Healing Hands Home Health Inc.

“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 review and interview, the agency failed to ensure the Registered Nurse provided Skilled Professional Services in accordance with current clinical practice guidelines as set forth by the Louisiana State Board of Nursing Declaratory Statement for Scope of Practice for Registered Nurses - Wound Care Management and accepted professional standards as set forth by the National Pressure Ulcer Advisory Panel for Prevention and Treatment of Pressure Ulcers for 1 (#2) of 1 patient reviewed with Pressure Ulcers. The agency failed to ensure the RN assessed Patient #2’s Pressure Ulcer weekly. Findings: Review of the Louisiana State Board of Nursing, Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management revealed, in part, the following: Registered nurses render care that is directed towards the prevention and the treatment of wounds. Scope of Practice - The Louisiana State Board of Nursing recognizes that assessment, planning, intervention, teaching, evaluation, and supervision are the major responsibilities of the registered nurse in the practice setting. The Registered Nurse initiates appropriate wound prevention measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by the authorized prescriber. The Registered Nurse initiates appropriate wound preventative measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by an authorized prescriber. Delegation - In accord with the Law Governing the Practice of Nursing (RS 37:913(14) the Registered Nurse may delegate select nursing interventions to qualified nursing personnel as set forth in the Board’s rules on delegation (LAC 46:XLVII.3703.). The Registered Nurse retains the accountability for the total nursing care of the individual. The Registered Nurse may delegate to a Licensed Practical Nurse wound care interventions in any situation when the Registered Nurse has deemed the patients status is stable, the intervention is based on a relatively fixed and limited body of scientific knowledge, can be performed by following a defined nursing procedure with minimal alteration, responses of the individual to the nursing care are predictable and changes in the patient’s clinical condition are predictable. Furthermore, the patient’s medical and nursing orders are not subject to continuous change or complex modification, and appropriate RN supervision is available. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following: Pressure Ulcer Assessment 1. Assess the Pressure Ulcers initially and re-assess it at least weekly. 1.1. Document the results of all wound assessments. Assess and document physical characteristics including: location, category/stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Review of Patient #2’s Clinical Record revealed she began receiving services from the agency on 02/21/2026, had a current certification period of 02/21/2026 through 04/21/2026, and diagnoses, which included Pressure Ulcer of Sacral Region – Stage 3. Further review revealed Patient #2 received skilled nursing visits once weekly for nine weeks. Review of Patient #2’s electronic Medical Record revealed an attachment with the following wound care order dated 02/23/2026: Sacrum: Cleanse with Vashe, apply Iodosorb Gel and Hydrofera Blue, and cover with silicone bordered gauze. Change dressing daily. Review of Patient #2’s Sacral Pressure Ulcer wound care order dated 03/02/2026 revealed to Cleanse with Vashe, apply Iodosorb Gel and Hydrofera Blue, and cover with a silicone bordered gauze. Review of Patient #2’s Visit Notes for certification period of 02/21/2026 through 04/21/2026 revealed nursing visits were conducted on 02/21/2026 and 02/26/2026. Further review revealed Patient #2’s Sacral Pressure Ulcer assessment dated 02/21/2026 did not include tissue type(s), color, peri-wound condition, and wound edges condition. There was no documentation Patient #2’s Sacral Pressure Ulcer was assessed by the RN on 02/26/2026. An interview was conducted with S2CD on 03/04/2026 at 12:15 p.m. She confirmed there was no documentation of the tissue type(s), color, peri-wound condition, and wound edges condition for Patient #2’s Sacral Pressure Ulcer assessment on 02/21/2026, which was not a full assessment. She confirmed she did not perform or document a full Pressure Ulcer assessment for Patient #2 on 02/26/2026. She confirmed Pressure Ulcer assessments should have been conducted and documented weekly.”

