Every finding on record at A1 America Home Health Agency, Inc

An unannounced focused infection control and complaint survey for #2021001478 was conducted on 3/3/21 at A1 America Home Health Agency, Inc., a home health agency in Fort Myers, Florida. Complaint #2021001478 was substantiated at F0454. A1 America Home Health Agency, Inc. is in compliance with Code of Federal Regulations (CFR) 42, Part 484, Conditions of Participation for Home Health Services. The following is a description of the Standard level noncompliance.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on record review, interviews with Administrative staff, and the patients representative, the Home Health Agency failed to provide the ordered Home Health Aide (HHA) services for personal hygiene, bathing, grooming, and assisting with transfers, for 2 (Patients #1 and #2) of the 3 patients sampled. The Home Health Agency failed to provide evidence of assisting the patient's representative, in choosing an alternative Home Health Agency upon their failure to provide the services ordered. The findings included: 1. Review of Patient #1's medical record revealed a start of care 10/8/20. The patient is medically complex status. The Health Certification and the Plan of Care services ordered are for Skill Nursing 24 hours. The medical record revealed the services were not provided by the Home Health agency during the following hours: 10/24/20=9:00pm-7:00am 10/31/20=7:05pm-7:00am 11/10/20=7:07am-7:00pm 12/31/20=7:09pm-9:17am 1/9/21= 9:25pm-7:00am 1/11/21=7:00pm-7:00am 1/16/21=7:02pm-7:00am 1/17/21=7:10pm-7:00am The Home Health Agency failed to provide evidence of searching for and finding another agency to provide the ordered services. 2. Medical record review revealed Patient #2's start of care day was 8/14/19. The home health certification and plan of care revealed certification dates of 12/6/20 through 2/3/21. The services ordered included skilled nurse, 1 visit every other month for recertification and supervision. A second service ordered Home Health Aide (HHA) 6 hours a day Monday through Friday, the caregiver was available after the HHA leaves and on the weekend. The HHA was to assist with personal care, hygiene, and grooming. Patient #2's medical record provided a communication note dated 11/2/20, subject: Missed Visits. Documentation noted, "Due to the HHA's personal situation, there are some shifts that are uncovered while the agency looks for an English speaking HHA in the service area. The shifts that cannot be covered are spontaneous. The patient will remain under the care of her parents for the uncovered shifts." The pediatric discharge form dated 1/8/21 notes the patient depends entirely upon someone else for grooming needs and depends entirely upon another person to dress the upper body. On 3/3/21 at 12:30 p.m., during an interview, the patients' representative said, "I guess we are discharged from the agency. The last visit we had was sometime in late December 2020 or early January 2021. They said they were going to help, but it is hard to find anyone. My daughter has a child medical services case manager. The case manager is aware, but I think she is new. I have a list and have been calling. I got a Home Health Agency in Naples; on Monday they haven't gotten back to me. I will call them tomorrow if I don't hear from them. My mother, the patient's grandmother sees to her getting on the bus for special need school and getting off the bus, that is about all she can do." On 3/3/21, at 2:00 p.m., during an interview, the scheduler failed to provide documentation of notifying the patient's representative of the discharge. The HHA failed to provide documentation of arranging a safe and appropriate transfer to other care entities since the needs of the patient continue. .