Every finding on record at Ace Home Care Network, Inc

On 3/25/24 through 3/26/24, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Ace Home Care Network, Inc. This was a standard survey. The requirements for participation in Medicare at 42 CFR Part § 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 3/25/24 through 3/26/24 at: Ace Home Care Network, Inc. 8424 E. 12 Mile Rd. suite B5 Warren, MI 48093 The agency has no other locations. For this survey no home visits were available. The agency had a census of zero. 3 record reviews were done for 3 discharged records. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the conditions of participation for home health agencies at: 42 CFR Part 484.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the comprehensive assessment included an accurate review of all medications to determine potential adverse effects or duplicate drug therapy in 3 of 3 (P-1, 2, 3) records reviewed, resulting in the potential for harmful medication effects for all patients serviced by this agency. Findings include: P-1: The start of care (SOC) was dated 12/1/23, with diagnoses that included congestive heart failure and hypertension. During record review on 3/25/24, it was noted that the initial Comprehensive Assessment stated (under M2001 Drug Regimen Review), “Yes, issues found during review.” The medication profile documented "No issues found." The record failed to include a medication interaction or duplicate drug therapy report, or any documentation related to the issues found during the Comprehensive Assessment review. There was no explanation regarding the discrepancy in findings between the Comprehensive Assessment and the Medication Profile. P-2: The start of care (SOC) was dated 12/8/23, with diagnoses that included osteoarthritis, Type 2 diabetes mellitus with neuropathy, and muscle weakness. During record review on 3/25/24, it was noted that the initial Comprehensive Assessment stated (under M2001 Drug Regimen Review), “Yes, issues found during review.” The medication profile documented "Yes issues found." The record failed to include a medication interaction or duplicate drug therapy report, or any documentation related to the issues found during the comprehensive assessment review. P-3: The start of care (SOC) was dated 12/9/23, with diagnoses that included thrombocytopenia, failure to thrive, and hypertension. During record review on 3/26/24, it was noted that the initial Comprehensive Assessment stated (under M2001 Drug Regimen Review), “No issues found during review.” The medication profile documented "Yes issues found." The record failed to include a medication interaction or duplicate drug therapy report, or any documentation related to the issues found during the medication review. There was no explanation regarding the discrepancy in findings between the Comprehensive Assessment and the Medication Profile. During an interview on 3/26/24, the alternate clinical manager (Staff-2) acknowledged the above findings.

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: Based on record review and interview, the agency failed to ensure the plan of care included objectively measurable goals specific to the individualized needs of the patient in 1 of 1 (P-1) records with Skilled Nursing services, from a total of 3 sampled records reviewed, resulting in the potential for poor patient outcomes and unmet care needs. Findings include: P-1: The start of care (SOC) was dated 12/1/23, with diagnoses that included congestive heart failure and hypertension. During record review on 3/25/24, it was noted that the Skilled Nursing goals on the Plan of Care were not measurable. One goal stated, "The patient/caregiver will verbalize understanding of individualized emergency plan by 12/23/2023." Another stated, "Patient will verbalize an understanding of energy conserving measures by 12/15/2023." There was no evidence of how these goals could be objectively measured to ascertain progress toward goals. During an interview on 3/26/24 at 3:30 p.m., the alternate clinical manager (Staff-2) acknowledged the above findings.

On 3/23/21 through 3/26/21, a recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs at Ace Home Care Network. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

The following standard level deficiencies were identified at a Medicare authorized Re-Certification survey, conducted by the Michigan Department of Licensing and Regulatory Affairs on 3/23/21 through 3/26/21 at: Ace Home Care Network 370 E. 12 Mile Rd., Suite 203. Madison Heights, MI 48071 Services provided: Skilled Nursing (SN), Physical Therapy (PT), Occupational Therapy (OT), Speech Therapy (ST), Medical Social Work (MSW), Home Health Aide (HHa). The agency does not maintain any branch locations. Records Reviewed: 3 records with home visits; 7 records without home visits, for a total of 10 records reviewed.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to inform the patient in advance of the disciplines that will furnish care in 3 of 10 records reviewed (MR# 1, 7, and 8) from a total sample of 10 records reviewed, resulting in the patient not having knowledge of the plan for treatment. Findings include: Agency policy: Admission Information (Revised March 2018) states, "Purpose: To provide patients with accurate information to make informed decisions regarding care or services ...At time of admission, the Agency will provide each patient with a statement of the scope of services provided directly and/or through contractual/written agreement." MR#1: The Start of Care (SOC) was dated 11/10/20. The Plan of Care (POC) identified diagnoses of Ulcerative Colitis, Hypotension, and Anemia. During record review on 3/23/21, the referral dated 11/6/20 documented, "May discharge resident to American House on 11/10/2020. Home health to evaluate need for PT (Physical therapy), OT (Occupational Therapy), Nursing and HHA (Home Health Aide)." There was no documentation of refusing OT and HHA services within the comprehensive assessment dated 11/10/20. MR#7: The Start of Care (SOC) was dated 2/18/21. The Plan of Care (POC) identified diagnoses of Transient Ischemic Attack (TIA) and Chronic Kidney Disease. During record review on 3/25/21, the referral dated the referral dated 2/17/21 documented, "Type of Homecare Service: Physical therapy; Skilled Nursing; Speech Language Therapy." There was no documentation of refusing Speech Language Therapy services within the comprehensive assessment dated 2/18/21. MR#8: The Start of Care (SOC) was dated 3/16/21. The Plan of Care (POC) identified diagnoses of Osteoarthritis and Chronic Obstructive Pulmonary Disease (COPD). During record review on 3/25/21, the referral dated the referral dated 3/15/21 documented, "Services: Physical therapy and Occupational Therapy." There was no documentation of refusing Occupational Therapy services within the comprehensive assessment dated 3/16/21. The Alt-Adm#1 was questioned on 3/26/21 at 9:50 am and confirmed the findings stating, "I do not see where the patient declined those services."

