Angels Care Home Health of East Oklahoma

“Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure: 1. SN provided wound care treatment as ordered for one (Patient #1) of nineteen patients. 2. OT frequencies were followed as ordered for two (Patients #3 and #10) of nineteen patients. 3. SN frequencies were followed as ordered for four (Patients #5, #7, #8, and 14) of nineteen patients. 1. Patient #1 A review of the POC dated 10/10/23 to 12/08/23 showed an order for SN to irrigate the left lower leg with saline, pat dry, apply remedy calazime zinc oxide paste (a skin protectant), 4x4.75, apply maxorb extra alginate dressing, apply conforming stretch gauze bandage, and cover with coban bandage. A review of the clinical records showed the following: A SN visit dated 10/11/23 documented the left lower leg was irrigated with normal saline and patted dry, then SN applied maxorb extra silver alginate dressing, qwick dressing, ABD pad, conforming gauze roll, and secured with coban. A SN visit dated 10/17/23 documented no wound care was provided to the left lower leg. A SN visit dated 10/19/23 documented no wound care was provided to the left lower leg. 2. Patient # 3 A review of a POC dated 10/27/23 to 12/25/23 showed an OT frequency of one visit per week for one week, effective 10/29/23. A review of the medical records showed no OT visit was made for the week of 10/29/23 to 11/04/23. Documentation showed no refusal of visits or services from the patient or caregiver, no contact made with the patient or caregiver and no physician order for a change in services. Patient #10 A review of a POC dated 10/25/23 to 12/23/23 showed an OT frequency of one visit per week for one week, and to evaluate the patient the week of 10/22/23. A review of the medical records showed no OT visit was made for the week of 10/22/23 to 10/28/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. 3. Patient #5 A review of a POC dated 10/02/23 to 11/30/23 showed SN frequencies of one time a week for nine weeks. A review of a SN missed visit note dated 10/06/23 documented the reason for the missed visit as waiting for authorization, and no other visits were documented for the week of 10/01/23 to 10/07/23. A review of a SN missed visit note dated 10/13/23 documented the reason for the missed visit as unable to reach patient, and no other visits were documented for the week of 10/08/23 to 10/14/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. Patient #7 A review of a POC dated 11/22/23 to 01/20/23 showed SN frequencies of one time a week for nine weeks. A review of the medical records showed no SN visits were made for the week of 11/19/23 to 11/25/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. Patient #8 A review of a POC dated 11/25/23 to 01/23/24 showed SN frequencies of three times a week for eight weeks, and one time a week for one week, effective 11/26/23. A review of a SN missed visit note dated 12/24/23 documented the reason for the missed visit as patient refused, and no other visits were documented for the week of 12/24/23 to 12/30/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. Patient #14 A review of a POC dated 08/16/23 to 10/14/23 showed SN frequencies of one time a week for nine weeks. A review of a SN missed visit note dated 08/17/23 documented the reason for the missed visit as no answer, and no other visits were documented for the week of 08/13/23 to 08/19/23. Documentation showed no refusal of visits or services from the patient or caregiver and no contact made with the patient or caregiver and no physician order for a change in services. On 01/26/24 at 10:20 a.m., Staff A stated: 1. the wound care treatment order for Patient #1 was not followed as ordered by the physician; 2. the OT frequencies for Patient #3 and Patient #10 were not met as ordered by the physician; and 3. the SN frequencies for Patient #3, Patient #5, Patient #7, Patient #8, and Patient #14 were not met as ordered by the physician.”