Every finding on record at Ross Home Health of Chickasha, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 12/02/25 - 12/03/25. A deficiency was cited as a result of the Emergency Preparedness Program. Glossary: MERC - Medical Emergency Response Center RMRS - Regional Medical Response System

Local, State, Tribal Collaboration Process CFR(s): 484.102(a)(4) §403.748(a)(4), §416.54(a)(4), §418.113(a)(4), §441.184(a)(4), §460.84(a)(4), §482.15(a)(4), §483.73(a)(4), §483.475(a)(4), §484.102(a)(4), §485.68(a)(4), §485.542(a)(4), §485.625(a)(4), §485.727(a)(5), §485.920(a)(4), §486.360(a)(4), §491.12(a)(4), §494.62(a)(4) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years [annually for LTC facilities]. The plan must do the following:] (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation. * * [For ESRD facilities only at §494.62(a)(4)]: (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation. The dialysis facility must contact the local emergency preparedness agency at least annually to confirm that the agency is aware of the dialysis facility's needs in the event of an emergency. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure that Emergency Preparedness documents were updated every two years for all patients and all employees. Findings: A review of administrative records showed a document dated 11/28/19 titled, "MERC Response Team Names and Phone Numbers." The surveyor compared information contained in "MERC Response Team Names and Phone Numbers" with current RMRS map including names of RMRS staff, titles, and telephone numbers. The contact information for agency staff to use was not updated. On 12/03/25 at 1:45 pm, Staff A stated the information in the document titled, "MERC Response Team Names and Phone Numbers" had not been updated in the last two years.

The Oklahoma State Department of Health conducted an unannounced Medicare Recertification survey at the agency on 12/02/25 - 12/03/25. An entrance conference was conducted with Staff A and B. The survey process was explained. Questions were answered. Staff A and B were identified as the contact persons for administrative and clinical issues. Findings were discussed during an informal exit conference with Staff A and B. Standard level deficiencies were cited as a result of the Medicare recertification survey. Glossary: POC - Plan of Care Pt - Patient PT - Physical Therapy ROC - Resumption of Care SOC - Start of Care

Patient's needs CFR(s): 484.55(c)(4) The patient's medical, nursing, rehabilitative, social, and discharge planning needs; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to include orders in the POC for one (Pt #2) of twelve patients. Findings: A review of the SOC assessment dated 11/19/25 documented in part, "She has trouble arranging her medications and will need a weekly med planner fill..." The review showed a POC dated 11/19/25 to 01/17/26 that did not show orders for a medication planner or a weekly med planner fill. On 12/03/25 at 2:20 pm, Staff A stated the orders for a weekly medication planner being filled should have been included in the POC orders.

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 provided the ordered wound care for one (Pt #9) of twelve patients. Findings: Pt #9 A review of the record showed a certification period dated 09/20/25 - 11/18/25 with a ROC dated 09/26/25. The orders for wound care from the ROC read as follows: "Incisional wound vac dressing is in place. Keep this in place for seven days and do not get the dressing wet. Reinforce with adhesive sheets as needed. After seven days, remove the wound vac dressing and replace with silver island dressing." The nurses' notes documented the followings. 10/02/25 - Wound care provided; Incisional wound vac dressing is in place. Keep this in place for seven days and do not get the dressing wet, reinforce with adhesive sheets, as needed after seven days remove the wound vac dressing replace with silver island dressing. 10/08/25 - Wound care not provided; covered by non-removable dressing or device. 10/15/25 - Wound care not provided; covered by non-removable dressing or device. 10/22/25 - Wound care provided; Incisional wound vac dressing is in place. Keep this in place for seven days and do not get the dressing wet, reinforce with adhesive sheets, as needed after seven days remove the wound vac dressing replace with silver island dressing. 10/29/25 - Wound care provided; Incisional wound vac dressing is in place. Keep this in place for seven days and do not get the dressing wet, reinforce with adhesive sheets, as needed after seven days remove the wound vac dressing replace with silver island dressing. On 12/03/25 at 2:50 pm, Staff A stated wrong wound dressings had been documented.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure: 1) A current POC was provided to the Assisted Living Facility for one (Pt #5) of one patients residing in an Assisted Living Facility; 2) A physician was notified of an oxygen saturation below parameters for one (Pt #6) of twelve patients. Findings: Pt #5 A review of the home health agency record at the assisted living showed no current plan of care for the certification period of 11/14/25 - 01/12/25. Pt #6 A review of the record showed a POC dated 10/26/25 - 12/2/24/25 with orders to report an oxygen saturation of less than 90%. A nursing assessment dated 10/27/25 did not show physician notification of an oxygen saturation of 84% with the patient receiving oxygen at 5 L/min per minute via nasal cannula on the day the patient assessment was conducted. On 12/03/25 at 10:25 am Assisted Living Staff #1 stated there was no current plan of care for Pt #5. On 12/03/2 at 2:50 pm Staff B stated the POC should be provided to a facility within 5 days of the SOC or recertification assessment. On 12/03/25 at 2:45 pm Staff B stated the nurse should have notified the physician of the oxygen saturation of 84% at the time of assessment for Pt #6.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure assessments were completed and uploaded in a timely manner for one (Pt #2) of twelve patients. Findings: A review of a POC dated 11/19/25 to 01/17/26 showed orders for PT effective 11/23/25 once a week for one week. The record did not contain a PT assessment for the week of 11/23/25. On 12/03/25 at 2:20 pm Staff A stated the PT assessment should have been turned in within 48 hours of the evaluation.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency from 10/31/22 to 11/01/22. 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 10/31/22 to 11/01/22. An entrance conference was conducted with Staff A and B. The survey process was explained. Questions were answered. Staff A was identified as the contact person for administrative issues and Staff A and B were identified as the contact persons for clinical 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:

