Every finding on record at Assess Homecare Solutions, LLC

Extended Substantial Allegation Survey Substantial Allegation 62388 An entrance conference was conducted with administrative staff on 04/20/22 at 3:00 PM, and an exit conference was completed with the administrative staff on 04/28/22 at 3:15 PM. On 04/22/22 at 12:13 PM Administrative staff were informed a determination of Immediate Jeopardy was made under Infection Control. On 04/22/22 it was determined 53.3% of staff were vaccinated against COVID-19 creating a likelihood of serious harm. In addition, the agency did not have a continency plan in place for unvaccinated staff and did not have a process in place for tracking exemptions. An acceptable action plan was received and on 04/28/22 at 9:49 AM, Administrative staff were informed the Immediate Jeopardy under Infection Control was removed. The following deficiencies are based on the Federal Vaccine Mandate QSO 22-09-All Revised review, completed on 04/28/22 at Assess Homecare Solutions 369186. Deficiencies were also issued in regard to allegations contained in substantial allegation 62388 investigated concurrently. Assess Homecare Solutions is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the exit date of this survey.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on record review and interview, the agency failed to ensure drugs, services, and treatments were administered only as ordered by a physician or allowed practitioner. The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' needs would be met. (G580)

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure drugs, services, and treatments were administered only as ordered by a physician or allowed practitioner for 12 of 12 patient records reviewed (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9 #10, #11, and #12). The patient census was 10. Findings include: 1. Review of the medical record for Patient #12 revealed a start of care of 05/20/21 with a primary diagnosis of critical illness polyneuropathy and a secondary diagnosis of chronic respiratory failure. The patient was discharged on 08/16/21. Review of the aide plan of care dated 07/16/21 revealed home health aide services were to be provided Tuesday through Sunday for a total of 58 hours a week. There was no physician ordered plan of care in the patient's record for these services. Further review of the patient's record revealed from 07/19/21 to 07/23/21 there were no timesheets available to determine how many hours of personal care the patient received. From 07/24/21 to 07/30/21 timesheets revealed 31.5 hours of personal care was received. From 07/31/21 to 08/06/21 timesheets revealed 32 hours of personal care was received. From 08/07/21 to 08/13/21 timesheets revealed 21 hours of personal care was received. There were no timesheets for 08/09/21, 08/12/21 or 08/13/21. 2. The medical record for Patient #2 revealed a start of care of 08/06/21 with diagnoses including Bipolar disorder and slight autism. Patient #2 was discharged from the agency on 03/25/22. An All Service Plan for 150 hours of home health aide services was in the patient's record and it was dated 08/14/21 to 08/13/22. There were no physician ordered plan of care in the patient's record for these services. Interview with Staff B on 04/22/22 at 4:41 PM revealed the service plan was for one year and Patient #2 was getting 150 hours a week of aide services. 3. Review of the medical record for Patient #3 revealed a start of care of 06/01/20. Home health aide time sheets from 01/03/22 through 02/27/22 revealed Patient #3 was receiving 25 hours a week for aide services. There was no physician ordered plan of care in the patient's record for these services. 4. Physician ordered plans of care were requested for Patients #1, #4, #5, #6, #7, #8 #9, #10 and #11. Interview with Staff B at 12:00 PM on 04/26/22 revealed he was not sure if those nine patients had physician ordered plans of care and would need to look for them. No additional information was provided as of the exit conference on 04/28/22 at 3:15 PM. This substantiates Substantial Allegation 62388.

Infection prevention and control CFR(s): 484.70 Condition of Participation: Infection prevention and control. The HHA must maintain and document an infection control program which has as its goal the prevention and control of infections and communicable diseases. This CONDITION is not met as evidenced by: Based on review of QSO memo 22-09-ALL Attachment G, review of facility COVID-19 vaccination records, observation, staff interview, and review of the facility policy, the facility failed to ensure 100% of staff were either vaccinated or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC) within 90 days from the effective date of the healthcare worker vaccine mandate, the agency failed to have a contingency plan in their policy for unvaccinated staff to prevent the spread of COVID-19, and the agency failed to develop a process for tracking exemption status. The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' infection control needs would be met. (G687)

