Every finding on record at American Healthcare Concepts Inc

A Recertification Survey was initiated with the Administrator on 02.21.2023 at 10:15 AM. Census: Licensed and Certified- 28 Licensed Home Health- 32 Personal Assistance Services- 60 The agency was found in substantial compliance with the Medicare Conditions of Participation for Emergency Preparedness, no deficiencies were cited.

A Recertification Survey was initiated with the Administrator on 02.21.2023 at 10:15 AM. Census: Licensed and Certified- 28 Licensed Home Health- 32 Personal Assistance Services- 60 Acronyms used: POC- Plan of Care SOC- Start of Care DON- Director of Nurses SN- Skilled Nurse hha- Home health aide PRN- as needed

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the POC's included pain level parameters to report to the physician for 3 (Patients # 3, 4 and 5) of 5 active patients whose physician had ordered the SN to assess pain. The agency failed to make sure that patients receiving skilled treatment under the direction of a physician, had formal plans of care that contained pain level parameters to report assess pain levels as ordered by the physician. FINDINGS: Patient #3: Review of the record revealed a POC dated 02/13/2023-04/13/2023 with a SOC date 02/13/2023. The POC listed the primary diagnosis as Hypertensive Chronic Kidney Disease (high blood pressure caused by the narrowing of the arteries that carry blood to the kidneys). The POC listed orders for SN visits once a week for eight weeks and for the “SN to assess pain level and effectiveness of pain medications … every visit.” The POC did not include a pain parameter to notify the physician of a pain level above an acceptable range. Patient #4: Review of the record revealed a POC dated 11/25/2022-01/23/2023 with a SOC date 08/07/2020. The POC listed the primary diagnosis as Chronic cystitis without hematuria (bladder infection without blood in the urine). The POC listed orders for SN visits once a week for nine weeks and 1-2 PRN and for the “SN to assess pain level and effectiveness of pain medications … every visit.” The POC did not include a pain parameter to notify the physician of a pain level above an acceptable range. Patient #5: Review of the record revealed a POC dated 12/22/2022-02/19/2023 with a SOC date 02/25/2022. The POC listed the primary diagnosis as Mononeuropathy of the right lower limb (damage to a single nerve or nerve group). The POC listed orders for SN visits once a week for eight weeks and for the “SN to assess pain level and effectiveness of pain medications … every visit.” The POC did not include a pain parameter to notify the physician of a pain level above an acceptable range. In an interview with the Administrator and DON on 03/03/2023 at approximately 1:30 PM, the surveyor reviewed the findings and asked why the POC’s did not include pain parameters. The DON stated, “oversight, they (POC’s) need directions when to notify the physician.”

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review and interviews, the agency failed to provide the patient and/or caregiver with written information outlining a visit schedule including frequency of visits by home health staff in 3 (Patients #1, 4 and 5) of 3 patients' home folders reviewed during home visits. This failure potentially placed the patients at risk of missed visits by staff when visits were not scheduled and conflicted with other appointments and the availability of the patients. FINDINGS: Patient #1: Review of the record revealed a POC dated 11/18/2022-01/16/2022 with a SOC date 09/19/2022. The POC listed the primary diagnosis as Chronic Atrial Fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow). The POC listed orders for SN visits once a week for nine weeks. Review of the record revealed no evidence that a visit schedule had been provided to Patient #1. During a home visit with Patient #1 on 03/01/2023 at approximately 10:30 AM, the patient's home folder was reviewed. The surveyor asked Patient #1 if any paperwork from the home folder had been removed or placed elsewhere. Patient #1 stated “it’s all there except the med (medication) list, the nurse wrote and I keep it separate.” The surveyor asked if a written visit schedule to show when the SN would be visiting was provided to the patient. Patient #1 stated the nurse came on Tuesdays or Thursdays and she called prior to coming. The home folder did not include a visit schedule for the patient. Patient #4: Review of the record revealed a POC dated 11/25/2022-01/23/2023 with a SOC date 08/07/2020. The POC listed the primary diagnosis as Chronic cystitis without hematuria (bladder infection without blood in the urine). The POC listed orders for SN visits once a week for one week, twice a week for two weeks and once a week for six weeks. Review of the record revealed no evidence that a visit schedule had been provided to Patient #4. During a home visit with Patient #4 on 03/01/2023 at approximately 8:30 AM, the patient's home folder was reviewed. The surveyor asked Patient #4 if any paperwork from the home folder had been removed or placed elsewhere? Patient #4 stated everything was in the folder. The surveyor asked if a written visit schedule to show when the SN would be visiting was provided to the patient. Patient #4 stated the nurse usually called or text prior to the visits. Patient #5: Review of the record revealed a POC dated 12/22/2022-02/19/2023 with a SOC date 02/25/2022. The POC listed the primary diagnosis as Mononeuropathy of the right lower limb (damage to a single nerve or nerve group). The POC listed orders for SN visits once a week for eight weeks. Review of the record revealed no evidence that a visit schedule had been provided to Patient #5. During a home visit with Patient #5 on 03/01/2023 at approximately 9:30 AM, the patient's home folder was reviewed. The surveyor asked Patient #5 if any paperwork from the home folder had been removed or placed elsewhere. Patient #5 stated, “it’s all in there.” The surveyor asked if a written visit schedule to show when the SN would be visiting was provided to the patient. Patient #5 stated the nurse usually called and visited on Tuesdays. In an interview with the Administrator and DON on 03/03/2023 at approximately 12:30 PM, the surveyor reviewed the findings and asked why the patients did not have written visit schedules provided by the agency. The DON stated she knew the regulation and the scheduler did the visit schedule. The surveyor asked why the patients did not have a written schedule. The DON stated that needed to be included. The Administrator did not respond.

Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure each of the tasks listed at 484.80(b)(3) were evaluated by observation of the hha performance of the tasks for 3 (employees A, B and C) of 3 hha personnel records reviewed. The competency evaluation was not completed by observation of the hha's performance of all the required tasks. This failure potentially placed the patients that receive hha services and any future patients with assigned hha services at risk for receiving substandard or unsafe care from the home health aide. FINDINGS INCLUDE: On 02/21/2023, the surveyor reviewed the employee roster provided by the Administrator. The employee roster included the following hire dates: hha, employee A, 04/27/2018 [sic-incorrect date] hha, employee, B, 01/25/2023 hha, employee, C 03/02/2022 In an interview on 03/03/2023 with the Administrator and DON, the date of hire was reported and corrected for hha, employee A as 10/05/2020. Personnel record, hha A: Review of the record revealed a job description for hha signed and dated 10/05/2020. The personnel record did not include a hha demonstrated skills evaluation form. The personnel record was reviewed by the Administrator and DON and no evidence of a hha skills evaluation form was found. Review of the entire hha personnel record and documents provided to the surveyor did not demonstrate evidence that the hha performed or was observed providing all the required tasks for a competency evaluation. In an interview on with the Administrator and DON on 03/03/2023 at approximately 1:00 PM, the surveyor asked why the agency did not conduct a competency evaluation of skills for the hha, employee A. The Administrator stated, “no, can’t tell you, it’s not there.” The DON stated, “oversight.” Personnel record, hha B: Review of the record revealed a job description for hha signed and dated 01/25/2023. The personnel record did not include a hha demonstrated skills evaluation form. The personnel record was reviewed by the Administrator and DON and no evidence of a hha skills evaluation form was found. Review of the entire hha personnel record and documents provided to the surveyor did not demonstrate evidence that the hha performed or was observed providing all the required tasks for a competency evaluation. In an interview with the Administrator and DON on 03/03/2023 at approximately 1:00 PM, the surveyor asked why the agency did not conduct a competency evaluation of skills for the hha, employee B. The Administrator stated, “I don’t know, will check and find out, she is not here any longer.” The DON stated, “it was not done if it’s not in the packet.” Personnel record, hha C: Review of the record revealed a job description for hha signed and dated 03/01/2022. A form titled, "HOME HEALTH AIDE SKILLS COMPETENCY CHECKLIST..." signed by the DON and dated 03/01/2022. The form included the name of the hha written on the top of the page and multiple-choice options for the following topics: "... III. Partial Bath (only one required) A. Sponge, B. Tub, C. Shower, Comments:” The option “Sponge” was circled and the topic was check marked as “Satisfactory.” “… V. Shampoo (only one required) A. Sink, B. Tub, C. Bed, Comments:” The option “Sink” was circled and the topic was check marked as “Satisfactory.” Review of the entire hha personnel record and documents provided to the surveyor did not demonstrate evidence that the hha performed or was observed providing all the required tasks for a competency evaluation. In an interview with the Administrator and DON on 03/03/2023 at approximately 1:00 PM, the surveyor asked if the tasks that were circled on the competency indicated the type of shampoo or bath observed by the nurse. The DON reviewed the personnel record and stated, "Yes, the marked ones were done- all the tasks were not completed, I didn’t do all of them and to be honest, I can’t tell you why. There has been a change in staff and the packet is incomplete."