Every finding on record at Tkg, Inc.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 04/30/24 to 05/02/24. 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 at the agency on 04/30/24 to 05/02/24. 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. Glossary: Pts Patients POC Plan of Care SN Skilled Nurse/Nursing PT Physical Therapy

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 PT frequencies were followed as ordered for two (Patients #2 and 5) of seven patients. Patient #2 A review of a POC dated 01/26/24 to 03/25/24 showed PT frequencies of one visit per week for one week, effective 01/28/24. A further review of a physician’s order dated 02/19/24 showed PT frequencies of two visits per week for five weeks, effective 02/18/24. A review of the medical records showed no PT visits were made for the week of 03/17/24 to 03/23/24 (two of two visits). Documentation 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. Patient #5 A review of a POC dated 01/19/24 to 03/18/24 showed PT frequencies of one visit per week for one week, two visits per week for four weeks, and one visit per week for two weeks, effective 01/21/24. A further review of a physician’s order dated 01/29/24 showed PT frequencies of two visits per week for four weeks and one visit per week for two weeks, effective 01/28/24. A review of the medical records showed a PT evaluation was made on 01/29/24, no missed visits documented, and no other visits made for the week of 01/28/24 to 02/03/24 (one of two visits). Documentation 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 05/02/24 at 09:20 a.m., Staff A stated the PT frequencies for Patients #2 and 5 were not met as ordered by the physician.

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 05/11/21 to 05/13/21. 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 05/11/21 through 05/13/21. An entrance conference was conducted with Staff A. 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, B and C. Standard level deficiencies were cited as a result of the Medicare re-certification survey. Glossary: FSBS finger stick blood sugar Pt's patients POC plan of care PT physical therapy QAPI quality assurance performance improvement SN skilled nurse

