Every finding on record at Rainbow Home Health, Inc

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 05/27/25 - 05/29/25. 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 05/27/25 - 05/29/25 in conjunction with an Incident investigation (#71548). An entrance conference was conducted with the Staff A and Staff B. The survey process was explained. Questions were answered. The Staff B was identified as the contact person for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff B and Staff C. Deficiencies were cited as a result of the Medicare re-certification survey. No deficiencies were cited as a result of the Incident investigation (71548) Glossary: SN Skilled Nurse POC Plan of Care DME Durable Medical Equipment FBS Fasting Blood Sugar RBS Random Blood Sugar

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 observation, record review and interviews, the agency failed to provide an individualized POC regarding patient specific supplies, interventions and safety measures based on the assessed needs of each patient for five (#1, #3 and #5, #6 and #7) of seven (#1 - #7) records reviewed. This deficient practice had the potential to prevent the patients progress towards goals and failure to protect patients from injury. Patient #1 Review of the current recertification POC dated 04/22/25 - 06/20/25 showed a diagnosis of disorders of the skin, Chronic Obstructive Pulmonary Disease and included orders for "SN to assess respiratory status..." and "Instruct patient to: Don't smoke anywhere near oxygen, keep oxygen canisters away from open flames, switch to a non-electric razor, pass on petroleum based lotions and creams" and "SN to assess that patient knows how to use oxygen and supplies and has precaution sign at door of home". Oxygen was not identified on the POC as DME/ Supplies or Safety Measures and not documented on the Medication Profile. During a home observation visit on 05/28/25 at 12:30 PM, Patient #5 was observed smoking upon entering the home. No oxygen was identified in the home and when this Surveyor asked if he used Oxygen, he stated "No". During medication reconciliation, the SN confirmed the patient does not require oxygen. Patient #3 Review of the current recertification POC dated 05/19/25 - 07/17/25 included a primary diagnosis of Type 2 Diabetes Mellitus with orders to "Notify physician of vital signs parameters out of range: FBS greater than 350 mg/dl less than 60 mg/dl, Random BS greater than 400 mg/dl less than 60 mg/dl" and "SN to assess diabetic status...". The POC did not contain DME / Supplies for diabetic management. During a home observation visit on 05/28/25 at 11:00 AM, when this Surveyor asked the patient how often she checks her blood sugar, Patient #3 stated, " I check it before meals, I have that monitor or my arm so I can check it just whenever". She also confirmed she has a glucometer to use if needed. Patient #5 Review of the recertification POC dated 04/15/25 - 06/13/25 included a primary diagnosis of Type 2 Diabetes Mellitus with orders to "Notify physician of vital signs parameters out of range: FBS greater than 150 mg/dl less than 60 mg/dl, Random BS greater than 250 mg/dl less than 70 mg/dl" and "SN to assess diabetic status...". The POC did not contain DME / Supplies for diabetic management. The presence of diabetes supplies in the home was confirmed by review of SN Note for 4/03/25 which documented, "Random blood sugar per patient Dexcom sensor". Patient #6 Review of the recertification POC dated 03/17/25 - 05/15/25 included a primary diagnosis of Chronic Obstructive Pulmonary Disease with orders for "SN to assess respiratory status..." The Medication Profile included Oxygen 2-4 LPM (liters per minute) PRN (as needed). The POC did not contain DME / Supplies, Safety Measures or SN orders specific to Oxygen safety and management. The presence of Oxygen in the home was confirmed by review of SN Note for 4/23/25 which documented, " Oxygen saturation= 97% and Oxygen at 2 Liters per minute per Nasal Cannula". Patient #7 Review of the current recertification POC dated 02/01/25 - 04/01/25 included a primary diagnosis of Type 2 Diabetes Mellitus with orders to "Notify physician of vital signs parameters out of range: FBS greater than 200 mg/dl less than 70 mg/dl, Random BS greater than 250 mg/dl less than 75 mg/dl" and "SN to assess diabetic status... monitor blood sugar levels". The POC did not contain DME / Supplies for diabetic management. The presence of diabetes supplies in the home was confirmed by review of SN Note for 3/19/25 which documented "sensor changed today". During an interview on 05/29/25 at 09:00 AM, Staff B stated the POC for Patients' #1, #3, #5, #6 and #7 were not individualized to the patients' specific needs based on the assessments by the SN staff.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 07/25/22 to 07/26/22. 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 07/25/22 to 07/26/22.An entrance conference was conducted with the Branch Manager. The survey process was explained. Questions were answered.The DON was identified as the contact person for administrative issues and for clinical issues.Findings were discussed during an informal exit conference with DON and ADON.Standard level deficiencies were cited as a result of the re-certification survey.GLOSSARY: DON Director of Nursing ADON Assistant Director of Nursing RN Registered Nurse SN Skilled Nurse POC Home Health Certification and Plan of Care HHA Home Health Aide SAV Supervisory Aide Visit

