Every finding on record at At Home Care Personal Home Services LLC

An unannounced Home Health Medicare/Medicaid complaint investigation # VA00051558 was conducted at the above noted agency on May 3-6, 2021 by a Medical Facilities Inspector from the Virginia Department of Health, Office of Licensure and Certification. Due to the Covid-19 pandemic, survey activities were conducted both onsite and interviews were conducted offsite by telephone. The complaint was substantiated with deficient practice cited. The agency was found to be out of compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies.

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 a review of clinical records and interviews it was determined the agency failed to send the patient's transfer summary to the referral agency within 2 business days of becoming aware of the transfer for one (1) of three (3) patients in the survey sample who were transferred to another agency (patient #4). The findings were: A review of the clinical record for patient #4 revealed a discharge date of 2/08/2021. The plan of care was for personal care services only for eight (8) hours per day, Monday through Friday. A nurse's note dated 2/19/2021 at 10 am titled Discharge summary revealed the care coordinator (from an insurance company) called stating the need for the patient's discharge paperwork. The note further revealed the patient's family had requested the patient be transferred to another agency. The home care nurse documented not being aware of the transfer and explained to the care coordinator the other agency just needed to call and request the information. A second note dated 3/15/2021 at 11:30 am by the same nurse; also titled discharge summary stated no new agency called for the discharge paperwork, explained to care coordinator the patient was discharged from service. The record failed to contain any information related to conversations with the family regarding the transfer of paperwork. A copy of a letter sent to the patient's family was in the record. The letter was dated 2/02/2021 and was signed by the executive director. The letter was a request for fees related to the family leaving the agency and taking the aide from the agency with them. In summary, the letter stated the family signed an agreement upon admission that they would not solicit the agency's employee that was assigned to their case and in doing so, they violated company policy and owed the agency $500.00. A review of the document in question revealed the following statement on what the home health aide is not allowed to do: Work privately for the client or any family member for any reason without prior authorization and in writing from the agency. No additional signed agreement(s) related to the hiring of aides was found in the record. The aide was not hired privately to work for the patient/client. (See interviews) An interview with the Director of Nursing (DON) and Executive Director was conducted on May 3, 2021 at 12:30 PM. The DON stated they did not know the family had switched agencies until they received the call from the care coordinator at the insurance company. The DON reports explaining the normal process to the care coordinator where the referral agency contacts them for information and it is then sent. The DON stated somehow the agency got what they needed because they were able to open the case and the patient is now on their service. It was not until after receiving the call from insurance person, that they realized the regular aide had not been clocking in or out for the past week or so. When the aide was contacted, the aide stated the family had reported aides make more money at the new company and that was why the decision was made to switch agencies with the patient. The aide failed to notify them of any intent to terminate employment however; services were being provided by the aide under the supervision of the new agency. The aide is still listed as an employee because they have not gotten an official notice of resignation. The Director of Nursing reports attempting to call and speak with the patient's parent regarding the reason for the transfer and the parent hung up the phone and would not talk to the DON. The DON and Executive Director acknowledged not sending the transfer or discharge summary as they were not aware of the transfer until after the fact and did not know what agency the patient went to for services. A phone interview with the complainant on 5/05/2021 at 9:15 AM revealed the patient was being serviced by another agency and agency #1 failed to provide the required documents needed so they were obtained "by other means". The complainant reports several attempts to obtain the documents from agency #1 were unsuccessful and that agency #2 tried to get them as well but was unsuccessful. According to the complainant, the aide was not satisfied with the employer and was switching agencies so they moved the patient to the agency where the aide was going to be working. A phone interview with agency #2 was conducted on 5/05/2021 at 10:15 AM. A nurse with the agency advised they had called and faxed a request for the patient's information from agency #1 with no response. The insurance company gave them the authorization since they could not get it from agency #1. The patient was opened to their care/service on 2/09/2021. The nurse also reported the aide had not been newly hired but had worked for their agency since October on an as needed basis. A phone interview with the DON of agency #1 was conducted on 5/06/2021 at 10:45 AM. The DON reported that the letter sent to the family by the Executive Director related to the fee for soliciting the aide was misdated and should have been 2/12/2021 rather than 2/02/2021. The DON reiterated the letter could not have gone out on 2/02/2021, as they did not know the patient had switched agencies at that time and were not notified until the care coordinator contacted them. The DON further stated they could not send paperwork to the referral agency as they did not know which agency was caring for the patient. The DON requested I call the care coordinator with the insurance company to verify the information. A phone interview with the patient's care coordinator was conducted on 5/06/2021 at 11 AM. The care coordinator explained that a call was made to the agency on 2/12/2021 to request the discharge paperwork needed for the patient to transfer to another agency. The care coordinator reports calling three times total and not getting the paperwork and as a result was able to get approval from the his/her supervisor to create the necessary documents to have the patient transferred. The care coordinator could not remember if the agency was given the name of the referral agency. The findings were reviewed with the DON during the exit conference conducted by phone on 5/06/2021 at 12:18 PM.