Every finding on record at Absolute Home Health Inc

The following reflects the findings of the California Department of Public Health during the Emergency Preparedness survey from 1/24/22 through 1/27/22. Representing the California Department of Public Health: Health Facilities Evaluator Nurse (HFEN) 36471 and 39448. No deficiencies were identified from this survey.

The following reflects the findings of the California Department of Public Health during a home health recertification survey conducted from 1/24/22 through 1/27/22. The agency reported 1523 unduplicated admissions for the last 12 months. The total number of sampled patients was 18, and 7 home visits were conducted. Representing the California Department of Public Health: Health Facilities Evaluator Nurse, 36471 and 39448. Glossary of Terms: DPCS - Director of Patient Care Services CS - Clinical Supervisor SN - Skilled Nurse PT - Physical Therapist OT - Occupational Therapist ST - Speech Therapist Auth - Authorizations

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: The agency failed to follow the plan of care when they did not complete visits as ordered for 3 of 18 sampled patients (2, 3, 4). As a result, patients did not receive the care and services ordered by their physician. Findings: 1 Per the agency’s Home Health Certification and Plan of Care, Patient 2 started care on 12/10/21 for Certification Period 12/10/21 through 2/7/22, with diagnosis of surgical aftercare, and there was an order for the agency to provide SN visits to Patient 2 one time per week for 9 weeks. On 1/27/22 at 11:24 A.M., a concurrent interview and record review was conducted with the CS. The CS stated, the agency did not complete SN visits for Patient 2 on the weeks of 12/12/21, 12/19/21, or 12/26/21 because the agency did not have authorization from Patient 2’s insurance to provide SN visits. On 1/27/22 at 1:33 P.M., an interview was conducted with Auth. Auth stated, she sent the authorization request to Patient 2’s insurance on 12/16/21. Auth further stated, she was not responsible to follow up on authorizations which had yet to be approved, because that task was completed by the DPCS and the CS. On 1/27/22 at 2 P.M., an interview was conducted with the CS. The CS stated, it was the Auth’s responsibility to follow up on authorizations which had yet to be approved. On 1/27/22 at 2:05 P.M., an interview was conducted with the DPCS. The DPCS stated, the agency should have documented that they notified Patient 2 and the physician of the delayed visits. 2 Per the agency’s Home Health Certification and Plan of Care, Patient 3 started care on 1/3/22 for Certification Period 1/3/22 through 3/3/22, with diagnosis of heart failure and kidney failure, and there was an order for the agency to provide an OT evaluation and a PT evaluation to Patient 3. On 1/27/22 at 11:24 A.M., a concurrent interview and record review was conducted with the CS. The CS stated, the agency had not completed the ordered PT or OT evaluations for Patient 3 because the agency had not yet received authorization for the evaluations from Patient 3’s insurance. The CS further stated, if there was a delay in authorization of more than five days, the agency should have notified the patient and physician of the delay. On 1/27/22 at 1:33 P.M., an interview was conducted with Auth. Auth stated, she did not send the authorization request to Patient 3’s insurance for PT and OT evaluations because she missed it. On 1/27/22 at 2:05 P.M., an interview was conducted with the DPCS. The DPCS stated, Auth should have sent the authorization request for Patient 3 to have PT and OT evaluations. The DPCS further stated, the missing authorization should have been caught by the DPCS’ quality assurance log. The agency did not have a policy which directed staff how quickly to submit requests for insurance authorization. 3 Per the agency’s Home Health Certification and Plan of Care, Patient 4 started care on 10/19/21 for Certification Period 12/18/21 through 2/15/22, with diagnosis of fractured ribs. Per the agency’s OT Evaluation, dated 10/23/21, the OT visit frequency was one time per week for one week, then two visits per week for five weeks. On 1/27/22 at 10:30 A.M., a concurrent interview and record review was conducted with the CS. The CS stated, the agency only had documentation of OT 5 visiting Patient 4 one time on the week of 11/22/21. On 1/27/22 at 12 P.M., a telephone interview was conducted with OT 5. OT 5 stated, she only visited Patient 4 1 time on the week of 11/22/21 because Patient 4 rescheduled the visit for the following week. OT 5 further stated, she did not remember why she did not document a communication note to explain the missed visit. On 1/27/22 at 2:05 P.M., an interview was conducted with the DPCS. The DPCS stated, OT 5 should have documented a communication note that Patient 4 requested the visit be rescheduled. Per the facility’s policy, titled Missed Visits, revised April 2019, “…2. If a visit is missed and not rescheduled the clinician will… B. Document in the patient’s clinical record the following information… 2. Date and type of visit that was missed 3. Reason for the missed visit… 5. Physician notification…”