COVID-19 Vaccination of Home Health Agency staff CFR(s): 484.70 (d)-(d)(3)(i-x) § 484.70 Condition of Participation: Infection Prevention and Control. (d) Standard: COVID-19 Vaccination of Home Health Agency staff. The home health agency (HHA) must develop and implement policies and procedures to ensure that all staff are fully vaccinated for COVID-19. For purposes of this section, staff are considered fully vaccinated if it has been 2 weeks or more since they completed a primary vaccination series for COVID-19. The completion of a primary vaccination series for COVID-19 is defined here as the administration of a single-dose vaccine, or the administration of all required doses of a multi-dose vaccine. (1) Regardless of clinical responsibility or patient contact, the policies and procedures must apply to the following HHA staff, who provide any care, treatment, or other services for the HHA and/or its patients: (i) HHA employees; (ii) Licensed practitioners; (iii) Students, trainees, and volunteers; and (iv) Individuals who provide care, treatment, or other services for the HHA and/or its patients, under contract or by other arrangement. (2) The policies and procedures of this section do not apply to the following HHA staff: (i) Staff who exclusively provide telehealth or telemedicine services outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section; and (ii) Staff who provide support services for the HHA that are performed exclusively outside of the settings where home health services are directly provided to patients and who do not have any direct contact with patients, families, and caregivers, and other staff specified in paragraph (d)(1) of this section. (3) The policies and procedures must include, at a minimum, the following components: (i) A process for ensuring all staff specified in paragraph (d)(1) of this section (except for those staff who have pending requests for, or who have been granted, exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations) have received, at a minimum, a single-dose COVID-19 vaccine, or the first dose of the primary vaccination series for a multi-dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the HHA and/or its patients; (ii) A process for ensuring that all staff specified in paragraph (d)(1) of this section are fully vaccinated for COVID-19, except for those staff who have been granted exemptions to the vaccination requirements of this section, or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations; (iii) A process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; (iv) A process for tracking and securely documenting the COVID-19 vaccination status of all staff specified in paragraph (d)(1) of this section; (v) A process for tracking and securely documenting the COVID-19 vaccination status of any staff who have obtained any booster doses as recommended by the CDC; (vi) A process by which staff may request an exemption from the staff COVID-19 vaccination requirements based on an applicable Federal law; (vii) A process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements; (viii) A process for ensuring that all documentation, which confirms recognized clinical contraindications to COVID-19 vaccines and which supports staff requests for medical exemptions from vaccination, has been signed and dated by a licensed practitioner, who is not the individual requesting the exemption, and who is acting within their respective scope of practice as defined by, and in accordance with, all applicable State and local laws, and for further ensuring that such documentation contains (A) All information specifying which of the authorized COVID-19 vaccines are clinically contraindicated for the staff member to receive and the recognized clinical reasons for the contraindications; and (B) A statement by the authenticating practitioner recommending that the staff member be exempted from the HHA's COVID-19 vaccination requirements for staff based on the recognized clinical contraindications; (ix) A process for ensuring the tracking and secure documentation of the vaccination status of staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by the CDC, due to clinical precautions and considerations, including, but not limited to, individuals with acute illness secondary to COVID-19, and individuals who received monoclonal antibodies or convalescent plasma for COVID-19 treatment; and (x) Contingency plans for staff who are not fully vaccinated for COVID-19. This STANDARD is not met as evidenced by: Based on review of QSO memo 22-09-ALL Attachment G, review of facility COVID-19 vaccination records, observation, staff interview, and review of the facility policy, the facility failed to ensure 100% of staff were either vaccinated or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC) within 90 days from the effective date of the healthcare worker vaccine mandate, the agency failed to have a contingency plan in their policy for unvaccinated staff to prevent the spread of COVID-19, and the agency failed to develop a process for tracking exemption status. The agency’s percentage of vaccinated staff for COVID-19 was 53.3%. Six of 15 staff members had not been vaccinated (Home Health Aide H, I, J, K, L, and M). This affected ten of ten patients receiving services from the agency (Patient #1, #3, #4, #5, #6 #7 #8, #9, #10 and #11). The agency census was 10. Findings include: Review of QSO memo 22-09-ALL Attachment G, dated 01/14/22, revealed within 90 days of issuance of this memorandum, 100% of staff have received the necessary doses to complete the vaccine series (i.e., one dose of a single-dose vaccine or all doses of a multiple vaccine series) or have been granted a qualifying exemption, or are identified as having a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC). The memo also stated the home health agency (HHA) must develop and implement policies and procedures and the policies and procedures must include, at a minimum, a process for ensuring the implementation of additional precautions, intended to mitigate the transmission and spread of COVID-19, for all staff who are not fully vaccinated for COVID-19; and a process for tracking and securely documenting information provided by those staff who have requested, and for whom the HHA has granted, an exemption from the staff COVID-19 vaccination requirements. Review of the agency policy titled, “Covid-19 Vaccination Mandate Policy,” approved 01/10/22, revealed staff were to have received one dose of the COVID-19 vaccine prior to 02/14/22 and a second dose of the COVID-19 vaccine no later than 03/15/22. The policy also revealed the agency must demonstrate 100% compliance with the vaccination mandate. The policy did not include a contingency plan for unvaccinated staff to prevent the spread of COVID-19, and the agency did not develop a process for tracking exemption status Review of staff vaccination records with Staff B on 04/25/22 at 2:42 PM revealed there were no COVID-19 vaccinations or exemptions on file for the following employees who provided direct patient care: Staff H, I, J, K, L, and M. There were two staff recently hired, Staff E and F, that had only received the first dose of the vaccine and were scheduled to get the second dose of the vaccine on 05/02/22. Interview with Staff B at that time confirmed Staff H, I, J, K, L, and M had not received the COVID-19 vaccination nor did they have an exemption on file. Staff B also stated that some refused for personal reasons. The agency identified Patient #1, #3, #4, #5, #6 #7 #8, #9, #10 and #11 as receiving care from the six unvaccinated staff members. Three home health aides (H, I, and K) refused the vaccine because they had COVID-19 at the end of 2021 and felt they may have antibodies to be able to refuse the vaccine. Three home health aides (J, L, and M) refused and there was no exemption on file. Two additional home health aides, Staff E and F, were newly hired and had their first dose of the vaccine on 03/29/22 with the second dose due on 04/26/22. Interview with Staff B on 04/28/22 at 1:33 PM revealed Staff E and F were in medication administration training and would not be getting the second dose of the COVID-19 vaccine until 05/02/22. Observation was made of Staff E, one of the newly hired staff, during a home visit for Patient #1 on 04/25/22 at 10:30 AM. Staff E was sitting at the same table with Patient #1, approximately three feet apart from each other. Staff E did not have her face mask on. Staff E revealed the agency did not tell her she had to wear a face mask but she would if she needed to. Staff E also revealed because she had her first dose of the COVID-19 vaccine she did not think she had to wear a face mask.