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 interviews, the Agency failed to provide an individualized POC to include patient-specific interventions and education for two (#5 and #7) of seven (#1- #7) records reviewed. Patient #5 A review of the Patient #5 POC for recertification period of 06/05/22 to 08/08/22 revealed a primary diagnosis of Congestive Heart Failure and a pertinent diagnosis of acute post-procedural pain. The patient is homebound due to pain that interferes with activity and has Oxygen at 2 liters per nasal canal as needed for shortness of breath. Further review of the POC failed to provide patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient related to Oxygen management and safety or Congestive Heart Failure management. Patient #7 A review of the Patient #7 POC for recertification period of 05/09/22 to 07/07/22 revealed a primary diagnosis of Type 2 Diabetes Mellitus, a pertinent diagnosis of Congestive Heart Failure and reveals the patient has Oxygen at 2 liters per nasal canal as needed. Further review of the POC failed to provide patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient related to Oxygen management and safety or Congestive Heart Failure management. On 07/26/22 at 1:15 PM, the DON stated the agency failed to include interventions and goals in the plan of care specific to the patient's assessed needs for Oxygen management and safety and Congestive Heart Failure for Patients #5 and #7.

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 interviews, the SN failed to follow physician orders on the POC for two (#1 and #3) of seven (#1- #7) records reviewed with orders to "Notify Physician of vital sign parameters out of range". Patient #1 A review of the POC for Patient #1 for recertification period 07/07/22 to 09/04/22 revealed a primary diagnosis of Atherosclerotic Heart Disease. The POC included orders to "Notify Physician of vital sign parameters out of range... Heart Rate Greater than 100 or less than 50". A review of SN Visit Note for 07/06/22 revealed a Heart Rate of 110 was obtained by the RN. Further review of the record indicated Patient #1 went to the Emergency Department later on 07/06/22 and was admitted with a diagnosis of Atrial Fibrillation. No documentation indicated the RN notified the Physician of the Heart Rate out of range as ordered. Patient #3 A review of the POC for Patient #3 for recertification period 05/25/22 to 07/23/22 revealed a primary diagnosis of Non Hodgkin Lymphoma and a pertinent diagnosis of Malignant Neoplasm of the Right and Left Breast. The POC included orders to "Notify Physician of vital sign parameters out of range... Pain Greater than "7". A review of SN Visit Notes for 06/06/22 and 07/11/22 revealed the patient reported a Pain rating of "8". Further review failed to provide evidence the SN notified the Physician of the Pain rating out of range as ordered. On 07/26/22 at 1:15 PM, the DON stated the SN staff failed to report vital signs out of range to the Physician as ordered in the POC.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure RN conducted onsite Supervisory Aide Visits at least every 14 days for one (#4) of five (#1,#2, #4, #5 and #7) patients records reviewed with orders for Home Health Aide (HHA) services. Patient#4 A review of the POC for Patient #4 for the period 05/27/22 to 07/25/22 with a Primary Diagnosis of Idiopathic Progressive Neuropathy included orders for Home Health Aide (HHA) services 1 time a week for 1 week and 2 times a week for 4 weeks. Review of HHA Visit notes revealed an initial HHA visit was conducted on 05/31/22 and continued 2 times a week through 07/21/22. Further review of SN Visit notes for the same time period failed to provide evidence of a Supervisory Aide Visit conducted by the RN during this certification period. On 07/26/22 at 1:150 PM, the DON stated the Supervisory Aide Visits were not conducted every 14 days by the RN as required.