Every finding on record at Southwest Arkansas Homecare, LLC

On 12/01/25 at 11:30 a.m., an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification Survey for compliance with CFR Part 484 Conditions of Participation for Home Health Agencies. On 12/10/25 at 3:52 p.m., an exit conference was conducted with Agency Representatives. The preliminary findings of the survey were discussed. The Agency Representatives were given an opportunity to provide further documentation.

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 Clinical Record review and Agency staff interviews, the Skilled Nurse (SN) failed to ensure the patients Plan of Care (POC) included the required elements of all medication and treatments in 2 (#14 and #18) of 18 (#1 - #18) Clinical Records reviewed. This failed practice had the potential to result in harm for all patients on census by inhibiting the SN and Physician's ability to make informed decisions regarding the clinical treatment regimen related to potential infection and safety due to use of a dialysis port (access line). Findings follow: Review of Clinical Record #14 with a start of care (SOC) date of 10/30/25 revealed a patient with a diagnosis of Osteomyelitis of vertebrae, unstageable pressure ulcers left and right buttock, and Paraplegia. The visit notes and the supplies list on the Plan of Care (POC) indicated the patient had an indwelling catheter. The Home Health Certification and Plan of Care with a certification period of 10/30/25 - 12/28/25 did not include orders for an indwelling catheter. Review of Clinical Record #18 with a SOC date of 10/31/25 revealed a patient with a diagnosis of chronic ulcer right lower leg and Acute Kidney Injury. The visit notes indicated the patient had a routine treatment for dialysis for Acute Kidney Failure. The Home Health Certification and Plan of Care with a certification period of 10/31/25 - 12/29/25 did not include orders for the care and prevention of injury in relation to the dialysis port. On 12/04/25, the Agency Representatives were asked to provide any further documentation regarding the orders and plan of care for these two identified issues, and none was provided.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on Clinical Record review and staff interview, it was determined the Agency staff did not provide care in accordance with the written Plan of Care (POC) in 3 (#11, #13 and #18) of 18 (#1 - #18) Clinical Records reviewed. This failed practice had the potential to affect the quality of care received by all patients currently on census, in that, there was a risk of adverse outcomes, potential to affect the attainment of the patients' individual goals and a risk of hospitalizations due to unrecognized signs/symptoms of disease exacerbation. Findings follow: Review of Clinical Record #11 with a start of care of 10/21/24 revealed a patient with diagnoses of post-surgical wound dressing and Type 2 Diabetes Mellitus. The Home Health Certification and Plan of care dated 10/18/25- 12/14/25 noted an order for skilled nursing visits 1 time a week for 1 week, 2 times a week for 8 weeks. 2 visits were ordered for the week of 11/10/25 but only one visit was made. Review of Clinical Record #13 with a start of care of 10/18/25 revealed a patient with diagnosis of Sequalae of Cerebral Infarction, Hypertension, and kidney disease. The Home Health Certification and Plan of care dated 10/18/25 - 12/16/25 noted an order for skilled nursing visits 1 time a week for 2 weeks, every 2 weeks for 2 weeks, 1 every 4 weeks times 4 weeks, and 1 time a week for 1 week. There was no skilled nursing visit in the week of 11/16/25 as ordered. Review of Clinical Record #18 with a start of care of 10/31/25 revealed a patient with diagnosis of Chronic Ulcer of right lower leg, Acute Kidney Failure requiring Dialysis and Hypertension. The Home Health Certification and Plan of Care dated 10/31/25 - 12/29/25 noted an order, "...Skilled nurse may perform up to 2 PRN [as needed] visits for cardiac complications such as ...Increase in weight of 5 # in 1 week..." There was no documentation of continued weight monitoring. The admission weight was documented in the vital signs report and none other since 10/31/25. On 12/04/25, the Agency Representatives stated the standing orders for those patients with a cardiac diagnosis include weight monitoring and ankle circumference monitoring which are to be completed on skilled nursing visits.

. On 11/7/2022 at 11:30 AM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 11/14/2022 at 5:00 PM, an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. .