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 interview and record review, the agency failed to ensure the plan of care was followed for 2 of 18 sampled patients (10, 11) when the SN did not perform a weekly weigh. As a result, there was a potential for Patients 10 and 11 to develop fluid imbalances and for care needs to not be addressed. Findings: 1. Per the Home Health Certification and Plan of Care, dated 10/19/21 through 12/17/21, Patient 10 was admitted to the agency on 6/21/21, with diagnoses which included End Stage Renal Disease (ESRD- kidneys not functioning). In addition, under “SN To Perform” indicated for the SN to weigh Patient 10 weekly. A review of Patient 10’s clinical record was conducted. Per the SN Visit Note, dated: On 10/20/21, SN 1 documented under Patient 10’s weight “n/a” [not applicable]. On 10/26/21, Patient 10’s weight was blank. On 11/2/21 through 11/30/21, SN 1 documented Patient 10 was unable to assess weight and Patient 10 have no scale. There was no documentation that the physician was notified or update the plan of care. On 1/27/22 at 11:10 A.M., an interview was conducted with SN 1. SN 1 stated Patient 10 was not weighed because there was no scale in the house. SN 1 further stated she did not notify the physician that the plan of care was not being followed. SN 1 stated she should have notified the physician and update the plan of care. 2. Per the Home Health Certification and Plan of Care, dated 12/4/21 through 2/1/22, Patient 11 was admitted to the agency on 4/12/20, with diagnoses which included schizoaffective disorder (mental illness). In addition, under “SN To Perform” indicated for the SN to weigh Patient 11 weekly. A review of Patient 11’s clinical record was conducted. Per the SN Visit Note, dated 1/5/22 and 1/19/22. The SNs documented under Patient 11’s weight “n/a” [not applicable]. On 1/27/22 at 9 A.M., a joint interview and record review was conducted with SN 2. SN 2 stated she was unaware that Patient 11 had to be weighed weekly. SN 2 confirmed that Patient 11's plan of care indicated for the SN to weigh Patient 11 weekly. SN 2 further stated Patient 11 was not being weighed on a weekly basis and should have notified the physician and updated the plan of care. On 1/27/22 at 11:30 P.M., an interview was conducted with the DPCS. The DPCS stated the plan of care should have been followed. Per the agency’s policy and procedure, revised 4/21, titled Care Planning Process, “…The care planning decisions will be reflected in the specific services that will be provided and the associated actions planned and implemented…The plan of care will be revised as frequently as deemed necessary by the clinicians based on the on going assessments of the patient…”

Coordinate referrals; CFR(s): 484.105(c)(3) Coordinating referrals, This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to document and coordinate the clinic referral order, for 1 of 18 sampled patients (12). As a result, there was a potential for Patient 12 to not receive care and services that were needed. Findings: Per the Home Health Certification and Plan of Care, dated 11/20/21 through 1/18/22, Patient 12 was admitted to the agency on 11/20/21, with diagnoses which included hemiplegia (paralysis of one side of the body). A review of Patient 12’s clinical record was conducted. Per the Clinic Referral Order, dated 11/4/21, the physician wrote a referral order for Patient 12 to be seen by the ST. There was no indication that Patient 12 was seen by the ST. On 1/26/22 at 4:08 P.M., a joint interview and record review was conducted with the DPCS. The DPCS stated her expectation was for the staff to follow all the referral orders, coordinate care and services, and document in the patient’s medical record. The DPCS stated Patient 12 had a referral to be seen by the ST and it did not happen. The DPCS further stated she was unsure why the order was not followed, and was afraid the order was missed. The DPCS stated there should have been a documentation as to why the referral order from the clinic was not followed. On 1/27/22 at 8:10 A.M., an interview was conducted with PT 3. PT 3 stated she conducted the initial visit and Patient 12 refused ST service. PT 3 further stated she should have documented of Patient 12's refusal and notified the physician. Per the Agency's policy and procedure, revised 1/21, titled Internal Referral Process, "...Referrals to other disciplines will be processed...1. All internal referrals to other disciplines will be documented within the clinical record..."