Every finding on record at Altercare of Palm Beach County LLC

An unannounced Complaint Survey, #2022008617, was conducted on 05/08/2023 at Trilogy Home Healthcare, Home Health Agency provider. The provider was not in compliance with 42 CFR Part 484, Subpart A-C, Conditions of Participation for Home Health Agencies.

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on the Home Health Agency (HHA)'s Policy and Procedure review, record review and interview, the HHA failed to ensure the coordination of care for 2 of 3 sampled patients as evidenced by Patient #1 who had ordered Lymphedema and wound care services, which were not coordinated between the Skilled Nursing and Physical Therapy, services nor was the patient's physician made aware of the patient's requests related to the care which necessitated a change in physician's orders and Patient #2 who had ordered wound care in which the Skilled Nurses failed to coordinate a change in the visit scheduling with the HHA's office staff, resulting in a "missed visit" (Patient #1 and #2). The findings included: 1) Review of the HHA's Policy and Procedure titled, "Coordination of Patient Care" revised October 2021 reveals, "Procedure: … 3. Staff provides communication with all physicians or allowed practitioners for the patient with plan of care changes on an ongoing basis regarding: Current condition and changes in condition; Outcomes of care and service. … 4. The Agency (Home Health Agency/HHA) designated experienced personnel as a patient care coordinator/case manager for each patient. The case manager coordinated activities with the patient, patient representative, physician/allowed practitioners, or other service personnel and organizations involved in the patient's care." Review of the record reveals Patient #1 was admitted to the HHA 's services on 09/03/21. Review of the plan of care for the certification period of 05/01/22 through 06/29/22 documented the skilled nurse was to provided wound care to an abdominal wound and lower extremities twice weekly for four weeks. Patient #1 was a patient at the wound care center for services related to her legs. Patient #1 went to the wound care center on 05/19/22 and supplemental orders were received to continue the wound care to the left lower leg, and for the HHA to set up Lymphedema (swelling of an extremity) therapy. During an interview on 05/08/23 at 2:25 PM, when asked the process for ordered Lymphedema therapy that includes wound care, Staff A, Care Team Manager for Patient #1, explained if the wound care and Lymphedema therapy frequency matches, the Physical Therapist does the wound care at the same time as the Lymphedema therapy; when asked how the patient is informed of the process, Staff A explained the patients are informed of the need for wound care and or Lymphedema therapy by the physician at the wound care center, and then the next HHA nurse, who does a visit, would explain the new order to the patient; when asked about Patient #1's ordered Lymphedema and wound care orders from 05/19/22, Staff A stated she spoke with the patient numerous times regarding the order changes and need for Lymphedema therapy; Staff A stated the patient had non-compliance issues and would refuse visits and or care by certain clinicians; when asked if she had explained to Patient #1 that the physical Therapist was able to provide the wound care at the same time as the Lymphedema therapy, Staff A stated she did, but was unable to provide documented evidence of any of the conversations. Review of the skilled nursing visit dated 05/23/22, the first visit after the 05/19/22 wound care center appointment, reveals Patient #1 refused to allow the skilled nurse to perform the abdominal dressing change, allowed the provision of wound care to their leg, but refused the ordered compression wrap. This skilled nursing visit note documented there was no communication with other disciplines involved and that there were no changes in frequency/duration, medications, or treatments. The documentation lacked any coordination of care or explanation to Patient #1 regarding the newly ordered Lymphedema therapy or process of wound care by the Physical Therapist. Review of the skilled nursing visit dated 05/26/22 documented the patient's refusal of the abdominal wound care, provision of wound care to the patient's leg and no documentation of coordination of care. A progress note, dated 05/29/22 documented a "missed visit" by the Physical Therapist as there was no answer to calling the patient's telephone or knocking on the patient's locked door. Review of the skilled nursing visit dated 06/01/22 documented the refusal of the abdominal