Every finding on record at 1 Amazing Home Health Care LLC

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 107681 EXTENDED SURVEY The following deficiencies are based upon substantial allegation OH00107681 completed on 07/18/24. 1 Amazing Home Health Care is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies. 1 Amazing Home Health Care (368489) is precluded from providing its own home health aide training and competency testing or competency evaluation program for a period of two years from the date of the receipt of the deficiency report (2567) for this survey.

Advise the patient of discharge for cause CFR(s): 484.50(d)(5)(i) (i) Advise the patient, representative (if any), the physician(s) or allowed practitioner(s), issuing orders for the home health plan of care, and the patient's primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) that a discharge for cause is being considered; This ELEMENT is not met as evidenced by: Based on record review, interview and policy review, the facility failed to notify a patient that a discharge for cause was being considered and failed to notify the patient when the discharge became imminent. This affected one (Patient #1) of five patients reviewed. The active census was 92. Findings include: Record review revealed Patient #1's start of care date was 11/30/23. Diagnoses included hereditary hemorrhagic telangiectasia and hypertension. Review of the physician ordered plan of care for the certification periods dated 11/29/23 to 01/27/24 and 01/16/24 to 01/15/24 revealed orders for home health aide services four hours a day seven days a week, 28 hours a week for 60 days to assist with personal care, daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, light housekeeping, make bed, change linens weekly and when soiled. No skilled nurse services were ordered. The facility provided a discharge from services 12/30/23 for not having a face to face meeting with the physician within 90 days of admission or 30 days after admission. The facility was unable to produce any evidence related to the face to face meeting with the physician being required until 01/03/24, four days after he was discharged. The facility was unable to produce any evidence of the patient or caregiver being informed of an impending discharge and evidence of the discharge being carried out until four days after they discharged Patient #1. Staff B provided a communication note of the patient and caregiver being informed of the discharge and need for a face to face visit with the physician on 01/03/24 four days after discharge. During an interview on 07/16/24 at 4:32 P.M., Staff A verified Patient #1 was discharged from service 12/30/23 for not having a face to face visit with the physician per regulation. Staff A wrote the discharge without a home visit. Staff A check marked on the discharge the patient was discharged for noncompliance. The discharge was checked goals were met. Staff A checked marked discharge instructions, medically necessary appropriate follow-up advised, understanding of need for medical follow up verbalized, medications reviewed at discharge visit, able to comprehend discharge instructions, instructed to call agency of choice for future home care needs, informed of discharge prior to discharge date per agency policy and timeline were all checked yes, provided to the patient. Staff A verified she did not speak with the patient or caregiver related to the impending discharge and discharge. She thought Staff B informed Patient #1. Staff A revealed she did not provide discharge instructions to Patient #1 verbally or in writing. Review of the policy titled "Discharge Criteria, and Planning", revised February 2024, included the patient is informed a discharge plan in a timely manner and acknowledges understanding reason. The evaluation of a patient's discharge needs, and discharge plan must be documented in a timely manner. The evaluation must be included in the medical record and discussed with the patient or patient representative. All relative information from the agency will be incorporated into the discharge plan to avoid delays. The patient will receive verbal and written discharge instructions.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on record review, interview and policy review, the agency failed to ensure services were provided as ordered and failed to ensure the physician was notified of missed visits. This affected two (Patients #1 and #2) of five patients reviewed. This could affect all patients receiving services from the agency. The active census was 92. See G572 and G576.

