Allen Parish 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 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) failing to obtain weights and blood sugar readings for patient (#1) for 1 out of 7 (#1-#7) sampled patients. Patient #1. Review of the patient’s electronic clinical record revealed the start of care date was 07/07/2021. The patient diagnoses included Diabetes with Diabetic Autonomic Poly Neuropathy. The certification period reviewed was 12/19/2024 to 02/16/2025. Review of the patient’s POC for certification period 12/19/2024 to 02/16/2025 revealed the following orders: SN 1wk8wk, 3 prn beginning during week of 12/22/2024 (skilled nurse visit one time a week for eight weeks, three visits as needed beginning during week of 12/22/2024). Further review of the POC revealed orders for the SN to assess blood sugar monitoring and results and to obtain Patient #1’s weight. Review of the patient’s SN visit note dated 01/07/2025 and 01/20/2025 revealed no evidence the SN obtained the patient’s blood sugar readings. Review of the patient’s SN visit note dated 12/30/2024, 01/07/2025, and 01/20/2025 revealed no evidence the SN obtained the patient’s weight. On 01/28/2025 at 11:45 a.m. during Patient #1’s home visit, an interview was conducted with S2RN (Registered Nurse). S2RN was observed completing the home visit and exited the patient’s home without weighing the patient. The surveyor asked S2RN if there was an order to weigh the patient. S2RN confirmed that there was an order to weigh the patient and she stated that she did not do it for every skilled nurse visit. On 01/28/2025 at 2:20 p.m., an interview was conducted with S1ADM (Administrator) and after a review of the patient’s electronic clinical records, she verified there was no evidence the SN obtained blood sugar readings for the SN visits made on 01/07/2025 and 01/20/2025. S1ADM verified there was no evidence the SN obtained the patient’s weight for the SN visits made on 12/30/2024, 01/07/2025 and 01/20/2025.”

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. 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 the physical therapist (PT) failed to inform the nursing staff of Patient #3’s complaint of low back pain on 01/23/2025 and failing to follow-up with the physician regarding Patient #4’s lab results for 2 (#3, #4) out of 7 (#1-#7) sampled patients. Patient #4: Review of the patient’s electronic clinical records revealed the start of care date was 11/01/2024. The patient’s diagnoses included Type 2 Diabetes mellitus, Retention of urine, Essential hypertension; Hyperlipidemia, Unspecified kidney failure and History of urinary tract infections. The certification period reviewed was 11/01/2024 to 12/30/2024 and 12/31/2024 to 02/28/2025. Review of the patient’s POC (Plan Of Care) for the certification period 11/01/2024 to 12/30/2024 revealed an order for “SN 1wk8wk, 3PRN (skilled nurse visit one time a week for eight weeks, three as needed visits).” Further review of the POC revealed an order for “Skilled nurse assess for signs/symptoms of urinary infection.” Review of the patient’s POC (Plan Of Care) for the certification period 12/31/2024 to 02/28/2025 revealed an order for “SN1wk9wk, 3PRN (skilled nurse visit one time a week for nine weeks, three as needed visits).” Further review of the POC revealed an order for “Skilled nurse assess for signs/symptoms of urinary infection.” Review of the skilled nurse visit note dated 12/28/2024 read, “Received notification that patient was c/o (complaining of) bladder spasms, leakage, and pain. SN (Skilled nurse) called family and daughter said that every time patient urinates it burns. SN call PCP (Personal Care Physician) office and NP (Nurse Practitioner) returned call and gave order to collect urine for UA (urinalysis) and C&S (culture and sensitivity)...” Review of the patient’s clinical record revealed a verbal order dated 12/28/2024 at 1 p.m. that read, “Collect a urine specimen for UA and culture and sensitivity—read back and confirmed” Review of the Interdisciplinary Communication notes revealed a note dated 12/28/2024 at 1:35 p.m. that read, “Urine collected and dropped off at (name of hospital) hospital.” Review of the patient’s clinical record revealed lab reports for a UA results dated 12/28/2024 and a C&S (culture and sensitivity) results dated 12/31/2024. The UA report indicated the following abnormal findings: “Clarity—cloudy (normal—clear); WBC (white blood cells)- 5-9/hpf (high power field)(normal—none seen); RBC (red blood cells)-3-5/hpf (normal—none seen); epithelial—Rare/lpf (low power field) (normal—none seen); Bacteria 2+/hpf (normal—none seen); yeast—Rare/hpf (normal—none seen). The C&S report indicated Escherichia coli greater