wound care, provision of wound care to the patient's leg, the patient's refusal of the ordered compression wraps and that Patient #1 was upset and unsure of their availability for Lymphedema therapy. The skilled nursing visit note lacked any documented explanation of the Physical Therapist's ability to do the wound care but did document the skilled nurse reported to Staff A, Care Team Manager. A progress noted dated 06/03/22 by Staff A documented the delay in care for Lymphedema therapy related to several attempts to schedule with patient and the patient's refusal and documented the patient was very agitated and non-compliant with care. Orders were received to attempt a PT (Physical Therapy) evaluation the following week. A skilled nursing note dated 06/03/22 documented the abdominal wound had healed, the provision of wound care without the compression wrap and lacked any explanation of the Physical Therapist's ability to do the wound care. A progress noted dated 06/06/22 by Staff A documented Patient #1 was only allowing the skilled nurse to provide care and that orders for wound care and frequency were needed. Further documentation reveals a skilled nursing visit was made on 06/06/22. Review of the PT Evaluation dated 06/09/22 documented the evaluation and plan for Lymphedema management; under "Care Coordination," the Physical Therapist documented, "not applicable" and wound care was not documented as provided, during the 06/09/22 PT visit. Continued review reveals coordination of care and receipt of additional orders for skilled nursing to do wound care and PT to do manual Lymphedema therapy were not obtained until 06/13/23. Review of the plan of care for the continued certification period of 06/03/22 through 08/28/22 documented the continuation of skilled nursing and physical therapy visits. Review of a progress note dated 07/02/22 documented a skilled nursing "missed" visit as Patient #1 refused the visit and requested the skilled nurse to return on Monday 07/04/22. Further review reveals the record lacked any skilled nursing visit on 07/04/22. During an interview on 05/08/23 at 3:13 PM, the Director of Clinical Services (DCS) confirmed she recalled Patient #1 and spoke with her over the telephone; the DCS stated during this certification period, Patient #1 requested skilled nursing visits on Monday and Friday afternoons after dialysis treatments, with Physical Therapy visits on Tuesdays and Thursdays. The DCS was shown the "missed" visit notification dated 07/02/22 with the request for a visit on Monday (07/04/22) and was asked why it was not completed; the DCS could not find any reason for the lack of a visit on Monday, further stating they (HHA) definitely had staff and did visits on that day even though it was a holiday but agreed to the lack of coordinated care. 2) Review of the record revealed Patient #2 was admitted to the HHA's services on 04/25/23 for the provision of wound care. Review of the plan of care for the certification period of 04/25/23 through 06/23/23 documented the orders for wound care every other day, as per specific weekly frequency. Review of the skilled nursing visits revealed a visit was completed on Saturday 04/29/23, a lack of a visit on Monday 05/01/23, and a visit made on Tuesday 05/02/23. Review of the progress notes lacked any documented evidence as to the reason for the "missed" visit on Monday 05/01/23. Further review of the skilled nursing visits lacked a visit on Thursday 05/04/23, but a visit was made on Friday 05/05/23. The progress notes lacked any documented evidence of the reason for the "missed" visit. The record lacked any subsequent orders for skilled nursing visit frequency changes. During an interview on 05/08/23 at 4:20 PM, Staff B, Care Team Manager for Patient #2, was asked if there were any order changes for the skilled nursing services for Patient #2 and Staff B stated she did not recall any changes but would check. On 05/08/23 at 4:45 PM, the DCS stated she reached out to the skilled nurse for Patient #2, who explained there was no answer at the door upon arrival to the patient's home on Monday 05/08/23; the DCS stated the skilled nurse explained she had telephoned the patient's son who requested the visit be moved to Tuesday, and that she had telephoned the physician who stated it was okay to move the visit; the DCS stated the skilled nurse stated they put a note into the patient's "electronic record," but the DCS confirmed she had not; the DCS confirmed that because of the lack of coordination between the direct care nurse and the HHA's office, the frequency of visits was not updated to every other day after Monday's missed visit.