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, interview and policy review, the agency failed to ensure services were provided as ordered and failed to ensure the physician was notified of missed visits. This affected two (Patients #1 and #2) of five patients reviewed. This could affect all patients receiving services from the agency. The active census was 92. Findings include: Record review revealed Patient #1's start of care was 11/30/23. Diagnoses included hereditary hemorrhagic telangiectasia and hypertension. Review of the physician ordered plan of care for the certification periods dated 11/29/23 to 01/27/24 and 01/16/24 to 01/15/24 revealed orders for home health aide services four hours a day seven days a week, 28 hours a week for 60 days to assist with personal care, daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, light housekeeping, make bed, change linens weekly and when soiled. No skilled nurse needs were identified at this time. A start of care assessment was conducted 11/29/24. There was no evidence home health aide (HHA) services were provided until 12/04/23. There were missed visits on 12/10/23, 12/12/23 and 12/16/23. The facility provided a time sheet dated 12/11/23. There were no additional timesheets provided. There was no evidence the physician was notified of the missed visits. Patient #1 was discharged on 12/30/23 and readmitted on 01/16/24. Review of the timesheet for the week of 01/16/24 revealed there were missed visits on 01/17/24 and 01/20/24; review of the timesheet for the week of 01/21/24 revealed there were missed visits 01/21/23, 01/26/24 and 01/27/24; review of the timesheet for the week of 01/28/24 revealed there were missed visits 01/28/24, 01/29/24 and 02/03/24; and review of the time sheets for the week of 02/11/24 revealed there were missed visits 02/11/24 and 02/16/24. The facility provided no timesheets for the week of 02/04/24. There was no evidence the physician was notified of the missed visits. Patient #1 asked to be discharged 02/16/24. Review of the timesheets used to document hours and care included there was a check mark system to mark what services were provided each day. Services ordered included four hours a day seven days a week, 28 hours a week for 60 days to assist with personal care, daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, light housekeeping, make bed, change linens weekly and when soiled. Staff D, Staff F and Staff G all provided care for Patient #1. Two showers and one laundry day were documented while he was a patient of the facility. Daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, make bed, and change linens weekly and when soiled were not check marked as being provided. During an interview 07/16/24 at 4:32 P.M., Staff A verified Patient #1 did not receive services as outlined in the plan of care. Patient #1's physician was not notified of missed visits. During an interview on 07/16/24 at 6:14 P.M., Staff H verified the facility failed to provide the services Patient #1 required. Staff H verified staff missed noticing the care was not being provided and the hours not provided when they collected time sheets and billed. 2. Record review revealed Patient #2's start of care was 03/08/24. Diagnoses included chronic obstructive pulmonary disease, nicotine dependence, anxiety disorder, major depressive disorder, muscle weakness, malignant neoplasm of breast, opioid abuse, and chronic kidney disease. Review of Patient #2's plan of care for the certification period dated 03/08/24 to 05/0624 ordered HHA services nine hours a week for 60 days. Patient #2 needed assist with dressing daily, weekly nail care, shampoo hair weekly, skin care daily, and shower three times a week. Review of aide time sheets starting 03/25/24 to 04/23/24 revealed there was no personal care provided as per plan of care; assisting with dressing daily, weekly nail care, shampoo hair weekly, skin care daily, and shower three times a week. None of the areas were check marked as completed. During an interview 07/16/24 at 6:24 P.M., Staff H verified the time sheets with associated documentation of care provided did not indicate the personal care was provided as care planned. Review of the policy titled "Management of Missed visits and Services Not Provided as Ordered", undated, included the agency staff will notify the physician of any and all missed visits or deficiencies in service hours provided that do not coincide with the services indicated on the 485 plan of care orders. This includes all nursing and aid services. The notification must be in writing must be sent as soon as possible. Documentation of physician must via fax with fax confirmation. Documentation of all visits be uploaded to the date , using the detail button next to the visit office staff is responsible for verifying that the previous weeks home health aide, timesheets, and nursing notes for the services that have been ordered by patient. Any 15 minute increments of a nursing shift missed is indicated to send a missed visit and a nursing visit that is awful filled during the week. It is indicated send a missed visit , the insurance chart check timesheets with each recertification that is completed to ensure the care provider flex what is ordered.

