Every finding on record at Nsi, Inc.

Nursing Specialties is in compliance with federal emergency preparedness requirements.

Recertification Survey

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 POC (Plan of Care) was followed as evidenced by the SN (Skilled Nurse) failing to notify the physician when Patient #7’s blood sugar reading was outside ordered parameters, and when the patient gained 5.2 pounds in 6 days for 1 (#7) out of 17 (#1 to #17) sampled patients. Patient #7. Review of the patient’s electronic clinical record revealed the start of care date was 01/21/2024. The patient’s diagnosis included Asthma with Acute Exacerbation, Diabetes, and Heart Failure. The certification period reviewed was 09/17/2024 to 11/15/2024. Review of the patient’s POC for certification period 09/17/2024 to 11/15/2024 revealed an order for “SN1wk9 (skilled nurse visit one time a week for nine weeks).” Further review of the POC revealed an order for “Skilled nurse to perform blood sugar analysis q (every) visit… Report… falling outside the following established parameters: …FBS (Fasting blood sugar) greater than (>) 250 or less than ( RBS (Random (non-fasting) blood sugar) greater than (>) 250 or less than ( The POC further revealed orders for “…Skilled nurse to perform weight q visit… reporting to RN/MD (Registered Nurse/Medical Doctor) any weight gain of 3 lbs (pounds) or greater in 24 hours or 5 lbs or greater in 7 days.” Review of the patient’s skilled nurse visit note dated 09/17/2024 revealed the patient’s blood sugar reading was 311, which was outside the ordered parameter. Further review of the patient’s SN visit note revealed there was no documented evidence the patient’s blood sugar reading was reported to the physician. Review of the patient’s skilled nurse visit note dated 10/01/2024 revealed the patient’s weight was 171.8 pounds. Review of the patient’s skilled nurse visit note dated 10/07/2024 revealed the patient’s weight was 177 pounds, which was a 5.2 pound weight gain in 6 days. Further review of the patient’s SN visit note revealed there was no documented evidence the physician was notified of the patient’s 5.2 pound weight gain in 6 days. On 10/15/2024 at 12:30 p.m., an interview and review of the patient’s electronic clinical record was conducted with S1DON (Director of Nursing). S1DON confirmed there was no documented evidence the patient’s blood sugar reading of 311 and weight gain of 5.2 pounds in 6 days was reported to the physician.

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

Recertification Survey

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 that the licensed professional followed the individualized plan of care as evidenced by the Occupational Therapist failed to conduct vital signs for 1 (#13) patient out of a total of 17 (#1-17) sampled patients. Findings: Patient #13 was admitted to the agency on 7/28/2021 with the diagnoses that included Right Hip Revision, Peri-prosthetic Fracture around Internal Prosthetic Right Hip Joint, Dependence of other enabling machines and devices, and Falls. The certification period reviewed was 7/28/2021 to 9/25/2021. The patient's Plan Of Care (POC) dated 7/28/2021 was reviewed and revealed the following order – Licensed Professional to report vital signs falling outside the following established parameters including: Temp 100, Pulse 100, Resp (respirations) 24, Systolic BP (blood pressure) 165, Diastolic BP 90, Pain >7, and O2Sat (saturation) <90. The patient's Visit Note Reports were reviewed and revealed that S4OT had provided occupational therapy services to Patient #13 on 8/6/2021, 8/10/2021, 8/12/2021, 8/17/2021, and 8/19/2021. Further review of the visit notes revealed that S4OT had failed to assess the patient’s vital signs on 8/10/2021, 8/17/2021, and 8/19/2021 during provision of occupational therapy. A review of the agency’s policy titled “Physician Communication” revealed: Policy. Physician communication will be established and maintained to ensure safe and appropriate care for the patient. Procedure. 1. Professional agency personnel contact the patient’s physician: B. When there are changes in the patient’s condition. A review of S4OT’s personnel file revealed a Louisiana State Board of Medical Examiners License Verification. An Occupational Therapist license had been issued to S4OT on 9/30/2010 and had an expiration date of 7/31/2022. On 11/18/2021 at 10:10 AM, at interview was conducted with S2RN/QA. She confirmed that Patient #13’s Plan of Care orders included that licensed professionals were to report vital signs falling out of the established parameters. She confirmed that S4OT was a licensed professional. She confirmed that S4OT had not conducted vital signs during each of the visits with Patient #13 to ensure that there was no need to report if the vital signs had fallen outside of the established parameters.

