Every finding on record at Magna Home Health Care, Inc

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 02/06/24 to 02/08/24. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 02/06/24 to 02/08/24. An entrance conference was conducted with Staff A, B, C, and D. The survey process was explained. Questions were answered. Staff A was identified as the contact person for clinical and administrative issues. Findings were discussed during an informal exit conference with Staff A, B, D, and E. Deficiencies were cited as a result of the re-certification survey. Glossary: POC Plan of Care SN Skilled Nurse/Nursing

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure: 1. SN frequencies were followed as ordered for three (Patients #4, 6, and 7) of seven patients; 2. SN notified the physician of diastolic blood pressure levels outside the ordered parameters for one (Patient #2) of seven patients. 3. SN performed a catheter irrigation as ordered for one (Patient #2) of seven patients; and 4. SN notified the physician of a blood sugar result outside the ordered parameters for one (Patient #4) of seven patients. 1. Patient #4 A review of the POC dated 10/11/23 to 12/09/23 showed a SN frequency of three visits a day for 60 days. A review of clinical records showed two SN visits were completed on 10/17/23, a third visit was noted as not started, and no missed visit notes documented. Documentation showed no refusal of visits or services from the patient or caregiver, no contact made with the patient or caregiver and no physician order for a change in services. Patient #6 A review of the POC dated 08/03/23 to 10/01/23 showed a SN frequency of one visit per week for nine weeks. A review of the clinical record showed a SN missed visit note dated 09/13/23 which documented the reason for the missed visit as no answer to phone call, and no other visits documented for the week of 09/10/23 to 09/16/23. Documentation showed no effort to make up the visit. Documentation showed no refusal of visits or services from the patient or caregiver, no contact made with the patient or caregiver and no physician order for a change in services. Patient #7 A review of the POC dated 07/10/23 to 09/07/23 showed a SN frequency of one visit per week for nine weeks. A review of the clinical record showed a SN missed visit note dated 08/14/23 which documented the reason for the missed visit as no answer to phone call, and no other visits documented for the week of 08/13/23 to 08/19/23. Documentation showed no effort to make up the visit. Documentation showed no refusal of visits or services from the patient or caregiver, no contact made with the patient or caregiver and no physician order for a change in services. 2. Patient #2 A review of the POC dated 11/23/23 to 01/21/24 showed an order for the physician to be notified of diastolic blood pressure greater than 90. A review of a SN visit note dated 12/11/23 showed a diastolic reading of 93. Documents showed no physician notification for the diastolic blood pressure reading greater than 90. 3. Patient #2 A review of the POC dated 11/23/23 to 01/21/24 showed an order for SN to irrigate the patient’s suprapubic catheter with 30 milliliters of Renacidin irrigation solution every four hours as directed. A review of SN visit notes showed the following: SN visit note dated 11/27/23 showed 10 ml of normal saline solution was instilled into the suprapubic catheter. SN visit note dated 12/04/23 showed 10 ml of normal saline solution was instilled into the suprapubic catheter. SN visit note dated 12/11/23 showed 10 ml of normal saline solution was instilled into the suprapubic catheter. SN visit note dated 12/18/23 showed 10 ml of normal saline solution was instilled into the suprapubic catheter. SN visit note dated 12/26/23 showed 10 ml of normal saline solution was instilled into the suprapubic catheter. SN visit note dated 01/02/23 showed 10 ml of normal saline solution was instilled into the suprapubic catheter. Documentation showed no physician orders to change or discontinue the use of Renacidin. 4. Patient #4 A review of the POC dated 10/11/23 to 12/09/23 showed an order for the physician to be notified of random blood sugar less than 70. A review of SN visit note dated 10/13/23 showed a blood sugar result of 65. Documents showed no physician notification for the blood sugar result of less than 70. On 02/08/24 at 11:23 a.m., Staff A stated: 1. the SN frequencies for Patient’s #4, #6 and #7 were not met as ordered by the physician. 2. there was no documentation of physician notification of the diastolic blood pressure being out of parameters for Patient #2; 3. SN did not irrigate the suprapubic catheter as ordered by the physician for Patient #2; and 4. there was no documentation of physician notification of the blood sugar being out of parameters for Patient #4.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the hospice on 03/09/21 though 03/10/21. No deficiencies were cited as a result of the Medicare Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced Medicare re-certification survey at the agency on 03/09/21 through 03/10/21. An entrance conference was conducted with Staff A. The survey process was explained. Questions were answered. Staff A was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff A and B. The following condition level deficiency was cited as a result of the Medicare re-certification survey: 484.65 Quality Assessment and Performance Improvement Glossary: PIP Performance Improvement Project QAPI Quality Assurance Performance Improvement

