Every finding on record at Precise Home Health Care Services, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 01/10/24 to 01/12/24. 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 in conjunction with complaint (98964) at the agency on 01/10/24 to 01/12/24. 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 clinical and administrative issues. Findings were discussed during an informal exit conference with Staff A and B. Deficiencies were cited as a result of the re-certification survey. Deficiencies were cited related to the complaint. 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 notified the physician of pulse levels outside the ordered parameters for one (Patient #5) of ten patients; and 2. SN frequencies were followed as ordered for one (Patient #8) of ten patients. 1. Patient #5 A review of the POC dated 10/12/23 to 12/10/23 showed an order for the physician to be notified of a pulse less than 60. A review of a SN note dated 10/15/23 showed a radial pulse of 55. Documents showed no physician notification for the reported pulse of less than 60. 2. Patient #8 A review of the plan of care dated 05/01/23 to 06/29/23 showed a SN frequency of one to two visits per week for nine weeks. A review of a SN missed visit note dated 05/22/23 documented no answer to phone call, with no other SN visits made for the week of 05/21/23 to 05/27/23. Documents showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. On 01/12/24 at 1:10 p.m., Staff A stated: 1. there was no documentation of physician notification of the pulse being out of parameters for Patient #5; and 2. the SN frequencies for Patient #8 were not met as ordered by the physician.

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: 1. SN obtained an order for oxygen administration for one (Patient #1) of ten patients; and 2. SN obtained an order for speech therapy services for one (Patient #9) of ten patients. 1. Patient #1 A review of the POC dated 10/26/23 to 12/24/23 showed no order for oxygen to be administered to the patient. A review of a SN visit note dated 10/31/23 documented the patient received 3 liters of oxygen per minute via nasal cannula. Documents showed no oxygen administration was ordered by the physician. 2. Patient #9 A review of the POC dated 10/11/23 to 12/09/23 showed no order for speech therapy to evaluate and treat and no speech therapy frequencies. A review of speech therapy notes showed Patient #9 received therapy services on 10/12/23, 10/19/23, 10/24/23, 10/31/23, 11/7/23, 11/16/23, 11/21/23, 11/30/23, and 12/7/23. Documents showed no speech therapy services were ordered by the physician. On 01/12/24 at 1:30 p.m., Staff A stated: 1. the plan of care did not show an order for oxygen use and there were no orders by the physician to administer oxygen for Patient #1; and 2. the plan of care did not show an order for speech therapy services and there were no orders by the physician to provide speech therapy services for Patient #9.