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 Patient #13's physician was promptly alerted that an Occupational Therapy evaluation and treatment ordered by the physician on admission was not conducted timely for 1 (#13) out of 17 (#1-17) sampled patients. Findings: Patient #13 was admitted to the agency on 7/28/2021 with the diagnoses that included Right Hip Revision, Peri-prosthetic Fracture around Internal Prosthetic Right Hip Joint, Dependence of Other Enabling Machines and Devices, and Falls. The certification period reviewed was 7/28/2021 to 9/25/2021. A review of the services order by Patient #13’s physician revealed: PT/OT(Physical Therapy/Occupational Therapy)/Skilled nursing eval & treat (evaluation and treatment). The order included WBAT (weight bearing as tolerated) RLE (right lower extremity)/ hip precautions, using rolling walker. The patient's Plan Of Care (POC) dated 7/28/2021 was reviewed and failed to reveal orders or a frequency for OT. A review of the agency’s complaints revealed a complaint dated 8/5/2021 that had been filed by the caregiver (CG) of Patient #13. The complaint included that CG called to report she has been waiting on Occupational Therapy (OT) evaluation for her mother and it has been a week now that her mother was admitted to services; and CG is very upset about the delay in getting OT eval. The resolution on the grievance included: OT evaluation was performed on 8/6/2021. A review of the skilled visit note reports revealed that an OT add-on evaluation had been not been conducted until 8/6/2021. The therapy assessment/plan included: The patient presents to occupational therapy with decreased safety and independence with transfers and her daily routine; She is mostly limited by right hip and knee pain and hip precautions; Her activity tolerance is impaired; she scored 10/20 on the Barthel Index assessment, which indicates the need for skilled home health OT intervention. She will benefit from OT frequency 1W1 (once a week for one week), 2W2 (twice a week for 2 weeks) with emphasis on adaptive equipment training, ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living) training, strength, endurance, balance, energy conservation, transfer training and home exercise program development. Further review of Patient #13’s clinical record failed to reveal that the physician had been notified that the OT evaluation had not been conducted upon admission to the agency as ordered. A review of the agency’s policy titled “Physician Communication” revealed: Policy. Physician communication will be established and maintained to ensure safe and appropriate care for the patient. Procedure. 1. Professional agency personnel contact the patient’s physician: A. After the initial visit to establish a plan of care; D. When changes occur in the patient’s expected response to treatment; F. When there is any problem implementing the plan of care. 2. All conferences or attempts to communicate with the physician will be documented in the clinical record. On 11/18/2021 at 10:10 AM, at interview S2RN/QA. She confirmed that Patient #13’s physician had ordered an OT evaluation upon admission and that the agency had not conducted one. She confirmed that the OT evaluation had not been conducted until 8/6/2021 after the patient’s daughter had filed a complaint. S2RN/QA further confirmed that there was no evidence in Patient #13’s clinical record that the physician had been notified that an Occupation Therapy evaluation had not been conducted upon admission as was ordered.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the staff followed standards of practice, including the uses of standard precautions to prevent the transmission of infections and communicable diseases as evidence by an observation made on 11/16/2021 during a home visit in which S3LPN failed to clean her reusable equipment after she used the equipment on Patient #3 out of a total of 17 (#1-17) sampled patients. Findings: The facility’s policy was reviewed and revealed the following documentation – Equipment Cleaning – Policy: To prevent the spread of infection and maintain clean equipment when providing patient care. Procedure: …..Stethoscope - Routinely clean the bell/diaphragm of the stethoscope with a disinfectant spray, or using a rotary motion, with an antiseptic wipe each visit. Blood Pressure Cuff - Routinely clean the blood pressure cuff with a disinfectant spray, or using a rotary motion, with an antiseptic wipe each visit. Glucose Meters – Follow specific manufacture’s recommendations for cleaning. Thermometers – Use an antiseptic wipe to clean glass thermometers; otherwise follow the manufacturer’s recommendations. Quintet AC Blood Glucose Meter Owner’s Manual was reviewed and the manufacture’s guidelines revealed the following documentation - Caring for the Meter – Cleaning the Meter – Clean the outside of the McKesson Quintet Blood Glucose Meter with a damp cloth and mild soap/detergent. Cleaning the Test Strip Port – If your Test Strip Port is stained with blood, control solution or any liquid, please use a dry tissue or alcohol swab to clean it up immediately….. Patient #3 was admitted to the agency on 9/8/2021 with the diagnoses that included the following: Essential Hypertension, Type 2 Diabetes Mellitus, Long term Use of Insulin and Atherosclerotic Heart Disease of Native Coronary Artery. The certification period reviewed was 11/7/2021 to 1/5/2022. On 11/16/2021 at 1:15 pm, a home visit was conducted with Patient #3 and S3LPN. S3LPN was observed obtaining vital signs on the patient using a blood pressure cuff she removed from a black bag she took out of her blue agency bag. S3LPN returned the blood pressure cuff to the black bag after using it on the patient and placed the black bag into her blue agency bag. S3LPN took a thermometer out of her bag, took the patient’s temperature, and placed the thermometer back in her blue agency bag. S3LPN took a pulse oximeter out of her blue agency bag, obtained the patient’s pulse oxygen reading, then placed the oximeter back in her blue agency bag. S3LPN then assessed the patient’s lungs with a stethoscope that was around her (S3LPN’s) neck, and placed the stethoscope back around her neck after the assessment was completed. S3LPN was observed taking a glucometer out of a black bag, placing a test strip in the glucometer, and obtaining a blood sample. After obtaining the patient’s blood sugar, S3LPN discarded the strip in the trash receptacle, placed the glucometer in the black bag, and return the bag to her blue agency bag. S3LPN did not clean the above listed equipment after using it on the patient or prior to placing it back into the blue agency bag. After the visit was completed, an interview was conducted with S3LPN outside the patient’s home. S3LPN verified that she had not cleaned her reusable equipment after she had used it on Patient #3, or before she returned the uncleaned equipment to her blue agency bag. On 11/16/2021 at 2:39 pm, an interview was conducted with S1ADM/DON and the home visit with S3LPN was discussed. S1ADM/DON verified that S3LPN should have cleaned her reusable equipment after using it on the patient and prior to placing in back in her blue agency bag.