than 100,000 colony forming units per ml (milliliter). Susceptibility profile is consistent with a probable ESBL (Extended-Spectrum Beta-Lactamase—a group of enzymes produced by certain bacteria that make them resistant to a wide range of antibiotics.)” Review of the patient’s clinical record revealed a second copy of the urinalysis and C&S results dated for 12/28/2024 with hand written order by the physician addressing the results of the UA and C&S on 01/15/2025, which was 18 days later. The order that read, “Tx (treat) c (with) 1 g (gram) rocephin (antibiotic) IM (intramuscular) once and po (by mouth) Cefdinir (antibiotic) 300 mg (milligram) bid (twice daily) for 6 days. Review of the patient’s Interdisciplinary Communication notes from 12/29/2024 to 01/14/2024 revealed no documentation that the patient’s physician was made aware of the results of her UA and C&S ordered on 12/28/2024. Review of the skilled nurse visit notes dated 01/03/2025, 01/10/2025, and 01/15/2025 revealed no documented evidence that the patient’s physician was made aware of the results of her UA and C&S ordered on 12/28/2024. On 01/28/2025 at 2:26 p.m., an interview and record review was conducted with S1ADM (Administrator). She confirmed that the agency’s secretary was responsible for ensuring lab results were sent to the patient’s primary physician for review and then uploaded in the patient’s clinical record. At 2:30 p.m., a review of Patient #4’s clinical record was conducted. S1ADM confirmed that on 12/28/2024, the nurse was informed by the patient’s family that the patient was having burning upon urination and the nurse informed the NP (Nurse Practitioner) and orders were given to collect a urinalysis and C &S. Further review revealed that a urinalysis was collected on 12/28/2024 and sent to the lab. A review of the urinalysis and C&S report results was conducted. She confirmed that the office received and faxed the results to the patient’s physician on 01/05/2025. She also confirmed that the results of the urinalysis and C&S were not addressed by the physician until 01/15/2025, which was too long. She stated the nurses were responsible for checking the communication notes in the patient’s record to identify any changes in the patient’s care. A review of the patient’s interdisciplinary communication notes from 12/29/2024 to 01/14/2025 was conducted. She confirmed the notes didn’t contain documented evidence the patient’s physician was made aware of her UA and C&S results. She stated the patient’s nurses should have followed up on the UA and C&S and ensured that the patient’s physician was made aware of the results. Review of the agency policy titled, “HH (Home Health) Care Planning, Coordination of Services, and Quality of Care” with a revision date of 01/13/2018 read in part, Purpose: For each patient to be accepted for treatment on the reasonable expectation that a HHA (Home Health Agency) care meet the patient’s medical, nursing rehabilitation and social needs in his/her plan of residence. Procedure: IV. Standard: Coordination of Care … C. Integrate services, whether services are provided directly or under arrangement, to assure the identification of the patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care by all disciplines… 1. Patient#3. Review of the patient’s electronic clinical records revealed the start of care date was 01/08/2025. The patient’s diagnoses included Age Related Osteoporosis with Current Pathological Fracture of Vertebrae and Hypertensive Heart Disease with Heart Failure. The certification period reviewed was 01/08/2025 to 03/08/2025. Review of the patient’s POC (Plan of Care) for certification period 01/08/2025 to 03/08/2025 revealed an order for “SN 1wk8wk, 3 prn beginning during week of 01/12/2025 (skilled nurse visit one time a week for eight weeks, three visits as needed beginning week of 01/12/2025), and PT 3wk8wk beginning during week of 01/13/2025 (physical therapy visit three times for eight weeks beginning during week of 01/13/2025). Review of the patient’s physical therapy note dated 01/23/2025 revealed S3PT (Physical Therapist) documented, “Patient reports he is still having a lot of low back pain.” Further review of the note revealed no evidence S3PT notified the nursing staff that Patient #3 was continuing to have pain in his lower back. On 01/27/2025 at 1:13 p.m., a telephone interview was conducted with S3PT. S3PT stated the patient reported that he was having a lot pain in his lower back and confirmed he did not notify the nursing staff at the agency. On 01/28/2025 at 1:05 p.m., an interview was conducted with S1ADM (Administrator). S1ADM confirmed that S3PT should have notified the RN (Registered Nurse) the patient was having lower back pain.”

