Every finding on record at All Metro Health Care

During the Recertification survey conducted on 02/23/2021 through 02/25/2021and 03/08/2021 at All Metro Health Care a Home Health Agency provider, Emergency Preparedness was reviewed. All Metro Health Care is not in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. This STANDARD is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed comply with the State of Florida Emergency Preparedness requirements to obtain approval for their Comprehensive Emergency Management Plan (CEMP) from the Local County Health Department as required. The findings included: During an interview on 03/08/21 at 08:55 AM, the Administrator was asked to locate and provide the HHA's Comprehensive Emergency Management Plan with evidence of submission and approval by the local county Health Department. During the interview, on 03/08/21 at 08:55 AM, the Administrator explained the "Compliance Officer," from the HHA's "Corporate (Office) in New York usually submits the CEMP and the Administrator stated that she does not know why the CEMP wasn't submitted. On 03/08/21 at 09:31 AM ,the Administrator provided the recent HHA's CEMP submission, dated 03/02/21 without evidence of documentation of an "Approval Letter," and she also provided the HHA's previous CEMP submission acknowledgement letter, dated 08/22/2018, without evidence of "Approval."

An unannounced Recertification survey was conducted on 02/23/2021 through 02/25/2021and 03/08/2021 at All Metro Health Care, Home Health Agency provider located in West Palm Beach, Florida. The provider was not in compliance with 42 CFR Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

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 and interview, the Home Health Agency (HHA) failed to follow the physicians' ordered Plan of Care (POC) for the frequency of SN (Skilled Nurse) visits for 4 of 7 sampled patients (Patient #1, #2, #3 and # 5) and failed to follow the physicians' ordered Plan of Care for the frequency of Home Health Aide visits for 1 of 2 sampled patients (Patient #7)(Patient #1, #2, #3, #5 and #7). The findings included: 1) Review of the record reveals Patient #1 was re-admitted to the HHA's services on 01/10/21 for the provision of Skilled Nursing 12 hours per day for 7 days a week for 180 days for the POC certification period of 01/10/21 through 03/10/21. Continued review reveals evidence that documents; On 01/15/21, an SN visit was conducted from 7:05 PM-10:04 PM (3 hours); On 01/16/21, an SN visit was conducted from 7:04 PM -9:27 PM (2.5 hours); On 01/22/21, an SN visit was conducted from 7:04 PM-10:15 PM (3 hours and 11 minutes); On 01/24/21, an SN visit was conducted from 7:04 PM-9:58 PM (2 hours and 54 minutes); On 01/28/21, an SN visit was conducted from 7:04 PM-10:24 PM (3 hours and 20 minutes); On 01/29/21, an SN visit was conducted from 7:05 PM-10:18 PM (3 hours and 13 minutes); On 01/31/21, an SN visit was conducted from 7:04 PM-10:18 PM (3 hours and 14 minutes); On 02/05/21, an SN visit was conducted from 7:04 PM-11:01 PM (4 hours); On 02/07/21, an SN visit was conducted from 7:04 PM-10:24 PM (3 hours and 20 minutes); On 02/11/21, an SN visit was conducted from 7:04 PM-9:53 PM (2 hours and 49 minutes); On 02/12/21, an SN visit was conducted from 7:04 PM-9:46 PM (2 hours and 42 minutes); On 02/13/21, an SN visit was conducted from 7:05 PM-10:07 PM (3 hours and 2 minutes) and On 02/14/21, an SN visit was conducted from 7:04PM-10:10 PM (3 hours and 6 minutes); Continued review reveals evidence that documents "Missed (SN) Visits" on 01/17/21, 01/21/21, 01/30/21 and 02/04/21. On 02/23/21 at 11:45 AM, an interview was held with the Clinical Manager, who acknowledged the findings. 2) Review of the records reveals Patient #2 was re-admitted to the HHA's services on 12/06/20 for the provision of Skilled Nursing, 24 hours per day for 7 days a week for 180 days, for the POC certification period of 12/06/20 through 02/03/21. Continued review reveals evidence that documents; On 12/12/20, an SN visit was conducted from 5:00 AM-12:40 PM (7 hours and 40 minutes); On 12/16/20, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 12/20/20, an SN visit was conducted from 7:00 AM-7:00 PM (12 hours); On 12/21/20, an SN visit was conducted from 8:00 PM-7:00 AM (11 hours); On 12/23/20, an SN visit was conducted from 7:30 PM-7:00 AM (11.5 hours); On 12/25/20, an SN visit was conducted from 8:00 PM-5:00 AM (9 hours); On 12/30/20, an SN visit was conducted from 7:37 PM-7:01 AM (11 hours 24 minutes); On 01/01/21, an SN visit was conducted from 7:15 PM-5:00 AM (9 hours 45 minutes); On 01/03/21, an SN visit was conducted from 9:00 PM-7:00 AM (10 hours); On 01/06/21, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 01/08/21, an SN visit was conducted from 7:30 PM-5:00 AM (9.5 hours); On 01/13/21, an SN visit was conducted from 7:02 PM-5:00 AM (10 hours ); On 01/14/21, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 01/15/21, an SN visit was conducted from 7:00 PM-5:00 AM (10 hours); On 01/18/21, an SN visit was conducted from 10:00 PM-7:00 AM (9 hours); On 01/20/21, an SN visit was conducted from 7:30 PM-7:00 AM (11.5 hours); On 01/22/21, an SN visit was conducted from 7:00 PM-5:00 AM (10 hours); On 01/27/21, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 01/29/21, an SN visit was conducted from 7:00 PM-5:00 AM (10 hours); On 02/03/21, an SN visit was conducted from 7:06 PM-7:00 AM (12 hours and 6 minutes) and On 02/09/21, an SN visit was conducted from 7:00PM-7:00 AM (12 hours). Continued review reveals evidence that documents "Missed (SN) Visits" on 12/11/20 and 12/13/20. On 02/24/21 at 9:08 AM, an interview was held with the Administrator who acknowledged the findings. 3) Review of the record reveals Patient #3 was re-admitted to the HHA's services on 11/23/20 for the provision of Skilled Nursing for the POC certification period of 11/23/20 through 01/21/21,10 hours per day for 5 days a week for 180 days. Continued review reveals evidence that documents; On 01/12/21, an SN visit was conducted for 4 hours and 45 minutes; On 01/13/21, an SN visit was conducted for 5 hours and 30 minutes; On 01/14/21, an SN visit was conducted for 4 hours and 48 minutes); On 01/15/21, an SN visit was conducted for 7 hours and 32 minutes); On 01/19/21, an SN visit was conducted for 4 hours and 31 minutes; On 01/20/21, an SN visit was conducted for 5 hours and 15 minutes) and On 01/21/21, an SN visit was conducted for 5 hours and 8 minutes. Continued review reveals evidence that documents "Missed (SN) Visits" on 11/26/20 and 11/27/20, 12/03/20, 12/10/20, 12/14/20, 12/15/20 and 12/17/20, 12/24/20, 12/25/20, 12/28/20, 12/31/20, 01/04/21 and 01/07/21. There was no evidence of documentation in the patient's records of notification to the physician of the "Missed" and or "incomplete visits." On 01/24/21 at 10:40 AM, an interview was conducted with the Administrator and the Clinical Manager, the Administrator stated that Patient #3's parent preferred care on the weekdays and would refuse care on the weekends; both the Administrator and Clinical Manager acknowledged the findings. 4) Review of the record reveals Patient #5 was re-admitted to the HHA's services on 09/16/20 for the provision services to include Skilled Nursing for the POC certification period of 09/16/20 through 11/14/20, 12 hours per day for 7 days a week for 180 days. Continued review reveals evidence that documents; On 09/18/20 and 09/20/20, the patient's record documents the HHA unable to find a SN to provide care and services to the patient; On 09/26/20 and 09/27/20, the patient's record documented the family was "moving" and no care and services were provided to the patient; On 10/03/20, the patient's record documented the HHA was unable to (provide SN) staff. On 10/04/20, the patient's record documented the HHA was unable to find an available SN; On 09/08/20, the patient's record documented the HHA was unable to find a SN available for shifts "due to lack of nursing staff; On 10/10/20, Saturday, the patient's record documented the HHA was unable to find a SN available for "weekend shifts, short staffed;" On 10/11/20, Sunday the patient's record documented the HHA was unable to find a SN "available for weekend shifts, short staffed;" On 10/12/20, the patient's record documented the assigned SN "called off work;" On 10/18/20, the patient's record documented the HHA was unable to find a SN "available for the shift" and On 10/23/20, the patient's record documented the HHA was unable to find an "available." On 02/25/21 at 9:48 AM, an interview was held with the Clinical Manager who acknowledged the findings and confirmed the HHA had difficulty providing SNs to Patient #5. 5) Review of the records reveals Patient #7 was re-admitted to the HHA's services on 11/28/20 for the provision of services to include a Home Health Aide for the POC certification period of 11/28/20 through 01/26/21, to provide care and services 6 hours per day, 5 days a week for 180 days. Continued review reveals evidence that documents; On 12/24/20, 12/25/20 and 12/31/20, there was no evidence of documentation that Home Health Aide services were provided, as the physician ordered, On 02/25/21 at 12:12 PM an interview was held with the Clinical Manager and the Administrator who acknowledged that there was no evidence of documentation available in the records as to why the Home Health Aide's visits were not provided as the physician ordered.