Every finding on record at Able Home Health, LLC

Recertification survey completed. Standard level deficiencies cited. Abbreviations: Pt./Pts. = Patient/Patients SOC = Start of Care POC/PsOC = Plan/Plans of Care SN = Skilled Nurse AM = Morning PM = Afternoon, Evening O2 = Oxygen L = Liters ml = milliliter NC = Nasal Canula PICC = Peripherally Inserted Central Catheter LPM = Liters per minute # = number cc = cubic centimeter OASIS = Outcome and Assessment Information Set

EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, OPO, "Organizations" under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE's emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI's emergency plan, as needed. This STANDARD is not met as evidenced by: A. Based on a review of the Agency's Emergency Preparedness Plan, and staff interview it was determined that the Agency failed to conduct annual testing of the Emergency Preparedness plan. Findings include: 1. The Agency's Emergency plan was reviewed on 11/16/2022 at 10:00 AM. The Emergency plan lacked documentation indicating that any testing of the Emergency plan was conducted since 2017. 2. During an interview with the Administrator on 11/16/2022 at 10:30 AM the Administrator stated and confirmed that Agency has not conducted any testing of the Emergency Preparedness since 2017.

Recertification survey completed. Standard level deficiencies cited. Abbreviations: Pt./Pts. = Patient/Patients SOC = Start of Care POC/PsOC = Plan/Plans of Care SN = Skilled Nurse AM = Morning PM = Afternoon, Evening O2 = Oxygen L = Liters ml = milliliter NC = Nasal Canula PICC = Peripherally Inserted Central Catheter LPM = Liters per minute # = number cc = cubic centimeter OASIS = Outcome and Assessment Information Set

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: A. Based on observation and interviews during a home visit, clinical record review and staff interviews, it was determined that the Agency failed to ensure Plans of Care included all the requirements. This was found in 2 of 17 (Pt. #2 and 6) clinical records reviewed. 2. Pt. # 6 SOC 10/07/2022. Principal Diagnosis: Malignant neoplasm of unspecified part of right bronchus. The clinical record was reviewed on 11/15/22 at 11:30 AM. The clinical record contained a POC for certification period 10/07/2022 to 12/05/22 that included physician orders for Oxygen to be used at 2 liters via nasal cannula and as needed. The POC included SN intervention orders for Oxygen saturation levels to be obtained as needed. The POC lacked patient specific parameter readings for oxygen saturation levels. 3. Findings of the PsOC not including patient specific patient interventions were confirmed during interviews with Administrator and Agency Supervisor on 11/16/22 at 2:00 PM and on 11/17/22 at 10:00 AM. Findings include: 1. Pt. #2. SOC 10/15/22. Principal Diagnosis: Cellulitis of Right Lower Limb. A home visit was conducted on 11/14/22 at 11:30 AM. Pt. #2 and patient’s family stated, “(Pt. 2) has cellulitis and an open sore on the legs… and had a PICC line for the antibiotics.” The clinical records were reviewed on 11/15/22 at 11:20 AM. The records included a POC for the period of 10/15/22 to 12/13/22. As of 11/16/22, the POC lacked documentation of Pt.–specific interventions and outcomes for the cellulitis and, also lacked documentation of supplies and equipment needed for PICC line site care and intravenous infusion.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: A. Based on clinical record review and staff interviews, it was determined the Agency failed to ensure that the treatments provided were ordered by the Physician as required in the POC. This was found in 1 of 2 (Pt. #12) reviewed wherein Pt. had a urinary catheter and oxygen. Findings include: 1. Pt. #12. SOC 10/22/22. Principal Diagnosis: Cellulitis of Left Lower Limb. The clinical record was reviewed on 11/16/22 at 10:00 AM. The POC for the period of 10/23/22 to 12/21/22 required: Assess/instruct use of oxygen at 2 liters/minute via NC or as needed… SN to change indwelling urinary catheter 18 French with 5 cc balloon monthly.” The record contained the following documentation: Physical Therapy Evaluation Care Plan dated 10/25/22: “Dependent upon…devices…O2 1 L/NC”; Occupational Therapy Evaluation Care Plan dated 10/27/22: “Using O2…1 Liter O2”; SN visit notes dated 10/27/22: “Genitourinary – Other: 16 French 5 ml foley”; SN visit notes dated 10/28/22: “Respiratory – O2 LPM 4 via nasal cannula”; SN visit notes dated 10/31/22: “Genitourinary – Other: 16 French 10 ml foley catheter removed…” The treatments provided were not as ordered by the Physician. 2. During an interview conducted with the Administrator and Agency Supervisor on 11/16/22 at 2:00 PM, it was stated that the treatment should be provided as ordered by the Physician. During the same interview, the findings were confirmed.

Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This ELEMENT is not met as evidenced by: A. Based on clinical record reviews and staff interview, it was determined that the Agency failed to ensure Pts. were assessed for the status and administration of Pneumonia vaccination. This was found in 10 of 17 (Pts. #1, 2, 3, 4, 7, 10, 12, 13, 14 and 15) clinical records reviewed. Findings include: 1. The following clinical records were reviewed from 11/15/22 from 9:30 AM to 11/17/22 at 9:30 AM. The records lacked documentation that the patients were assessed for Pneumococcal Pneumonia vaccine. Pt. #1 SOC 5/12/22 Pt. # 2 SOC 10/15/22 Pt. # 3 SOC 11/5/22 Pt. # 4 SOC 11/7/22 Pt. # 7 SOC 8/1/22 Pt. # 10 SOC 9/25/22 Pt. # 12 SOC 10/23/22 Pt. # 13 SOC 11/22/21 Pt. # 14 SOC 11/17/21 Pt. # 15 SOC 6/28/22 2. During interviews with Administrator and Agency Supervisor from 11/16/22 at 2:00 PM to 4:00 PM and at 11/17/22 from 10:00 AM to 11:30 AM. The Agency Supervisor stated that there is no separate form to document the pneumonia vaccination assessments but should be documented in SOC assessments. The Agency Supervisor confirmed that these records lacked above findings.