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 individualized patient POC included: 1. Pain reporting ranges for seven (Pt's #1, 2, 3, 6, 8, 9 and #10) of 10 patients; 2. FSBS reporting ranges for five (Pt's #1, 2, 4, 5 and #9) of 10 patients and; 3. Recurring urinary catheter change due date was documented for one (Patient #1) of 10 patients. Findings: Patient #1 A review of the plan of care dated 01/09/21 to 03/09/21 documented a principal diagnosis of Diabetes mellitus Type II with a secondary diagnosis of retention of urine. The POC showed orders for SN observation and assessment of pain and to perform skilled teaching related to pain management; insert Foley catheter and change every month; and SN to check blood sugar via finger stick for signs and symptoms of hypo/hyperglycemia. The POC documented no parameter of pain to report to the physician for further intervention; documented no blood sugar parameters to report to the physician for further interventions; and showed no documentation of when monthly Foley catheter changes were conducted or due. Patient #2 A review of the plan of care dated 04/16/21 to 06/14/21 documented a principal diagnosis of chronic obstructive pulmonary disease. The POC showed orders for SN observation and assessment of pain and to perform skilled teaching related to pain management and SN to check blood sugar via finger stick for signs and symptoms of hypo/hyperglycemia. The POC documented no parameter of pain to report to the physician for further intervention and documented no blood sugar parameters to report to the physician for further interventions. Patient #3 A review of the plan of care dated 02/12/21 to 04/12/21 documented a principal diagnosis of infection to left hip prosthesis. The POC showed orders for SN observation and assessment of pain and to perform skilled teaching related to pain management. The POC documented no parameter of pain to report to the physician for further intervention. Patient #4 A review of the plan of care dated 04/07/21 to 06/09/21 documented a principal diagnosis of diabetes mellitus Type II. The POC showed orders for SN to check blood sugar via finger stick for signs and symptoms of hypo/hyperglycemia. The POC documented no blood sugar parameter to report to the physician for further interventions. Patient #5 A review of the plan of care dated 03/12/21 to 05/10/21 documented a principal diagnosis of congestive heart failure with a secondary diagnosis of diabetes mellitus Type II. The POC showed orders for SN to check blood sugar via finger stick for signs and symptoms of hypo/hyperglycemia. The POC documented no blood sugar parameters to report to the physician for further interventions. Patient #6 A review of the plan of care dated 04/12/21 to 06/10/21 documented a principal diagnosis of congestive heart failure. The POC showed orders for SN for observation and assessment of pain and to perform skilled teaching related to pain management. The POC documented no parameter of pain to report to the physician for further intervention. Patient #8 A review of the plan of care dated 03/08/21 to 05/06/21 documented a principal diagnosis of diabetes mellitus Type II. The POC showed orders for SN for observation and assessment of pain and to perform skilled teaching related to pain management. The POC documented no parameter of pain to report to the physician for further intervention. Patient #9 A review of the plan of care dated 03/19/21 to 05/17/21 documented a principal diagnosis of diabetes mellitus Type II with a foot ulcer. The POC showed orders for SN for observation and assessment of pain and to perform skilled teaching related to pain management and SN to check blood sugar via finger stick for signs and symptoms of hypo/hyperglycemia. The POC documented no parameter of pain to report to the physician for further intervention and documented no blood sugar parameters to report to the physician for further interventions. Patient #10 A review of the plan of care dated 04/15/21 to 06/13/21 documented a principal diagnosis of spinal stenosis and secondary diagnosis of diabetes mellitus Type II. The POC showed orders for SN for observation and assessment of pain and to perform skilled teaching related to pain management and SN to check blood sugar via finger stick for signs and symptoms of hypo/hyperglycemia. The POC documented no parameter of pain to report to the physician for further intervention and documented no blood sugar parameters to report to the physician for further interventions. On 05/13/21 at 11:00 a.m., Staff A stated: 1. Pain reporting ranges for Pt's #1, 2, 3, 6, 8, 9 and #10 should have been included on the patient POC's; 2. FSBS reporting ranges for Pt's #1, 2, 4, 5 and #9 should have been included on the patient POC's and; 3. the urinary catheter change due date should have been documented on the POC for Patient #1.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure: 1. SN documented physician orders for wound care for one (Patient #1) of 10; 2. PT documented a change in evaluation orders for one (Patient #7) of 10 and; 3. SN documented a changed SN frequency for one (Patient #9) of 10. Findings: Patient #1 A review of an interim physician order dated 01/11/21 documented SN to apply dressing to right hip. The interim order showed no type of wound care, type of dressing, or frequency and duration of dressing change to the right hip. The documentation showed no SN attempt to clarify the order. Patient #7 A review of an interim physician order dated 04/04/21 documented PT to evaluate post hospital resumption of care the week of 04/08/21 to 04/10/21. A review of PT notes and clinical documentation showed no PT evaluation was conducted 04/08/21 through 04/10/21. Documentation showed no patient/caregiver refusal of visit, no physician notification the evaluation wasn't completed and no changes in order to evaluate for the week beginning 04/08/21. Patient #9 A review of an interim physician order dated 04/25/21 documented a SN visit frequency one time a week to begin week of 04/22/21. A review of nursing notes and clinical documentation showed no SN visit was conducted 04/22/21 through 04/24/21, no patient or caregiver refusal of the visit and showed no changes or updates to the physician's order to begin visits the week of 04/25/21. On 05/13/21 at 11:30 a.m., Staff A stated: 1. SN should have documented a complete physician order for wound care to the right hip for Patient #1; 2. The order had been changed for the PT evaluation and PT should have documented a change in evaluation orders for Patient #7; 3. There was an order change in the date the SN frequency was to begin and the nurse should have documented the physician's order for the change in SN frequency begin date when the order was received for Patient #9.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure a comprehensive infection control program was conducted for all patients and employees. Findings: A review of administrative records showed no comprehensive infection control program for the agency. Additional infection control surveillance documentation was requested and yielded no further reports. On 05/13/21 at 10:45 a.m., Staff A stated: 1. the agency had no comprehensive infection surveillance program in place and; 2. no infection surveillance activities were reported through the agency's QAPI program.

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 record reviews and interview, the agency failed to ensure the SN performed weekly medication planner device prefills as ordered by the physician for two (Pt's #5 and #10) of 10. Findings: Patient #2 A review of the clinical record showed physician orders for SN to prefill medication planner device weekly. Clinical documentation showed SN visits were conducted on 04/16/21 and 04/19/21. Documentation showed no prefill of the medication planner device, no patient or caregiver refusal to fill medication planner device, no physician notification of medication device prefill and no changes in orders. Patient #10 A review of the clinical record showed physician orders for SN to prefill medication planner device weekly. Clinical documentation showed SN visits were conducted on 04/30/21 and 05/07/21. Documentation showed no prefill of the medication planner device, no patient or caregiver refusal to fill medication planner device, no physician notification of medication device prefill and no changes in orders. On 05/13/21 at 11:30 a.m., Staff A stated SN should have prefilled the medication planner devices for Pt's #2 and #10 weekly.