“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 interviews and record reviews, the agency failed to ensure each patient’s plan of care included nutritional requirements, patient-specific interventions, and/or measurable outcomes and goals for 2 (#1 and #2) of 2 patients reviewed. The agency failed to ensure the plan of care included: Patient #1’s occupational therapy goals and interventions; andPatient #2’s enteral feeding order and skilled nursing goals and interventions. Findings: Review of the agency’s undated policy titled, “Physician’s Plan of Care/Change Orders” revealed the following, in part: The physician’s plan of care (CMS-485) is an individualized plan for care and treatment prepared by the client’s physician with the assistance from the nurse and/or therapist who establishes the plan based upon the current assessment of the client. The plan of care shall be developed within five days of the assessment… The agency will provide care/services consistent with the plan of care. The plan of care shall include but not limited to: Nutritional requirements Specific procedures for treatments, treatments performed by therapies include the amount, frequency and duration of the modalities… Goals and outcomes to be achieved Review of the agency’s policy titled, “Professional/Ancillary Care Plans” revealed the following, in part: An individualized plan of care may be developed and implemented by each professional discipline providing service. Each plan will include: Identified problems and needs Specific, individualized, measurable goals and interventions Specific services to be provided including frequency and duration 1. Patient #1 Review of Patient #1’s Clinical Record revealed she began receiving services from the agency on 02/20/2026, had a current certification period of 02/20/2026 through 04/20/2026, and diagnoses, which included Spinal Stenosis – Lumbar Region. Further review revealed Patient #1 received skilled nursing visits once weekly for nine weeks and occupational therapy visits once weekly for one week beginning the week of 02/22/2026 then twice weekly for two weeks. Review of Patient #1’s plan of care for certification period of 02/20/2026 through 04/20/2026 revealed no documented occupational therapy goals or interventions. Patient #2 Review of Patient #2’s Clinical Record revealed she began receiving services from the agency on 02/21/2026, had a current certification period of 02/21/2026 through 04/21/2026, and diagnoses, which included Traumatic Cerebral Hemorrhage, Pressure Ulcer of Sacral Region – Stage 3, Type II Diabetes Mellitus, Quadriplegia, Aphasia, Tracheostomy Status, Dependence on Supplemental Oxygen, and Gastrostomy Status. Further review revealed Patient #2 received skilled nursing visits once weekly for nine weeks. Review of Patient #2’s plan of care for certification period of 02/21/2026 through 04/21/2026 revealed no documented enteral feeding order and no documented nursing goals or interventions. An interview was conducted with S1ADM and S2CD on 03/04/2026 at 2:41 p.m. S1ADM stated the agency’s process for developing a plan of care was S2CD and/or the therapy discipline performed an initial assessment, and based on the assessment, a plan of care was established. S1ADM stated he was responsible to ensure therapy goals and interventions were placed on the plan of care. S1ADM confirmed Patient #1 received occupational therapy services. S1ADM reviewed Patient #1’s plan of care. S1ADM confirmed there were no occupational therapy goals or interventions on Patient #1’s plan of care. S2CD reviewed Patient #2’s plan of care and confirmed there were no nursing goals or interventions on the plan of care. S2CD confirmed Patient #2’s only source of nutrition was through enteral feedings. S2CD confirmed Patient #2’s enteral feeding order was not on the plan of care and should have been. S1ADM and S2CD confirmed each patient’s plan of care should have reflected the therapy and nursing goals and interventions to ensure care and services were provided adequately and accurately.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure wound care orders were recorded on the plan of care for 1 (#2) of 2 patients reviewed with wounds. Findings: Review of the agency’s undated policy titled, “Physician’s Plan of Care/Change Orders” revealed the following, in part: The physician’s plan of care (CMS-485) is an individualized plan for care and treatment prepared by the client’s physician with the assistance from the nurse and/or therapist who establishes the plan based upon the current assessment of the client. The plan of care shall include but not limited to: Specific procedures for treatments Review of Patient #2’s Clinical Record revealed she began receiving services from the agency on 02/21/2026, had a current certification period of 02/21/2026 through 04/21/2026, and diagnoses, which included Pressure Ulcer of Sacral Region – Stage 3. Further review revealed Patient #2 received skilled nursing visits once weekly for nine weeks. Review of Patient #2’s electronic Medical Record revealed an attachment with the following wound care order dated 02/23/2026: Sacrum: Cleanse with Vashe, apply Iodosorb Gel and Hydrofera Blue, and cover with silicone bordered gauze. Change dressing daily. Review of Patient #2’s plan of care for certification period of 02/21/2026 through 04/21/2026 revealed no documented treatment for her Sacral Pressure Ulcer. An interview was conducted with S2CD on 03/04/2026 at 10:28 a.m. She confirmed Patient #2 had received wound care since the start of care. She confirmed Patient #2’s wound care order was not recorded on the plan of care. An interview was conducted with S1ADM on 03/04/2025 at 11:08 a.m. He confirmed Patient #2’s current wound care order should have been recorded on the plan of care.”

