Conway Regional Homecare Svcs

“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 interview, it was determined the agency failed to ensure a means of measuring pain control was part of the assessment tool for the skilled nurse and other professionals to utilize as part of the individualized care plan for 13 (#1- #6 and #8 - #14) of 17 (#1 - #17) clinical records reviewed. This failed practice had the potential to affect all patients on census that have pain or have pain medications ordered on an as needed basis. Findings follow: Clinical Records #1 - #6 and #8 - #14 were reviewed and noted orders for pain medications. Clinical Records #1 - #6 and #8 - #14 revealed there was no pain parameter (0-10 scale for verbal, cognitive patients or the Wong-Baker Faces pain scale utilized for non-verbal patients or for those that have cognitive decline) as part of the pain assessment. On 12/05/24 the Director of the Home Health agency was interviewed and asked to provide any further information on how the agency has a measurable assessment of current pain and response to pain interventions for their patients and none was provided.”

“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 observation, clinical record review, and staff interview, it was determined the agency failed to ensure a physician’s order was followed as demonstrated by sterile water was utilized rather than saline during a wound care dressing change for 1 (#6) of 5 (#6 -#10) patients with wound care observed and clinical records reviewed. Findings follow: Clinical Record Review #6 with a start of care date of 04/02/21 and certification period of 11/12/23 - 01/10/25 revealed a patient with a diagnosis of Progressive Bulbar Palsy. A document titled, “Physician Order” and dated 11/27/24 documented, “SN [Skilled Nurse] to perform wound care to right low back. Remove dressing and dispose. Cleanse with normal saline and gauze, pat dry. Apply foam border dressings once daily. CG [Caregiver] to perform in absence of nurse.” During a home visit on 12/03/24 at 11:59 a.m., Surveyor observed SN cleanse the wound with sterile water rather than saline as ordered. During an interview on 12/05/24 the Director of Home Health was provided with the information regarding this observation, given an opportunity to provide any further information and none was provided.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on clinical record review and staff interview, it was determined the agency failed to ensure the nurse visited a patient and notify the physician with a change of condition status for 1 (#16) of 17 (#1 - #17) clinical records reviewed. This failed practice had the potential to affect all patients on census as a failure to assess a patient during a change of condition and subsequent physician notification could result in a further decline in patient condition. Findings follow: Clinical Record #16 with a start of care date of 07/08/24 and certification period of 09/06/24 - 11/01/24 revealed a patient with a diagnosis of Hemiplegia following Cerebral Infarction. A Patient Communication note dated 09/12/24 and documented by Physical Therapy Assistant (PTA) revealed, “Have attempted to schedule PT [Physical Therapy] visit x [times] 3 this week with patient refusal. Daughter stated that patient has been ill all week with diarrhea. She stated that buttocks wound has gotten worse. Requested SN [Skilled Nurse] visit and rescheduled visit to next week.” A note labeled “phone call” dated 09/13/24 and documented by a Registered Nurse (RN) documented the patient has had diarrhea for several days and now has open wound to buttocks related to diarrhea. Instructions given to caregiver. There was no evidence of an in-home visit and assessment until 09/16/24. There was no evidence of physician notification. On 12/05/24 at 9:45 a.m., a Director of Home Health #2, stated it appeared the nurse who is case manager and assigned to the patient was not on call that day and decided to check in on them by phone. She further stated, “You know they get territorial; they know their patients so well and don’t want to have another nurse (on-call nurse) to go see their patients.””

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on clinical record review and staff interview, it was determined the agency failed to ensure orders for therapy visits were set as a frequency consistent with the patient’s current plan of care for 9 (#1, #3 - #7, #9, #16, and #17) of 9 clinical records reviewed that had orders for therapy. This failed practice had the potential to affect all patients on census that have orders for therapy. Findings follow: Clinical Records #1, #3 - #7, #9, #16, and #17 revealed patients with orders for therapy that were set by month rather than by week as skilled nursing, home health aide visit frequencies are managed. For example, therapy orders read 3mo1 (3 times a month for 1 month). Skilled nursing and home health aide visit frequencies are set as follows, for example, 1wk9 (1 time a week for 9 weeks). The Skilled Nursing and Home Health Aide visit frequencies are set from Sundays to Saturdays. The Therapy orders are set on 30 days’ time-frame and not via calendar. The patients would not be able to know with certainty when the therapists would be expected to arrive at their home for services. On 12/04/24 and 12/05/24 Director #1 and Director #2 were informed of this finding and agreed there was a difference in how the orders were written and could confuse the patients regarding upcoming services.”