Every finding on record at Advanced Home Care of Ohio Inc

Extended Substantial Allegation Survey Substantial Allegation 105474 and 105082 An entrance conference was conducted on 04/09/24 at 9:20 AM with administrative personnel and an exit conference was completed via phone on 04/22/24 with the Director. The following deficiencies are based upon the extended substantial allegation 105474 and 105082 completed on 04/22/24. Advanced Home Care of Ohio is not in compliance with the requirements at 42 CFR Part 484 Subpart B, C for Home Health Agencies. Advanced Home Care of Ohio is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the exit date of this survey.

Basis and Scope CFR(s): §484.1 Basis and Scope (a) Basis. This part is based on: (1) Sections 1861(o) and 1891 of the Act, which establish the conditions that an HHA must meet in order to participate in the Medicare program and which, along with the additional requirements set forth in this part, are considered necessary to ensure the health and safety of patients; and (2) Section 1861(z) of the Act, which specifies the institutional planning standards that HHAs must meet. (b) Scope. The provisions of this part serve as the basis for survey activities for the purpose of determining whether an agency meets the requirements for participation in the Medicare program. This CONDITION is not met as evidenced by: Based on review of medical records, review of current services provided to patients, and staff interviews, the agency failed to meet the Medicare and Medicaid statute of provisions to be classified as a home health agency by failing to be primarily engaged in providing skilled nursing services and other therapeutic services. This had the potential to affect all patients of the agency. During the entrance conference with the Director of Nursing (DON), Staff A, on 04/09/24 it was discovered this agency has stopped accepting skilled patients and have discharged all their skilled patients as of 03/18/24, accepting only patients requiring home health aide services. 1. Review of the medical record for Patient #1 revealed a start of care (SOC) of 12/07/19 with admitting diagnosis of quadriplegia (C5-7 incomplete injury). The certification period reviewed was for 01/15/24-03/14/24 with skilled nursing (SN) ordered four times per week. Skilled nursing was provided with the last day of service completed 03/18/24. Review of a 30 day notice sent to Patient #1 on 02/21/24 revealed nursing services will be terminated effective 03/21/24. Review of the discharge summary completed by the nurse, Staff E, on 03/18/24 listed as the reason for discharge: Agency is no longer accepting skilled patients. 2. Review of the medical record for Patient #3 revealed a SOC date of 02/07/19 with a primary diagnosis of congenital malformations with a tracheostomy and G-tube currently in place. The certification period reviewed was for 09/17/23-11/15/23 with SN ordered for 84 hours per week. Review of an email to Patient #3's provider, dated 10/03/23, stated this agency will no longer be providing nursing services for this patient due to lack of staff availability and a business model change within the company. A 30 day notice of discontinuation of services will be sent to the patient's mother next week. The case manager was notified on 10/03/23 by the DON stating they have been asked by the Executive Director of Corporate Development to notify them the company's plan moving forward was to discontinue providing nursing services. This will affect this patient's care. Review of a letter to Patient #3's family, dated 10/10/23, stated this was a 30 day notice to stop care on 11/10/23. 3. Review of the medical record for Patient #3 revealed a SOC of 10/13/22 with diagnoses of diabetes mellitus type 2 and rheumatoid arthritis. The certification period reviewed for 10/08/23-12/06/23. Skilled nursing was ordered once per day for insulin administration. Review of a letter found in the medical record dated 10/10/23 stated to please allow this to serve as a 30 day notice of the end of home health services provided by the agency. Services will be terminated effective 11/10/23. The agency has been in communication with the physician to inform them of this discharge. This agency provided the name of another agency who agreed to take over services with the new agency's contact information provided. Review of the current services provided to the patients of the agency revealed only home health aide services are provided. No skilled nursing or therapy services are currently being provided to the patients. A phone interview with the Director, Staff B, on 04/09/24 at 3:30 PM revealed the agency is not able to provide skilled nursing at this time. Staff B stated they would have to implement policies and hire more nurses in order to provide skilled nursing. Interview Staff A on 04/10/24 at 5:30 PM verified the Patient #1, Patient #3, and Patient #4 were discharged from the agency when the agency stopped providing skilled nursing services and only provided home health aides. Interview on 04/17/24 at 10:51 AM with the Interim Administrator, Staff G, revealed the agency discharged all the skilled patients as they were not equipped to provide the skilled service. The administrator stated they had a DON who was not qualified for the job. The agency then decided to stop all skilled services and to reorganize. They have not had skilled services since 03/18/24. At the current point in time the agency could not provide skilled services as they only have one nurse, who is the DON, and no therapy employed or on contract.

Condition of Participation: Patient rights. CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on medical record review and staff interview, the agency failed to follow patient rights when patients were discharged patients from the agency without a cause when the agency decided to cease providing skilled nursing services. (G454). The cumulative effects of this systemic practice resulted in the agency's inability to ensure patient care needs would be met. .

