Cohesive Healthcare

“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 notified the physician of blood pressure levels outside the ordered parameters for one (Patient #3) of twelve patients; 2. SN provided treatment as ordered for one (Pt #4) of twelve patients; 3. SN notified the physician of pain levels outside the ordered parameters for one (Patient #5) of twelve patients; and 4. SN frequencies were followed as ordered for two (Patient #6 and 12) of twelve patients. 1. Patient #3 A review of the POC dated 09/13/23 to 11/11/23 showed an order for the physician to be notified of diastolic blood pressure less than 60. A review of a vital signs record showed diastolic readings of 58 (9/18/23), 58 (9/25/23), 41 (10/2/23), 56 (10/16/23), 52 (10/23/23), and 51 (11/6/23). Documents showed no physician notification for the diastolic blood pressure readings less than 60. 2. Patient #4 A review of the POC dated 09/23/23 to 11/21/23 showed an order for SN to provide bilateral ear irrigation for ear wax removal monthly or as needed for prevention of ear wax impaction. A review of clinical records showed no ear irrigation treatments were provided. Documentation showed no refusal of services from the patient or caregiver and no physician order for a change in treatment. 3. Patient #5 A review of the POC dated 09/10/23 to 11/08/23 showed an order for the physician to be notified of pain greater than five out of ten. A review of a SN note dated 10/25/23 showed the patient’s reported pain as an eight out of ten. Documents showed no physician notification for the reported pain greater than five. 4. Patient #6 A review of a physician’s order dated 10/04/23 showed a SN frequency of once a week for eight weeks and two as needed, from 10/09/23 to 12/02/23. A review of a SN missed visit note dated 10/23/23 documented the reason the missed visit as other schedule conflicts, and no other visits documented 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. Patient #12 A review of the POC dated 10/14/23 to 12/12/23 showed a SN frequency of once a week for eight weeks and two as needed. A review of a SN missed visit note dated 10/26/23 documented the reason the missed visit as patient in care of family, and no other visits documented 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. On 12/14/23 at 2:23 p.m., Staff A stated: 1. there were no documentation of physician notification of the diastolic blood pressures being out of parameters for Patient #3; 2. the ear treatment were not provided as ordered by the physician for Patient #4; 3. there were no documentation of physician notification of the pain level being out of parameters for Patient #5; and 4. the SN frequencies for Patient’s #6 and #12 were not met as ordered by the physician.”

“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 a home health aide supervisory visit were completed every 14 days for two (Patients #1 and 2) of seventeen patients. Patient #1 A plan of care dated 09/05/23 to 11/03/23 showed a home health aide visit frequency of once a week for eight weeks. A review of the clinical record showed home health aide visits were completed on 09/12/23, 09/18/23, 09/25/23, 10/02/23, 10/09/23, 10/18/23, 10/25/23, and 11/01/23, with no supervisory aide visits conducted from 10/11/23 to 11/03/23 (24 days without supervisory visits). Patient #2 A plan of care dated 09/12/23 to 11/10/23 showed a home health aide visit frequency of once a week for one week and twice a week for eight weeks. A review of the clinical record showed home health aide visits were completed on 09/15/23, 09/18/23, 09/22/23, 09/25/23, 09/29/23, 10/02/23, 10/06/23 and 10/09/23, 10/13/23, 10/16/23, 10/19/23, 10/23/23, and 10/27/23, with no supervisory aide visits conducted from 10/03/23 to 10/29/23 (27 days without supervisory visits). On 12/14/23 at 2:30 p.m., Staff A stated the supervisory visits were not completed every 14 days for Patient’s #1 and #2.”