Every finding on record at Arc Vista Home Care, Inc

On 11/28/22 through 12/1/22, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Arc Vista Home Care. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey was conducted on 11/28/22 through 12/1/22 by the Michigan Department of Licensing and Regulatory Affairs at: Arc Vista Home Care 5226 State Street Saginaw, MI 48603 At the time of the survey, the agency did not operate any branch offices. For this survey, five active records were reviewed with three home visits and two discharge records were reviewed for a total of seven records reviewed. The agency was determined to be in compliance with the Covid-19 Vaccine requirement stated at QSO-22-07-ALL Attachment G for Home Health Agencies. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the Conditions of Participation for Home Health Agencies at: 42 CFR Part 484.

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 include objectively measurable goals in the Plans of Care (POC) in 4 of 8 (MR#s 1, 2, 3, 4) records reviewed, resulting in the inability to determine the patient's progress towards achieving goals. Findings included: MR#1: The Start of Care (SOC) was dated11/17/2022. Diagnoses on the POC included: "Diabetes type 2 (DM2), Chronic Obstructive Pulmonary Disease (COPD), Chronic Kidney Disease (CKD), Peripheral Vascular Disease (PVD), Hypertension (HTN), and Bilateral Edema. Upon review of the POC, it was noted the goals on the POC were not objectively measurable. Examples include: "Stabilization of cardiovascular pulmonary condition by 1/15/23; Verbalizes pain controlled at an acceptable level by 1/15/2023; B/P will remain between normal parameters by 1/15/2023; Blood Sugar will be within normal limits. These goals are not objectively measurable to determine the patient's progress towards goals. MR#2: The Start of Care was dated 4/18/2022. The Plan of Care identified diagnoses of Bilateral Primary Osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), Hypertension (HTN), Atrial Fibrillation (A-Fib), Osteoarthritis, and Alzheimer's Disease. Upon review of the Plan of Care it was noted the goals on the POC were not objectively measurable to determine the patient's progress towards goals. Examples included: "patient is incontinent: is stable as evidenced by absence of the following: persistent involuntary loss of urine, skin breakdown related to incontinence, inability to manage perineal hygiene." These goals are not objectively measurable to determine the patient's progress towards goals. MR#3: The Start of Care was dated 4/15/2022. The Plan of Care for the period 4/15/2022 to 6/13/2022 identified diagnoses of Bilateral Primary Osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), Abnormalities of Gait and Mobility, Anxiety Disorder, Benign Prostatic Hyperplasia, and Constipation. Upon review of the Plan of Care, it was noted the goals were not objectively measurable to determine the patient's progress towards obtaining goals. Examples included: "Constipation unspecified, is stable as evidenced by absence of the following, persistent abdominal pain, increased abdominal sounds, bloody stools, diarrhea, persistent oral temperature greater than 99.0." This goal is not objectively measurable to determine the patient's progress towards goals. The goals for the Physical therapist included, "Needed some help, patient needed partial assistance from another person to complete activities" The goal/discharge plan was documented as "living in assisted living facility with 24-hour staffing." These goals are not objectively measurable to determine the patient's progress towards goals. MR#4: The Start of Care was dated 11/01/2022. The Plan of Care for the period 11/01/22 to12/30/22 identified diagnoses of non-ST elevation (NSTEMI), pleural effusion, Atrial Fibrillation, Respiratory Failure with hypoxia, Hypertension, and muscle weakness. Upon review of the Plan of Care, it was noted the goals were not objectively measurable. Examples included: For Skilled Nursing, "patient is incontinent: is stable as evidenced by absence of the following: persistent involuntary loss of urine, skin breakdown related to incontinence, inability to manage perineal hygiene." Examples of the Physical Therapy goals included: "demonstrates urinary incontinence management including bladder training, Kegel exercises, skin care; Muscle Weakness: is stable as evidenced by absence of the following: persistent pain of affected muscle, spasms, patient/caregiver recalls/demonstrates pain control, therapeutic exercises for muscle strengthening and flexibility, diet and fluids to optimize healing and prevent constipation." {sic} These goals are not objectively measurable to demonstrate the patient's progress toward achieving the goals. These findings were reviewed and acknowledged by the Clinical Manager (CM-B) during an interview on 12/1/2022 at 2:30 p.m.