Home Health Care 2000 - Lafayette

“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 home health agency failed to ensure the patient’s written individualized POC (Plan of Care) was followed as evidenced by the SN (Skilled Nurse) and PT (Physical Therapist) failing to make visits as ordered per the POC for 1 (patient #4) out of 10 sampled patients. Findings: Patient #4. Review of the patient’s electronic clinical record revealed the start of care date was 01/15/2025. The patient’s diagnosis included peripheral vascular disease. The certification period reviewed was 01/10/2026 to 03/10/2026. Review of the patient’s POC for certification period 01/10/2026 to 03/10/2026 revealed an order for SN 1w9 (skilled nurse visit one time a week for nine weeks). Further review of the POC revealed orders for PT 1w9 (physical therapy visit one time a week for nine weeks). Review of the patient’s SN visit notes and PT visit notes revealed no evidence that a SN or PT visit was made for the week of 01/10/2026 as ordered per the POC. On 01/21/2026 at 8:25 a.m., an interview was conducted with S1VPO (Vice President of Operations) and S2Admin (Administrator). S1VPO and S2Admin reviewed the patient’s clinical record and confirmed there was no evidence that SN or PT visits were made for the week of 01/10/2026 as ordered.”

“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 the patient’s written individualized POC (plan of care) was followed for 2 (Patient #1 and Patient #3) and out of 5 (#1-5) sampled patients as evidenced by: SN (Skilled Nurse) failing to attempt to reschedule missed visit and Patient #1 and Patient #3 and 2. SN failing to ensure that wound care supplies were available in the home for Patient #1. S Review of the HH (Home Health) agency’s “Missed Visit” policy read in part, Policy: Missed visits will be communicated to the clinical supervisor and the patient’s physician. A missed visit will be rescheduled the same week if possible…Procedure: 1. If a visit is missed for any reason, the clinician should attempt to reschedule it for the same week so that the physician ordered frequency is maintained and would not be considered a missed visit. 2. If a visit is missed and not rescheduled the clinician will: A. Notify the physician and clinical supervisor of the missed visit and reason for missed visit. B. Document in the patient’s clinical record that the following information: 5. Physician notification including date, time, physician name, method of notification and the staff reporting the information. 1. Patient #1. Review of the patient’s electronic clinical records revealed the start of care date was 03/10/2025. The patient’s diagnosis included Non-pressure chronic ulcer to right thigh limited to breakdown skin and Pressure ulcer sacral region. The certification period reviewed was 03/12/2025 to 05/17/2025. Review of the patient’s POC for certification period 03/12/2025 to 05/17/2025 revealed an order for “SN 2w1, 3w8 (skilled nurse visit twice a week for one week, three times a week for eight weeks). Further review of patient’s electronic clinical record revealed a missed SN visit for 04/09/2024 and 04/23/2025. Further review of the patient’s clinical record revealed no documented evidence that an attempt was made to schedule another visit. Patient # 3. Review of the patient’s electronic clinical records revealed the start of care date was 05/01/2025. The patient’s diagnosis included unspecified open wound, left foot, initial encounter. The certification period reviewed was 05/01/2025 to 06/29/2025. Review of the patient’s POC for certification period 05/01/2025 to 06/29/2025. revealed an order for “SN 2w1, 3w8 (skilled nurse visit twice a week for one week, three times a week for eight weeks).” Further review of the patient’s electronic record revealed a missed SN visit on 05/8/2025, 05/15/2025, and 05/22/2025. There was no documented evidence that an attempt was made to schedule another visit. 2. Patient #1: Review of the patient’s electronic clinical records revealed the start of care date was 03/10/2025. The patient’s diagnosis included Non-pressure chronic ulcer to right thigh limited to breakdown skin and Pressure ulcer sacral region. The certification period reviewed was 03/12/2025 to 05/17/2025. Review of the patient’s clinical record revealed wound care orders dated 03/24/2025 from the outpatient wound care clinic read in part, … Patient notified APRN (Advanced Practice Registered Nurse) of need of supplies. Please order Xeroform, ABD (abdominal) pad, tape, collagen for this patient… Patient notified APRN of need of supplies. Please order Kerlix for this patient. On 06/09/2025 at 8:40 a.m., and interview was conducted with S1ADM (Administrator). She stated that the wound clinic provides wound care for those patient’s that are not able to leave their home to get wound care. The wound clinic staff goes to the patient home to assess the patient’s wounds and then write orders for wound care. She stated that the HH agency