Ochsner Home Health of Raceland

“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: 1. A patient’s pulse oxygen saturation level (a measurement of the amount of oxygen circulating in a patient’s blood) was obtained per the plan of care (Patient #17); 2. A patient’s capillary blood glucose (blood sugar) level was obtained per the plan of care (Patient #17); and, 3. A patient’s weight or ankle circumference was obtained per the plan of care (Patient #7, Patient #16). This deficient practice was identified for 3 (Patient #7, Patient #16, and Patient #17) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for care and services provided per their plan of care. Findings: 1. Patient #17 Review of Patient #17’s Home Health Certification and Plan of Care for the certification period of 12/19/2023 through 02/16/2024 revealed, in part, Patient #17 was to receive skilled nursing services once a week for eight weeks. Further review revealed the skilled nurse was to obtain a pulse oxygen saturation level for Patient #17 every visit. There was no documented evidence, and the agency presented no documented evidence, a pulse oxygen saturation level was obtained during the skilled nurse visits for Patient #17 conducted on 12/28/2023, 01/05/2024, 01/12/2024, 01/18/2024, 01/25/2024, and 02/01/2024. In an interview on 10/16/2024 at 2:48 p.m., S2Patient Care Manager (PCM) indicated the agency had no documented evidence Patient #17’s pulse oximetry was completed as ordered for the above mentioned dates per the plan of care. 2. Patient #17 Review of Patient #17’s Home Health Certification and Plan of Care for the certification period of 12/19/2023 through 02/16/2024 revealed, in part, Patient #17 was to receive skilled nursing services once a week for eight weeks. Further review revealed the skilled nurse was to instruct Patient #17 on diabetes, and assess Patient #17 for diabetic complications, and notify the physician of a fasting blood sugar of less than 60 milligrams (mg) per deciliter (dL) or greater than 350 mg/dL, or a random blood sugar of less than 60 mg/dL or greater than 350 mg/dL. There was no documented evidence, and the agency presented no documented evidence, Patient #17’s capillary blood glucose was monitored on 12/28/2023, 01/12/2024, and 01/18/2024. In an interview on 10/16/2024 at 2:48 p.m., S2PCM indicated the agency had no documented evidence Patient #17’s capillary blood glucose was monitored by the skilled nurse per the plan of care. 3. Patient #7 Review of Patient #7’s Home Health Certification and Plan of Care for the certification period of 09/12/2024 through 11/10/2024 revealed, in part, Patient #7 was to receive skilled nursing services once a week for nine weeks. Further review revealed the skilled nurse was to obtain Patient #7’s weight every visit and notify the physician of a weight gain or loss of three pounds within one day or five pounds within one week. Further review also revealed the skilled nurse was to obtain Patient #7’s ankle circumference every visit and notify the physician of an increase of 2 centimeters (cm) within one day. Review of Patient #7’s record revealed no documented evidence, and the agency presented no documented evidence, Patient #7’s weight was obtained on 09/24/2024, 10/01/2024, and 10/08/2024. Further review revealed no documented evidence, and the agency presented no documented evidence, Patient #7’s ankle circumference was obtained during the skilled nursing visits on 09/17/2024, 09/24/2024, 10/01/2024, and 10/08/2024. In an interview on 10/16/2024 at 2:31 p.m., S2PCM indicated the agency had no documented evidence that the skilled nurses had obtained Patient #7’s weights and/or ankle circumference measurements for the above mentioned dates per the plan of care. Patient #16 Review of Patient #16’s Home Health Certification and Plan of Care for the certification period of 04/11/2024 through 06/09/2024 revealed, in part, Patient #16 was to receive skilled nursing services once a week for one week, then twice a week for eight weeks. Further review revealed the skilled nurse was to obtain Patient #16’s ankle circumference measurements every visit and notify the physician of an increase of 1 cm within one day. Review of Patient #16’s record revealed no documented evidence, and the agency presented no documented evidence, Patient #16’s ankle circumference measurements were obtained during the skilled nursing visits on 04/12/2024, 04/15/2024, 04/22/2024, 04/26/2024, and 04/29/2024. In an interview on 10/16/2024 at 2:45 p.m., S2PCM indicated the agency had no further evidence to present that Patient #7 and Patient #16’s weight and/or ankle circumference measurements were obtained as ordered for the above mentioned dates per their plan of care.”