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 record review and interview, the agency failed to ensure medication embedded wound care supplies were included in the review of medications for potential/adverse effects, drug reactions, side effects, interactions and duplicate drug therapy for one (Patient #7) of seven patients. Findings: Patient #7 A review of the plan of care dated 01/04/20 to 03/04/21 documented a principal diagnosis of acute kidney failure. A physician's order dated 01/22/21 documented orders for skilled nursing to perform wound site care using "Aquacel Ag" dressing (a medication embedded wound care supply material). A review of the clinical record showed the "Aquacel Ag" dressing was not added to the medication profile. On 03/10/21 at 12:50 pm, Staff A stated the medication embedded wound care supplies ordered for wound care on Patient #7 was not on the medication profiles and the Home Health Agency did not review medication embedded wound care supply materials for patient interactions, effects, or allergies.

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 record review and interview, the agency failed to ensure an individualized plan of care was fully developed for reporting of pain in relation to the disease process for one (Patient #6) of seven patients. Findings: Patient #6 A review of the plan of care dated 11/22/20 to 01/20/21 showed a primary diagnosis of post laminectomy. The plan of care showed no pain parameters for the staff to alert the physician. Skilled nurse assessments dated 11/30/20, 12/08/20, 12/15/20, 12/30/20 and 01/12/21 each documented a pain level of 7 out of 10 (rating falls between hurts even more and hurts a whole lot on the 1-10 pain scale) with no physician notification of the continued elevated pain levels. On 03/10/21 at 12:58 pm, Staff A stated the plan of care should have been developed with pain parameters for physician notification.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure occupational therapy services were followed as ordered for one (Patient #1) of seven patients. Findings: Patient #1 A review of the plan of care dated 12/14/20 to 02/11/21 showed a primary diagnosis of chronic obstructive pulmonary disease. A review of a physician order dated 01/25/21 instructed the agency to add occupational therapy services. A review of a physician order dated 02/09/21 instructed the agency to add occupational therapy services. A review of the electronic medical record showed no occupational therapy visits completed from 01/25/21 to 02/11/21. Clinical documentation showed no additional orders to reduce the occupational therapy visits, no refusal of the additional ordered therapy by the patient or family/caregiver and no notification to the ordering practitioner that orders to begin occupational therapy had not been followed. On 03/10/21 at 12:41 pm, Staff A stated occupational therapy orders were not followed for Patient #1.

Quality assessment/performance improvement CFR(s): 484.65 Condition of participation: Quality assessment and performance improvement (QAPI). The HHA must develop, implement, evaluate, and maintain an effective, ongoing, HHA-wide, data-driven QAPI program. The HHA's governing body must ensure that the program reflects the complexity of its organization and services; involves all HHA services (including those services provided under contract or arrangement); focuses on indicators related to improved outcomes, including the use of emergent care services, hospital admissions and re-admissions; and takes actions that address the HHA's performance across the spectrum of care, including the prevention and reduction of medical errors. The HHA must maintain documentary evidence of its QAPI program and be able to demonstrate its operation to CMS. This CONDITION is not met as evidenced by: Based on record review and interview, the agency failed to ensure a patient centered QAPI Program for all patients and employees. This failed practice had the potential to place 38 patients and all employees at risk for insufficient self-monitoring and efforts to improve care, services and operations. See G642. Based on record review and interview, the agency failed to ensure utilization of QAPI data to improve program effectiveness, quality of patient care and overall program improvement. This failed practice had the potential to place 38 patients at risk of repeated agency mishaps, ineffective management of care and poor quality of care. See G644. Based on record review and interview, the agency failed to ensure improvement activities were identified and focused on high risk problem-prone areas for 38 current patients. This failed practice had the potential to place 38 current patients at risk of repeated unidentified, unexplored and unresolved agency problems that remained un-addressed within the QAPI program. See G648 Based on record review and interview, the agency failed to ensure conduction of a patient centered QAPI Program which measured and tracked agency performance strategies to ensure improvements were sustained for all patients and employees. The failed practice had the potential to place 38 patients and all employees at risk for insufficient self-monitoring and efforts to improve care, services and operations. See G656. Based on record review and interview, the agency failed to ensure the initiation and review of a PIP through their QAPI Program for 38 patients and all employees. This failed practice had the potential to place the agency, all patients and all employees at risk for stagnated efforts for improvement as a result of unidentified problematic clinical, administrative, infection control or personnel problems. See G658.

