Every finding on record at Aaran Home Health Services

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATIONS 109936 AND 109259 At the time of the substantial allegation survey completed on 10/09/24, no deficiencies were issued in regard to allegations contained in substantial allegation numbers 109936 and 109259; however, the facility was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiency is cited. Aaran Home Health Services is in substantial compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies.

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on record review, interview and policy review, the facility failed to ensure complaints were documented with resolution. This affected two (Patient's #74 and #103) and had the potential to affect all 102 current patients. Findings include: Review of the complaint log on 10/03/24 revealed eight complaints for 2024. The log did not identify the patient involved or the complaint resolution. I On 05/39/24, Patient #103 had stated Staff D, a home health aide, had tried to transfer money from his bank account. The bank statement showed four transactions were attempted to transfer money into cash app accounts belonging to Staff D and another person. Review of the complaint log revealed the complaint was not documented on 05/29/24 when Patient #103 reported the attempted theft. The complaint was logged on 06/06/24 when a third party requested information related to the incident. There was no resolution documented. Record review revealed Patient #74 called and complained on 09/18/24 that his girlfriend gave Staff C, a home health aide, money to grocery shop. Staff C returned with groceries, but not all the change from the shopping trip. Staff C said he lost the money. The facility reimbursed Patient #74's girlfriend. The complaint log did not contain an entry until 09/30/24, when a third party requested information related to the incident. During an interview on 10/08/24 at 3:02 P.M., Manager F stated they had an internal complaint log related to documentation in the electronic record. The complaint log had an entry for Patient #103 but listed the complaint as "other" without a description of what the complaint was about or the resolution. There was no entry on the internal log for Patient #74. Review of the facility policy titled "Complaint Policy", dated November 2020, stated the facility will investigate complaints made by the patient, patient representative, caregiver and family related to misappropriation documenting both the existence of the complaint and the resolution of the complaint.

Substantial Allegation Survey Substantial Allegations 104058 The following deficiencies are based on substantial allegation 104058 completed on 02/22/24. Aaran Home Health Services 368495, is in substantial compliance with the requirements 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 record review, policy review, and staff interview, the agency failed to ensure patients received home health services as written in the individualized plan of care for two of three patients reviewed (Patient #16 and #136). This could affect all patients receiving services from the agency. The census was 132. Findings include: 1. Review Patient #136's medical record revealed a start of care date of 12/21/23. Diagnoses included cerebral infarction, dysplasia, hypertension, chronic pain syndrome, and urinary incontinence. The physician ordered plan of care for the certification period dated 12/21/23 to 02/18/24 revealed orders for a skilled nursing visits once every sixty days and home health aide services 40 hours weekly for 60 days. The home health aide was to assist with personal care, incontinence care, and activities of daily living, (ADL). Review of the staff time sheets for the week of 12/21/23 and 12/28/23 revealed no services were provided. The first day services were provided was 01/02/24. There was no evidence the physician was notified of the missed visits on 12/22/23, 12/25/23, 12/26/23, 12/27/23, 12/28/23, 12/29/23 or 01/01/24. There was no evidence the physician was notified of the delay in the start of care. There was no evidence of communication with the patient to activate a back up plan or provide a fill in home health aide. Interview on 02/21/23 at 4:48 P.M. with Staff B revealed she had no explanation as to why services did not start 12/22/23. Staff B indicated home health aide services normally started the day after the nurse went in and conducted the start of care assessment. She verified there was no evidence the facility provided services from 12/22/23 through 01/01/24. There was no evidence of physician notification of the aide missing the first seven days of service. Review of the agency's undated policy titled, Missed Visit, revealed when there is a missed visit a replacement aide should be scheduled if the patient requests one. If a patient does not want a replacement caregiver, they should be advised to use their emergency backup plan. Review of the policy titled, Coordination of Patient Care, updated November of 2020, revealed staff were to notify the physician and make sure that he/she is aware of missed visits within 48 hours. 