Every finding on record at Aaa Home Health Services, Inc

During the recertification survey conducted on 06/23/2025 to 06/26/2025 at AAA Home Health Services Inc., Home Health Agency, Emergency Preparedness was reviewed. AAA Home Health Services Inc. is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

A recertification survey was conducted on 06/23/2025 to 06/26/2025 at AAA Home Health Services Inc. The home health agency was in non-compliance with Code of Federal Regulations (CFR) 484 Subpart A-C. Requirements for Home Health Agencies.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation and conversation, the home health agency failed to follow basic infection control during a home visit on Sampled Patient #6 on 06/25/2025 at 01:01pm by not sanitizing a reuseable item used on multiple patients between uses. Direct observation on a home visit done 06/25/2025 of Sample Patient #6 revealed LPN staff #4 placed her nursing bag directly on the floor at 12:46pm without using a barrier. She then at 01:01pm picked up that same nursing bag and place it on a chair arm again without a barrier. She proceeded at that time to take out of her bag a pulse oximeter and placed it on Sample Patient #6 finger, she did place a paper towel as a barrier over the finger before the pulse oximeter was placed on the finger. Once the pulse oximeter reading was completed the nurse removed the oximeter and took off the paper towel and wiped the pulse oximeter with used barrier and then placed it back into her bag without thoroughly sanitizing the reuseable item. The surveyor did an exit interview with the administrator 06/26/2025 at 01:00pm and he agreed with the findings and stated obviously infection control was not met and this, need to again be discussed with staff.

During the recertification survey conducted on 07/18/2022 to 07/20/2022 at AAA Home Health Services Inc., a Home Health Agency, Emergency Preparedness was reviewed. AAA Home Health Services Inc is in compliance with Emergency Preparedness per Code of Federal (CFR) 42 Part 484.102, Condition of Participation for Home Health Agencies.

A recertification survey was conducted on 07/18/2022 to 07/20/2022 at AAA Home Health Services Inc. The home health agency was in non-compliance with 42 CFR 484 Subpart A-C, Requirements for Home Health Agencies.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on record review and interview, the provider failed to ensure that the patients were informed in advance of the disciplines’ frequency of visits proposed to be furnished for 9 out of 10 Sampled Patients (SP). SP#1, SP#2, SP#3, SP#4, SP#5, SP#6, SP#7, SP#9 and SP#10 Findings include: Clinical records review was conducted from 07/18/22 to 07/19/22 of SP#1, SP#2, SP#3, SP#4, SP#5, SP#6, SP#7, SP#9 and SP#10. Further review revealed all contain written agreements that had incomplete documentation showing the home health agency failed to advise them in advance of the frequency of visits proposed to be furnished by the discipline(s). On 07/19/22 at 2:00 pm Interview was conducted with Administrator, Alternate Administrator and Office Staff. The missing documentation on the consents were presented, and the Office Staff confirmed that nurses are not identifying frequency on consent upon admission. The Alternate Administrator informed the Office Staff that they must write a frequency in the consent, cannot be left blank.

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 clinical record review and interview, the provider failed to record all patient care orders in the plan of care for 1 out of 10 Sampled Patients (SP). SP#8 Findings include: Clinical record review conducted on 07/18/22 of SP#8 contained a Plan of Care (POC) for certification period 05/10/22 to 07/08/22 that revealed the patient is receiving Skilled Nurse once a week to provide assessment of all system and medication management. On 06/08/22 the patient was transferred to the hospital. On 06/15/22 the patient resumed service with the agency to continue providing skilled nursing service and for physical (PT) and occupational (OT) therapies. The clinical record did not contain documentation that the physician was notified and approved a revised plan of care that reflects current information from the patient's initial evaluations of the physical and occupational therapies. On 07/19/22 at 1:50 pm interview was conducted with the Administrator, Alternate Administrator and Office Staff, who reviewed SP#6 clinical record for the stated findings made above. The Administrator confirmed that form 486 sent to the physician only contained the PT/OT frequencies and omitted the treatments and goals set in the PT/OT care plans. In addition, the Office Staff acknowledged that PT/OT initial evaluation/care plan can be sent to the physician in order to meet this requirement.

Infection control education CFR(s): 484.70(c) Standard: Education. The HHA must provide infection control education to staff, patients, and caregiver(s). This STANDARD is not met as evidenced by: Based on record review and interview, the provider failed to demonstrate that 3 out of 11 active staff received education on infection control. (Staff D, Staff E and Staff F) Findings include: Record review of personnel files conducted on 07/20/22 of Staff D (Occupational Therapy) revealed a date of hire of 05/09/22; Staff E (Occupational Therapy Assistant) revealed a date of hire of 06/20/22; Staff F (Physical Therapy) revealed a date of hire of 06/06/22. Further review revealed no documentation or written evidence that Staff D, Staff E and Staff F at the beginning of employment were provided with infection control education provided to staff at periodic intervals consistent with accepted standards of practice. Such education must be provided at orientation, annually, and as needed to meet the staff's learning needs to provide adequate care; identify infection signs and symptoms; identify routes of infection transmission; appropriately disinfect/sanitize/transport equipment and devices used for patient care; and use proper medical waste disposal techniques. Such education must include instructions on how to implement current infection prevention/treatment practices in the home setting. Interview conducted with Alternate Administrator on 07/20/22 at 12:20 pm confirmed that they did not provide written information upon hire because they assumed that since the pool (therapy staffing company) already provides that information, the agency didn’t need to do that again.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on record review and interview, the home health agency staff failed to prepare and record clinical notes for 1 out of 10 Sampled Patients (SP). SP#8 Findings include: Electronical clinical record review conducted on 07/18/22 of SP#8 contained a Plan of Care (POC) for certification period 05/10/22 to 07/08/22 that revealed the patient is receiving Skilled Nurse once a week to provide assessment of all system and medication management. On 06/08/22 the patient was transferred to the hospital. On 06/15/22 the patient resumed service with the agency to continue providing skilled nursing service and for newly added physical (PT) and occupational (OT) therapies to be provided. Further review of the electronic clinical record revealed the occupational therapist completed the initial evaluation and care plan on 06/16/22. The occupational therapist assistant has not completed the scheduled visit notes of dates 06/21/22, 06/23/22, 06/28/22, 06/30/22, 07/05/22, 07/07/22 and 07/12/22 revealing status as "Not Started". Interview conducted with the Administrator on 07/19/22 at 1:50 PM acknowledged findings made by the surveyor, failure of the provider to have a complete clinical record with all the notes for care rendered by the occupational therapist assistant.

Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This STANDARD is not met as evidenced by: Based on record review and interview, the home health agency failed to show that 1 out of 5 (Staff I) home health aides/Certified nursing assistant completed a competency evaluation program that included an observation of aide's performance of the task before home health aide services were furnished. Findings include: Personnel record review conducted on 07/20/22 of Staff I (Home Health Aide) revealed a date of hire of 01/19/22. Further record review revealed documentation omitted that Staff I completed a competency evaluation program that included the task(s) that must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient [tasks include communication skills; reading and recording temperature, pulse and respiration; appropriate and safe techniques in performing personal hygiene and grooming tasks; safe transfer techniques and ambulation; normal range of motion and positioning] before home health aide services were furnished. On 07/20/22 at 12:29 pm a telephone interview was conducted with Staff I. The Staff I stated of being evaluated in the office only by the Director of Nursing (DON) and not while providing care to a patient. On 7/20/22 at 12:35 pm the Alternate Administrator reviewed the personnel record for Staff I. The Alternate Administrator confirmed that the DON did not write under “observed” to identify the task(s) observed from Staff I.

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 provider failed to ensure that an onsite visit to the patient's home no less frequently than every 14 days is conducted for supervision of the Home Health Aide (HHA) by a Registered Nurse or other appropriate skilled professional in 1 out of 10 Sampled Patients (SP). SP#2 Findings include: Clinical record review conducted on 07/18/22 of SP#2 revealed patient is receiving Skilled Nursing (SN) and Home Health Aide (HHA) services provided by the home health agency. Further review of the clinical record revealed the provider failed to demonstrate that HHA supervisions were conducted every 14 days from last documented supervision(s) dated 05/24/22 to 07/09/22 (last registered nurse note entered in clinical record) which is an interval of 46 days. Interview conducted with the Administrator on 07/18/22 at 2:34 PM confirmed findings, failure of the provider to demonstrate onsite supervision of the home health aide every 14 days. The Administrator stated she assumed because patient was receiving the HHA service through the long-term care insurance it was no required every 14 days. It was inquired from the Administrator to know if the agency was providing the nursing and HHA services even though through different payor source, and the Administrator answered yes.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record review and interview, the agency failed to maintain a complete and accurate medical record that included all interventions (care rendered) for 1 out of 10 sampled patients (SP). SP#6 Findings include: Clinical record review conducted on 07/18/22 of SP#6 revealed the Plan of Care for certification period 06/16/22 to 08/14/22 reads for skilled nursing service to be provided once a week for three weeks to inject [medication name] 10,000 unit/ml under the skin every week. Review of the clinical record for date range 06/23/22 to 07/14/22 revealed the progress note from the Registered Nurse (Staff B) documented the administration of the medication to be intramuscular and not under the skin (subcutaneous) as stated on the Plan of Care. On 07/19/22 at 2:05 pm a telephone interview was conducted with Staff B (Registered Nurse providing care to SP#6). The Staff B stated that SP#6 receives [name of medication] via subcutaneous. The Staff B acknowledged that if its miswritten as intramuscular is due to her using a transcriber, but usually she revises them and, in this case, it must have slipped her review. The Administrator and Office Staff were present during the telephone interview with Staff B and stated that they saw it too and notified her this morning. The Office Staff added that Staff B already fix the notes.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the 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) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on clinical record and interview, the home health agency (HHA) failed to ensure the clinical record included a completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer; the home health agency failed to complete a discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge (DC) from the Home Health Agency (if any) within 5 business days of the patient's discharge for 2 out of 10 Sampled Patient (SP). SP#9 and SP#10 Findings include: Closed record reviews of the SP#9 and SP#10 were conducted on 07/19/22. Electronic closed clinical record review of the SP#9 contained a discharge summary from agency with discharge date 06/06/22. Electronic closed clinical record review of the SP#10 contained a discharge summary from agency with discharge date 06/17/22. The “Discharge Summary” form for SP#9 and SP#10 omitted information of the following areas: does not list reason for admission to home health; omits the type of services provided and frequency of services; omits any Lab data; does not list the summary of care/outcomes in meeting the goals in the Plan of Care; omits discharge condition notation, and post-discharge instructions. In addition, the SP#10 was admitted to hospital on 04/29/22 with the “Transfer Summary” incomplete. Further review of the clinical record for SP#10 omitted notation of the transfer summary being sent to the receiving facility within 2 business days of becoming aware of an unplanned transfer. Record reviews of SP#9 and SP#10 revealed no documentation of a discharge summary being sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge (DC) from the Home Health Agency (if any) within 5 business days of the patient's discharge. On 07/19/22 at 1:58 pm the Administrator confirmed that agency does not send the transfer and discharge summaries because they are VA (veteran’s affair) patients and get admitted to the VA so most of the times, the VA notifies the home health agency of the admission.