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 Clinical Record review and staff interviews, it was determined the Skilled Nurse (SN) failed to include all medications during the review of the patients medications in 1 (#1) of 17 (#1 - #17) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for patients on census by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. Clinical Record #1 revealed the following: A. Document titled "visit note report" dated 11/8/22 showed Skilled Nurse (SN) documentation of Patient reported taking an OTC (over the counter) medication Aleve, (medication used for pain). B. A document titled "Client Medication Report" dated 11/14/22 showed no evidence Aleve was on the medication list nor checked for potential adverse effects, drug reactions, significant side effects or significant drug interactions with all other Patient medications. 2. During an interview on 11/14/2022 at 4:00 PM, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 confirmed the Agency staff did not include all medications the patients were currently using during a review of medications. .

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 Clinical Record review and staff interview, it was determined the Agency staff did not follow the Attending Physician orders contained in the Plan of Care (POC) for 5 (#1, #2, #9, #10, and #16) of 17 (#1 - #17) Clinical Records reviewed. This failed practice if not corrected, had the potential to negatively impact Patients , in that the Patients might not recieve the care ordered by their Physician. This lack of following orders could cause exacerbations of diagnosis up to and including hospitalizations. 1. Review of Clinical Record #1 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)", dated 10/23/22 to 12/21/22 which contained an order for "Skilled Nurse (SN) to obain weights every SN visit and notify RN/MD (Registered Nurse/Medical Doctor) of weight gain of 3 lbs (pounds) within one day or 5 lbs. withing seven days." B. Document titled "Visit Note Report" dated 10/25/22 and 11/8/22 showed no evidence weights were assessed by the SN for these visits. 2. Review of Clinical record #2 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)" dated 9/12/22 to 11/10/22, contained an order for :Skilled Nurse (SN) to obtain body measurements of left calf every SN visit and to notify the physician of left calf measurement increase of 3 cm (centimeters) in 24 hours or 5 cm in 7 days. B. Documents titled "Visit Note Report" showed no evidence that the SN obtained measurements of left calf on 9/12/22,9/21/22, 9/29/22, 10/4/22, 10/12/22,10/18/22, 10/25/22, 11/1/22, 11/3/22, 11/7/22 and 11/8/22 as ordered by the Physician. 3. Review of Clinical record #9 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)" dated 9/27/22 to 11/25/22 contained orders for Physical Therapist (PT) to make visits 3 times per week for 4 weeks and 2 times per week times 2 weeks. B. A review of PT visits showed 1 PT visit was missed for the weeks of 10/10/22 and 10/23/22. 3. Review of Clinical record #10 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)" dated 8/18/22 to 10/11/22 which contained orders for SN 1 time per week times 1 week, 3 times per week times 1 week and 1 time per week times 7 weeks. B. Review of SN visits for the week of 9/11/22 showed no SN visits were completed for that week. 4. Review of Clinical record #16 revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC) dated 7/10/22 to 9/7/22 which contained orders for "Skilled Nurse to perform site care for infusion access device, (a device used to administer medication, etc.) B. Documents titled "Visit notes Report" dated 7/13/22, 7/20/22, 7/27/22, and 8/3/22 showed no evidence the SN performed site care for infusion access device. 5. During an interview on 11/14/22 at 4:00 PM, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 and #2 confirmed the Agency staffs failure to provide interventions as ordered in the individualized POC for Patients # 1, #2, #9, #10, and #16. .

