Every finding on record at Whhc I, LLC

The Oklahoma State Department of Health conducted an unannounced Medicare Emergency Preparedness Program survey at the agency on 11/14/23 to 11/17/23. No deficiencies were cited as a result of the Emergency Preparedness Program survey.

The Oklahoma State Department of Health conducted an unannounced re-certification survey at the agency on 11/14/23 to 11/17/23. 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 issues and administrative issues. Findings were discussed during an informal exit conference with Staff A. Deficiencies were cited as a result of the re-certification survey. Glossary: Pts Patients POC Plan of Care SN Skilled Nurse PIP Performance Improvement Program

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 an individualized plan of care for three (Patient #10, 11 and 14) of 17 patients. Patient #10 A review of the plan of care dated 08/26/23 to 10/24/23 showed a primary diagnosis of Alzheimer's disease with interventions which included instruct in the need to establish proper lighting, instruct in appropriate footwear, provide instruction in safe use of assistive device, instruct in need to establish clear pathways, and instruct in correct usage of safety products. Documentation showed no evidence the patient was capable of learning/being taught the interventions. Patient #11 A review of the plan of care dated 09/08/23 to 11/06/23 showed a primary diagnosis of Pressure area sacral stage III with no interventions to assess the wound with wound care. Patient #14 A review of the plan of care dated 06/08/23 to 08/06/23 showed a primary diagnosis of dementia with interventions which included provide instruction in safe use of assistive devices, instruct medication actions, side effects, length of therapeutic onset and when to report side effects to registered nurse or physician. Documentation showed no evidence the patient was capable of learning/being taught the interventions. On 11/17/23 at 10:20 am, Staff A stated the plan of care should have been fully developed for the primary diagnosis for Patient #10, 11 and 14.

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 frequencies were followed as ordered for one (Patient #3) of seventeen patients; 2. wound care treatment orders were followed for one (Patient #7) of seventeen patients. 3. home health aide frequencies were not followed for one (Patient #10) of seventeen patients; and 4. physical therapy frequencies were not followed for one (Patient #17) of seventeen patients. Patient #3 A review of a physician’s order dated 10/17/23 showed a SN frequency of once a week for one week starting the week of 10/22/23. A review of nurses’ notes showed no SN visits the week of 10/22/23 - 10/28/23. Documentation showed no orders for SN frequency changes, no patient/caregiver refusals, and no missed visit notes. Patient #7 A review of the POC dated 08/27/23 to 10/25/23 showed an order to apply gentamicin nickel to wounds, cover with adaptic and a piece of acticoat and cover with optifoam. A review of the clinical records showed the following: A SN visit dated 08/28/23 documented Prisma was applied to wound bed and covered with Xeroform gauze and covered with Optifoam. A SN visit dated 08/30/23 documented Prisma was applied to wound bed and covered with Xeroform gauze and covered with Optifoam. A SN visit dated 09/05/23 documented Prisma was applied to wound bed and covered with Xeroform gauze and covered with Optifoam. Patient #10 A review of the plan of care dated 08/26/23 to 10/24/23 showed a home health aide frequency of two visits per week for four weeks and one visit per week for five weeks. A review of the medical record showed one home health aide visit dated 09/26/23 and one missed visit dated 09/29/23 due to scheduling conflict for the week of 09/24/23 to 09/30/23. There were 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 #17 A review of the plan of care dated 06/12/23 to 08/10/23 showed a physical therapy frequency of one visit per week for one week, two visits per week for three weeks and one visit per week for one week. A physician's order dated 07/17/23 showed a physical therapy order for two visits per week for three weeks. Physical therapy missed visit notes dated 07/21/23, 07/22/23, 0728/23 and 07/29/23 documented the reason for the missed visit was a scheduling error. There were 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 11/17/23 at 11:05 am, Staff A stated 1. the SN frequencies for Patient #3 were not met as ordered by the physician; 2. the wound care orders for Patient #7 were not followed as ordered by the physician; 3. the home health aide frequencies for Patient #10 were not met as ordered by the physician; and 4. the physical therapy frequencies for Patient #17 were not met as ordered by the physician.

Program activities CFR(s): 484.65(c) Standard: Program activities. The HHA's performance improvement activities must-- This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to monitor the effectiveness of the agency PIP which affected all current patients. A review of the agency’s documentation showed a PIP for home health aide supervisory visits not being completed as required, with a start date of November 2021. The PIP continued to be implemented with no changes through November 2023 (2 years). On 11/17/23 at 11:35 a.m., Staff A confirmed there were no changes made to the PIP over the two years it was implemented.

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 a home health aide supervisory visit was completed every 14 days for two (Patients #5 and 6) of seventeen patients. Patient #5 A plan of care dated 08/25/23 to 10/23/23 showed a home health aide visit frequency of twice a week for eight weeks and one visit per week for one week. A review of the clinical record showed home health aide visits completed on 08/29/23, 09/01/23, 09/06/23, 09/08/23, 09/12/23, 09/15/23, 09/19/23, 09/22/23, 09/26/23 and 09/28/23, with no supervisory aide visits conducted from 08/30/23 to 10/01/23 (39 days without supervisory visits). Patient #6 A plan of care dated 07/22/23 to 09/19/23 showed a home health aide visit frequency of twice a week for eight weeks and one visit per week for one week. A review of the clinical record showed home health aide visits completed on08/15/23, 08/18/23, 08/22/23, 08/25/23, 08/29/23, 09/01/23, 09/05/23 and 09/07/23, with no supervisory aide visits conducted from 08/15/23 to 09/10/23 (26 days without supervisory visits). On 11/17/23 at 11:00am, Staff A stated the supervisory visits were not completed within 14 days for Patient #5 and 6.