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency discharged patients from the agency without a cause when the agency decided to cease providing skilled nursing services. This affected three (Patient #1, Patient #3, and Patient #4) with the potential to affect all patients cared for by this agency. During the entrance conference with the Director of Nursing on 04/09/24 it was discovered this agency has stopped accepting skilled patients and have discharged all their skilled patients as of 03/18/24, accepting only patients requiring home health aide services. 1. Review of the medical record for Patient #1 revealed a start of care (SOC) of 12/07/19 with admitting diagnosis of quadriplegia (C5-7 incomplete injury). The certification period reviewed was for 01/15/24-03/14/24 with skilled nursing (SN) ordered four times per week. Skilled nursing was provided with the last day of service completed 03/18/24. Review of a 30 day notice sent to Patient #1 on 02/21/24 revealed nursing services will be terminated effective 03/21/24. This letter further stated the agency had been in contact with the patient's physician and case manager to get the patient switched to another agency. Review of the discharge summary completed by the nurse, Staff E, on 03/18/24 listed as the reason for discharge: Agency is no longer accepting skilled patients. Listed under condition at discharge noted the patient still requires daily nursing services for bowel program and catheter care. 2. Review of the medical record for Patient #3 revealed a SOC date of 02/07/19 with a primary diagnosis of congenital malformations with a tracheostomy and G-tube currently in place. The certification period reviewed was for 09/17/23-11/15/23 with SN ordered for 84 hours per week. Skilled visits were completed as ordered on the plan of care (POC). Review of an email to Patient #3's provider, dated 10/03/23, stated this agency will no longer be providing nursing services for this patient due to lack of staff availability and a business model change within the company. A 30 day notice of discontinuation of services will be sent to the patient's mother next week. The case manager was notified on 10/03/23 by the DON stating they have been asked by the Executive Director of Corporate Development to notify them the company's plan moving forward was to discontinue providing nursing services. This will affect this patient's care. Review of a letter to Patient #3's family, dated 10/10/23, stated this was a 30 day notice to stop care on 11/10/23. 3. Review of the medical record for Patient #4revealed a SOC of 10/13/22 with diagnoses of diabetes mellitus type 2 and rheumatoid arthritis. The certification period reviewed for 10/08/23-12/06/23. Skilled nursing was ordered once per day for insulin administration. Review of a letter found in the medical record dated 10/10/23 stated to please allow this to serve as a 30 day notice of the end of home health services provided by the agency. Services will be terminated effective 11/10/23. The agency has been in communication with the physician to inform them of this discharge. This agency provided the name of another agency who agreed to take over services with the new agency's contact information provided. Interview Staff A on 04/10/24 at 5:30 PM verified the Patient #1, Patient #3, and Patient #4 were discharged from the agency when the agency stopped providing skilled nursing services and only provided home health aides.

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 review of personnel files and staff interview, the agency failed to provide 75 hours of classroom and supervised practical training for the home health aides (HHA). This has the potential to affect all patients cared for by this facility. Review of the personnel file for Staff C, a HHA, revealed a hire date of 02/08/24. No documentation was found of any nurse aide training or previous experience as a home health aide. Review of the personnel file for Staff D, a HHA, revealed a hire date of 12/27/23. No documentation was found of any nurse aide training or previous experience as a home health aide. Interview on 04/09/24 at 2:45 PM with the Director of Nursing, Staff A , revealed the agency hires mostly family who have no experience. They provide a brief orientation go over checklist, job duties, and have them take a test. Staff A stated she was not aware of HHA needing training hours, they just make sure they know their job duties. Staff A verified both Staff C and D had no previous HHA experience and no nurse aide training as required.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on record review, staff interview, review of personnel files, and review of a job description for a home health aide, a home health aide (HHA) administered medications which is not allowed within their job description. This affected Patient # 2 with the potential to affect all patients cared for by home health aides. Review of the medical record for Patient #2 revealed a start of care (SOC) date of 03/01/24 with a primary diagnosis of muscular dystrophy. The certification period reviewed was for 03/01/24-04/29/24 with 20 hours of HHA services ordered. The medical record revealed HHA services were provided as ordered. The plan of care (POC) lists the aide to assist with bathing, grooming, laundry, light housekeeping, HHA may assist with errands limited to prepaid order pick up but no medication. The plan of care states for the HHA to notify the office immediately if any change in mental status, injury or falls, if no BM in three days, new skin issues, bruises or hospitalizations. An interview was completed with Staff C, Patient #2's HHA, on 04/09/24 at 9:20 AM. Staff C stated this patient lives with family so not much house cleaning needs to be done. Staff C stated they keep the patient company and his bath is completed on Thursday by another caregiver. Staff C stated one time when the patient's family wasn't there and the patient was having difficulty giving himself his shot Staff C gave it. Staff C stated the patient told them his daughter usually gives this, so Staff C gave it. Staff C was informed afterwards by the DON that they should not have done this. Interview on 04/09/24 at 9:45 AM, with the DON, Staff A, revealed this agency was notified by the patient's family the aide gave a shot. Staff A stated they spoke with Staff C who stated she helped this patient with his shot. Education was provided this is not allowed and the aides cannot touch medication. Staff A stated they did not provide all the home health aides with re-education regarding medications. Review of the personnel file for Staff C revealed a hire date of 02/08/24. A HHA job description was on file which stated HHAs do not administer any medications. A disciplinary action form was on file stating the disciplinary incident was a caregiver helped the patient an injection which is a violation of company policy. A verbal warning was given on 03/22/24 per phone call further stating this caregiver will be on a probation watch, if it occurs actions will lead to termination. Employee statement stated the caregiver did not know it was against policy since she did not dial up the medication. The personnel file for Staff D was reviewed on 4/10/24. Staff D was hired on 12/27/23 with a job description on file for home health aide. A skills checklist, HHA competency checklist and HHA test was completed on 12/27/23 along with signed policies. Interview with Staff D verified both Staff C and D had no previous HHA experience. Interview with Staff A on 04/10/24 at 2:00 PM verified it is in their HHA job description to not touch medications. Staff A further verified Staff C did give the medication shot which is not allowed as a HHA.