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 record review and interview, the facility failed to ensure physician orders were recorded in the medical record. This affected one (Patient #3) of five records reviewed. The current active census was 92. Findings include: Record review revealed Patient #3's start of care date was 01/25/24. Diagnoses include lymph-edema, ventricular premature depolarization, cardiomyopathy, severe persistent asthma, osteoarthritis and presence of an artificial knee. The patient was oriented to person, place and time. Review the plan of care for the certification period dated 05/24/24 to 07/22/24 revealed home health aide services of 28 hours a week for 60 days. Review of the physician orders revealed home health aide services four hours daily, seven days a week for 60 days. Review of the time sheets from 05/19/24 to 07/06/24 revealed the patient was receiving home health aide services three days a week for 9 hours. During an interview on 07/17/24 at 8:42 P.M., Patient #3 stated she agreed to home health aide services three days a week since she was getting better. She had bilateral knee replacements that were healing. However, she did say that she had an aide who wanted her to sign the time sheet when she hadn't done the time and they were never able to provide her the services seven days a week. Review of an email 07/17/24 at 6:43 P.M. from Staff B verified the patient was not receiving the hours reflected on her plan of care because the order was not written for the change to three days a week for nine hours.

Substantial Allegation Survey Substantial Allegation 62207 An entrance conference was conducted with administrative staff on 04/07/22, and an exit conference was conducted on 04/07/22. The following deficiency is based upon substantial allegation 62207 completed on 04/07/22. 1 Amazing Home Health Care LLC 368489, is not in compliance with the requirements found at 42 CFR, Part 484 Subpart B,C for Home Health Agencies.

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 medical record review, staff interview, and policy review, the agency failed to ensure each patient received the home health services that are written in the plan of care for one of three medical records reviewed (Patient #1). The active census was 77. Findings include: Review of the policy titled, "Plan of Care -CMS #485 and Physicians Orders," revised March 2019, revealed skilled nursing and other home health services will be provided in accordance with the plan of care based on the patient's diagnosis and assessment of immediate and long range needs and resources. Review of the medical record for Patient #1 revealed a start of care date of 01/14/22 with a primary diagnosis of pneumonia. The physician orders included skilled nursing once every sixty days and home health aide services twenty-one hours weekly. The home health aide orders included assistance with personal care, activities of daily living, and light housekeeping. Review of the home health aide time sheets revealed the following information: 1). No home health aide services provided the week of 01/16/22 through 01/22/22. 2). Home Health aide services provided from 01/24/22 through 01/28/22 did not follow the home health aide plan of care. The time sheet was not signed by the patient. 3). A second home health aide was assigned to the case and called off due to being sick on 01/31/22 and 02/01/22. The medical record revealed no home health aide services were provided on 02/02/22, 02/03/22, 02/04/22, 02/07/22, 02/08/22 and the aide called off on 02/09/22. There were no further home health aide visits and the patient was not discharged until 03/14/22. There was no evidence the physician was notified of missed visits 01/16/22 through 01/22/22, 02/02/22, 02/03/22, 02/04/22, 02/07/22, or 02/08/22. Staff A confirmed these findings in an interview on 04/07/22 at 2:46 PM. This deficiency substantiates Substantial Allegation 62207.

Extended Substantial Allegation Survey Substantial Allegation 32011 An entrance conference was conducted with administrative staff on 10/26/21, and an exit conference was conducted with administrative staff on 10/27/21. The following deficiencies are based on the substantial allegation 32011 completed on 10/27/21. 1 Amazing Home Health Care LLC 368489, is not in compliance with the requirements of 42 CFR, Part 484 Subpart B,C for Home Health Agencies. 1 Amazing Home Health Care LLC is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the exit date of this survey.