Written instructions to patient include: CFR(s): 484.60(e) Standard: Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: This STANDARD is not met as evidenced by: . Based on Clinical Record review, observation during home visits, and staff interviews, it was determined the Agency failed to provide written information to the patients and/or caregivers regarding staff visit schedules, treatments or instructions specific to the patients care in 6 (#1, #2, #3, #5, #6, and #7) of 7 (#1 - #7) home visits completed. This deficient practice did not ensure the affected patients/caregivers had the opportunity to participate in the Plan of Care and had the potential risk of poor understanding of visit schedules and the purpose and expectations of services provided by this Agency. Review of Clinical Record #1 showed the following: A. Document titled "Home Health Certification and Plan of Care" dated 10/23/22 to 12/21/22 which contained orders for the Skilled Nurse (SN) frequency of 2 times per week times 1 week and 1 time per week times 8 weeks.. B. During a home visit on 11/8/22 at 1:40 PM, the Surveyor reviewed the Patient's home folder and there was no evidence the Patient had been provided a Plan of Care showing treatments, services or visits scheduled. As the SN, Clinical Manager, and Surveyor were leaving the Patient's home, the Patient asked the SN "When will you back?" Indicating the Patient was not aware of the visit schedule for the SN. 2. Review of Clinical Record #2 showed the following: A. Document titled "Home Health Certification and Plan of Care" dated 9/12/22 to 11/10/22 which contained orders for the SN frequency of 1 time per week times 4 weeks, 1 every 2 weeks times 2 weeks, and 1 time per week times 3 weeks. B. During a home visit on 11/8/22 at 12:10 PM, the Surveyor reviewed the Patient's home folder and there was no evidence the Patient had been provided a Plan of Care showing treatments, services or visits scheduled. 3. Review of Clinical Record #3 showed the following: A. Document titled "Home Health Certification and Plan of Care" dated 10/28//22 to 12/26/22 which contained orders for the SN frequency of 1 time per week times 1 week, 2 times per week times 1 week, and 1 time per week times 7 weeks. B. During a home visit on 11/9/22 at 12:43 PM, the Surveyor reviewed the Patient's home folder and there was no evidence the Patient had been provided a Plan of Care showing treatments, services or visits scheduled. 4. Review of Clinical Record #5 showed the following: A. Document titled "Home Health Certification and Plan of Care" dated 11/2/22 to 12/31/22 which contained orders for the SN frequency of 1 times per week times 9 weeks. B. During a home visit on 11/9/22 at 12:43 PM, the Surveyor reviewed the Patient's home folder and there was no evidence the Patient had been provided a Plan of Care showing treatments, services or visits scheduled. 5. Review of Clinical Record #6 showed the following: A. Document titled "Home Health Certification and Plan of Care" dated 9/19/22 to 11/17/22 which contained orders for the SN frequency of 1 time per week times 1 week and every other week times 6 weeks. B. During a home visit on 11/9/22 at 11:43 PM, the Surveyor reviewed the Patient's home folder and there was no evidence the Patient had been provided a Plan of Care showing treatments, services or visits scheduled. 6. Review of Clinical Record #7 showed the following: A. Document titled "Home Health Certification and Plan of Care" dated 10/6/22 to 12/4/22 which contained orders for the SN frequency of 1 time per week times 9 weeks. B. During a home visit on 11/9/22 at 9:17 AM, the Surveyor reviewed the Patient's home folder and there was no evidence the Patient had been provided a Plan of Care showing treatments, services or visits scheduled. 7. During an interview on 11/14/22 at 5:00 PM Agency Personnel #1 confirmed there was no written information pertaining to the visit schedules, and Plans of treatments for Patients #1, #2, #3, #5, #6, and #7. .

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 observations during Patient home visits the Skilled Nurse (SN) failed to demonstrate appropriate infection control standards of practice and follow Agency policy while performing Patients care for 4 (#1, #3, #5, and #6) of 7 (#1 - #7) home visits. . Review of patient #1 revealed the following: A. Observations during a home visit on 11/8/22 at 12:50 PM to Patient #1 home the Surveyor observed wound care that was provided by the SN. During the wound care procedure the SN failed to maintain and adhere to standards of practice pertaining to placing a barrier for wound care supplies, in that the SN was observed placing a barrier for wound supplies next to and slightly on top of a soiled pet food bowl. B. The Surveyor observed that when the SN removed the soiled dressings that the soiled dressings were handed off into the ungloved/unprotected patient's family member hands for disposal. The SN did not remove gloves, perform hand hygiene, or don clean gloves prior to cleansing wound or placing new dressing onto the wound area. 2 Observations during a home visit for patient #3 revealed the following: A. During the provision of wound care, the SN failed to maintain and adhere to standards of practice in that scissors used for the wound care were not cleaned prior to removal of soiled dressing, and the SN failed to clean the scissors prior to cutting clean/new dressing materials to place on Patient #3 wound.. 3. 3. Observations during a home visit for patient #5 revealed the following: A. During the provision of wound care, On 11/09/2022 at 10:00 AM, the Surveyor observed the SN failed to clean the patient’s personal scissors after cutting old dressing off and cutting/preparing new dressing materials.. B. The Surveyor observed that when the SN removed the soiled dressings that the soiled dressings were handed off into the ungloved/unprotected patient's family member hands for disposal. C. The SN failed to place a barrier under the leg being treated, either prior to removal of old dressing, for cleaning of leg or for placing new dressings. 4. Observations during a home visit for patient #6 revealed the following: A. The SN provided an IM (intramuscular Injection) for Patient #6 to administer medication on 11/09/2022 at 11:43 AM. The Surveyor observed that the SN recapped the used needle on the syringe after the medication was administered.