Every finding on record at Arkansas In-Home Partner-I, LLC

On 5/15/23 at 2:20 PM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 5/18/23 at 2:35 PM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on Clinical Record review and staff interview it was determined the Agency failed to alert the Physician of relevant assessment findings which may have necessitated an alteration in the Plan of Care (POC) in 2 (#16 and #17) of 17 (#1 - #17) Clinical Records reviewed. This failed practice had the potential to affect all current patients on census in that Physicians may be unaware of new assessment findings resulting in missed opportunities for revision of patient goals/interventions and prevention of hospitalizations. 1. A review of Patient #16 clinical record revealed the following: A. Document titled "Home Health Certification and Plan of Care (POC)" dated 2/14/23 through 4/14/23 showed an order for "Skilled Nurse (SN) to obtain body measurements of calves every visit." for "SN to notify Physician of 5cm (centimeter) increase." B. Document titled "vital Sign Report" showed SN documented on 3/2/23 that the left calf circumference was measured at 42 cm and the right calf circumference was measured at 38 cm. On 3/10/23, the SN documented the left calf circumference was at 47 cm (an increase of 5 cm) and the right calf was measured at 47 cm (an increase of 9 cm). C. There was no evidence in the clinical record that the SN notified the Physician of the significant changes in the measurements of the calf circumference for Patient #16. 2. A review of Patient #17 clinical record revealed the following: A. Document titled “Home Health Certification And Plan of Care, dated 2/5/23 through 4/5/23 showed an order for “Skilled Nurse to obtain weights every visit once scale arrives and report a gain of 3 LBS (pounds) in one day, or 5 LBS weekly." B. Review of visits completed by SN dated 02/08/2023, 2/14/2023, 2/21/23, and 3/3/2023 showed no evidence that weights were completed by the SN. Although there was no physicians' order, the SN measured the calf circumference(s) each visit. On 02/08/2023, the SN documented the right calf measured 34.5 cm. On 2/14/23, both calves were measured- the right was 46 cm, the left was 43 cm. This was a significant increase of 11.5 cm from the 2/8/23 and the 2/14/23 SN visits. There was no evidence the SN had contacted the Physician. 3. Agency staff were given an opportunity to provide additional information. With no additional information provided, Agency staff verified the Physician was not contacted for the significant changes in condition for Patients #16 and #17.