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: Based on medical record review, staff interview, and policy review, the agency failed to ensure skilled nursing services were provided as ordered by the physician or allowed practitioner as indicated in the plan of care (G710). The agency failed to communicate with the physician related to the patient's current plan of care (G718). The agency failed to ensure nursing services are provided under the supervision of a registered nurse (G726). The cumulative effect of these systemic practices resulted in the agency’s inability to ensure that the patients’ nursing needs would be met.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure skilled nursing services were provided as ordered by the physician or allowed practitioner as indicated in the plan of care for three of three records reviewed (Patient's #1, #2, and #3). This could affect all patients receiving services from the agency. The agency census was 74 patients. Findings include: 1). Review of the medical record for Patient #1 for the certification period dated 06/05/21 through 08/03/21 revealed physician orders for skilled nursing services once daily to monitor the tracheostomy for signs and symptoms of infection and to provide tracheostomy care including the change of the inner cannula. In addition, the nurse was to perform a skin assessment with each visit to ensure no skin breakdown and report any findings to the registered nurse. Review of the skilled nursing documentation dated 06/01/21 revealed an assessment of the integumentary status with the skin dry and within normal limits. Review of the licensed practical nurse documentation beginning 06/07/21 noted decreased skin integrity due to obesity resulting in erythema in the skin folds. On 06/08/21, 06/18/21, and 06/22/21 the nurse noted the patient to have leaking of fluid to the outer thighs due to lymphedema. On 06/23/21 the nurse noted the skin as warm, dry, and within normal limits however the nursing narrative on this date noted the patient notified the nurse of having maggots in the thigh folds. Upon assessment the nurse identified a maggot infestation with physician notification with orders to cleanse with soap and water. The medical record lacked evidence the supervising registered nurse was notified of the change in patient condition. Review of the nursing documentation dated 06/10/21 revealed the nurse provided tracheostomy care with the inner cannula changed. The tracheostomy was noted to have redness, odor, and dark yellow drainage. The physician was notified with orders to culture the tracheostomy. The culture was obtained and taken to the laboratory for testing. The medical record lacked evidence the registered nurse was notified or that the nurse followed up with the laboratory results. On 06/14/21, 06/15/21, and 06/16/21 the skilled nurse noted the patient complained of a headache, nausea, and diarrhea. The patient reported to the nurse of receiving an antibiotic from pharmacy for a tracheostomy infection. The medical record lacked evidence the registered nurse was notified of the new symptoms and/or of the tracheostomy infection. Review of the nursing documentation revealed skilled nurse missed visits on 06/05/21, 06/06/21, 06/12/21, 06/13/21, 06/19/21, and 06/20/21 with no documentation recording that the visits were missed or that the physician was notified. Review of missed visit notes dated 06/25/21, 06/26/21, 06/27/21, and 06/28/21 revealed a cancellation of care and that the nurse was off for personal reasons. The patient refused to have another nurse and stated she would call the office if she needed any1hing. It was documented that the physician was not notified of the missed visits and that care was not provided as ordered. Skilled nurse missed visits were also noted on 07/03/21 and 07/04/21 because the patient refused care for the weekend. It was documented that the physician was not notified of the missed visits and that care was not provided as ordered. Review of the nursing documentation on 06/21/21, 06/22/21, 06/24/21, 06/29/21, 06/30/21, 07/01/21, 07/02/21, 07/05/21, 07/06/21, 07/08/21, 07/09/21, 07/12/21, and 07/13/21 revealed the patient refused tracheostomy care. There was no documentation the physician was notified the patient refused the care. Staff A confirmed the findings in an interview on 10/27/21 at 2:14 PM. 2). Review of the medical record for Patient #2 for the certification period dated 09/28/21 through 11/26/21 revealed physician orders for skilled nursing services five times weekly. Review of the nursing notes lacked evidence visits were completed on 10/15/21, 10/18/21, and 10/19/21. The nursing notes documented cancellation of care with no further information. Staff A confirmed in an interview on 10/27/21 at 2:19 PM there was no documentation as to why the visits were not conducted. 