Every finding on record at Assurance Home Care Solutions LLC

A recertification survey was conducted on 09/05/2024. The census was 10 Licensed and Certified patients. An exit conference was conducted on 09/10/2024. The agency was in compliance with the Conditions of Participation for Emergency Preparedness for Home Health Agencies.

Recertification survey was conducted on 09/05/2024. The census was 10 Licensed and Certified patients, An exit conference was conducted on 09/10/2024. Abbreviations: BS – Blood Sugar DON – Director of Nurses / Supervising Nurse CMS – Centers for Medicare and Medicaid Services OASIS – Outcome Assessment and Information Set POC- Plan of Care RN- Registered Nurse SN – Skilled nurse Yr- year Q - every LVN – Licensed Vocational Nurse CEO- Chief Executive Officer CFO – Chief Financial Officer OIG – Office of Inspector General QAPI – Quality assurance performance Improvement PIP – Performance Improvement Project FSBS – Finger Stick Blood Sugar

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to transmit OASIS data for each completed OASIS assessment to the CMS system within 30 days of completing the assessment of the beneficiary for 9 of 9 OASIS assessments submitted from 09/01/2023 – 09/01/2024. Failure of the agency to transmit OASIS data within the required time frame prevented the agency’s patient data from being made available to CMS for analysis to evaluate the agency performance levels in the provision of patient care. The surveyor reviewed the OASIS Error Detail Report for the agency in the IQIES portal on 09/05/2024, as part of the preparation for the survey. The report documented 9 late assessments transmitted from 09/01/2023 to 09/01/2024 were submitted more than 30 days after the M0090 (the date of completion of the assessment.) During the entrance conference on 09/05/2024 at 2:45 PM, the surveyor noted the late submissions found during survey preparation and asked for OASIS final validation reports for the last two years. No OASIS Final Validation reports provided by the agency during the survey. Review of QAPI report dated January 24,2023 documented the agency had 3 of 10 late OASIS transmissions for the 6-month auditing period. Review of QAPI report dated July 12, 2023 documented the agency had 13 of 24 late OASIS transmissions for the 6-month auditing period. An interview was conducted with the Administrator on 09/10/2024 at 2:15PM. The surveyor asked who was responsible for OASIS transmission. The Administrator / DON stated she was responsible. The surveyor asked why the OASIS transmissions were past the 30-day requirement. The Administrator / DON stated: “it's a lot of work. “The surveyor shared the findings from QAPI that the poor outcomes had not improved. The surveyor asked the Administrator / DON to describe the agency procedure for OASIS assessment, encoding and uploading. The Administrator / DON stated: “When we have a notice of admission we do (the OASIS) within 5 days. When I don't get all the information I need from the doctor, sometimes honestly, it is past the 5 days, and sometimes I even forget that was the timeline.” The Administrator / DON stated: “I realize I forgot, but I keep track of them and by the time I'm happy with them, the time has passed, and 14 days have passed.” The Administrator / DON stated that she was “sometimes busy with a lot of things” and forgot to transmit the OASIS, and sometimes the agency was “waiting for the doctor because we have a discrepancy with the diagnosis.” Agency policy titled: “8.10 Timelines” revised 01/29/2020 read in part: “The Agency will ensure timely provision of service and services to meet the client's needs in compliance with all federal and state laws and regulations…. Encoding and locking OASIS data for the state will be completed within seven (7) days of completion of the Comprehensive Assessment. Completed, encoded and locked OASIS data will be transmitted within thirty (30) days of the M0090 date.”

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure 2 (Patient 1 and Patient 2) of 2 patients failed to receive the home health services that were written in their individualized plan of care that identifies patient-specific measurable outcomes and goals, and which was established, periodically reviewed, and signed by a physician or allowed practitioner. Patient 1 and 2 had a diagnosis of Diabetes Mellitus 2 (chronic disorder where the body has trouble controlling blood sugar and using it for energy). Patient 1 and 2 had orders on the POC for the skilled nurse to check blood sugar each visit and report findings outside specific parameters to the physician or practitioner that were not done. This failure meant the patients were subjected to potential harm and poor-quality care. Review of Patient 1’s plan of care from 07/17/2024 to 09/14/2024 revealed diagnoses of Diabetes Type 2 and Dementia (A group of thinking and social symptoms that interferes with daily functioning.) The POC documented orders for SN visits weekly to perform FSBS check q visit, instruct patient on disease process of Diabetes, signs and symptoms of hyper/hypoglycemia, management of DMII, diabetic foot care, sick day rules and s/s to report to MD/SN. SN to instruct patient/cg on self-management program to include, disease process, who to contact if signs and symptoms persist or worsen as well as dietary measures, medication management, foot care precautions, blood sugar monitoring, hypo/hyperglycemia management and long-term complications. SN may provide cup of milk, 6 ounces of soda (½ can), ½ cup of orange juice, quick-acting glucose (sugar) product i.e: 3 or 4 glucose tablets or 1 tube of glucose gel if blood sugar level is between [60- 80] mg/dl. Wait 10 to 15 minutes, Re-check blood glucose level. Repeat quick-acting glucose product if blood glucose level is less than [80]mg/dl and contact physician. If greater than [80]mg/dl, administer insulin. Review of visit notes by the DON for Patient 1 dated 07/17/2024 and 07/22/2024 did not include blood sugar results or evidence the blood sugar was checked as ordered. Review of Patient 2’s plan of care from 07/10/2024 to 09/07/2024 revealed a diagnosis of Type 2 Diabetes Mellitus (a long-term condition in which the body has trouble controlling blood sugar and using it for energy). Review of visit notes by the DON for Patient 2 dated 07/10/2024 and 07/17/2024 did not include blood sugar results or evidence the blood sugar was checked as ordered. An interview was conducted with the Administrator / DON on 09/10/2024 2:05 PM. The surveyor reviewed the record review findings and asked if the DON checked Patient 1 and Patient 2s blood sugars during the visits. The DON stated Patient 2 was just diagnosed in April and the patient did not like to be sticked and she did not check her blood sugar on 07/10/2024 and 07/17/2024. The DON stated Patient 1 was in denial and said he wasn’t a diabetic and “I explained his medical history from the Veterans Administration documented he was a diabetic.” The DON stated Patient 1 “refused to be checked.” The DON stated she did not check Patient 1s blood sugar during the visits on 07/10/2024 and 07/17/2024. The surveyor asked if the DON notified the physician to report the lack of following the orders and/ or to request updated orders. The DON stated she did not. Agency policy titled: “5.6 Orders for Care” revised 01/29/2020 read in part: “The Agency will obtain orders and provide care in accordance with physician’s … orders which are established prior to initiating patient care and reviewed / revised the physician … as needed… Each patient/client must receive an individualized POC, including any revisions or additions. The individualized POC must specify the care and services necessary to meet the patient/client needs as identified in the comprehensive assessment…The POC, which includes the following plan of care elements … specific procedures/treatments to be performed…”