was responsible for conducting the wound care ordered and providing the supplies for the care. The nurses bring the supplies to the patient’s home when need. She denied any issues or complaints related to patient not having enough supplies. She also denied that the wound clinic staff had informed her that the patient didn’t have adequate supplies in the home to conduct wound care. On 06/09/2025 at 12:10 p.m., an interview was conducted with the owner of the wound clinic on wheels. She stated they go to the patient’s home to assess their wound and order the necessary wound care treatment and supplies needed and an order is faxed to the home health agency. She stated that the home health agency was responsible for ensuring that adequate wound care supplies are in the patient’s home to conduct wound care. She stated this has been an ongoing issue with the home health agency providing the necessary treatment and supplies needed for Mrs. Williams. She stated that she could provide documentation of visits they made, were wound care supplies were not available. Review of the wound clinic on wheels clinic notes from 01/13/2025, 01/20/2925, 01/27/2025, 02/03/2025, and 03/24/2025 revealed documentation of ongoing issues with the home health providing the appropriate and adequate wound care supplies for Resident #1. On 06/11/2025 at 11:50 a.m., a phone interview was conducted with S2LPN (Licensed Practical Nurse) who denied having any issues with adequate wound care supplies available. On 06/11/2025 at 12:22 p.m., a second interview and record review was conducted with S1ADM. After review of Patient #1 and Patient #3’s medical record, she confirmed that both patient’s clinical record did not contain documented evidence that attempts were made to reschedule the missed SN visits. She agreed that the SN should attempt to reschedule missed visit if possible. She stated that the field staff let someone in the office know when a patient’s wound care supplies are needed. She confirmed that the agency’s staff did not have effective communicate with the wound clinic on wheels and /or the agency’s office staff regarding the need for wound care supplies in the home for Patient #1.”

“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 review and interview, the SN (Skilled Nurse) failed to promptly notify the physician of missed SN (Skilled Nurse) visits for 2 (Patient #1 and Patient #3) out of 5 (#1-5) sampled patients. Review of the HH (Home Health) agency’s “Missed Visit” policy read in part, Policy: Missed visits will be communicated to the clinical supervisor and the patient’s physician….2. If a visit is missed and not rescheduled the clinician will: A. Notify the physician and clinical supervisor of the missed visit and reason for missed visit. B. Document in the patient’s clinical record that the following information: 5. Physician notification including date, time, physician name, method of notification and the staff reporting the information. Patient #1. Review of the patient’s electronic clinical records revealed the start of care date was 03/10/2025. The patient’s diagnosis included non-pressure chronic ulcer to right thigh limited to breakdown skin and pressure ulcer sacral region. The certification period reviewed was 03/12/2025 to 05/17/2025. Review of the patient’s POC (plan of care) for certification period 03/12/2025 to 05/17/2025 revealed an order for “SN 2w1, 3w8 (skilled nurse visit twice a week for one week, three times a week for eight weeks). Review of patient’s electronic records revealed missed SN visits for 04/09/2025 and 04/23/2025. Further review of the patient’s clinical record revealed no documented evidence that the missed visits were rescheduled. Review of the patient’s missed visit forms for 04/09/2025 and 04/23/2025 revealed the patient’s physician was not notified of the missed visits. Patient # 3. Review of the patient’s electronic clinical records revealed the start of care date was 05/01/2025. The patient’s diagnosis included unspecified open wound, left foot, initial encounter. The certification period reviewed was 05/01/2025 to 06/29/2025. Review of the patient’s POC for certification period 05/01/2025 to 06/29/2025 revealed an order for “SN 2w1, 3w8 (skilled nurse visit twice a week for one week, three times a week for eight weeks). Review of patient’s electronic records revealed missed SN visits for 05/8/2025, 05/15/2025, and 05/22/2025 Further review of the patient’s clinical record revealed no documented evidence that the missed visit were rescheduled. Review of the patient’s missed visit forms for 05/8/2025, 05/15/2025, and 05/22/2025 revealed the patient’s physician was not notified of the missed visits. On 06/11/2025 at 12:22 p.m., an interview and record review was conducted with S1ADM. She confirmed that there was no documented evidence that the nurses notified Patient #1 and Patient #3’s physician of the above mentioned missed visits. She confirmed that the physician should have been notified.”