Program scope CFR(s): 484.65(a)(1),(2) Standard: Program scope. (1) The program must at least be capable of showing measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care. (2) The HHA must measure, analyze, and track quality indicators, including adverse patient events, and other aspects of performance that enable the HHA to assess processes of care, HHA services, and operations. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure a patient centered QAPI Program for all patients and employees. This failed practice had the potential to place 38 patients and all employees at risk for insufficient self-monitoring and efforts to improve care, services and operations. Findings: A review of administrative records showed no documentation of an ongoing patient centered QAPI program and no QAPI data was collected, monitored or evaluated by the agency for January 1, 2020 through December 31, 2020 and January 1, 2021 through March 10, 2021. On 03/10/21 at 3:19 p.m., Staff A stated there was no documentation of a QAPI program for 2020 and no current documentation of a QAPI program for 2021.

Program data CFR(s): 484.65(b)(1),(2),(3) Standard: Program data. (1) The program must utilize quality indicator data, including measures derived from OASIS, where applicable, and other relevant data, in the design of its program. (2) The HHA must use the data collected to- (i) Monitor the effectiveness and safety of services and quality of care; and (ii) Identify opportunities for improvement. (3) The frequency and detail of the data collection must be approved by the HHA's governing body. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure utilization of QAPI data to improve program effectiveness, quality of patient care and overall program improvement. This failed practice had the potential to place 38 patients at risk of repeated agency mishaps, ineffective management of care and poor quality of care. Findings: A review of administrative records showed no data collection activities utilized in the agency's QAPI Program for calendar year of 2020 and from January 01, 2021 to March 10, 2021. On 03/10/21 at 3:19 p.m., Staff A stated they had no analysis of data collected available that showed improved quality of patient care and program improvement data was not available.

High risk, high volume, or problem-prone area CFR(s): 484.65(c)(1)(i) (i) Focus on high risk, high volume, or problem-prone areas; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure improvement activities were identified and focused on high risk problem-prone areas for 38 current patients. This failed practice had the potential to place 38 current patients at risk of repeated unidentified, unexplored and unresolved agency problems that remained un-addressed within the QAPI program. Findings: A review of administrative records showed a plan for a QAPI Program with no record of data utilization or improvement efforts for 2020 and from January 01, 2021 to March 10, 2021. On 03/10/21 at 3:19 pm, Staff B stated there was no documentation of the QAPI program for 2020 and 2021.

Improvements are sustained CFR(s): 484.65(c)(3) The HHA must take actions aimed at performance improvement, and, after implementing those actions, the HHA must measure its success and track performance to ensure that improvements are sustained. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a patient centered QAPI Program which measured and tracked agency performance strategies to ensure improvements were sustained for all patients and employees. The failed practice had the potential to place 38 patients and all employees at risk for insufficient self-monitoring and efforts to improve care, services and operations. Findings: A review of administrative records showed no ongoing QAPI program activities which measured and tracked agency performance strategies to ensure improvements were sustained to improve the care, services, and operations of the agency for calendar year 2020 and January 01, 2021 to March 10, 2021. On 03/10/21 at 3:19 p.m., Staff A stated they had no QAPI documentation for calendar year 2020 and January 01, 2020 to March 10, 2021.

Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA's services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the initiation and review of a PIP through their QAPI Program for 38 patients and all employees. This failed practice had the potential to place the agency, all patients and all employees at risk for stagnated efforts for improvement as a result of unidentified problematic clinical, administrative, infection control or personnel problems. Findings: A review of QAPI records showed no initiation, review, data analysis, or status of PIPs for the calendar year of 2020 and January 01, 2021 to March 10, 2021. On 03/10/21 at 3:19 pm, Staff A stated the agency had no documented PIP activities for 2020 and from January 01, 2021 to March 10, 2021.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure clinical notes were included in the clinical record for one (Patient #7) of seven patients. Findings: Patient #7 A review of the plan of care dated 01/04/21 to 03/04/21 documented a skilled nurse frequency of two visits per day for 60 days. A review of the electronic medical record showed the following: On 01/09/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 01/10/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 01/16/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 01/17/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 01/23/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 01/24/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 01/30/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/06/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/07/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/13/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/14/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/17/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/18/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/19/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/20/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/21/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/22/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/24/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/25/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/26/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/27/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 02/28/21 two skilled nurse visits were performed with no skilled nurse assessment completed. On 03/10/21 at 12:58 pm, Staff A stated the visits were performed but not documented in the electronic medical record.