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 document review and interview, it was determined that the agency failed to ensure the Plan of Care included objectively measurable and individualized goals in 8 of 8 records reviewed (MR#s 1, 2, 3, 4, 5, 6, 7 and 10) with skilled nursing ordered out of a total of 10 records reviewed, resulting in a potential for failure to measure progress toward achievement of desired outcomes. Findings include: **Agency Policy: Plan of Care (Revised March 2018) states, "The individualized plan of care must include the following: Patient specific interventions and education, measurable outcomes and goals identified by the Agency and the patient." MR#1: The Start of Care (SOC) was dated 11/10/20. The Plan of Care (POC) identified diagnoses of Ulcerative Colitis, Hypotension, and Anemia. During record review on 3/23/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient will verbalize understanding of proper use of pain medication. Patient will be free from signs and symptoms of respiratory distress during the episode." There was no evidence of how these goals could be quantitatively measured. MR#2: The Start of Care (SOC) was dated 4/18/20. The Plan of Care (POC) identified diagnoses of Urinary Tract Infection and Hypertension. During record review on 3/24/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient skin integrity will remain intact during this episode. Patient will be free from signs and symptoms of respiratory distress during the episode." There was no evidence of how these goals could be quantitatively measured. MR#3: The Start of Care (SOC) was dated 11/26/20. The Plan of Care (POC) identified diagnoses of Stage 2 Pressure Ulcer and Hypertension. During record review on 3/25/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient will verbalize understanding of proper use of pain medication. Patient will be free from signs and symptoms of respiratory distress during the episode." There was no evidence of how these goals could be quantitatively measured. MR#4: The Start of Care (SOC) was dated 3/12/21. The Plan of Care (POC) identified diagnoses of Pulmonary Embolism and Chronic Obstructive Pulmonary Disease (COPD). During record review on 3/25/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient will verbalize an understanding of energy conserving measures by 3/12/21. Patient skin integrity will remain intact during this episode." There was no evidence of how these goals could be quantitatively measured. MR#5: The Start of Care (SOC) was dated 3/18/21. The Plan of Care (POC) identified diagnosis of Chronic Obstructive Pulmonary Disease (COPD). During record review on 3/25/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient will verbalize understanding of proper use of pain medication by 3/26/21. Patient will be free from signs and symptoms of respiratory distress during the episode." There was no evidence of how these goals could be quantitatively measured. MR#6: The Start of Care (SOC) was dated 2/25/21. The Plan of Care (POC) identified diagnoses of Post Pacemaker Placement, Chronic Kidney Disease and Congestive Heart Failure (CHF). During record review on 3/25/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient will verbalize understanding of proper use of pain medication by 3/12/21. Patient will be free from signs and symptoms of respiratory distress during the episode." There was no evidence of how these goals could be quantitatively measured. MR#7: The Start of Care (SOC) was dated 2/18/21. The Plan of Care (POC) identified diagnoses of Transient Ischemic Attack (TIA) and Chronic Kidney Disease. During record review on 3/25/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, Patient will verbalize understanding of proper use of pain medication by 2/26/21. Patient skin integrity will remain intact during this episode." There was no evidence of how these goals could be quantitatively measured. MR#10: The Start of Care (SOC) was dated 1/28/21. The Plan of Care (POC) identified diagnoses of Hypertension, Osteoarthritis and Falls. During record review on 3/26/21, it was noted that the goals on the POC were not measurable, for example the Skilled Nursing goals stated, "Patient will verbalize an understanding of energy conserving measures by 1/28/21. Patient will demonstrate proper pursed lip breathing techniques by 1/28/21." There was no evidence of how these goals could be quantitatively measured. The Alt-Adm#1 was questioned on 3/26/21 at 9:45 am and confirmed the findings stating, "The nursing goals are not measurable."

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on record review, observation and interview it was determined that the agency failed to ensure the professional staff provided ongoing objective measurements of the patient's heart failure including weights in 1 of 2 records (MR# 6) in which the patient had congestive heart failure, out of a total of 10 records reviewed, which resulted in the potential for unidentified patient needs. Findings include: MR#6: The Start of Care (SOC) was dated 2/25/21. The Plan of Care (POC) identified diagnoses of Post Pacemaker Placement, Chronic Kidney Disease and Congestive Heart Failure (CHF). The POC ordered Skilled Nursing (SN) at a frequency of 1w1 (1 time a week for 1 week), 2w2, 1w2. The POC had an order stating, "SN to instruct patient on daily weight self-monitoring program where the patient utilizes the same scales on a hard, flat surface each morning prior to breakfast and after urination. Report to SN weight gain of 3lb/1 day, 5lb/1 week. SN to assess patient's weight log every visit." The SOC weight and subsequent SN visit on 3/2/21 was 136lbs. The subsequent SN visits on 3/5/21, 3/9/21, 3/11/21, and 3/16/21 failed to document a weight as directed. The agency failed to ensure that SN had monitored and assessed the patient's weight as directed in the POC. The Alt-Adm#1 was questioned on 3/26/21 at 10:00 am and confirmed the findings stating, "The nurse should document the patients weight every visit."