Nevada Preferred Home Health Care LLC

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to ensure the timely submission of OASIS (Outcome and Assessment Information Set) to IQIES (Internet Quality and Improvement and Evaluation System). The failure had the potential to affect all 20 patients receiving services from the HHA who require evaluation and care. Findings include: The facility’s OASIS submission data for calendar year 2024 was reviewed and revealed 7 out of 197 assessments were coded as being transmitted to IQIES more than 30 days late during that time period. This resulted in an error code of -3330 (late submission) for 3.6% of all assessments submitted in the 2024 calendar year. During an interview on 02/26/25 at 10:02 AM, the Administrator confirmed responsibility for submitting OASIS data to IQIES and confirmed some OASIS submissions were likely transmitted late due to the failure of field nursing staff entering patient data late.”

“Exercise of rights CFR(s): 484.50(b)(1)(2)(3) Standard: Exercise of rights. (1) If a patient has been adjudged to lack legal capacity to make health care decisions as established by state law by a court of proper jurisdiction, the rights of the patient may be exercised by the person appointed by the state court to act on the patient’s behalf. (2) If a state court has not adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient’s representative may exercise the patient’s rights. (3) If a patient has been adjudged to lack legal capacity to make health care decisions under state law by a court of proper jurisdiction, the patient may exercise his or her rights to the extent allowed by court order. This Standard is not met as evidenced by: Based on record review and interviews, the Home Health Agency (HHA) failed to ensure Advanced Directives were entered into the Electronic Medical Record (EMR) for 1 of 7 patients (Patient (P) 7) reviewed in the sample. This failure had the potential to affect all 20 patients receiving services from the HHA who may have had designated Advance Directives in place. Findings include: Review of P7’s Home Health Certification and Plan of Care, found in P7’s Electronic Medical Record (EMR), revealed P7 had diagnoses including type 2 diabetes, colon cancer, and sleep apnea. Review of P7’s Plan of Treatment, dated 07/30/24 and found in the EMR, revealed P7 had an Advance Directive (Medical Durable Power of Attorney (MDPOA)) in place. The record indicated the resident’s spouse was the patient’s designated MDPOA and indicated copies of the MDPOA were to be obtained by the agency and placed in the patient’s record. Further review of P7’s record lacked documented evidence to indicate the MDPOA had ever been obtained and placed in the patient’s record. During an interview on 02/26/25 at 4:50 PM, the Administrator/Director of Nursing (DON) confirmed P7’s MDPOA had never been obtained or placed in the patient’s record. The DON stated the MDPOA should have been placed in the patient’s record timely after the agency became aware P7 had an Advance Directive in place.”

“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 record review and interviews, the Home Health Agency (HHA) failed to ensure nursing goals were included in the plan of care for 1 of 7 patients (Patient (P) 5) reviewed in the sample. This failure had the potential to affect all 20 patients receiving services from the HHA who required a comprehensive plan of care. Findings include: Review of P5’s Home Health Certification and Plan of Care, found in P5’s Electronic Medical Record (EMR), revealed P5 had diagnoses including Hodgkin’s Lymphoma, hypertension, and polyneuropathy. The record indicated an order dated 01/29/25, documented for P5 to receive Skilled Nursing Visits one time a week for nine weeks for physical assessment, assistance with medication management/teaching, and education related to her disease processes. Review of the comprehensive plan of care for P5 lacked documented evidence to show nursing goals related to physical nursing assessment, education related to disease processes or medication management had been entered into the patient’s plan of care. There were no goals related to the patient’s nursing services in the plan of care. On 02/26/25 at 4:50 PM, the Administrator/Director of Nursing (DON) confirmed nursing goals had not been entered into P5’s plan of care until after the surveyor requested the information of 02/25/25. The DON stated the nursing goals were expected to be incorporated into the plan of care for any patient receiving nursing services from the agency.”

“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 observation, record review, and interview, the Home Health Agency (HHA) failed to ensure that the agency’s physicians’ orders for medications were entered accurately for 1 of 7 sampled patients (Patient (P) 2). This deficient practice had the potential to affect all 20 patients receiving services from the HHA who were receiving medications. Findings include: Observation during P2’s homecare visit performed by Physical Therapist (PT1) on 02/26/25 at 11:50 AM, revealed P2 was receiving several medications ordered by the HH physician. Review of the medication records in P2’s home, signed by her primary care physician, as well as the actual medication containers for the patient’s medication, revealed the patient was receiving Clopidogrel (a blood thinning medication) 75 milligrams (MG) once daily as a blood thinner and Tylenol (a pain-relieving medication) 1000 MG every eight hours as needed for pain. Review of P2’s medical record on 02/24/25 at 12:00 PM (before the visit occurred) revealed physician’s orders for the patient to receive Clopidogrel 75 milligrams (MG) three times and Tylenol 650 MG every eight hours as needed. During an interview on 02/26/25 at 4:45 PM, the Administrator/DON confirmed the agency’s physician’s orders for the Clopidogrel and Tylenol had been incorrectly entered into the agency’s Electronic Medical Record (EMR). The DON stated the agency’s physician had been contacted to ensure the orders were updated to indicate P2’s actual current medication orders.”