Every finding on record at 24 Hour Quality Home Healthcare LLC

A recertification and complaint survey was initiated on 5/22/2023. The census was: LCHH-21 LHH-416 Total agency census: 437 Intakes: 373197 398760 371869 392771 The agency was in compliance with 42 CFR part 484.102, Emergency Preparedness Requirements for Home Health Agencies.

A recertification and complaint survey was initiated on 5/22/2023. The census was: LCHH-21 LHH-416 Total agency census: 437 Intakes: 373197 398760 371869 392771 Abbreviations LCHH-Licensed and Certified Home Health LHH-Licensed Home Health PT/INR-measures of prothrombin ratio and international normalized ratio RN-registered nurse LVN-licensed vocational nurse BID-twice a day

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 furnish services in conformance with physician orders in 2 (Patient #1 and #6) of 12 charts reviewed. This failure placed the patients at risk of not receiving the ordered care and services to achieve the patient goals and addressing the patient’s healthcare needs. Findings include: Patient #1: The chart included a plan of care for episode 10/21/22 through 12/19/22 with a start of care date of 10/21/22 signed and dated by RN A on 10/21/22. The plan of care included diagnosis of chronic pain syndrome, low back pain, essential primary hypertension (high blood pressure), and type 2 diabetes without complications (adult onset chronic condition that affects the way the body processes blood sugar). The plan of care included orders for skilled nursing for 1 time a week for 9 weeks and physical therapy to evaluate and treat. There was no evidence of skilled nursing visit during the week of 12/2/22. The chart included a missed visit for 12/2/22 indicating the visit was missed due to a scheduling error. The agency failed to follow the plan of care in following the ordered frequency of 1 time a week. On 11/2/22 LVN A received an order to perform a PT/INR (a lab test to determine how fast your blood clots) weekly. The skilled nurse notes for 11/10/22 and 11/17/22 signed and dated by LVN A failed to indicate the PT/INR was performed. The agency failed to perform weekly PT/INR’s per physician orders. An interview was conducted on 6/7/23 4:23 pm with LVN A via phone. The surveyor reviewed the above findings. The surveyor asked LVN A if she had performed the PT/INR on 11/10/22 and 11/17/22 as ordered. LVN A said, “No.” An interview was conducted on 5/25/23 at 3:00 pm with the Supervising Nurse. The surveyor reviewed the findings for Patient #1’s chart review with the Supervising Nurse. The surveyor asked why there was no skilled nurse visit the week of 12/2/22. The Supervising Nurse said, “That was due to a scheduling error.” The surveyor asked why the PT/INR was not performed on 11/10/22 and 11/17/22 by LVN A. The Supervising Nurse said, “I don’t know.” Patient #6: The chart included a plan of care for episode 2/15/23 through 4/15/23 with a start of care date of 2/15/23 signed and dated by RN B on 2/14/23. The plan of care included diagnosis of type 2 diabetes mellitus (adult onset chronic condition that affects the way the body processes blood sugar) with hyperglycemia (high blood sugar) and long-term use of insulin. The plan of care included orders for BID for 60 days and physical therapy to evaluate and treat. The plan of care included orders for skilled nurse to perform finger sticks for fasting blood sugar/random blood sugar during visit if it has not been done or if the patient reports signs and symptoms of hyper/hypoglycemia. Skilled nurse to notify the physician of fasting blood sugar greater than 250 or less than 60 and random blood sugar (non-fasting) greater than 350 or less than 60. The chart included skilled nurses notes with the following random blood sugar readings: 2/16/23 -384, 2/17/23-407, 2/20/23-357, 3/3/23-365, 3/5/23-412, 3/6/23-400, 3/7/23-375, 3/10/23-360, 3/12/23-375, 3/14/23-366, 3/17/23-412, 3/21/23-379, 3/26/23-371, 3/28/23-401, 3/29/23-385, 3/30/23-361, 3/31/23-405, 4/1/23-431, 4/2/23-427, 4/7/23-568, 4/12/23-439, 4/13/23-381, and 4/14/23-429. The skilled nurse notes were signed and dated by LVN B. The skilled nurses notes did not include documentation of the physician being notified of the random blood sugar out of ordered parameters of greater than 350 or less than 60 for random blood sugar 23 times during episode 2/15/23 through 4/15/23 An interview was conducted on 5/25/23 at 2:55 pm with the Supervising Nurse. The surveyor reviewed the above findings and asked if she knew why LVN B failed to notify the physician of the random blood sugars out of ordered parameters. The Supervising Nurse said, “I don’t know.” An interview was conducted on 6/1/23 at 3:42 pm with LVN B. The surveyor reviewed the above findings with LVN B and asked LVN B if she had reported the random blood sugars out of ordered parameters to the physician. LVN B said, “I didn’t, her (Patient #6) blood sugar is always that way, it’s always crazy and the doctor is aware of this (sic).”