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the registered nurse prepared written patient care instructions that included the frequency and duration of visits for the aide for 5 of 6 (MR# 2, 3, 5, 6, 7) records reviewed in which aide services were provided, resulting in a lack of direction regarding weekly visits pertinent to the needs of these patients. Findings include: MR #2: The SOC was dated 4/18/2022. The Plan of Care for the Certification Period 10/15/22 to 12/13/22 identified diagnoses of Bilateral Primary Osteoarthritis of Knee, Chronic Obstructive Pulmonary Disease (COPD) with Acute Exacerbation, Paroxysmal Atrial Fibrillation (A-Fib); Alzheimer's disease; and Dependence on Wheelchair. The patient is currently receiving Skilled Nursing (SN) Home Health aide (HHa), Physical Therapy (PT), and Occupational Therapy (OT) services. During record review on 12/1/2022, it was noted that the aide care plan, which was reviewed or revised by the nurse on 10/15/2022, failed to include the frequency and duration of visits resulting in the inability of the aide to plan for the number of visits required each week and how many weeks the aide would be providing aide services to the patient. These findings were reviewed and acknowledged by the Clinical Manager (CM-B) during an interview on 12/1/2022 at 2:30 p.m. MR#3: The Start of Care was dated 4/15/2022. The Plan of Care for the period 4/15/2022 to 6/13/2022 identified diagnoses of Bilateral Primary Osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), Abnormalities of Gait and Mobility, Anxiety Disorder, Benign Prostatic Hyperplasia, and Constipation. The Plan of Care included orders for Skilled Nursing (SN), Physical Therapy (PT), and Home Health Aide (HHa) Services. The Plan of Care ordered HHa visits were to occur as follows: Week 1 (4 visits); (Week 2 (3 visits); Week 3 (3 visits); Week 4 (2 visits); Week 5 (2 visits); Week 5 (2 visits); Week 6 (1 visit); Week 7 (1 visit). However, a review of the Aide Care Plan/Assignment sheet within the patient's record was completely blank with no orders for frequency of visits, or tasks assigned to be completed each visit. These findings were reviewed and acknowledged by the Clinical Manager during an interview on 12/1/2022 at 2:30 p.m. MR#5: This patient was admitted to the agency on 4/15/22 with diagnoses of cellulitis to several areas and chronic obstructive pulmonary disease. The patient is currently receiving skilled nursing and home health aide services. During record review on 11/30/22, it was noted that the aide care plan reviewed or revised by the nurse on 6/13/22 failed to indicate a visit frequency and duration for the aide. It was unclear how the aide would know how many visits to make each week. During an interview on 12/1/22 at 10:30 a.m., the clinical manager (CM-B) explained that she calls the aide and informs the aide of the frequency & duration of visits. CM-B acknowledged that the aide care plan failed to note a frequency and duration of visits to direct the aide how many visits to make each week to provide patient care. MR#6: This patient was admitted to home care on 7/14/22 with diagnoses of cellulitis to several areas and generalized anxiety disorder. The patient received skilled nursing and home health aide services. During record review on 11/29/22, it was noted that the aide care plan created by the nurse on 7/14/22 failed to indicate a visit frequency and duration for the aide. It was unclear how the aide would know how many visits to make each week. MR#7: This patient was admitted to home care on 10/14/22 with diagnoses of right femur fracture, anxiety, depression, and fibromyalgia (chronic widespread pain). The patient is currently receiving skilled nursing, home health aide, and physical therapy services. During record review on 11/28/22, it was noted that the aide care plan created by the nurse on 10/14/22 failed to indicate a visit frequency and duration for the aide. It was unclear how the aide would know how many visits to make each week.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the clinical record contained visit notes for 3 of 5 (MR#s 2, 5, and 7) active records reviewed, resulting in a lack of information for the physician and all agency staff caring for these patients. Findings include: MR#2: The Start of Care was dated 4/18/2022. The Plan of Care identified diagnoses of Bilateral Primary Osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), Hypertension (HTN), Atrial Fibrillation (A-Fib), Osteoarthritis, and Alzheimer's Disease. This patient was receiving Skilled Nursing Services. Upon review of the record on 12/1/2022, it was noted the most recent skilled nurse visit note was dated November 11th, 2022, which was 20 days ago. There was no documentation to review regarding the patient's status and the care provided by the Skilled Nurse for the past 20 days. During the entrance conference on 11/27/22 the Clinical Manager (CM-B) stated all clinical visit notes for the week are due the following Monday of the visit. This finding was reviewed and acknowledged by CM-B during an interview on 12/01/22 at 2:30 p.m. The