Every finding on record at A&D Health Care Professionals, Inc

EMERGENCY PREPAREDNESS SURVEY At the time of the Emergency Preparedness survey completed on 07/13/23, A&D Health Care Professionals, Inc was in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Standard Recertification Survey An entrance conference was conducted with administrative staff on 07/10/23 at 2:00 PM, and an exit conference was conducted with administrative staff on 07/13/23 at 5:15 PM. The following deficiency is based on the standard recertification survey completed on 07/13/23. A&D Health Care Professionals, Inc 368017, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on home visit observations, medical record review, facility policy review, and staff interview, the agency failed to ensure home health aides provided services included in the aide care plan for one of two patients reviewed who were receiving home health aide services (Patient #3). The total patient sample was seven. The facility census was 78. Findings include: An aide home visit was conducted on 07/12/23 at 2:00 PM to observe Staff B with Patient #3. While gathering supplies for a bed bath, Staff B was observed tearing four pieces of white medical tape and sticking each end on a bedside table. A packet of 4x4s dressings was also placed on the bedside table prior to the bed bath. Once all supplies were gathered, Staff B assisted Patient #3 to roll to his right lateral side. When he was on his side, a dressing was noted to be taped to the patient's coccyx. Donning disposable gloves, Staff B removed the dressing and disposed of the dressing in a plastic bag on the floor. Once the dressing was removed, this surveyor observed the skin on the patient's coccyx area. There were no reddened areas or areas of broken skin observed. Staff B removed the gloves, donning a new pair and wiped the patient's entire buttock with a soapy washcloth and dried the area with a dry towel. The home health aide was observed opening the 4x4 package, and then placing a 4x4 on the patient's coccyx. Removing each of the four pieces of tape, Staff B placed a piece of tape on each side of the 4x4 and completed the bed bath. Staff B was interviewed following the bed bath and was asked if she typically performed this dressing change with a bed bath and she nodded her head in the affirmative, stating she did. Review of Patient #3's medical record revealed the patient was admitted to the agency on 03/13/23. The patient was admitted with diagnoses including supraventricular tachycardia, cerebral infarction, presence of cardiac pacemaker, and weakness. The certification periods reviewed included 05/12/23 through 07/10/23 and 07/11/23 through 09/08/23. There was no diagnosis of pressure injury or wound noted on either plan of care. The patient was ordered to receive services of a home health aide up to six hours weekly, once a week for one week and three times a week for eight weeks to provide assistance with personal care for activities of daily living and light housekeeping. The aide care plan outlined bathing, hygiene/grooming, and light housekeeping tasks to be performed. Neither application nor removal of a dressing were listed as tasks to be performed by the home health aide. The facility undated policy titled, Home Health Aide In-Service Policy, was reviewed on 07/12/23 at 4:10 PM. According to the policy, advanced home health aide skills are those skills performed by the home health aide which fall outside the basic care skills required for job performance. Staff A was interviewed on 07/12/23 at approximately 4:20 PM. Staff A stated after following up with both Staff B and Staff C, the 4x4's were applied to the patient's coccyx as "cushion" to prevent pressure injury. Staff A also revealed the facility home health aides, including Staff B, had not been provided any advanced training to perform dressing changes and this was not a task that was listed on the aide care plan, therefore, should not be performed by Staff B or any facility home health aide.

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION OH00123433 An entrance conference was made the morning of 07/06/21 with the administrative staff and an exit conference was completed the afternoon of 07/07/21 with the administrative staff. No deficiencies were cited related to the allegation contained in substantial allegation OH00123433 completed on 07/07/21; however, the facility was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiency is cited. A&D Health Care Professionals, Inc 368017, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C 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 record review and interview, the agency failed to ensure services were provided as written in the plan of care for two of three patients reviewed (Patient #1 and #2). This could affect all patients receiving services from the agency. Findings include: 1. Review of the medical record for Patient #2 revealed the start of care was on 03/25/21 with a primary diagnosis of peripheral vascular disease. The certification period reviewed was from 05/24/21 to 07/22/21. The plan of care revealed orders for skilled nursing services two times a week times one week, three times a week times one week, two times a week times two weeks, three times a week time one week, two times a week times two weeks, three times a week times one week, one times a week times one week and then every three days. Review of the skilled nursing visits revealed there were skilled nursing missed visits on 05/30/21, 06/08/21 and 06/26/21. However, there was no evidence the patient's physician was notifed that services were not provided as ordered. This finding was confirmed in an interview with Staff B on 07/06/21 at 2:00 PM. 2. Review of the medical record for Patient #1 revealed the start of care was on 03/11/21 with a primary diagnosis was chronic kidney disease (stage 4 severe). The certification period reviewed was from 05/10/21 to 07/08/21. During the certification period, Patient #1 was admitted to the hospital on 06/22/21 for a left foot wound related to neuropathy and intermittent pain in his left leg. The resumption of care was on 06/29/21. The physician orders included daily wound care to the left foot. There were missed visits for 07/01/21 and 07/02/21. There was no evidence the physician was notified that services were not provided as ordered. This finding was confirmed in an interview with Staff A on 07/07/21 at 11:00 AM.