Every finding on record at At Home Rehab LLC

Based on the findings of an unannounced onsite Home Health Agency Medicare Re-Recertification Survey conducted October 23, 2023 through October 26, 2023, At Home Rehab LLC was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite Home Health Agency Medicare Re-Certification Survey conducted October 23, 2023 through October 26, 2023, At Home Rehab LLC was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on review of clinical records (CR), and interview with the administrator, the agency failed to notify potential medication interactions to physician for one (1) of ten (10) clinical records (CR # 1). A review of policy No. 3-002.1 “Medication Profile” conducted on 10/26/23 from 11:30 AM and revealed the following: Policy reads, “procedure 3. A drug regimen review will be performed at the time of admission, when updates to the comprehensive assessments are performed, and when care is resumed after a patient has been placed on hold. The review will identify drug/food interactions, potential adverse effects and drug reactions… procedure 7. The medication profile and other relevant data will be available to all clinicians providing care.” A review of clinical records (CR) was conducted on 10/23/23 from approximately 1:00PM until 4:00PM, 10/24/2023 from approximately 11:00 AM until 3:00 PM, and 10/25/2023 from approximately 10:00 AM until 3:00 PM revealed the following: CR#1. Start of Care: 7/1/2023. Certification period reviewed: 8/30/23 – 10/28/23. File contained patient’s medication order dated 8/28/2023. The order includes duloxetine 30 mg capsule delayed release, 1 capsule taken by mouth daily; and rasagiline 1 mg tablet, 1 tablet taken by mouth daily. File contained a client coordination note report dated 9/1/23 states the following: “duloxetine 30 mg capsule, delayed release interacts with rasagiline 1mg tablet. This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. There was no documentation that the physician was notified about the above drug interactions, and there was no verbal order to update or discontinue the order. An interview with the administrator on 10/26/2023 at approximately 12:00 PM confirmed the above findings.

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 a review of clinical records (CR), agency’s policy, and an interview with the administrator, the agency failed to provide the home health services that are written in an individualized plan of care for three (3) of ten (10) clinical records (CR # 2, 4, and 9). A review of policy no. 2-057.1 “Missed Visit” conducted on 10/26/23 at approximately 11:00 AM revealed the following: Policy reads, “missed visits will be communicated to the clinical supervisor and patient’s physician. A missed visit will be rescheduled the same week if possible. Missed visits will be documented in the clinical record.” A review of clinical records (CR) was conducted on 10/23/23 from approximately 1:00PM until 4:00PM, 10/24/2023 from approximately 11:00 AM until 3:00 PM, and 10/25/2023 from approximately 10:00 AM until 3:00 PM revealed the following: CR#2. Start of Care: 9/3/23. Certification period reviewed: 9/3/23 – 11/1/23. File contained Social Worker orders for evaluation. File contained a coordination note from a physical therapist to social worker stating the patient was hospitalized on 9/11/23 and not to bother to evaluate. File did not contain evidence of social worker visit made after the discharge from hospital nor updated order that social worker evaluation is no longer needed. File did not contain missed visit documentation, there was no documentation that the physician was notified about the above missed visits, and there was no verbal order to update or discontinue the order. CR#4. Start of Care: 8/29/2023. Certification period reviewed: 10/2/2023 – 12/1/2023. File contained physical therapist order for one (1) time weekly for one (1) week staring 10/3/23. During the week of 10/3/2023 – 10/7/2023, no visits were conducted. File contained physical therapist order for three (3) time weekly for one (1) week starting 10/8/23. During the week of 10/8/23 – 10/14/2023, only two (2) visits were conducted. File contained occupational therapist order for two (2) times weekly for two (2) weeks starting 10/8/2023. During the week of 10/15/23 – 10/21/2023, only one (1) visit was conducted. File did not contain missed visit documentation, there was no documentation that the physician was notified about the above missed visits, and there was no verbal order to update or discontinue the order. CR#9. Start of Care: 6/27/2023. Certification period reviewed: 6/27/23 – 8/25/2023. File contained physical therapist order for two (2) times weekly for nine (9) weeks. During the week of 6/27/2023 – 7/1/2023, only one (1) visit was conducted. During the week of 7/23/23 – 7/29/2023, only one (1) visit was conducted. File did not contain missed visit documentation, there was no documentation that the physician was notified about the above missed visits, and there was no verbal order to update or discontinue the order. An interview with the administrator on 10/26/2023 at approximately 12:00 PM confirmed the above findings.