Every finding on record at All Nation Home Healthcare, LLC

Substantial Allegation Survey Substantial Allegation 101871 An entrance conference was conducted on 11/21/23 at 11:45 AM with Human Resources. An exit conference was conducted on 11/29/23 at 4:00 PM with administrative staff. The following deficiencies are based upon substantial allegation 101871 completed on 11/29/23. All Nation Home Healthcare, LLC 368410, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C 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 policy review, record review and staff interview, the agency failed to ensure each patient received the home health services that are written in an individualized plan of care for eight of nine records reviewed with home health aide (HHA) services (Patient #1, #2, #3, #4, #5, #7, #9 and #10). The total sample was 12. This could affect all patients receiving services from the agency. The census was 88. Findings include: Review of the undated agency policy titled, “Missed Visits,” revealed all missed visits should be reported immediately to enable timely communication to all case managers as well as any appropriate health care workers that are directly involved in the plan of care. 1. Review of the medical record for Patient #1 and the physician ordered plan of care dated 07/31/23 revealed orders for home health aide (HHA) services 42 hours per week to provide assistance with personal care and activities of daily living. Review of the HHA treatment sheets from 07/30/23 to 08/26/23 revealed missed visits and only 15 hours of HHA services provided the week of 07/30/23, only 19 hours provided the week of 08/06/23, only 24 hours provided the week of 08/13/23 and only 20.5 hours provided the week of 08/20/23. There was no documentation that the physician was notified services were not provided as ordered. 2. Review of the medical record for Patient #2 and the physician ordered plan of care dated 09/22/23 revealed orders for HHA services 26 hours per week to provide assistance with personal care and activities of daily living. Review of the HHA time sheets revealed the HHA provided 21.5 hours the week of 10/01/23, 12 hours the week of 10/08/23, 10.75 hours the week of 10/15/23 and 19.5 hours the week of 10/22/23. There was no documentation that the physician was notified services were not provided as ordered. 3. Review of the medical record for Patient #3 and the physician ordered plan of care dated 08/08/23 revealed orders for HHA services eight hours per week to provide assistance with personal care and activities of daily living. Review of the HHA time sheets revealed the HHA provided four hours the week of 08/13/23, six and half hours the week of 08/20/23, no HHA service was provided the weeks of 08/27/23, 09/03/23 and 09/17/23, and only five and half hours was provided the week of 09/10/23. 4. Review of the medical record for Patient #4 and the physician ordered plan of care dated 10/03/23 revealed orders for HHA services 20 hours per week to provide assistance with personal care and activities of daily living. Review of the HHA time sheets revealed the HHA provided 14 hours the week of 10/10/23, 16 hours the week of 10/17/23, 10 hours the week of 10/31/23 and 14.5 hours the week of 11/07/23. There was no documentation that the physician was notified services were not provided as ordered. 5. Review of the medical record for Patient #5 and the physician ordered plan of care dated 10/17/23 revealed orders for HHA services 25 hours per week to provide assistance with personal care and activities of daily living. Review of the HHA time sheets revealed the HHA provided 15 hours the week of 10/22/23 and 20 hours the week of 10/01/23. There was no documentation that the physician was notified services were not provided as ordered. 6. Review of the medical record for Patient #7 and the physician ordered plan of care dated 10/01/23 revealed orders for HHA services 15 hours per week to assist with personal care. Review of the medical record for Patient #7 revealed the last HHA time sheet was 09/01/23. Interview on 11/28/23 at 1:32 PM with Staff V revealed stated Patient #7 went with another agency for the HHA services. The last HHA visit was 09/01/23. Interview on 11/28/23 at 1:45 PM with Staff A confirmed there was no documentation in the record to reflect that Patient #7 was receiving HHA services from another agency, or that the physician had been notified of the change in the plan of care. 7. Review of the medical record for Patient #9 and the physician ordered plan of care dated 10/09/23 revealed orders for HHA services 28 hours per week to assist with personal care. Review of the HHA time sheets for Patient #9 revealed the HHA provided five and a half hours the week of 10/22/23, nine and a quarter hours the week of 10/29/23, no hours the week of 11/05/23 and 20 hours the week of 11/12/23. 8. Review of the medical record for Patient #10 and the physician ordered plan of care dated 08/12/23 revealed orders for HHA services six hours per week to provide assistance with personal care and activities of daily living. Review of the HHA time sheets revealed only two hours were provided the week of 07/30/23. There was no documentation that the physician was notified services were not provided as ordered. Interview on 11/22/23 at 1:08 PM with Staff A revealed they only notified the physician if a skilled nurse visit was missed not for any HHA missed visits. This deficiency represents non-compliance investigated under Substantial Allegation 101871.

