Every finding on record at Accucare Home Nursing Inc

Based on the findings of an unannounced onsite complaint investigation conducted October 26, 2021, and concluded on October 27, 2021, Accucare Home Nursing, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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: Based on review of agency policy, clinical records (CR), electronic time keeping reports, communication notes, and staff interviews, the agency failed to provide services in accordance with the "Home Health Certification and Plan of Care" (POC) for one (1) of three (3) CR reviewed. (CR# 1). Review of clinical records, electronic time keeping records, and communication logs on October 26, 2021, from approximately 9:30 A.M. to 11:00 A.M. revealed the following: CR #1, start of care February 25, 2021. Certification period October 2, 2021,through November 30, 2021, POC contained orders for HHA (home health aide) 22-24 hours per day, 5-7 days per week to assist with personal care, ADLs (activities of daily living) and IADLs (instrumental activities of daily living). Review of “Home Health Aide Activity Report and Care Plan” identified the personal care tasks to be completed to include bathing, hair care, oral hygiene, lotion/ointment, and assistance with dressing. Review of “Home Health Aide Activity Report and Care Plan” revealed that the HHA documented that the patient was bathed on October 2, 5, 8, and 14, 2021. There was no documentation of CR #1 receiving a bath On October 3, 4, 6, 7, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19 and 20, 2021. Communication log notes document calls from the HHA’s on October 1, 4, 8, and 15, 2021, stating that the patient is refusing to allow the HHA to give the patient a bath. Communication log notes contain documentation on October 3 and 15, 2021, that the caseworker was notified that the patient is refusing to allow the HHA’s to help the patient get a bath. Review of “Home Health Aide Activity Report and Care Plan” revealed that the HHA only provided services in the duration and frequency ordered for the period reviewed on five (5) of nineteen (19) days. Services were provided as follows: October 2, 2021, 15 hours of care provided, October 3, 2021, 22.25 hours of care provided, October 4, 2021, 19.4 hours of care provided, October 5, 2021, 21.75 hours of care provided, October 6, 2021, 21.75 hours of care provided, October 7, 2021, 15 hours of care provided, October 8, 2021, 21 hours of care provided, October 9, 2021, 13.25 hours of care provided, October 10, 2021, 20 hours of care provided, October 11, 2021, 23.75 hours of care provided, October 12, 2021, 21.75 hours of care provided, October 13, 2021, 22.25 hours of care provided, October 14, 2021, 23.75 hours of care provided, October 15, 2021, 20.5 hours of care provided, October 16, 2021, 15.25 hours of care provided, October 17, 2021, 19.5 hours of care provided, October 18, 2021, 23.75 hours of care provided, and October 19, 2021, 20.75 hours of care provided. Review of “Communication Logs” on October 20, 2021, stated, “Patient daughter called the on call phone at 7A.M. to say that the caregiver overnight never showed up. Caregiver or patient did not call that on call to inform that no one showed up.” Note in HHA Exchange dated October 20, 2021, at 4:25 P.M. which was a calendar note for October 8, 2021, stated, “caregiver did no call/no show. The patients said is ok that [patient] will wait for [next shift caregiver] to arrive on Saturday.” Note in HHA Exchange dated October 20, 2021, at 4:32 P.M. which was a revised calendar note from October 15, 2021, stated, “Caregiver did no call/no show and the patient said is ok that [patient] will wait for [next shift caregiver] to arrive on Saturday.” There were no other notes, physician notifications or verbal order for the remaining missed shifts. CR #2, start of care July 13, 2021, certification period September 11, 2021, through November 9, 2021, contained orders for HHA 8-10 hours per day, 5-7 days per week to assist with personal care, ADLs and IADLs. Review of “Home Health Aide Activity Report and Care Plan” for the certification period revealed that HHA services were provided in accordance with the POC. CR #3, start of care March 25, 2021, certification period September 22, 2021, through November 19, 2021, contained orders for HHA 6-8 hours per day, 5-7 days per week to assist with personal care, ADLs and IADLs. Review of “Home Health Aide Activity Report and Care Plan” for the certification period revealed that HHA services were provided in accordance with the POC. An interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above findings.

Classroom and supervised practical training CFR(s): 484.80(b)(1) Home health aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while providing services to an individual under the direct supervision of a registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse. Classroom and supervised practical training must total at least 75 hours. This ELEMENT is not met as evidenced by: Based on a review of agency policy, personnel files (PFs), and an interview with agency staff, the agency failed to employ Home Health Aides (HHA) with a minimum of 75 hours of training for four (4) of four (4) HHA personnel files reviewed. (PF # 1, 2, 3, and 4) Review of the Home Health Aide job description on October 26, 2021, at approximately 11:30 A.M. stated, “Qualifications: 1. A certificate of accreditation of an approved home health aide training program; or, 2. Certified as a nurse aide by the State of Pennsylvania …” Review of PF on October 26, 2021, at approximately 11:00 A.M. and October 27, 2021, at approximately 3:30 P.M. revealed the following: PF #1, date of hire March 23, 2021, contained no documentation of the required 75 hours of training or a CNA (certified nursing assistant) certification. PF #2, date of hire September 5, 2020, contained no documentation of the required 75 hours of training or a CNA certification. PF #3, date of hire August 27, 2021, contained no documentation of the required 75 hours of training or a CNA certification. PF #4, date of hire September 7, 2021, contained no documentation of the required 75 hours of training or a CNA certification. Interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above findings.

HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient's plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient's condition; and (vi) Honoring patient rights. This ELEMENT is not met as evidenced by: Based on review of agency policy, Home Health Aide (HHA) personnel file (PF) reviews, and interview with agency staff, the agency failed to ensure that the HHA furnished care in a safe and effective manner by demonstrating competency with assigned tasks for four (4) of four (4) PF reviewed. (PF #1, 2, 3, and 4) Review of agency policy #510 title “Home Health Aide Competency Valuation” on October 26, 2021, at approximately 12:30 P.M. stated, “Procedure: 1. The registered nurse will evaluate through direct observation the individual’s ability to competently perform the following tasks: reading and recording temperature, pulse, respiration and blood pressure, bed bath, sponge, tube or shower bath, shampoo, sink, tub or bath, nail and skin care, oral hygiene, toileting and elimination, safe transfer techniques, normal range of motion and positioning, and making an occupied bed… The evaluation of the aide’s performance by the qualified registered nurse will be documented on the “Checklists or Skills Demonstration” or other similar document…” Review of PF on October 26, 2021, at approximately 11:00 A.M. and October 27, 2021, at approximately 3:30 P.M. revealed the following: PF #1, date of hire March 23, 2021, contained a skills assessment, which was not the required "Aide Skills Inventory" form, that was part of a supervisory visit dated March 25, 2021. PF #2, date of hire September 5, 2020, contained an “Aide Skills Inventory” form completed by PF #2 on September 5, 2020, but was not documented as skills observed by the registered nurse (RN). PF #3, date of hire August 27, 2021, contained an “Aide Skills Inventory” form completed by PF #3 on August 27, 2021, but was not documented as skills observed by the registered nurse (RN). PF #4, date of hire contained an “Aide Skills Inventory” form completed by PF #2 on September 5, 2020, but was not documented as skills observed by the registered nurse (RN). An interview with the general manager on October 26, 2021, at approximately 1:00 P.M. confirmed the above finding.