2. Review Patient #16's medical record revealed a start of care date of 10/23/23. Diagnoses included quadriplegia, type 2 diabetes, muscle wasting and atrophy and neurogenic bowel. The physician ordered plan of care for the certification period dated 02/20/24 to 04/19/24 revealed orders for a skilled nurse visit once every sixty days and home health aide services 63 hours weekly for 60 days. The home health aide was to assist with personal care, incontinence care, and activities of daily living (ADL). The patient utilized the wheelchair, hospital bed and Hoyer lift. He was up as tolerated in a wheelchair. The patient was to be provided oral care, skin care, assist with dressing, medication reminders, empty Foley catheter drainage bag, and catheter care. He was to be turned and repositioned, assisted with transfer and range of motion. He required the use of a Hoyer lift for transfers. His bed was to be made daily, his linens changed weekly or as needed, light housekeeping daily and weekly laundry or as needed. He was also a daily meal set up, a daily assist with feeding, grocery shopping weekly or as needed. He was not independent with medication administration and depended on a caregiver. Review of the staffing sheets revealed there was no morning aide on 01/16/24, no evening aide on 01/17/24 or 01/18/24, no morning aide on 01/19/24, and no morning aide on 01/22/24. Review of Communication Notes revealed a 01/18/24 missed visit note and the patient was informed they were still looking for a replacement aide. A 01/19/24 note revealed the case manager was informed there were no evening hours on 01/17/24 or 01/18/24 or morning hours on 01/19/24. A 01/22/24 Communication note revealed a note to the case manager of missed visits on 01/19/24 and 01/22/24. There was no documentation the physician was notified that services were not provided as ordered. Interview on 02/21/24 at 3:32 P.M. with Staff B verified there was no evidence of physician notification of the missed visits. The deficiency represents non-compliance investigated under Substantial Allegation 104058.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on record review and interview, the facility failed to ensure coordination of care to meet the needs of one of three patients reviewed (Patient #16). This could affect all patients receciving services from the agency. The census was 132. Findings include: Review Patient #16's medical record revealed a start of care date of 10/23/23. Diagnoses included quadriplegia, type 2 diabetes, muscle wasting and atrophy and neurogenic bowel. The physician ordered plan of care for the certification period dated 02/20/24 to 04/19/24 revealed orders for a skilled nursing visit once every sixty days and home health aide services 63 hours weekly for 60 days. The home health aide was to assist with personal care, incontinence care, and activities of daily living, (ADL). The patient utilized the wheelchair, hospital bed and a Hoyer lift for transfers. His mental status was oriented. He had a fair prognosis. He was up as tolerated in a wheelchair. The patient was to be provided oral care, skin care, assist with dressing, medication reminders, empty Foley catheter drainage bag, and catheter care. He was to be turned and repositioned, assisted with transfer and range of motion. His bed was to be made daily, his linens changed weekly or as needed, light housekeeping daily and weekly laundry or as needed. He was also a daily meal set up, a daily assist with feeding, grocery shopping weekly or as needed. He was not independent with medication administration and depended on a caregiver. Review of a 11/27/23 Communication note revealed there were missed visits the morning of 11/24/23, 11/25/23 and 11/26/23. The facility was not made aware of the missed visits until the patient called in. Review of a third party oversight agency document dated 12/27/23 revealed a request for staff sheets from 11/24/23 till 11/27/23. The facility response revealed the on-call staff member was hospitalized Saturday 11/25/23. The facility management was not made aware until 11/27/23. Interview on 02/21/24 at 1:58 P.M. with Patient #16 revealed when he did not hear from the facility, his sister and brother-in-law stopped in to empty his Foley catheter bag and to bring him food. The patient did have a backup neighbor for assistance, but she was out of town. He said he did stay in his wheelchair the whole weekend because he had ordered things on Friday and he wanted to be able to go to the door if they were delivered or go to the door if he ordered food. Interview 02/21/24 at 3:18 P.M. with Staff B revealed the patient was to have nine home health aide hours daily seven days a week. On the weekend of 11/25/23 Staff C had the on-call phone. Patient #16's aide texted him on 11/25/23 at 7:07 A.M. stating that she was not coming to work. Patient #16 texted the facility on call number at 7:12 A.M. that his aide was not coming to work. The on-call staff did not respond to the text message. Staff C ended up in the hospital on 11/25/23 and did not inform management she did not have the on-call phone. When Staff C did not show up for work on 11/27/23, Staff B called the on-call phone and Staff C's daughter answered and said Staff C was in the hospital. Staff B drove and picked up the on-call phone. The unanswered text was on the cell phone. Staff B had a replacement aide go to Patient #16's house on Monday 11/27/23. Because Staff C failed to notify management that she was unable to handle incoming calls from patients due to her unavailability, a replacement aide could not be sent to provide care to Patient #16, who was dependent on caregivers. The deficiency represents non-compliance investigated under Substantial Allegation 104058.