agency failed to ensure the clinical record contained skilled nursing visit notes due every Monday per agency practice. MR#5: This patient was admitted to the agency on 4/15/22 with diagnoses of cellulitis to several areas and chronic obstructive pulmonary disease. The patient is currently receiving skilled nursing and home health aide services. During record review on 11/30/22, it was noted that the most recent visit note available for review was a skilled nursing visit note dated 11/10/22, which was 20 days ago. The most recent aide visit note was dated 11/7/22, which was 23 days ago. There was no documentation to review regarding the patient's status and the care provided by the aide and the clinical manager (CM-B) for the past 20 days. MR#7: This patient was admitted to home care on 10/14/22 with diagnoses of right femur fracture, anxiety, depression, and fibromyalgia (chronic widespread pain). The patient is currently receiving skilled nursing, home health aide, and physical therapy services. During record review on 11/28/22, it was noted that the most recent visit note available for review was a skilled nursing visit note dated 11/10/22, which was 18 days ago. The most recent aide visit note was dated 11/7/22, which was 21 days ago. There was no documentation to review regarding the patient's status and the care provided by the aide and CM-B for the past 18 days. During an interview on 11/29/22 at 1:00 p.m., CM-B explained that all visit notes from the previous week are due on the following Monday. The agency failed to ensure the clinical record contained skilled nursing and aide visit notes due every Monday per agency practice.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure a transfer summary was sent to the receiving health care facility within 2 business of becoming aware of the transfer for 1 of 2 (MR# 7) records reviewed with transfers to other health care facilities, resulting in a lack of information to ensure continuity of care for this patient. Findings include: MR#7: This patient was admitted to home care on 10/14/22 with diagnoses of right femur fracture, anxiety, depression, and fibromyalgia (chronic widespread pain). During record review on 11/28/22, it was noted that the patient was transferred to the emergency room for nausea & vomiting on 11/2/22. The clinical manager (CM-B) completed the transfer summary and signed the summary on 11/3/22. The transfer summary was fax stamped on 11/14/22 which was 11 days after CM-B was aware of the transfer. The patient was discharged home on 11/5/22 and home health care was resumed on 11/7/22. The following week, the patient was transferred to the hospital on 11/15/22 for nausea & vomiting. CM-B completed the transfer summary and signed the summary on 11/15/22. The transfer summary was fax stamped on 11/21/22 which was 6 days after CM-B was aware of the transfer. There was no evidence the agency sent a transfer summary to the receiving hospital within 2 business days of becoming aware of the transfer to facilitate continuity of care for this patient. The finding was reviewed with and acknowledged by CM-B during an interview on 12/1/22 at 10:30 a.m.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on Record Review and interview, the agency failed to ensure legible documentation was written within the patient's visit notes in 3 of 7 (MR# 2, 3 and 4) records reviewed resulting in the inability to decipher the care provided to the patient. Findings included: MR#2: The Start of Care was dated 4/18/2022. The Plan of Care identified diagnoses of Bilateral Primary Osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), Hypertension (HTN), Atrial Fibrillation (A-Fib), Osteoarthritis, and Alzheimer's Disease. Upon review of the record, it was noted that both the Physical Therapist's and Occupational Therapist's handwriting was illegible making it difficult to determine the care that was provided during the patient visits. MR#3: The Start of Care was dated 4/15/2022. The Plan of Care for the period 4/15/2022 to 6/13/2022 identified diagnoses of Bilateral Primary Osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), Abnormalities of Gait and Mobility, Anxiety Disorder, Benign Prostatic Hyperplasia, and Constipation. Upon review of the record, it was noted that the Physical Therapist's handwriting was illegible making it difficult to determine the care that was provided during the patient visits. MR#4: The Start of Care was dated 11/01/2022. The Plan of Care for the period 11/01/22 to12/30/22 identified diagnoses of non-ST elevation (NSTEMI), pleural effusion, Atrial Fibrillation, Respiratory Failure with hypoxia, Hypertension, and muscle weakness. Upon review of the record, it was noted that the Physical Therapist's and Occupational Therapist's handwriting were illegible, making it difficult to determine the care that was provided during the patient visits. These findings were reviewed and acknowledged by the Clinical Manager (CM-B) during an interview on 12/1/2022 at 2:30 p.m.