“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, interview, and record review, the agency failed to ensure wound care was provided as ordered by the physician for 1 (#2) of 1 resident observed for wound care. Findings: Review of the agency’s undated policy titled, “Physician’s Plan of Care/Change Orders” revealed the following, in part: The physician’s plan of care (CMS-485) is an individualized plan for care and treatment prepared by the client’s physician with the assistance from the nurse and/or therapist who establishes the plan based upon the current assessment of the client. The agency will provide care/services consistent with the plan of care. Review of Patient #2’s Clinical Record revealed she began receiving services from the agency on 02/21/2026, had a current certification period of 02/21/2026 through 04/21/2026, and diagnoses, which included Pressure Ulcer of Sacral Region – Stage 3. Further review revealed Patient #2 received skilled nursing visits once weekly for nine weeks. Review of Patient #2’s Sacral Pressure Ulcer wound care order dated 03/02/2026 revealed to Cleanse with Vashe, apply Iodosorb Gel and Hydrofera Blue, and cover with a silicone bordered gauze. A home visit was conducted with Patient #2 on 03/03/2026 at 3:00 p.m. with S2CD. S2CD performed wound care during the home visit to Patient #2’s Sacral Pressure Ulcer. S2CD cleansed the wound with Vashe soaked gauze and applied Solosite wound gel, hydrofera blue, and a dry, adhesive dressing. S2CD did not apply Iodosorb to the wound bed. An interview was conducted with S2CD on 03/04/2026 at 10:28 a.m. S2CD confirmed Patient #2’s current sacral wound care order was to apply Iodosorb to the wound bed. She confirmed she should have applied Iodosorb to the wound bed and not Solosite wound gel. An interview was conducted with S1ADM on 03/04/2025 at 11:08 a.m. He confirmed Patient #2’s wound care should have been performed as ordered by the physician.”

“Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure a physician’s order for Physical Therapy was integrated into the patient’s plan of care for 1 (#1) of 2 patients reviewed. Findings: Review of Patient #1’s Clinical Record revealed she was referred to the agency on 02/18/2026 with a physician order for Physical Therapy Services. Further review revealed Patient #1 began receiving services from the agency on 02/20/2026, had a current certification period of 02/20/2026 through 04/20/2026, and diagnoses, which included Spinal Stenosis – Lumbar Region. Review of Patient #1’s Plan of Care for certification period of 02/20/2026 through 04/20/2026 revealed no documentation pertaining to physical therapy services or refusal of physical therapy services. Review of Patient #1’s Physician Orders and Coordination Notes for the certification period of 02/20/2026 through 04/20/2026 revealed no documented evidence the physician was contacted for clarification of the physical therapy services, to discontinue the order, or that physical therapy services would not be provided. An interview was conducted with S2CD on 03/04/2026 at 10:28 a.m. She confirmed Patient #1’s referral included an order for physical therapy. She confirmed physical therapy was not provided for Patient #1 and should have been. An interview was conducted with S1ADM on 03/04/2026 at 10:54 a.m. He confirmed physical therapy services were not provided for Patient #1. He reviewed Patient #1’s clinical record. He confirmed there was no documentation Patient #1 refused physical therapy. He confirmed there was no order to discontinue physical therapy services.”