“Communication with all physicians CFR(s): 484.60(d)(1) Standard: Coordination of Care. The HHA must: (1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This Element is not met as evidenced by: Based on record review and interview, the home health agency staff failed to demonstrate that effective coordination of care occurred when SN (Skilled Nurse) failed to inform the wound care practitioner(s) that a patient (#1) wound care medication was not available in the patient’s home to effectively conduct wound care treatments ordered for 1 (Patient #1) out of 5 (#1-5) sampled patients. Patient #1. Review of the patient’s electronic clinical records revealed the start of care date was 03/10/2025. The patient’s diagnosis included Non-pressure chronic ulcer to right thigh limited to breakdown skin and Pressure ulcer sacral region. The certification period reviewed was 12/25/2024 to 02/08/2025. Review of the wound clinic note date 01/27/2025 read in part …adding Santyl (wound debridement ointment) to assist with debridement. Review a wound care orders dated 01/27/25, faxed to the agency on 01/27/25 revealed Patient #1 had 2 wounds. Wound #1: Wound type: unknown—(possible burn) venous insufficiency to upper RLE (right lower extremity) (scattered) and Wound #2: Wound type: burn to lower medial RLE. The wound care orders read to cleanse wound with Vashe wound cleanser and pat dry. Apply Calmosetine to peri-wound area. Place versatel against wound bed. Follow santyl to mesalt then cover with vashe moist gauze. Wrap with kerlix and secure with ace wrap. Review of the SN visit notes 01/31/2025, 02/02/2025, 02/05/2025, 02/07/2025 and 02/08/2025 revealed documentation that Santyl was applied to the Patient #1’s wounds and documentation that the patient did not have the Santyl in the home. Review of the wound clinic on wheels clinical note dated 02/03/2025 read in part, Patient has not received topical ointment Santyl. Clinic is double checking on status of this… On 06/11/2025 at 11:50 a.m., a phone interview was conducted with S2LPN (Licensed Practical Nurse). S1ADM (Administrator) was present. S2LPN stated that if she documented in the SN visits that Patient #1 did not have Santyl, then the patient did not have the Santyl at that time. When asked if the patient did not have Santyl, why did she document that she applied Santyl to the wounds. S2LPN gave no answer. She stated she did contacted the wound clinic to inform them the patient did not have the Santyl. She confirmed that she was unable provide documentation that she had spoken with someone at the wound clinic regarding this matter. On 06/11/2025 at 12:00 p.m., an interview was conducted with S3LPN. S1ADM was present. She stated that she used the previous wound care orders of Patient #1 due to Santyl was not available. S2LPN confirmed that Patient #1 did not have Santyl in the home at time of the SN visit on 01/29/2025. She stated that she did not contact the wound care clinic to inform them that the patient’s Santyl was not available when she conducted her wound care. On 06/11/2025 at 12:22 p.m., an interview and record review was conducted with S1ADM. S1ADM confirmed there was no communication note in the patient’s clinical record indicating that S2LPN and had spoken with someone at the wound clinic regarding this matter. She stated that she was unable to provide documented evidence that the wound care clinic was informed that Patient #1 had not received the Santyl. S1ADM stated they failed to effectively communicate with the wound care clinic that Patient #1’s Santyl had not been delivered timely.”

“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 review and interview, the agency failed to ensure that the SN (Skilled Nurse) provided services ordered by the physician or allowed practitioner as indicated in the plan of care for 3 (Patient #1, #2 and #5) out 5 (#1-5) sampled patients as evidence by: 1. SN failing to assess and conduct wound care as ordered for Patient #2, #3 and #5 and 2. SN failing to provide the correct wound care treatment as ordered for Patient #1 1. Patient #2. Review of the patient’s electronic clinical records revealed the start of care date was 02/06/2019. The patient’s diagnosis included Pressure ulcer of unspecified buttock, Stage 2. The certification periods reviewed was 03/06/2025 to 05/04/2025 and 06/01/2025 to 07/30/2025. Review of the patient’s POC for certification period 03/06/2025 to 05/04/2025 revealed an order date 03/19/2025 for “SN 2w3, 1w5 (skilled nurse visit twice a week for three weeks, one time a week for five weeks).” Review of the patient’s POC for certification period 06/01/2025 to 07/30/2025 revealed an order for “SN 1wk9 (skilled nurse visit once a week for nine weeks.)” Review of the patient’s clinical record revealed a wound care order dated 03/12/2025 that read in part, “Wound #2: HH (Home Health) SN to assess wound and change dressing twice weekly; Wound #3: HH SN to assess wound and change dressing twice weekly…” and a wound care order dated 06/04/2025 that read in part, “…HH SN to assess wound and change dressing twice weekly.” Review of the SN visit notes revealed on 03/17/2025, 03/20/2205, 03/31/2025, 