Every finding on record at Applecare Home Health Services Inc

A Recertification Survey entrance conference was conducted on 04/09/2021 with the Administrator/LVN, Employee A, (in person) at 11:37 AM. A pre-survey COVID-19 screening was conducted with Employee A, per the Texas Health and Human Services protocol. The census was: L&C 10 LHH 0 PAS 0 An exit conference was conducted on 04/13/2021 with Employee A, (in person) at 3:20 PM. The preliminary findings were discussed. The agency was found in compliance with the Medicare Conditions of Participation 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies and no deficiencies were cited. ABREVIATIONS: L&C - Licensed and Certified LHH - Licensed Home Health PAS - Personal Assistance Services

A Recertification Survey entrance conference was conducted on 04/09/2021 with the Administrator/LVN, Employee A, (in person) at 11:37 AM. A pre-survey COVID-19 screening was conducted with Employee A, per the Texas Health and Human Services protocol. The census was: L&C 10 LHH 0 PAS 0 An exit conference was conducted on 04/13/2021 with Employee A, (in person) at 3:20 PM. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. The agency was found in compliance with the Medicare Conditions of Participation. Deficiencies cited at standard level. ABBREVIATIONS: CDC - Centers for Disease Control CMS - Centers for Medicare and Medicaid Services COVID-19 -Novel Coronavirus Disease of 2019 DON - Director of Nurses EMR - electronic medical record HHA - Home Health Agency L&C - Licensed and Certified LHH - Licensed Home Health LVN - Licensed Vocational Nurse NOMNC - Notice of Medicare Non-Coverage PAS - Personal Assistance Services PIP - Performance Improvement Projects POC - plan of care QAPI- Quality Assurance Performance Improvement QIO - Quality Improvement Organization SN - skilled nurse

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide a completed written NOMNC no later than two days in advance of terminating on-going care that included the QIO name and contact information in two of two (Patient 4 and 5) patient records reviewed with goals met as reason for discharge. This failure had the potential to result in patients being unable to contact the QIO in the event they chose to exercise their right to appeal the discharge decision. FINDINGS INCLUDE: A patient discharge list with discharge reason was provided to the surveyor by the Administrator, Employee A, on 04/09/2021. The discharge list included discharge dates of 02/18/2020 for Patient 4 and 02/10/2020 for Patient 5. Discharged Patient 4: Record review of the discharge record included a POC dated 12/26/2019 to 02/23/2020. The record contained the NOMNC form that was signed and dated by Patient 4 on 02/17/2020. The discharge date was blank. The form did not include the QIO name and contact information to appeal the discharge decision, if the patient chose to do so. Patient 4 was only provided one day notice of discharge. Discharged Patient 5: Record review of the discharge record included a POC dated 12/19/2019 to 02/16/2020. The record contained the NOMNC form that was signed and dated by Patient 5 on 02/07/2020. The discharge date was 02/10/2020. The form did not include the QIO name and contact information to appeal the discharge decision, if the patient chose to. During an interview with Employee A and the DON, Employee B, on 04/13/2021 at approximately 1:00 PM, the surveyor reviewed the agency's NOMNC form that Patient 4 and 5 signed that did not include the QIO name and contact information. The surveyor asked why discharged Patient 4 and 5 were not given the QIO name and contact information on the NOMNC for the Patient 4 and 5 to exercise their right to appeal the discharge decision, if they chose to do so. Employee A stated, "I don't know." The surveyor asked why Patient 4 did not receive the NOMNC at least two days prior to discharge. Employee A stated, "I don't know." Agency policy titled, "PATIENT/CLIENT TRANSFER AND DISCHARGE NOTICES" with a revision date of 01/13/2018 read in part, " ...PURPOSE To provide guidance on completion of the required transfer and discharge notices. Policy...II. Notice of Medicare Non-Coverage ...A. Agency staff will provide valid delivery notice (involves both delivery and completion) of the NOMNC to the patient ...when the end of all foreseen coverage is foreseen, even if the patient/client agrees with the discharge ..." According to the Federal Code of Regulations, §405.1200 Notifying beneficiaries of provider service terminations: (a) Applicability and scope. (1) For purposes of §§405.1200 through 405.1204, the term, provider, is defined as a home health agency (HHA); (1) Timing of notice. A provider must notify the beneficiary of the decision to terminate covered services no later than 2 days before the proposed end of the services. (iii) A description of the beneficiary's right to an expedited determination under §405.1202, including information about how to request an expedited determination and about a beneficiary's right to submit evidence showing that services must continue; (a) Beneficiary's right to an expedited determination by the QIO. A beneficiary has a right to an expedited determination by a QIO under the following circumstances: (1) For services furnished by a non-residential provider, the beneficiary disagrees with the provider of those services that services should be terminated, and a physician certifies that failure to continue the provision of the service(s) may place the beneficiary's health at significant risk.

Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA's services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to conduct PIP for the calendar year 2018, 2019 and 2020 that reflected the scope, complexity, and past performance of the agency's services and operations. The failure to conduct PIP placed the agency at risk of not improving and providing quality of care and services to the agency's patients. Findings include: The surveyor requested the QAPI program documents during the entrance conference on 04/09/2021. The Administrator, Employee A, provided the QAPI binder to the surveyor on 04/12/2021. Record review of the QAPI manual failed to contain any reports which indicated the agency had conducted any PIP. There was no documentation that showed the agency had PIP either in development, on-going or completed for the year 2018, 2019 and 2020. During an interview with Employee A on 04/13/2021 at approximately 3:15 PM, the surveyor discussed the above findings and asked what was the agency's PIP for 2018, 2019 and 2020. Employee A asked if PIP was a new rule. The surveyor stated that beginning July 13, 2018, HHA's must conduct PIP. Employee A asked how often the agency was required to conduct PIP. The surveyor stated at least annually. The surveyor asked why the agency did not conduct PIP in 2018, 2019 and 2020. Employee A stated, "I didn't know we were supposed to."