Enhabit Home Health of Eastern 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 the physician was notified of fasting blood sugar levels outside of ordered parameters for two (Patient #3 and 5) of 17 patients. Patient #3 A review of the plan of care dated11/15/23 to 01/13/24 showed a primary diagnosis of type II diabetes mellitus with hyperglycemia and documented the physician be notified of fasting and random blood glucose levels greater than 180. A review of the clinical record showed the following: A skilled nurse assessment dated 12/06/23 showed a fasting blood glucose level of 217 and documented the physician was not notified. A skilled nurse assessment dated 12/11/23 showed a fasting blood glucose level of 250 and documented the physician was not notified. A skilled nurse assessment dated 12/21/23 showed a fasting blood glucose level of 211 and documented the physician was not notified. A skilled nurse assessment dated 12/28/23 showed a fasting blood glucose level of 274 and documented the physician was not notified. A skilled nurse assessment dated 01/04/24 showed a fasting blood glucose level of 274 and documented the physician was not notified. Patient #5 A review of the plan of care dated11/09/23 to 01/07/24 showed a primary diagnosis of type II diabetes mellitus with hyperglycemia and documented the physician be notified of fasting and random blood glucose levels greater than 180. A review of the clinical record showed the following: A skilled nurse assessment dated 11/28/23 showed a fasting blood glucose level of 188 and documented the physician was not notified. A skilled nurse assessment dated 12/07/23 showed a fasting blood glucose level of 272 and documented the physician was not notified. On 01/26/24 at 2:30 pm, Staff C stated the skilled nurse assessments for Patients #3 and 5 documented the physician was not notified of fasting blood sugar reading outside of the ordered parameters.”

“Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This Element is not met as evidenced by: Based on record review and interview, the agency failed to document resolutions for three (Complaint #1, 2 and 3) of 15 agency complaints reviewed. A review of agency records showed the following: Complaint #1 A complaint dated 09/19/23 documented a complaint regarding a fall during physical therapy in which the therapist failed to use a gait belt. No resolution was made regarding the lack of use of the gait belt and only changed clinicians. Complaint #2 A complaint dated 12/05/23 which documented a complaint related to how the clinician spoke to the patient in an unprofessional manner and use of the word “cripple”. No resolution was documented on the behalf of the patient other than the change of clinician as an intervention. Complaint #3 A complaint dated 12/06/23 which documented a complaint related to an inappropriate statement made by a clinician. No resolution was documented. On 01/26/24 at 1:45 pm, Staff B stated Complaints #1, 2 and 3 documented no resolutions.”

“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 interview, the hospice failed to ensure the plan of care was fully developed to include individualized interventions in relation to the primary diagnosis for seven (Patients #1, 2, 3, 4, 5, 7 and 8) of 17 patients reviewed. Patient #1 A review of the plan of care dated 01/08/24 to 03/07/24 showed a primary diagnosis of dementia and showed interventions for the education and training of gait and balance. Patient #2 A review of the plan of care dated 12/21/23 to 02/18/24 showed a primary diagnosis of dementia and showed interventions for the education and training of gait and balance. Patient #3 A review of the plan of care dated 11/15/23 to 01/13/24 showed a primary diagnosis of diabetes type II with hyperglycemia and showed no patient specific interventions for the management of the hyperglycemia. Patient #4 A review of the plan of care dated 12/01/23 to 01/29/24 showed a primary diagnosis of chronic obstructive pulmonary disease and showed no patient specific interventions for the management of the primary diagnosis. Patient #5 A review of the plan of care dated 11/09/23 to 01/07/24 showed a primary diagnosis of diabetes type II with hyperglycemia and showed no patient specific interventions for the management of the hyperglycemia. Patient #7 A review of the plan of care dated 11/29/23 to 01/27/24 showed a primary diagnosis of hypertensive heart disease with heart failure and showed no patient specific interventions for the management of the primary diagnosis. Patient #8 A review of the plan of care dated 11/07/23 to 01/05/24 showed a primary diagnosis of hypertensive heart disease with heart failure and showed no patient specific interventions for the management of the primary diagnosis. On 01/26/24 at 1:30 pm, Staff C stated there were no patient specific interventions for the primary diagnosis for Patients #1, 2, 3, 4, 5, 7 and 8.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(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 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 §484.80(g), must make an onsite visit to the patient’s home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure home health aide supervisory visits were completed every 14 days for three (Patients #7, 8 and 12) of 17 patients. Patient #7 A plan of care dated 11/06/23 to 01/04/24 ordered home health aide visits twice per week for four weeks and a physician order dated 12/03/23 ordered home health aide visits twice per week for five weeks. A review of the clinical record showed the following: A home health aide visit was performed on 11/27/23 and 11/30/23 for the week of 11/26/23 to 12/02/23. A home health aide visit was performed on 12/04/23 and 12/07/23 for the week of 12/03/23 to 12/09/23. A home health aide visit was performed on 12/11/23 and 12/14/23 for the week of 12/10/23 to 12/16/23. A skilled nurse assessment dated 11/29/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 12/15/23 documented a supervisory aide visit was conducted (16 days after the last supervisory visit). Patient #8 A plan of care dated 11/07/23 to 01/05/24 ordered home health aide visits twice per week for nine weeks.. A review of the clinical record showed the following: A home health aide visit was performed on 11/08/23 and 11/10/23 for the week of 11/07/23 to 11/11/23. A home health aide visit was performed on 11/15/23 and 11/18/23 for the week of 11/12/23 to 11/18/23. A home health aide visit was performed on 11/22/23 and 11/24/23 for the week of 11/19/23 to 11/25/23. A home health aide visit was performed on 11/29/23 and 12/02/23 for the week of 11/26/23 to 12/02/23. A home health aide visit was performed on 12/05/23 and 12/08/23 for the week of 12/03/23 to 12/09/23. A skilled nurse assessment dated 11/14/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 12/12/23 documented a supervisory aide visit was conducted (27 days after the last supervisory visit). Patient #12 A plan of care dated 11/15/23 to 01/13/24 ordered home health aide visits once per week for one week and twice per week for eight weeks. A review of the clinical record showed the following: A home health aide visit was performed on 11/28/23 and 12/01/23 for the week of 11/26/23 to 12/02/23. A home health aide visit was performed on 12/05/23 and 12/08/23 for the week of 12/03/23 to 12/09/23. A skilled nurse assessment dated 11/29/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 12/14/23 documented a supervisory aide visit was conducted (15 days after the last supervisory visit). A home health aide visit was performed on 12/12/23 and 12/15/23 for the week of 12/10/23 to 12/16/23. A home health aide visit was performed on 12/19/23 and 12/21/23 for the week of 12/17/23 to 12/23/23. A home health aide visit was performed on 12/29/23 for the week of 12/24/23 to 12/30/23. A home health aide visit was performed on 01/02/24 and 01/06/24 for the week of 12/31/23 to 01/06/24. A home health aide visit was performed on 01/09/24 and 01/12/24 for the week of 01/07/24 to 01/13/24. A skilled nurse assessment dated 12/14/23 documented a supervisory aide visit was conducted. A skilled nurse assessment dated 01/11/24 documented a supervisory aide visit was conducted (28 days after the last supervisory visit). On 01/26/24 at 2:45 pm, Staff C stated supervisory aide visits exceeded 14 days for Patient #7, 8 and 12.”