Substantial Allegation Survey Substantial Allegations 102447, 102401, and 102377 The following deficiency was cited related to allegations contained in substantial allegations 102401 and 102377. No deficiencies were issued as a result of the allegations contained in substantial allegation 102447. Aaron Home Health Services 368495, is in substantial compliance with the requirements 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 record review, policy review, and staff interview, the agency failed to ensure patients received home health services as written in the individualized plan of care for two of four patients reviewed (Patient #114 and #135). This could affect all patients receiving services from the agency. The census was 132. Findings include: 1. Review Patient #135's record revealed a start of care date of 08/18/23. Her primary diagnosis was alcoholic cirrhosis of the liver, with additional diagnoses including type 2 diabetes. hepatic encephalopathy, asthma, gastroesophageal reflux disease, persistent mood affective disorder, anxiety disorder, depression and muscle weakness. The physician ordered plan of care for the certification period dated 08/18/23 to 10/16/23 revealed orders for a skilled nurse visit once every sixty days and home health aide services 28 hours weekly for 60 days. The home health aide was to assist with personal care, incontinence care, and activities of daily living, (ADL). Review of emails between the patient's case manager and the agency revealed a 08/15/23 email to the case manager that the Registered Nurse was going to the patient's home on 08/15/23 for a start of care visit. The visit was planned for 08/15/23 and it was arranged for the aide from another agency to finish up on Friday 08/18/23. The email included this agency's aide would start with the patient on Monday 08/21/23 indicating the patient was perfectly fine with the arrangement. On 08/17/23 emails between the case manager and agency agreed on a Monday through Friday days of service of 5.5 hours per day with some flexibility for appointments. An email dated 08/21/23 at 10:18 A.M. from the case manager revealed the patient received a text from the aide that she would not be able to come. The response email revealed the aide was told once she turns in her paperwork she could start. On 08/22/23 the agency responded to the case manager that the aide would be starting on 08/23/23 and would work 10:00 A.M. till 3:00 P.M. Review of the staff time sheet for the week of 08/20/23 revealed Patient #135 received 21 of the 28 hours ordered for the week. There was no evidence the physician was notified of the missed visits on 08/21/23 and 08/22/23. Review of Staff H's personnel record revealed Staff H was Patient #135's only aide. Patient #135 was the only patient Staff H serviced during her employment. The staff's personnel record had a written communication her first day was to be 08/23/23 not 08/21/23 as per the communication from the agency to the case manager and patient. Interview on 12/14/23 at 12:09 P.M. with Staff B verified that Staff H did not provide services on 08/21/23 or 08/22/23. Staff B verified the emails to the case manager and the patient said the aide would start to provide services on 08/21/23 but did not provide services until 08/23/23. Staff B verified the patient received 21 of the ordered 28 hours. There was no evidence of physician notification of the aide missing the first two days of service on 08/21/23 and 08/22/23. Review of the agency's undated policy titled, Missed Visit, revealed when there is a missed visit a replacement aide should be scheduled if the patient requests one. If a patient does not want a replacement caregiver, they should be advised to use their emergency backup plan. The review of the missed visit protocol does not mention the physician is to be notified. Review of the policy titled, Coordination of Patient Care, updated November of 2020, revealed staff were to notify the physician and make sure that he/she is aware of missed visits within 48 hours. 2. Review of Patient #114's record revealed a 07/16/22 start of care date. Diagnoses included a primary diagnosis of type 2 diabetes, gastroesophageal reflux disease, major depressive disorder, osteoarthritis, irritable bowel syndrome, hyperlipidemia, essential primary hypertension, moderate persistent asthma with acute exacerbation, anxiety disorder, morbid severe obesity due to excess calories, and fibromyalgia. The patient had a memory deficit, very forgetful, paralysis due to cerebral vascular infarction, and poor hand coordination. Review of the physician ordered plan of care for the certification period dated 11/08/23 to 01/06/24 revealed orders for home health aide services 63 hours weekly for 60 days. The patient had morning and evening assist with personal care, incontinence care, activities of daily living, and light housekeeping as needed. Review of the timesheets revealed the patient received care from 8:00 A.M. to 2:00 P.M. a six hour time block and from 3:30 P.M. to 8:30 P.M. a five hour time block. The week of 11/19/23 the patient received 56 aide hours, the week of 11/26/23 the patient received 51 hours of aide services, and the week of 12/03/23 the patient received 61 hours of aide services. Interview 12/14/23 at 2:00 P.M. with Staff B revealed the patient had been receiving shortened aide hours on Sundays per her request. Staff B revealed the patient had not had 63 aide hours per week for quite some time. Staff B was unable to provide evidence of the patient asking for reduced hours. Staff B verified the physician continued to sign the plan of care for 63 hours of home health aide services weekly and had not been notified the agency was not providing the 63 hours per week as ordered. The deficiency represents non-compliance investigated under Substantial Allegation 102401 and 102377.