Every finding on record at Abacus Home Health Inc

A complaint investigation survey entrance conference was conducted on 03/30/2021 at 10:45 A.M. with the Alt. Adm. and the DON. Census: L&C: 54 LHHS: 10 Complaints: #269718, #271162, and #271497. An exit conference was conducted on 04/08/2021 at 4:45 P.M. with the Adm, Alt. Adm, and the DON. The preliminary findings were discussed. The agency was given the opportunity to provide additional information. Violations were cited, and written instructions were provided for submitting an acceptable Plan of Correction within 10 days of the receipt of the Statement of Deficiencies. Deficiencies cited. Abbreviations used: Adm - Administrator Alt Adm - Alternate Administrator DON - Director of Nursing RN - Registered Nurse PIR - Provider Investigation Report TULIP - Texas Unified Licensure Information Portal - a database utilized by the state to maintain licensing, demographic information, complaints, and self-reported incidents on Home HHSC - Health and Human Services Commission DADS - Department of Aging and Disability Services DFPS - Department of Family and Protective Services ANE - Abuse, Neglect and Exploitation CR - Clinical Record SN - Skilled Nurse PT - Physical Therapy PTA - Physical Therapy Assistance HHA - Home Health Aide Mod Assist - Moderate Assistance Min Assist - Minimum Assistance NT- Not Tested WC - Wheelchair

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to promptly alert the patient's physician for 1 of 1 patient (#2) when there were changes of the patient's health conditions, in that: The DON failed to promptly notify MD #J that Patient #2's condition had changed and continued to deteriorate. Failure of the agency to promptly alert the patient's physician of the patient's deteriorating condition placed any patient at risk of harm from unattended health emergency in a timely fashion. Findings include: Record review of Patient #2's electronic CR revealed a POC for the certification period 03/08/2021 - 05/06/2021 showing a start of care date of 01/13/2020. The POC included the diagnoses of radiculopathy, lumber region, unspecified fracture of T11 - T12 vertebra, Muscle weakness, Atherosclerotic heart disease of native coronary artery, malignant neoplasm of prostate. The POC orders for treatment included: SN: 1 w 9 (one time a week for nine weeks) PT: Evaluate and treat per plan of care HHA: 2 w 8 (two times a week for 8 weeks), 1 w 1 (One time a week for one week) Record review of the PT evaluation by PT #F showed the frequency of 2w4 (two times a week for 4 weeks) and 1w1; and 4 follow-up visits by PTA #G. Record review of a "Missed Visit Form (PTA Visit)" dated 03/25/2021 included "Comments: Patient's daughter called to cancel therapy all together secondary to patient now having compression fractures of his spine. HHA aware." Record review of the communication/Care coordination notes did not show that the Patient #2's x-ray results of compression fractures of his spine was communicated to the physician, by the SN (#D) and the HHA (#E) by the agency. Further review of the CR revealed an HHA visit on 03/25/2021 and SN visit on 03/26/2021. Interview on 03/30/21 at 11:15 A.M., with the DON, the surveyor requested clarification on the stated reason for Patient #2's PT discharge. The DON stated that Patient #2's FM called the agency to report that Patient #2 sustained injury during a therapy session and that Patient #2's health status had deteriorated as a result. When asked if she communicated and exchanged this pertinent information about Patient #2's new condition to the physician, the skilled nurse and to the home health aide, the DON stated that she did not notify the physician because it was he who ordered the x-ray and so knew the results already. She further stated, she did not communicate the x-ray results to the skilled nurse and the home health aide, because she did not think it was a new condition for Patient #2 since he had always had pains and that his start of care diagnoses included fractures. The DON further stated that the POC already included safety interventions for the clinicians. Interview on 04/08/2021 at 11:00 A.M., with MD #J , the surveyor asked if the agency communicated and exchanged pertinent information about Patient #2's current health status with him. MD #J, stated he was looking through the patient's chart but did not see any communication and pertinent information about the patient's condition from the agency. When asked for his reason for requesting the x-ray examination on Patient #2, MD #J stated that on 03/23/2021, Patient #2's FM requested that Patient #2 needed an x-ray to determine why his back was hurting more than before. MD #J stated that he was reviewing his encounters and that all he was seeing were the encounters with the FM about the PT incident and his passing; and that nothing came from the agency about the PT incident or that Patient #2 had passed away. Record review of agency policy titled, "Coordination of Services & Progress Summary" read in part: "The Home Health Agency must: Ensure communication with all physicians involved in the care; Integrate services, whether services are provided directly or under arrangement, to ensure the identification of patient treatment effectiveness and the coordination of care provided by all discipline .... Care will be coordinated initially and ongoing among staff providing care. The Home Health Agency must promptly alert the relevant physician(s) to any changes in the patient's condition or need that suggest that outcomes are not being achieved and/or that the plan of care should be altered." Record review of agency document titled, Monitoring Patient Care/ Coordination of Care read in part, "Purpose: To ensure coordination of patient/client care and treatment. The agency will monitor, evaluate, and report to the patient's/client's physician and/or non-physician practitioner regarding the patient's/client's progress toward.......... The agency will coordinate care delivery to meet the patient's/client's needs, and involve the patient/client, representative, and caregiver as appropriate, in the coordination of care activities. Effective interchange and reporting, as well as collaboration and coordination of care will occur between all agency personnel providing care, whether the care and services are provided directly or under arrangement ..."