3). Review of the medical record for Patient #3 for the certification period dated 09/24/21 through 11/24/21 revealed physician orders for skilled nursing services five times weekly. Review of the nursing documentation revealed missed visits on 10/11/21, 10/18/21, and 10/25/21. Staff A confirmed in an interview on 10/27/21 at 2:25 PM that there was no documentation as to why the visits were not conducted. This deficiency substantiates Substantial Allegation 32011.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and policy review, the agency failed to communicate with the physician related to the patient's current plan of care for one of three medical records reviewed (Patient #1). This could affect all patients receiving services from the agency. The agency census was 74 patients. Findings include: Review of the Policy and Procedure Plan of Care- CMS #485 and Physician Orders 9.10.1 ( Revised March 2019) states the physician orders for treatments and services are the foundation of the plan of care. If the agency misses a visit or a treatment or services as required by the plan of care, which results in any potential for clinical impact upon the patient, the agency must notify the responsible physician of such missed treatment or service. The physician decides whether the treatment or service may be skipped or whether additional intervention is required by the agency due to the clinical impact on the patient. If the patient or the patient's representative refuses care that could impact the patient's clinical well being on more than one occasion, the agency must attempt to identify the reason for the refusal. If the agency is unable to identify and address the reason of the refusal, the agency must communicate with the patient's responsible physician to discuss how to proceed with patient care. Review of the medical record for Patient #1 for the certification period dated 06/05/21 through 08/03/21 revealed physician orders for skilled nursing services once daily to monitor the tracheostomy for signs and symptoms of infection and to provide tracheostomy care including the change of the inner cannula. . On 06/14/21, 06/15/21, and 06/16/21 the skilled nurse noted the patient complained of a headache, nausea, and diarrhea. The medical record lacked evidence the physician was notified of the new symptoms. Review of the nursing documentation revealed skilled nurse missed visits on 06/05/21, 06/06/21, 06/12/21, 06/13/21, 06/19/21, and 06/20/21 with no documentation recording that the visits were missed or that the physician was notified. Review of missed visit notes dated 06/25/21, 06/26/21, 06/27/21, and 06/28/21 revealed a cancellation of care and that the nurse was off for personal reasons. The patient refused to have another nurse and stated she would call the office if she needed any1hing. It was documented that the physician was not notified of the missed visits and that care was not provided as ordered. Skilled nurse missed visits were also noted on 07/03/21 and 07/04/21 because the patient refused care for the weekend. It was documented that the physician was not notified of the missed visits and that care was not provided as ordered. Review of the nursing documentation on 06/21/21, 06/22/21, 06/24/21, 06/29/21, 06/30/21, 07/01/21, 07/02/21, 07/05/21, 07/06/21, 07/08/21, 07/09/21, 07/12/21, and 07/13/21 revealed the patient refused tracheostomy care. There was no documentation the physician was notified the patient refused the care. Staff A confirmed the findings in an interview on 10/27/21 at 2:14 PM. On 07/14/21 Staff A completed a transfer summary noting the patient was transferred to the hospital and admitted due to a respiratory problem. Review of the nursing documentation on 07/15/21 at 9:01 AM revealed notification to the physician the patient expired at the hospital.

Nursing services supervised by RN CFR(s): 484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k). This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and policy review, the agency failed to ensure nursing services are provided under the supervision of a registered nurse for one of three medical records reviewed (Patients #1). The agency census was 74 patients. Findings include: Review of the Policy and Procedure for Supervision of Staff revealed all therapeutic services furnished are under the supervision and direction of a physician or a registered nurse. The Registered Nurse conducts a supervisory visit of the Licensed Practical Nurse at least every 30 days. Review of the medical record for Patient #1 revealed the Registered Nurse completed a supervisory visit for the Licensed Practical Nurse on 06/01/21 at 4:20 PM and no supervisory visit thereafter. The patient was transferred to the hospital on 07/14/21. Staff A stated in an interview on 10/26/21 at 10:36 AM the registered nurse was required to complete a supervisory visit for the licensed practical nurse once every 60 days.