South Arkansas Home Health

“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 Clinical Record review and staff interviews, the Agency failed to ensure the established individualized Plan of Care (POC) was followed regarding Skilled Nurse (SN) visits scheduled in 1 (#9) of 17 (#1 - #17) Clinical Records reviewed. The deficient practice identified, if continued, could result in potential harm or risk of adverse outcomes or re-hospitalization for patients by delaying the SN and Physician’s ongoing assessment of patient needs and progression toward goals. Findings follow: Review of Clinical Record #9 with a Start of Care (SOC) date of 05/28/26 revealed a patient with a diagnosis of Open Wound to right and left extremities and Infection. The Home Health Certification and Plan of Care dated 05/28/26 - 07/26/26 documented Skilled Nurse visits 2 times a week for 3 weeks then 1 time a week for 6 weeks. There was a missed visit on the week of admission 05/28/26 and the week of 06/07/26. On 07/16/26, the agency was given an opportunity to provide any documentation of why these visits were missed and no further information was provided.”

“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 observation during home visits, Clinical Record review and staff interview, the agency failed to ensure all medications were included in the medication regimen review in 2 (#1 and #3) of 17 (#1 -#17) clinical records reviewed. This failed practice had the potential to affect all patients currently on census in that the Clinician may be unaware of all medications being taken by the patients and could fail to identify and notify the Physician of potential reactions, ineffective drug therapy, interactions, duplicate drug therapy and noncompliance. Findings follow: The computer program utilized by the agency automatically cross-references medications for the Medication Regimen Review and those highlighted in blue are not in the software. Therefore, these must be done manually by the agency and documented a review was completed. Review of Clinical Record #1 with a Start of Care (SOC) of 06/12/26 revealed a patient with a diagnosis of Infection following surgery and Mastitis. The current physician’s orders documented, “...Vancomycin 1 GM [gram]/ 100ml [milliliters] in 0.9% normal saline every 12 hours intravenous...” This medication was highlighted in blue in the computer system. Review of Clinical Record #3 with a SOC date of 03/11/26 revealed a patient with a diagnosis of Zoster Blisters, and Type 2 Diabetes Mellitus. The physician’s orders documented, “...Vitamin B-12, Fiber Advance Gummies, Magnesium Citrate, and Procera Advanced Brain 2...” On 07/16/26, the agency was provided an opportunity to show evidence of a manual medication regimen review, and no further information was provided.”

“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, home visit, and staff interview it was determined the Agency failed to develop a patient specific written Plan of Care (POC) with current treatments and patient specific interventions for meeting the patients’ needs in 1 (#1) of 17 (#1-#17) Clinical Records reviewed. This failed practice had the potential to affect the quality of care received by all patients currently on census in that care provided may not result in attainment of patient goals and may not meet the patient’s needs. Findings follow: Review of Clinical Record #1 with a Start of Care (SOC) date of 06/12/26 revealed a patient with a diagnosis of Infection following surgery and Mastitis. The current physician’s orders after a Resumption of Care on 07/11/26 did not include the care and treatment of the JP [Jackson-Pratt] drains (a type of flexible tube that is placed under the skin to remove excess fluids from a wound after surgery). There was no care provided for the JP drain while at the home visit. On 07/16/26 the agency was given an opportunity to provide any further documentation. The Executive Director stated, “we had an order from before she went to the hospital [7/7/26 - 7/10/26] but we didn’t have one when she came back to us.””