Every finding on record at Afinity Healthcare Solutions, LLC

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION NUMBERS 96983 AND 97031 The following deficiencies are based upon Substantial Allegation Numbers 96983 and 97031 completed on 05/04/23. Afinity Healthcare Solutions is not in compliance with the requirements at 42 CFR Part 484, Subpart B,C 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 record review, interview and policy review, the facility failed to ensure the physician was notified of missed visits. This affected two (Patients #1 and #2) of three patients reviewed. The census was 9. Findings include: 1. Record review revealed Patient #1 was admitted to the agency on 01/11/17. Patient #1 had functional limitations including bowel and bladder incontinence, ambulation, and contracture. Review of the physician ordered plan of care for the certification period of 01/03/23 through 03/09/23, Patient #1 had 15 hours of aide services ordered to assist with activities of daily living. The aide was ordered to perform homemaking duties as well as personal care including assistance with bathing, skin care, shaving, oral hygiene, fluid encouragement and to assist the patient with a wheelchair. Review of the time sheets revealed missed visits occurred 02/27/23 through 03/03/23. The medical record lacked documentation that a physician was notified of the missed visits. A Discharge Summary Form revealed the patient was discharged from the agency on 04/21/23 due to the patient requesting discharge. 2. Record review revealed Patient #2 was admitted on 01/11/17. Patient #2 had functional limitations including contracture, ambulation, and an unsteady gait. Review of the physician ordered plan of care for the certification period of 01/03/23 through 03/09/23, Patient #2 had 15 hours of aide services ordered to assist with activities of daily living. The aide was ordered to perform homemaking duties as well as personal care including assistance with bathing, skin care, shaving, oral hygiene, fluid encouragement and to assist the patient with a wheelchair. Review of the time sheets revealed missed visits occurred 02/27/23 through 03/03/23. The medical record lacked documentation that a physician was notified of the missed visits. A Discharge Summary Form revealed the patient was discharged from the agency on 04/21/23 due to the patient requesting discharge. During interview on 05/04/23 at 4:40 PM, Staff A reported that the spouse of the SP was also being serviced by the agency. Staff A revealed that the aide remains a staff member with the agency, however, continues to refuse to provide care to the patient and spouse. It was confirmed that both Patient #1 and Patient #2 went without the services of an aide from 02/27/23 through 04/21/23. Staff A was asked to provide documentation a physician was notified of the missed visits. No documentation was provided. Review of the facility policy titled “Service Monitoring and Verification”, with no effective date, revealed the agency nurse supervisor will verify each service visit to ensure that service is being delivered in accordance with the care plan. In cases where a staff does not show up for service as scheduled, the supervisor will first inform the case manager of this fact, and then make every effort to send a back-up staff. The policy further stated the administrator would randomly verify that staff members were providing care in accordance with the plan of care. This would allow the agency to troubleshoot any missed visits by staff before it became problematic. The policy stated that based on current realities, a substitute staff member would arrive at the patient’s home within an hour. This deficiency represents non-compliance investigated under Complaint Numbers 96983 and 97031.

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 95782 The following deficiency is based on substantial allegation survey completed on 02/22/23. Afinity Healthcare Solutions is not in compliance with the requirements at 42 CFR Part 482, Subpart B, C, Home Health Agencies.

HH aide services under arrangement CFR(s): 484.80(h)(5) If the home health agency chooses to provide home health aide services under arrangements, as defined in section 1861(w)(1) of the Act, the HHA's responsibilities also include, but are not limited to: This ELEMENT is not met as evidenced by: Based on record review and interview, the facility failed to ensure the agency provided services as planned, specifically personal care assistance by the home health aide (HHA). This affected one (Patient #3) of three sampled patients. The census was 10. Findings include: Review of the medical record for Patient #3 revealed diagnoses including congestive heart failure, diastolic, myocardial infarction, morbid obesity, displaced fracture of the fifth cervical vertebrae, hyperlipidemia, anxiety, polyneuropathy, chronic kidney disease, type two diabetes, high blood pressure, and depression. Review of Patient #3’s agency admission consent for treatment dated at the start of care, 05/22/22, revealed a plan of care (POC) for fifteen hours HHA services per week, three hours each day. Review of the HHA time sheets provided by the agency on 02/22/23 revealed there were home making tasks completed at each visit including cleaning of floors, kitchen and bathroom, assistance with laundry, companionship, tasks provided each visit, for three hours each dated, from 9:00 AM to 11:00 AM. Review of the HHA time sheets revealed Patient #3 had signed each date for a total of fifteen hours per week. Review of the Medicaid service plan with a start date of 08/01/22 and an end date of 06/30/23 revealed an order for 15 hours weekly, with services to include aide services of dressing, bathing, grooming, mobility, toileting, meal prep, laundry and shopping. Review of the Medicaid POC revealed Patient # 3 was to receive personal care services by the HHA assigned to the case. Review of the supervisory visits dated 07/20/22, 09/15/22 and 11/11/22 revealed the registered nurse had documented that P #3 was satisfied with the HHA services, and the duties observed were personal care, but not specified what was completed at the visit. During interview on 02/22/23 at 2:43 PM, Staff B confirmed Patient #3 did not receive personal care services and confirmed that the personal services were not documented on the agency plan of care or the HHA time sheets. Staff B did not have an explanation for the discrepancy between the order for personal care and the lack of personal care delivery despite the supervisory visits to Patient #3’s home.