A qualified HH aide successfully completed: CFR(s): 484.80(a)(1)(i-iv) A qualified home health aide is a person who has successfully completed: (i) A training and competency evaluation program as specified in paragraphs (b) and (c) respectively of this section; or (ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or (iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of §483.151 through §483.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or (iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section. This ELEMENT is not met as evidenced by: Based on policy review, personnel file review, and staff interview, the agency failed to ensure home health aides (HHA) were qualified for eight of eight HHA personnel files reviewed (Staff E, F, G, H, K, R, S and T). This could affect all patients receiving services from the agency. The census was 88. Findings include: Review of the agency policy titled, “Home Health Aide Services and training Program,” revised 10/2017, revealed all home health aides (HHA) employed by the agency will satisfactorily complete a HHA training program and competency evaluation program prior to performing patient care. A qualified Home Health Aide is a person who has successfully completed a training and competency evaluation program, or a competency evaluation program that meets the requirements. Interview on 11/27/23 at 10:14 AM with Staff P stated HHA's must have at least one year experience. If they do not, then they must take the HHA training class. Interview on 11/27/23 at 10:42 AM with Staff A revealed that on hire the HHA's must have at least one year of experience or take the HHA class. Review of the personnel files for Staff E, F, G, H, K, R, S and T did not reveal documentation of any HHA training prior to hire. Interview on 11/29/23 at 11:15 PM with Staff A confirmed the lack of documentation of any HHA training prior to hire. This deficiency represents non-compliance investigated under Substantial Allegation 101871.

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 policy review, record review and staff interview, the agency failed to ensure home health aides (HHA) provide services that are included in the plan of care for five of ten records reviewed with HHA services (Patient #1, #4, #5, #6, and #11). The total sample was 12. This could affect all patients receiving services from the agency. The census was 88. Findings include: Review of the agency policy titled, “Home Health Aide Documentation,” revised 10/2017, revealed the home health aide (HHA) will document services rendered to the patient on the appropriate Home Health Aide charting form as directed in the Aide care plan/assignment sheet. 1. Review of the medical record for Patient #1 and HHA care plan dated 07/27/23 revealed the HHA was to give a shower on each visit and assist with dressing. Review of the HHA visit sheets from 09/17/23 to 09/28/23 revealed no documentation the patient received a shower on 09/22/23 or 09/27/23. There was no documentation the patient received assistance with dressing on 09/22/23. 2. Review of the medical record for Patient #4 and home health aide (HHA) care plan dated 09/30/23 revealed the HHA was to give a shower and do skin care on each visit. Review of the HHA visit sheets from 10/10/23 to 11/10/23 revealed no documentation the patient received a shower or skin care for five weeks. Interview on 11/27/23 at 2:20 PM with Staff A confirmed the findings in Patient #4's record. 3. Review of the medical record for Patient #5 and home health aide (HHA) care plan dated 10/15/23 revealed the HHA was to provide skin care, peri care, nail care and assist with dressing on every visit. Review of the HHA visit sheets from 10/01/23 to 10/27/23 revealed no documentation the patient received skin care, peri care, nail care or assistance with dressing the weeks of 10/01/23, 10/08/23 or 10/22/23. Interview on 11/27/23 at 3:50 PM with Staff A confirmed the HHA did not follow Patient #5's HHA plan of care. 4. Review of the medical record for Patient #6 and home health aide (HHA) care plan dated 11/09/23 revealed the HHA was to provide a shower, skin care and assist with dressing on every visit. Review of the HHA visit sheets from 09/24/23 to 10/21/23 revealed the HHA visited four times the week of 10/15/23 but the documentation showed that the patient only received one shower. The HHA visited five times the week of 10/01/23 but the documentation showed that the patient only received two showers. The HHA visited four times the week of 09/24/23 but the documentation showed that the patient only received one shower. 5. Review of the medical record for Patient #11 and the HHA plan of care dated 10/14/23 revealed the HHA was to assist with showering, shampooing skin care and peri care on every visit. Review of the HHA time sheets for Patient #11 revealed the HHA made seven visits the week of 10/22/23 but the documentation showed that the patient only received one shower. The HHA made six visits the week of 10/29/23 but the documentation showed that the patient only received two showers. The HHA made seven visits the week of 11/05/23 but the documentation showed that the patient only received two showers. The HHA made seven visits the week of 11/12/23 but the documentation showed that the patient only received one shower. Interview on 11/27/23 at 3:30 PM with Staff A confirmed the HHAs did not follow the HHA plans of care. This deficiency represents non-compliance investigated under Substantial Allegation 101871.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on policy review, record review and staff interview, the agency failed to ensure the Administrator was responsible for all day-to-day operations of the agency for 11 of 11 personnel files reviewed (Staff B, C, D, F, G, H, J, K, L, M and N). This could affect all patients receiving services from the agency. The census was 88. Findings include: Review of the agency policy titled, “Personnel Records,” revised 10/2017, revealed the personnel file will include a cardiopulmonary resuscitation (CPR) certificate, if required. Interview on 11/21/23 at 4:12 PM with Staff A revealed CPR was required by all staff. Staff A stated they were the CPR instructor, and all certificates were online. Staff A confirmed the CPR certificates were not in the personnel files per policy. On 11/21/23 at 4:30 PM the online CPR certificates were reviewed with Staff A. The review revealed Staff B, C, D, F, G, H, J, K, L, M and N did not have a current CPR certificate. Interview on 11/21/23 at 4:37 PM with Staff A confirmed 11 of 11 staff reviewed did not have a current CPR certificate. This deficiency represents non-compliance investigated under Substantial Allegation 101871.

