Every finding on record at Aspirus VNA Home Health, Inc

A Medicare complaint investigation survey (61101) was conducted by the Michigan Department of Licensing and Regulatory Affairs on 12-1-21 at 1101 N. Elevation St, Hancock , MI 49930. The agency operates one branch office located at: N10504 Grandview Lane #2 Ironwood, MI 49338

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to ensure the initial assessment visit was conducted within 48 hours of referral, return home or on a physician ordered start of care date in 3 of 6 records reviewed out of a total sample of 6 records reviewed (MR #1, #2 and #3). Findings include: **Agnecy Policy "Admission Criteria Policy" ID 9998648, dated 06/2021, stated, "Purpose:... To establish a clear sequence of events for the intake and admission process to insure appropriate services and timely start of care... A Registered Nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient... The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician-ordered start of care date." MR #1: The record contained a home care referral order dated 9-8-21. The initial assessment visit documented by the Registered Nurse was dated 9-22-21. There was no documentation in the record to explain why the patient's initial assessment visit was not provided until 14 days after the patient was referred to the home care agency. There was no evidence the physician was consulted regarding the delay in the start of care for this patient. During an interview on 12-1-21 at 4:15 PM MGR#1 stated, "I don't know why the patient's initial assessment visit was not conducted within 48 hours of the referral. There is nothing in the record to explain this and nothing documented showing the physician was notified of the delay in the start of care." Copies of the documentation referred to in this interview were requested but were not provided by the agency. MR #2: The record contained a home care referral order dated 5-26-21. The initial assessment visit documented by the Registered Nurse was dated 6-2-21. There was no documentation in the record to explain why the patient's initial assessment visit was not provided until 7 days after the patient was referred to the home care agency. There was no evidence the physician was consulted regarding the delay in the start of care for this patient. During an interview on 12-1-21 at 4:30 PM MGR#1 stated, "We have documentation that the patient requested a delay in the start of care until 5-27, then there is a notation that the weekend staff notified the supervisor the patient's admission had to be delayed until next week due to staff availability. There is nothing in the record showing the physician was notified of the delay in the start of care." MR #3: The agency was asked to provide a copy of the patient's referral documents and the initial plan of care. The referral order provided by the agency was dated 11-18-21. The initial assessment visit documented by the Registered Nurse was dated 11-23-21. There was no documentation in the record to explain why the patient's initial assessment visit was not provided until 5 days after the patient was referred to the home care agency. There was no evidence the physician was consulted regarding the delay in the start of care for this patient. During an interview on 12-1-21 at 4:45 PM MGR#1 stated, "We have another referral order for that patient that is dated 11-22. I don't know why we did not give you the 11-22 order when you first asked for the referral. I don't know why we have two different referral dates." There was no evidence the agency admitted the patient within 48 hours of the first referral date of 11-18-21.