“Duties of a HH aide CFR(s): 484.80(g)(3) The duties of a home health aide include: (i) The provision of hands-on personal care; (ii) The performance of simple procedures as an extension of therapy or nursing services; (iii) Assistance in ambulation or exercises; and (iv) Assistance in administering medications ordinarily self-administered. This Element is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure the duties of the home health aide (HHA) were completed as evidenced by the HHA not following the POC (Plan of Care) for obtaining weights for 2 (#2, #3) out 7 (#1-#7) sampled patients. 1. Patient #2. Review of the patient’s electronic clinical records revealed the start of care date was 10/09/2023. The patient’s diagnoses included Hypertensive Heart Disease with Heart Failure and Generalized Osteoarthritis. The certification period reviewed was 12/02/2024 to 01/30/2025. Review of the patient’s POC (Plan of Care) for certification period 12/02/2024 to 01/30/2025 revealed an order for “Aide 2wk9wk beginning during week of 12/02/2024 (Home Health Aide visit two times a week for nine weeks beginning during the week of 12/02/2024). Further review of the POC revealed an order for the Aide to obtain Patient #2’s weight. Review of the patient’s HHA visit notes dated 12/03/2024, 12/05/2024, 12/10/2024, 12/12/2024, 12/18/2024, 12/19/2024, 12/23/2024, 12/26/2024, 12/31/2024, 01/07/2025, 1/10/2025, 01/14/2025, 01/16/2025, 01/20/2025, 01/23/2025 revealed no evidence the HHA obtained the patient’s weight on those visits. On 01/28/2025 at 9:10 a.m. during the patient’s home visit, an interview was conducted with S4HHA. S4HHA confirmed that she did not obtain the patient’s weight during the home visits. On 01/28/2025 at 12:20 p.m., an interview was conducted with S1ADM (Administrator). S1ADM reviewed the HHA orders and confirmed there were orders for the HHA to obtain Patient #2’s weights. S1ADM confirmed that there was no evidence the HHA obtained the patient’s weight during the home visits as ordered. 2. Patient #3. Review of Patient #3’s electronic clinical records revealed the start of care date was 01/08/2025. The patient’s diagnoses included Age Related Osteoporosis with Current Pathological Fracture of Vertebrae and Hypertensive Heart Disease with Heart Failure. The certification period reviewed was 01/08/2025 to 03/08/2025. Review of the patient’s POC (Plan of Care) for certification period 01/08/2025 to 03/08/2025 revealed an order for “Aide 3wk8wk beginning during week of 01/02/2025 (Home Health Aide visit three times a week for eight weeks beginning during the week of 01/02/2025). Further review of the POC revealed an order for the Aide to obtain Patient #3’s weight. Review of the HHA visit notes dated 01/13/2025, 01/15/2025, 01/17/2025, 01/20/2025, and 01/24/2025 revealed no evidence the HHA obtained the patient’s weight on those visits. On 01/28/2025 at 10:00 a.m., an interview was conducted with Patient #3. The patient stated that the HHA did not obtain his weight during the visits. On 01/28/2025 at 12:20 p.m., an interview was conducted with S1ADM (Administrator). S1ADM reviewed the HHA orders and confirmed there were orders for the HHA to obtain weights. S1ADM confirmed that there was no evidence the HHA obtained Patient #3’s weight during the home visits as ordered.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure a Registered Nurse (RN) made an onsite visit for patients who were receiving home health aide (HHA) services no less frequently than every 14 days for 1 (#2) out of 7 (#1-#7) sampled patients. Patient #2. Review of the patient’s electronic clinical records revealed the start of care date was 10/09/2023. The patient’s diagnoses included Hypertensive Heart Disease with Heart Failure and Generalized Osteoarthritis. The certification period reviewed was 12/02/2024 to 01/30/2025. Review of the patient’s POC (Plan of Care) for certification period 12/02/2024 to 01/30/2025 revealed an order for “Aide 2wk9wk beginning during week of 12/02/2024 (Home Health Aide visit two times a week for nine weeks beginning during the week of 12/02/2024). Review of the patient’s HHA Visit Note dated 12/12/2024, 12/18/2024, 12/19/2024, 12/23/2024, 12/26/2024, 12/31/2024, 01/07/2025, and 01/10/2025 revealed the aide was performing the visits with the patient as ordered. There was no evidence the RN made a supervised visit within the time frame from 12/13/2024 to 01/09/2025, which was 28 days. On 01/28/2025 at 1:08 p.m., an interview was conducted with S1ADM (Administrator) and after a review of the patient’s electronic clinical records, she verified the RN did not make a supervisory visit for the HHA no less frequently than every 14 days.”