Every finding on record at Advance Home Care LLC

Substantial Allegation Survey Substantial Allegation 101406 The following deficiencies are based upon substantial allegation 101406 completed on 11/02/23. Advance Home Care LLC 368468, is in substantial compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on record review and interview, the facility failed to ensure the existence of complaints and the resolutions of the complaints were documented for two of three patients reviewed (Patient #62 and #80). This could affect all patients receiving services from the agency. The current patient census was 90. Findings include: Upon entrance on 11/01/23, the agency facility did not have a complaint/concern log. A complaint log was written up after Staff G arrived based on known issues that had been reported. 1.The newly written complaint log included on 09/11/23 Patient #80's case manager called in a complaint related to "failure to coordinate services". The resolution was to provide education every six months to staff related to rules and regulations. There was no evidence of education provided. Review of Patient #80's medical record revealed a start of care date on 10/03/22 with diagnoses including Chronic Obstructive Pulmonary Disease, hypertensive heart disease with heart failure, psychotic disorder with delusions due to non psychological condition, pain in right hip, insomnia, long term use of anticoagulants, unspecified glaucoma, obesity, hyperlipidemia, type 2 diabetes, hallucinations, personal history of venous thrombosis and embolism, anemia, congestive heart failure, atherosclerotic heart disease, gastroesophageal reflux disease, unspecified dementia, altered mental status, constipation, shortness of breath, falls, history of pulmonary embolism and a right hip replacement. Patient #80 lived alone in a senior living apartment. The patient was having hallucinations and chronic pain. She had an increase in hallucinations despite medication, so Home Health Aide (HHA) hours were increased on 09/10/23 to provide more support. Interview 11/01/23 at 3:16 P.M. with Patient #80's case manager revealed Adult Protective Services called her because the home health aide (HHA) for Patient #80 did not show up and did not call anyone. The backup plan was not implemented when the aide was not there. There was an increase in hours after the patient was released from the hospital and the aide could not provide all the hours, so there were care hours missed while waiting for a backup aide to be found. The case manager met with a nurse and the patient on 09/11/23. The case manager sent a complaint on 10/16/23 to the agency related to above. Review of a 10/16/23 letter from the case management company revealed a request for documentation between 09/03/23 and 09/16/23 along with proof of any and all communication with the individual, back up plan, and case manager regarding any missed services and any changes in authorization in that time. The reason for missed shifts and documentation, case notes, or written statements reflecting if a replacement aide was offered. Interview 11/02/23 at 3:26 P.M. with Staff B revealed he only sent the time sheets from September of 2023 and did not provide answers to the other questions related to the inquiry. Staff B verified he did not do a thorough investigation. He did not notify the other management staff of the request. Further interview with Staff B on 11/02/23 at 4:54 P.M. revealed he did not have documentation of an investigation or resolution to the allegations or the email request for information. Staff B stated he sent time sheets and verbally spoke to the HHA. He had no documentation of interviews and/or education with the patient, HHA, or staff. 2. Review of the complaint log revealed on 10/30/23 Patient #62 called to report that his HHA was late. The resolution was the HHA was educated on calling the office if they were going to be late. The next day, 10/31/23, Patient #62 called again to report that his HHA was late. The resolution was the HHA was educated on promptness. Interview 11/02/23 at 6:24 P.M. with Staff B revealed he received a call from Patient #62 on 10/30/23 around 12:30 P.M. stating that his aide was not there. The aide was called and arrived at approximately 1:00 P.M. She was due at the patient's house at 12:00 noon. Staff B stated he gave her a verbal warning for being late. On 10/31/23 Patient #62 called at 1:30 P.M. to report the HHA was not there. Staff B called her, and she arrived around 2:00 P.M. There was no documentation of the allegation from the patient until the complaint log was written on the day of the investigation. There was no written documentation of the conversation with Patient #62, subsequent calls to the HHA, or education of the aide. Staff B only verbally recalled the conversations. Staff B verified he did not have written documentation of an investigation and resolution to the patient's complaint.

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 record review, interview and policy review, the facility failed to ensure patients received home health services as written in the physician ordered plan of care for two of three patients reviewed (Patient #62 and #80). This could affect all patients receiving services from the agency. The current patient census was 90. Findings include: 1. Review of Patient #80's medical record revealed a start of care date of 10/03/22. Review of the physician ordered plan of care for the certification period dated 07/30/23 through 09/27/23 revealed orders for 56 hours of home health aide (HHA) services per week and three hours skilled nursing services. Review of the physician ordered plan of care for the certification period dated 09/28/23 to 11/26/23 revealed the patient was to receive 56 hours of HHA services per week and skilled nursing services twice a week for nine weeks. The patient's hours were increased on 09/10/23 to provide additional support and the total hours per week for the certification period dated 09/28/23 through 11/26/23 should have been 68 hours of HHA services per week. Review of the HHA time sheets between 08/28/23 and 09/02/23 revealed 26 of 56 hours were provided. The patient went to the hospital on 08/26/23 and returned on 08/30/23 which would account for some of the missed hours. There was no evidence the physician was notified of services not being provided as ordered. Further review of the HHA time sheets revealed the week of 09/03/23 to 09/09/23 only 40 of 56 HHA hours were provided. The week of 09/10/23 to 09/16/23 the hours were increased, but only 61 of 68 hours were provided. The week of 09/17/23 to 09/23/23 revealed only 63 of 68 HHA hours were provided. The week of 10/15/23 to 10/21/23 only 65 of 68 hours were provided. There was no documentation the physician was notified that services were not provided as ordered. Interview on 11/02/23 at 3:26 P.M. with Staff G verified Patient #80 did not receive HHA services as ordered and that the physician was not notified. 2. Review of the complaint log revealed on 10/30/23 Patient #62 called and reported that his HHA was late. The next day on 10/31/23 Patient #62 called again and reported that his HHA was late. Review of Patient #62's medical record revealed a 10/18/23 start of care date. Review of the certification period dated 10/18/23 to 12/16/23 revealed orders for 20 hours of HHA services weekly. On 10/24/23 the hours changed to 58 hours every two weeks with 20 hours one week and 38 hours the opposite week to equal the 58 hours every two weeks. The hours were to be provided by two agencies. Review of the HHA time sheets revealed only one week of time had been submitted. According to the time sheet the week of 10/22/23 the aide provided 33 hours of services instead of 38 hours. Interview on 11/02/23 at 6:18 P.M. with Staff G verified the HHA did not provide the patient with the ordered service hours. Review of the policy titled, Coordination of Patient Care, revised in March 2018, revealed staff were to notify the patient in a timely manner about schedule changes. Notify the physician and make sure that he or she is aware of missed visits. Missed visits should be documented. This deficiency represents non-compliance investigated under Substantial Allegation 101406.