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on observation, record review and interviews, the agency failed to provide the patient and/or caregiver with written information outlining a visit schedule including frequency of visits by home health staff in 7 (Patients #2, #4, #6, #7, #8, #9, & #10) of 7 patients' home folders reviewed during home visits. This failure placed the patients at risk of missed visits by staff when visits were not scheduled and conflicted with other appointments and the availability of the patients. Findings included: Patient #2: Record review contained a plan of care for the period of 12/19/22 through 2/16/23 with a start of care of 2/22/22. The frequency for the skilled nurse was ordered 1 time a week for 9 weeks and home health aide 2 times a week for 9 weeks. During a home visit with Patient #2 on 5/31/23 at 10:15 am, no documentation was found in the agency home folder provided to Patient #2 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #2 said “No.” The surveyor asked if Patient #2 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #2 said, "No." Patient #4: Record review contained a plan of care for the period of 2/3/23 through 2/16/23 with a start of care of 12/53/22. The frequency for the skilled nurse was ordered 1 time a week for 9 weeks. During a home visit with Patient #4 on 5/31/23 at 11:30 am, no documentation was found in the agency home folder provided to Patient #4 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #4 said “No.” The surveyor asked if Patient #4 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #4 said, "No." Patient #6: Record review contained a plan of care for the period of 2/15/23 through 4/15/23 with a start of care of 2/15/23. The frequency for the skilled nurse was ordered BID for 60 days and physical therapy to evaluate and treat. During a home visit with Patient #6 on 5/30/23 at 11:00 am, no documentation was found in the agency home folder provided to Patient #6 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #6 said “No.” The surveyor asked if Patient #6 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #6 said, "No." Patient #7: Record review contained a plan of care for the period of 2/27/23 through 4/27/23 with a start of care of 2/27/23. The frequency for the skilled nurse was ordered 2 times a week for 8 weeks then 1 time a week for 1 week. During a home visit with Patient #7 on 5/30/23 at 9:30 am, no documentation was found in the agency home folder provided to Patient #7 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #7 said “No.” The surveyor asked if Patient #7 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #7 said, "No." Patient #8: Record review contained a plan of care for the period of 5/18/23 through 7/16/23 with a start of care of 5/18/23. The frequency for the skilled nurse was ordered 1 time a week for 9 weeks and home health aide 2 times a week for 9 weeks. During a home visit with Patient #8 on 5/31/23 at 12:20 pm, no documentation was found in the agency home folder provided to Patient #8 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #8 said “No.” The surveyor asked if Patient #8 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #8 said, "No." Patient #9: Record review contained a plan of care for the period of 2/22/23 through 4/22/23 with a start of care of 8/26/22. The frequency for the skilled nurse was ordered 1 time a week for 8 weeks and physical therapy to re-evaluate. During a home visit with Patient #9 on 5/31/23 at 9:00 am, no documentation was found in the agency home folder provided to Patient #9 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #9 said “No.” The surveyor asked if Patient #9 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #9 said, "No." Patient #10: Record review contained a plan of care for the period of 4/21/23 through 6/19/23 with a start of care of 4/21/22. The frequency for the physical therapy 2 times a week for 1 week, 4 times a week for 2 weeks and 3 times a week for 2 weeks. During a home visit with Patient #10 on 5/30/23 at 11:40 am, no documentation was found in the agency home folder provided to Patient #10 of written information outlining a visit schedule including frequency of visits to be made by the skilled nurse. The surveyor asked if anything had been removed from the folder. Patient #10 said “No.” The surveyor asked if Patient #10 had been provided with a written schedule of visits to be made by the skilled nurse. Patient #10 said, "No." An interview was conducted on 6/1/23 at 2:50 pm with the Supervising Nurse. The surveyor reviewed the home visit findings above with the Supervising Nurse. The surveyor asked the Supervising Nurse why Patient’s #2, #4, #6, #7, #8, #9, or #10 was not provided with a written schedule of visits. The Supervising Nurse said, “I don’t know, they should have all had a calendar for that.”