Substantial Allegation Survey Substantial Allegations 100568 and 100810 An entrance conference was conducted on 09/18/23 at 10:15 AM with the Administrator. An exit conference was conducted on 09/19/23 at 4:30 PM with administrative staff. The following deficiency is based upon substantial allegation 100568 completed on 09/19/23. No deficiencies were cited related to allegation(s) contained in substantial allegation 100810 also completed on 09/19/23. All Nation Home Healthcare, LLC 368410, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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 and staff interview, the agency failed to ensure the home health aide (HHA) provided services that are included in the plan of care for two of three patients reviewed (Patient #1 and #3). This could affect all patients receiving services from the agency. The census was 78. Findings include: 1. Review of the home health aide (HHA) care plan for Patient #3 dated 02/24/23 to 04/24/23 revealed the HHA was to provide a shower with chair and skin care at every visit. Review of Staff D’s HHA time sheets from 03/12/23 to 04/01/23 revealed Staff D provided care from 1:00 PM to 5:00 PM Sunday through Saturday. The HHA time sheets for the week of 03/12/23 revealed no documentation Patient #3 received a shower on 03/12/23, 03/13/23, 03/15/23, 03/17/23 or 03/18/23. There was no documentation Patient #3 received skin care on 03/12/23, 03/13/23, 03/15/23, 03/16/23, 03/17/23 or 03/18/23. For the week of 03/19/23 there was no documentation Patient #3 received a shower/bath on 03/20/23, 03/21/23, 03/22/23, 03/23/23, 03/24/23 or 03/25/23 and no documentation Patient #3 received skin care that week. For the week of 03/26/23 there was no documentation Patient #3 received a shower/bath on 03/28/23 and no documentation the patient received skin care on 03/27/23, 03/28/23, 03/30/23, 03/31/23 or 04/01/23. Review of the HHA time sheets for Patient #3 dated 04/05/23 to 04/15/23 revealed Staff F provided HHA services. Review of the HHA time sheets for the week of 04/05/23 revealed no documentation Patient #3 received a shower/bath on 04/06/23, 04/07/23 or 04/08/23. There was no documentation Patient #3 received skin care that week. For the week of 04/09/23 there was no documentation Patient #3 received a shower/bath on 04/09/23, 04/10/23, 04/11/23, 04/13/23, 04/14/23 or 04/15/23. There was no documentation Patient #3 received skin care that week. 2. Review of the HHA care plan for Patient #1 dated 03/27/23 to 05/17/23 revealed the HHA was to provide a shower with chair, shampoo, oral care and skin care at every visit. Staff G provided services during that time period. Review of the HHA time sheets revealed for the week of 05/01/23 there was no documentation Patient #1 received a shower/bath, shampoo or oral care on 05/02/23 or 05/04/23. There was no documentation Patient #1 received skin care that week. Interview on 09/19/23 at 1:00 PM with Staff A confirmed the findings. This deficiency represents non-compliance investigated under Substantial Allegation 100568.

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 31933 The following deficiency is based on the Substantial Allegation Survey #31933 completed on 09/21/21.

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 medical record review and staff interview, the facility failed to follow the physician's ordered plan of care for Home Health Aide (HHA) hours or services. This affected one (Patient #1) of three patients reviewed. Medical record review revealed Patient #1 was admitted to the agency on 04/30/21. Diagnoses included chronic obstructive pulmonary disease, amnesia, and disorientation. FFor the certification period of 06/29/21 through 08/27/21 the physician ordered plan of care was for the SP to receive two hours of HHA services five days a week Monday through Friday, for a total of ten hours per week. For the week of 06/28/21 and 07/05/21 the SP received 12 hours of HHA services. For the week of 07/12/21 the SP received 10 hours of HHA services. For the week of 07/19/21 the SP received 14.5 hours of HHA services. For the week of 07/26/21 the SP received 14 hours of HHA services. Review of a communication note dated 07/29/21, revealed the Skilled Nurse (SN) asked the physician for an addendum to the 485 to add an additional 16 hours of HHA services per week for a total of 26 HHA per week. The record did not contain a physician signed order for the additional hours. FFor the week of 08/01/21 the SP received 22.5 hours of HHA services. For the week of 08/08/21 the SP received 27 hours of HHA services. For the week of 08/15/21 the SP received 28 hours of HHA services. For the week of 08/22/21 the SP received 25.5 hours of HHA services. Review of the HHA timesheet from 08/16/21 to 08/22/21 revealed the HHA had not documented any services were provided during the PM shift. On 09/20/21 at 3:00 PM the Administrator confirmed the extra hours performed some weeks for the SP and lack of hours on other weeks, as well as the lack of services provided marked on HHA time sheet from 08/16/21 to 08/22/21. The Administrator also revealed they agency did not have a signed order for the increase in HHA hours on 07/30/21. She stated she called the physician’s office and the staff told her they were still waiting for the physician to sign the document. This deficiency substantiates Complaint Number 31933