient’s current medication list. She further stated the patient’s last home visit was on 03/16/2022 and the medications should have been added at that time and had not been. Interview on 03/23/2022 at 11:14 a.m. with S1 ED/RN revealed the patients Lasix, Allopurinol, and Albuterol inhaler should have been reconciled and added to the patient’s medication list during his SN visit on 03/16/2022 and had not been.

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on observation, interview, and record review the agency failed to ensure staff that were not fully vaccinated for COVID-19 implemented additional precautions intended to mitigate the transmission and spread of COVID-19 for 2 (S2 RN and S3 LPN) of 2 staff observed that were not fully vaccinated for COVID-19. Findings: 1. Observation on 03/22/2022 at 9:15 a.m. with Patient #2 revealed S2 RN entered the patient’s home and provided skilled nursing services that included wound care to the patient wearing only a surgical mask. 2. Observation on 03/23/2022 at 8:37 a.m. with Patient #8 revealed S3 LPN entered the patient’s home and provided skilled nursing services wearing only a surgical mask. Review of the COVID-19 Staff Vaccination Status for Providers for the agency revealed there were 4 staff that were not vaccinated but had either a medical or a religious exemption out of a total of 20 staff. Further review revealed S2 RN and S3 LPN had not received the COVID-19 vaccine due to religious exemptions. Interview with S1 ED/RN on 03/23/2022 at 11:11 a.m. revealed the provider agency had no additional precautions in place for PPE requirements during home visits for unvaccinated staff. She stated unvaccinated staff were allowed to wear surgical mask during home visits and were not being tested for COVID-19 routinely at this time.