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to communicate with the physician to provide notification to the physician of "missed" and "incomplete" visits' that failed to follow the physicians' ordered Plan of Care (POC) for the frequency of SN (Skilled Nurse) visits for 4 of 7 sampled patients (Patient #1, #2, #3 and #5) and failed to communicate with the physician to provide notification to the physician of "missed" visits and the failure to follow the physicians' ordered Plan of Care for the frequency of Home Health Aide visits for 1 of 2 sampled patients (Patient #7) (Patient #1, #2, #3, #5 and #7). The findings included: 1) Review of the record reveals Patient #1 was re-admitted to the HHA's services on 01/10/21 for the provision of Skilled Nursing 12 hours per day for 7 days a week for 180 days for the certification period of 01/10/21 through 03/10/21. Continued review reveals evidence that documents; On 01/15/21, an SN visit was conducted from 7:05 PM-10:04 PM (3 hours); On 01/16/21, an SN visit was conducted from 7:04 PM -9:27 PM (2.5 hours); On 01/22/21, an SN visit was conducted from 7:04 PM-10:15 PM (3 hours and 11 minutes); On 01/24/21, an SN visit was conducted from 7:04 PM-9:58 PM (2 hours and 54 minutes); On 01/28/21, an SN visit was conducted from 7:04 PM-10:24 PM (3 hours and 20 minutes); On 01/29/21, an SN visit was conducted from 7:05 PM-10:18 PM (3 hours and 13 minutes); On 01/31/21, an SN visit was conducted from 7:04 PM-10:18 PM (3 hours and 14 minutes); On 02/05/21, an SN visit was conducted from 7:04 PM-11:01 PM (4 hours); On 02/07/21, an SN visit was conducted from 7:04 PM-10:24 PM (3 hours and 20 minutes); On 02/11/21, an SN visit was conducted from 7:04 PM-9:53 PM (2 hours and 49 minutes); On 02/12/21, an SN visit was conducted from 7:04 PM-9:46 PM (2 hours and 42 minutes); On 02/13/21, an SN visit was conducted from 7:05 PM-10:07 PM (3 hours and 2 minutes) and On 02/14/21, an SN visit was conducted from 7:04PM-10:10 PM (3 hours and 6 minutes); Continued review reveals evidence that documents "Missed (SN) Visits" on 01/17/21, 01/21/21, 01/30/21 and 02/04/21. On 02/23/21 at 11:45 AM, an interview was held with the Clinical Manager, who, when inquired regarding notification to the Physician of "Missed" and "Incomplete visits," states that the Home Health Agency did not notify the physician of "Missed Visits" per shift or for the specific dates of the "Missed Visits" and stated that the physician should be notified on the specific dates of the "Missed" visits. 2) Review of the records reveals Patient #2 was re-admitted to the HHA's services on 12/06/20 for the provision of Skilled Nursing, 24 hours per day for 7 days a week for 180 days, for the certification period of 12/06/20 through 02/03/21. Continued review reveals evidence that documents; On 12/12/20, an SN visit was conducted from 5:00 AM-12:40 PM (7 hours and 40 minutes); On 12/16/20, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 12/20/20, an SN visit was conducted from 7:00 AM-7:00 PM (12 hours); On 12/21/20, an SN visit was conducted from 8:00 PM-7:00 AM (11 hours); On 12/23/20, an SN visit was conducted from 7:30 PM-7:00 AM (11.5 hours); On 12/25/20, an SN visit was conducted from 8:00 PM-5:00 AM (9 hours); On 12/30/20, an SN visit was conducted from 7:37 PM-7:01 AM (11 hours 24 minutes); On 01/01/21, an SN visit was conducted from 7:15 PM-5:00 AM (9 hours 45 minutes); On 01/03/21, an SN visit was conducted from 9:00 PM-7:00 AM (10 hours); On 01/06/21, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 01/08/21, an SN visit was conducted from 7:30 PM-5:00 AM (9.5 hours); On 01/13/21, an SN visit was conducted from 7:02 PM-5:00 AM (10 hours ); On 01/14/21, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 01/15/21, an SN visit was conducted from 7:00 PM-5:00 AM (10 hours); On 01/18/21, an SN visit was conducted from 10:00 PM-7:00 AM (9 hours); On 01/20/21, an SN visit was conducted from 7:30 PM-7:00 AM (11.5 hours); On 01/22/21, an SN visit was conducted from 7:00 PM-5:00 AM (10 hours); On 01/27/21, an SN visit was conducted from 7:00 PM-7:00 AM (12 hours); On 01/29/21, an SN visit was conducted from 7:00 PM-5:00 AM (10 hours); On 02/03/21, an SN visit was conducted from 7:06 PM-7:00 AM (12 hours and 6 minutes) and On 02/09/21, an SN visit was conducted from 7:00PM-7:00 AM (12 hours). Continued review reveals evidence that documents "Missed (SN) Visits" on 12/11/20 and 12/13/20. There was no evidence of documentation in the patient's records of notification to the physician of the "Missed" and or "incomplete visits." On 02/24/21 at 9:08 AM, an interview was held with the Administrator who acknowledged the findings and did not provide evidence of notification of the "Missed" and "incomplete visits" to the patient's physician. 