04/07/2025, 04/14/2025, the SN documented that the three wounds on the patient’s right buttocks were not addressed. Further review of the notes revealed on 03/27/2025 and 06/06/2025 there was no documented evidence that the SN assessed the patient’s wounds or conducted wound care. Patient #3. Review of the patient’s electronic clinical records revealed the start of care date was 05/01/2025. The patient’s diagnosis included Unspecified open wound, left foot, initial encounter. The certification period reviewed was 05/01/2025-06/29/2025. Review of the patient’s POC for certification period 05/01/2025 to 06/09/2025 revealed an order for “SN 1w1, 3w8 (skilled nurse visit one time a week for one week, three times a week for eight weeks). Further review of the patient’s POC revealed an orders for…”Silver sulfadiazine—apply to wounds every other day and Services ordered: Skilled Nursing observation/assessment for disease related to wound care, etc. Procedure/Treatment for wound care to diabetic ulcer…” Review the SN visit note dated 05/27/2025 and 5/29/2025 revealed that the SN documented that the patient had an open wound to her left second toe and to the underside of left great toe that were not addressed on the above mentioned visits. Further review of the SN notes revealed no documented evidence that the SN observed and assessed Patient #3’s wounds to her feet on the visit conducted on 05/31/2025. Patient #5. Review of the patient’s electronic clinical records revealed the start of care date was 12/20/2021. The patient’s diagnosis included Osteomyelitis, ankle and foot. The certification period reviewed was 05/16/2025 to 07/14/2025. Review of the patient’s POC for certification period 05/16/2025 to 07/14/2025 revealed an order for “SN 1w9 (skilled nurse visit once a week for nine weeks). “ Further review of the Patient #5’s clinical record revealed wound care orders dated 06/02/2025 which read in part, “HH SN to assess wound and change dressing every other day.” Review of the SN visit note for 06/06/25 revealed no documented evidence that the SN performed wound care. The SN indicated that the wound was not addressed on the visit. 2. Patient #1. Review of the patient’s electronic clinical records revealed the start of care date was 03/10/2025. The patient’s diagnosis included Non-pressure chronic ulcer to right thigh limited to breakdown skin and Pressure ulcer sacral region. The certification period reviewed was 03/12/2025 to 05/17/2025. Review of the patient’s POC for certification period 03/12/2025 to 05/17/2025 revealed an order for “SN 2w1, 3w8 (skilled nurse visit twice a week for one week, three times a week for eight weeks). Review a wound care orders dated 01/27/2025, faxed to the agency on 01/27/2025 revealed a wound care orders that read, “Cleanse wound with Vashe wound cleanser and pat dry. Apply Calmosetine to peri-wound area. Place versatel against wound bed. Follow santyl to mesalt then cover with vashe moist gauze. Wrap with kerlix and secure with ace wrap.” Review of the SN visit note dated per S3LPN (Licensed Practical Nurse) revealed the SN documented that she cleansed the wounds with vashe wound cleanser, patted dry. Applied calmoseptine to peri wound. Placed adaptive against wound bed, followed by mesalt to calcium alginate with moist vashe gauze then covered with dry gauze and abd (abdominal) pad wrapped with kerlix and secured with ace wrap. On 06/10/2025 at 4:25 p.m., an interview and record review was conducted with S1ADM. She confirmed that on 05/27/2025 and 05/29/2025, S2LPN documented that Patient #3’s wounds were not addressed on the visit. She confirmed based on the physician orders, the S2LPN should have documented that she assess all of the patient’s wounds on every visit on the visit note. On 06/11/2025 at 12:00 p.m., an interview was conducted with S3LPN. S1ADM (Administrator) was present. A review of her SN visit note for 01/29/2025 was conducted. When asked why she used calcium alginate on the Patient #1’s wound when the order was for Santyl, she stated that she was not aware of the new order at the time. A review of the wound care orders was conducted and S1ADM (Administrator) who confirmed that the order was received and upload in the patient’s electronic medical record prior to the visit on 01/29/2025 and the SN should have been aware of the new order. She stated that she used the previous wound care orders due to Santyl not available. On 06/11/2025 at 12:22 p.m., a second interview was conducted with S1ADM. She confirmed that S3LPN (Licensed Practical Nurse) had performed the incorrect wound treatment during her SN visit on 01/29/25. She agreed that S3LPN should have contacted the wound clinic and inform them that Patient#1 did not have Santyl to put on her wound before conducting the wound care. On 06/11/2025 at 1:15 p.m., a subsequent interview and record review was conducted with S1ADM. She confirmed that S2LPN documented that Patient #3’s wounds were not addressed on the SN visits for 3/17/2025 to 04/14/2025 and on 06/05/2025. She confirmed based on the physician orders, the S2LPN should have documented that she assess all of the patient’s wounds on every visit in the visit note.”