“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 reviews and interview, the agency failed to maintain surveillance of infections for 4 (Patient #8, Patient #10, Patient #15, and Patient #16) of 8 (Patient #2, Patient #3, Patient #8, Patient #9, Patient #10, Patient #15, Patient #16, and Patient #17)) sampled patients identified as having infections in a total sample of 17. Findings: Findings: Patient #8 Review of Patient #8’s Client Medication Record revealed, in part, Patient #8 received Valacyclovir (medication used to treat infections) 1 gram tablet by mouth two times per day with a start date of 08/09/2024 and end date 08/18/2024. Patient #10 Review of Patient #10’s Client Medication Record revealed, in part, Patient #10 received Penicillin V Potassium (medication used to treat infections) 500 milligrams (mg) tablet by mouth every six hours with a start date of 06/05/2024 and end date 06/24/2024. Patient #15 Review of Patient #15’s Client Medication Record revealed, in part, Patient #15 received Levofloxacin (medication used to treat infections) 750 mg one tablet by mouth daily with a start date of 05/08/2024. Further review revealed patient #15 also received Rifampin (medication used to treat infections) two 300 mg capsules by mouth daily with a start date of 06/11/2024. Patient #16 Review of Patient #16’s Client Medication Record revealed, in part, Patient #16 received Vancomycin (medication used to treat infections) Topical 1gram and Meropenem (medication used to treat infections) Topical one gram apply both medications to wounds once daily with a start date of 04/11/2024. Review of the agency’s Infection Control Logs for the year of 2024 revealed no documented evidence, and the agency presented no documented evidence, the above mentioned medications used to treat Patient #8, Patient #10, Patient #15, and Patient #16’s infections were included in the agency’s surveillance of infections. In an interview on 10/16/2024 at 2:22 p.m., S1Administrator/Executive Director acknowledged these antibiotic and/or antiviral medications for Patient #8, Patient #10, Patient #15, and Patient #16 were not included in the agency’s surveillance of infections.”

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on record reviews and interviews, the agency failed to ensure a patient’s wounds were assessed and measured upon identification of the wound, and weekly for 5 (Patient #7, Patient #11, Patient #15, Patient #16, and Patient #17) of 7 (Patient #7, Patient #9, Patient #11, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for provision of services. Findings: Review of the Wound Ostomy and Continence Nurses Society’s Guidelines revealed, in part, assessment and documentation of a wound’s status, which included comprehensive clinical data to demonstrate evidence of progress in healing or failure to heal. Further review revealed comprehensive wound assessment included the measurement of: dimensions and depth; presence, location and depth of any sinus tracts or undermining areas; status and characteristics of the wound bed; volume, color, and odor of exudates; and, evidence of infection in surrounding tissues. Further review revealed when the above mentioned data was recorded over time, this information could be used to track the progress of wound healing. Patient #7 Review Patient #7’s Home Health Certification and Plan of Care for the certification period of 09/12/2024 to 11/10/2024 revealed, in part, Patient #7 was to receive skilled nursing services once a week for nine weeks and the nurse was to perform wound care for Patient #7’s skin tears. Review of Patient #7’s Nurse Visit Note Report dated 10/12/2024 revealed, in part, an anterior proximal right pretibial (right front of lower leg) skin tear was identified, and no measurements of the wound was obtained. Further review revealed an anterior left proximal pretibial skin tear was identified, and no measurements were obtained. In an interview on 10/16/2024 at 2:31 p.m., S2Patient Care Manager (PCM) indicated there was no wound care measurements obtained on the above mentioned wounds on 10/12/2024, and the nurse should have measured the wounds upon identification. Patient #11 Review of Patient #11’s Home Health Certification and Plan of Care for the certification period of 08/10/2024 to 10/08/2024 revealed, in part, Patient #11 was to receive skilled nursing services three times a week with wound care to be performed by the nurse to the wound to Patient #11’s anus. Review of Patient #11’s record revealed no documented evidence, and the agency did not present any documented evidence, wound care measurements had been obtained on Patient #11’s anus wound the week of 08/25/2024 thru 08/31/2024. In an interview on 10/16/2024 at 2:35 p.m., S2PCM indicated the agency had no documented evidence the skilled nurse obtained Patient #11’s wound measurements as required for the week of 08/25/2024 thru 08/31/2024 for Patient #11’s anus wound. Patient #15 Review of Patient #15’s Home Health Certification and Plan of Care for the certification period of 11/09/2023 thru 01/07/2024 revealed, in part, Patient #15 was to receive skilled nursing services twice a week for eight weeks which included wound care . Review of Patient #15’s Nurse Visit Note Report dated 12/21/2023 revealed Patient #15 had a newly identified Stage II (open wound of the skin) pressure ulcer to the upper right buttock. Review of Patient #15’s Nurse Visit Note Report dated 12/26/2023 and 12/28/2023 revealed no documented evidence, and the agency presented no documented evidence Patient #15’s upper right buttock wound was measured and assessed the week of 12/24/2023 thru 12/30/2023. In an interview on 10/16/2024 at 2:40 p.m., S2PCM indicated the agency had no documented evidence Patient #15’s upper right buttock wound had been assessed and measured the week of 12/24/2023 thru 12/30/2023. Patient #16 Review of Patient #16’s Home Health Certification and Plan of Care for the certification period of 04/11/2024 thru 06/09/2024 revealed, in part, Patient #16 was to receive skilled nursing services once a week for one week, then twice a week for eight weeks. Further review revealed, in part, Patient #16 was also to receive wound care services. Review of Patient #16’s Wound Visit Note Report dated 04/22/2024 revealed, in part, Patient #16 was identified as having a new right heel wound with bloody drainage. Further review revealed no documented evidence, and the agency presented no documented evidence, wound care measurements and/or assessment was completed for Patient #16’s new right heel wound. In an interview on 10/16/2024 at 2:45 p.m., S2PCM indicated the agency had no documented evidence a wound care assessment and/or wound measurements were completed on Patient #16’s new right heel wound on 04/22/2024. S2PCM further indicated an assessment with wound measurements should be completed for all newly identified wounds. Patient #17 Review of Patient #17’s Home Health Certification and Plan of Care for the certification period of 12/19/2023 to 02/16/2024 revealed, in part, Patient #17 was to received skilled nursing services once a week for eight weeks. Further review revealed, in part, the skilled nurse was to provide wound care. Review of Patient #17’s record revealed no documented evidence, and the agency was unable to present any documented evidence, wound measurements and/or assessment was completed on Patient #17’s left lower buttock wound the weeks of 01/07/2024 thru 01/13/2024, and 01/28/2024 thru 02/03/2024. In an interview on 10/16/2024 at 2:48 p.m., S2PCM indicated the agency did not have any documented evidence Patient #17’s left lower buttock wound was assessed which included wound measurements weekly as required.”

“Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient’s condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This Element is not met as evidenced by: Based on record reviews and interviews the agency failed to ensure verbal orders were signed by the physician within 60 days for 1 (Patient #10) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for care and services. Findings: Review of Patient #10’s Home Health Certification and Plans of Care for the certification periods from 06/09/2023 to 11/29/2023 revealed, in part, no physician signature was documented on any orders from 06/09/2023 to 11/29/2023. Review of Patient #10’s record revealed no documented evidence, and the agency presented no documented evidence, of having any signed physician’s orders for the time period of 06/09/2023 to 11/29/2023. In an interview on 10/16/2024 at 2:06 p.m., S1Administrator/Executive Director acknowledged no physician’s signature was present on any of Patient #10’s physician’s orders from 06/09/2023 to 11/29/2023.”

“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 record reviews and interviews, the agency failed to notify the physician when a patient’s vital signs were outside of parameters for 1 (Patient #15) of 17 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #11, Patient #12, Patient #13, Patient #14, Patient #15, Patient #16, and Patient #17) sampled patients reviewed for physician notification requirements. Findings: Review of Patient #15’s Home Health Certification and Plan of Care for the certification period of 11/09/2023 to 01/07/2024 revealed, in part, licensed professional staff were to report vital signs falling outside of the following parameter to Patient #15’s physician: a systolic blood pressure below 90 millimeters of mercury (mmHg). Review of Patient #15’s Nurse Visit Note Report dated 11/09/2023 revealed, in part, a systolic blood pressure of 84 mmHg. Further review revealed no documented evidence, and the agency presented no documented evidence, Patient #15’s physician had been notified of the above. In an interview on 10/16/2024 at 2:40 p.m., S2Patient Care Manager (PCM) indicated the nurse should have notified the physician of Patient #15’s systolic blood pressure being below the above specified parameter. S2PCM further indicated the agency had no further evidence to present that the nurse had notified the physician that Patient #15’s systolic blood pressure was below the above mentioned parameter.”