Supervise skilled professional assistants CFR(s): 484.75(c) Standard: Supervision of skilled professional assistants. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the PT supervised a PTA for 1 of 3 patient (#2) whose records were reviewed. This failure could place the agency's active patients at risk of receiving substandard care that could result in negative health outcomes due to the lack of supervision. Finding include: Record review of Patient #2's electronic CR revealed a POC for the certification period 03/08/2021 - 05/06/2021 with a start of care date of 01/13/2020. The POC included the diagnoses of radiculopathy, lumber region, unspecified fracture of T11 - T12 vertebra, Muscle weakness, Athscl heart disease of native coronary artery, malignant neoplasm of prostate . The POC orders for treatment included: SN: 1w 9 PT: Evaluate and treat per plan of care HHA: 2w8, 1w1 A PT evaluation by PT #F shows a frequency of 2w4 and 1w1. PT Evaluation read in part:" Functional Assessment: " ...Transfer Sit-Stand Mod Assist Stand-Sit Mod Assist Bed-Wheelchair NT Wheelchair-Bed NT Toilet or BSC Min Assist Tub or Shower NT Car/Van NT Factors Contributing to Functional Impairment: Patient presents with decreased strength, balance, and safety awareness limiting transfers ...." Further review of the PT Evaluation revealed a "Treatment Plan" that included "Transfer Training, Bed Mobility Training and Home Safety Training." Record review revealed PTA #G provided the follow-up visits on 03/16/2021, 03/18/2021, and 03/23/2021. Review of the PTA Visit note dated 03/23/2021 included the following "Transfer Training Transfer/Intervention: "Mod A TC/VC back to bed. To push up from WC to BSC to transfer back to bed" ... Patient presents with decreased strength, balance and safety awareness limiting transfers. ... Patient in bed upon arrival was able to get up into the WC and sit up for about 15-20 minutes." There was no evidence that the PT supervised the PTA services provided to Patient #2. Interview on 03/30/2021 at 12:42 p.m. PTA #G was asked the services she provided to Patient #2 on 03/23/2021. PTA #G stated that Patient #2 was in bed when she arrived in the afternoon of 03/23/2021 and that she picked him up from his bed and put him on his wheelchair for the day's routine training and after the exercises, she picked him up from the wheelchair onto the bed. When asked if that was the transfer intervention ordered on the PT Evaluation, PTA #G stated that there was no intervention ordered from bed to wheelchair transfer and besides, Patient #2 had lost so much weight from his disease progression that he was very little and it was no problem for her to lift from bed to wheelchair and from wheelchair to bed. When asked what the standard transfer procedure was, PTA #G stated that she would usually use a gait belt but that Patient #2 would have bruised badly if a gait belt was used to transfer him. Interview on 03/30/2021 at 1:05 p.m. PT #F was asked why she failed to include transfer training/interventions for bed to wheelchair and wheelchair back to bed. PT #F stated that Patient #2 was asleep in bed when she arrived and she could not test the transfer from bed to wheelchair and wheelchair to bed, and that was why she added "NT" meaning "Not Tested" to the evaluation. When asked if she supervised the PTA to supervise the therapy service provided, knowing that the PTA would need to get Patient #2 out of bed and back into bed, PT #F stated that she did not supervise PTA's care to Patient #2. When asked if picking up a Patient from his bed onto his wheelchair and from wheelchair back into his bed was a standard practice, PT #F stated, "No. We do not pick up Patients like we would a baby." Interview on 03/30/2021 at 1:10 p.m. with PTA #H who provided PT services to Patient #2 on 03/12/2021, Surveyor asked how she transferred Patient #2 during her visit. PTA #H stated that she did not transfer him and that he could stand, and she helped pivot him on his right leg since he could not bear any weight on his left leg. When asked how she got the Patient out of bed, PTA #H stated that she got him up on the side of the bed, before mode assisting him into standing and pivoting. Record review of agency's job description for the Licensed Physical Therapist read in part: "Responsibilities: ...Supervises therapy assistants & ... every two weeks ... "