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 the plan of care included services for the assessment of wounds for one (patient #8) of ten patients. Patient #8 A plan of care dated 08/26/22 to 10/24/22 showed a primary diagnosis of pressure induced deep tissue damage of right heel and secondary diagnosis of pressure induced deep tissue damage of left heel with a skilled nurse frequency of three visits for one week, four visits for one week, three visits for seven weeks and one visit for one week. The plan of care showed no orders to observe and assess the skin integrity of the pressure areas to the left and right heels. A review of the electronic medical record showed the following: The week of 08/28/22 to 09/03/22 showed skilled nurse assessments dated 08/28/22, 08/29/22, 08/31/22 and 09/02/22 with no assessment of the pressure ulcers to the left and right heels (four of four assessments). The week of 09/04/22 to 09/10/22 showed skilled nurse assessments dated 09/05/22, 09/07/22 and 09/09/22 with no assessment of the pressure ulcers to the left and right heels (three of three assessments). The week of 09/11.22 to 09/17/22 showed skilled nurse assessments dated 09/13/22, 09/15/22 and 09/16/22 with no assessment of the pressure ulcers to the left and right heels (three of three assessments). The week of 09/18.22 to 09/24/22 showed skilled nurse assessments dated 09/19/22, 09/21/22 and 09/23/22 with no assessment of the pressure ulcers to the left and right heels (three of three assessments). The week of 09/25.22 to 10/01/22 showed skilled nurse assessments dated 09/26/22, 09/28/22 and 09/30/22 with no assessment of the pressure ulcers to the left and right heels (three of three assessments). The week of 10/02.22 to 10/08/22 showed skilled nurse assessments dated 10/03/22, 10/05/22 and 10/07/22 with no assessment of the pressure ulcers to the left and right heels (three of three assessments). On 11/01/22 at 2:08pm, Staff A and B stated plan of care should have been fully developed to include assessment of the wounds for Patient #8.

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 the physician was notified of pain ratings outside of ordered parameters for one (Patient #7) of ten patients. Patient #7 A review of the plan of care dated 08/31/22 to 10/29/22 showed orders to notify they physician of pain ratings greater than 6 on the classic 1-10 pain scale. A review of the clinical record showed the following: A skilled nurse assessment dated 09/02/22 documented a pain rating of 7 with no notification to the physician. A skilled nurse assessment dated 09/16/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 09/22/22 documented a pain rating of 9 with no notification to the physician. A skilled nurse assessment dated 09/27/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 09/29/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 09/30/22 documented a pain rating of 8 with no notification to the physician. On 11/01/22 at 2:50 pm, Staff A stated the physician should have been notified of the pain ratings above the ordered parameters for Patient #7.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure coordination of care was provided for the management of pain for two (Patients #7 and 8) of ten patients. Patient #7 A review of the plan of care dated 08/31/22 to 10/29/22 showed orders for the physician to be notified of a pain level greater than 6 on the classic 1-10 pain scale. A review of the clinical record showed the following: A skilled nurse assessment dated 09/02/22 documented a pain rating of 7 with no notification to the physician. A skilled nurse assessment dated 09/16/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 09/22/22 documented a pain rating of 9 with no notification to the physician. A skilled nurse assessment dated 09/27/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 09/29/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 09/30/22 documented a pain rating of 8 with no notification to the physician. A skilled nurse assessment dated 10/07/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 10/07/22 showed a pain rating of 7 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 10/11/22 showed a pain rating of 9 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 10/14/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 10/21/22 showed no evaluation of the patient's pain rating. A skilled nurse assessment dated 10/28/22 showed no evaluation of the patient's pain rating. Patient #8 A plan of care dated 08/28/22 to 10/26/22 showed orders for the physician to be notified of a pain level greater than 6 on the classic 1-10 pain scale. A review of the clinical record showed the following: A skilled nurse assessment dated 09/09/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 08/28/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 09/12/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 09/13/22 showed no evaluation of the patient's pain rating. A skilled nurse assessment dated 09/14/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 09/16/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 09/17/22 showed a pain rating of 8 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 09/18/22 showed a pain rating of 9 with a notation that the physician was aware of the elevated pain rating. No new physician orders were received for the management of pain. A skilled nurse assessment dated 09/19/22 showed no evaluation of the patient's pain rating. A discharge by death at home was completed on 09/23/22. On 11/01/22 at 2:20 pm, Staff A and B stated the coordination of care was not performed properly regarding the pain management for Patient's #7 and 8.