3) Review of the record reveals Patient #3 was re-admitted to the HHA's services on 11/23/20 for the provision of Skilled Nursing for the certification period of 11/23/20 through 01/21/21,10 hours per day for 5 days a week for 180 days. Continued review reveals evidence that documents; On 01/12/21, an SN visit was conducted for 4 hours and 45 minutes; On 01/13/21, an SN visit was conducted for 5 hours and 30 minutes; On 01/14/21, an SN visit was conducted for 4 hours and 48 minutes); On 01/15/21, an SN visit was conducted for 7 hours and 32 minutes); On 01/19/21, an SN visit was conducted for 4 hours and 31 minutes; On 01/20/21, an SN visit was conducted for 5 hours and 15 minutes) and On 01/21/21, an SN visit was conducted for 5 hours and 8 minutes. Continued review reveals evidence that documents "Missed (SN) Visits" on 11/26/20 and 11/27/20, 12/03/20, 12/10/20, 12/14/20, 12/15/20 and 12/17/20, 12/24/20, 12/25/20, 12/28/20, 12/31/20, 01/04/21 and 01/07/21. There was no evidence of documentation in the patient's records of notification to the physician of the "Missed" and or "incomplete visits." On 01/24/21 at 10:40 AM, an interview was conducted with the Administrator and the Clinical Manager, the Administrator stated that Patient #3's parent preferred care on the weekdays and would refuse care on the weekends; both the Administrator and Clinical Manager acknowledged the findings and did not provide evidence of notification to the physician of the "Missed" and or "incomplete visits." 4) Review of the record reveals Patient #5 was re-admitted to the HHA's services on 09/16/20 for the provision services to include Skilled Nursing for the POC certification period of 09/16/20 through 11/14/20, 12 hours per day for 7 days a week for 180 days. Continued review reveals evidence that documents; On 09/18/20 and 09/20/20, the patient's record documents the HHA unable to find a SN to provide care and services to the patient; On 09/26/20 and 09/27/20, the patient's record documented the family was "moving" and no care and services were provided to the patient; On 10/03/20, the patient's record documented the HHA was unable to (provide SN) staff. On 10/04/20, the patient's record documented the HHA was unable to find an available SN; On 09/08/20, the patient's record documented the HHA was unable to find a SN available for shifts "due to lack of nursing staff; On 10/10/20, Saturday, the patient's record documented the HHA was unable to find a SN available for "weekend shifts, short staffed;" On 10/11/20, Sunday the patient's record documented the HHA was unable to find a SN "available for weekend shifts, short staffed;" On 10/12/20, the patient's record documented the assigned SN "called off work;" On 10/18/20, the patient's record documented the HHA was unable to find a SN "available for the shift" and On 10/23/20, the patient's record documented the HHA was unable to find an "available." On 02/25/21 at 9:48 AM an interview was held with the Clinical Manager who acknowledged the findings, confirmed the HHA had difficulty providing SNs to Patient #5 and the Clinical Manager did not provide evidence of documentation of notification to the patient's physician of the "missed" visits. 5) Review of the records reveals Patient #7 was re-admitted to the HHA's services on 11/28/20 for the provision of services to include a Home Health Aide for the POC certification period of 11/28/20 through 01/26/21, to provide care and services 6 hours per day, 5 days a week for 180 days. Continued review reveals evidence that documents; On 12/24/20, 12/25/20 and 12/31/20, there was no evidence of documentation that Home Health Aide services were provided, as the physician ordered, On 02/25/21 at 12:12 PM an interview was held with the Clinical Manager and the Administrator who acknowledged that there was no evidence of documentation available in the records as to why the Home Health Aide's visits were not provided as the physician ordered and no evidence of documentation available in the patient's record of the notification to the physician regarding the "missed" visits.