Every finding on record at Baby Boomers Home Health Care, LLC

Substantial Allegation Survey Substantial Allegation OH00120186 COVID 19 Focused Infection Control Survey An entrance conference was conducted on 02/22/21 at 10:46 AM with administrative personnel, and an exit conference was completed on 02/25/21 at 3:00 PM with administrative personnel. The following deficiencies are based on the COVID 19 Focused Infection Control Survey and Substantial Allegation Survey completed on 02/25/21.

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 medical record review and staff interview, the agency failed to ensure care was provided as written in the physician ordered plan of care for three of four medical records reviewed (Patients #1, #2, and #4). The agency census was 74. Findings include: 1. Review of the medical record for Patient #1 revealed orders on the physician ordered plans of care dated 09/29/2020 to 11/27/2020 and 11/28/2020 to 01/26/21 for home health aide services 35 hours per week. Review of the medical record revealed the home health aide services were provided twice a day, with three hours provided in the morning and two hours provided in the evening. The medical record lacked documentation of any home health aide services from 11/13/2020 through 11/18/2020. The medical record lacked documentation of the three hour morning home health aide visit on 11/19/2020, 11/20/2020, 11/23/2020, and 11/26/2020 and the medical record lacked documentation of the two hour evening home health aide visit on 11/24/2020 and 11/30/2020 through 12/03/2020. The medical record lacked documentation of physician notification that care was not provided as ordered or the reason these services were not provided. This was verified in an interview on 02/24/21 at 10:38 AM by Staff B. 2. Review of the medical record for Patient #2 revealed an order dated 11/11/2020 for home health aide services four hours per week. Review of the medical record revealed only three hours of home health aide services were provided the week of 12/06/2020. The medical record lacked documentation of physician notification that care was not provided as ordered. This was verified in an interview on 02/24/21 at 10:38 AM by Staff B. 3. Review of the medical record for Patient #4 revealed an order dated 12/22/2020 for home health aide services to increase to five hours per day for a total of 25 hours per week starting on 12/21/2020. Review of the medical record revealed the patient received home health aide services Monday through Friday. The medical record contained documentation of home health aide services four hours per day on 12/21/2020 and 12/22/2020. The medical record lacked documentation of physician notification care was not provided as ordered. This was verified in an interview on 02/24/21 at 10:38 AM by Staff B.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and staff interview, the facility failed to maintain a coordinated agency-wide program for the identification and control of COVID-19 for one of four medical records reviewed (Patient #1). This could affect all patients receiving services from the agency. The agency census was 74. Findings include: Review of the medical record for Patient #1 revealed the patient received home health aide services twice a day, with three hours provided in the morning and two hours provided in the evening. The medical record lacked documentation of any home health aide services from 11/13/2020 through 11/18/2020. The medical record lacked documentation of the three hour morning home health aide visit on 11/19/2020 and 11/20/2020 and the medical record lacked documentation of the two hour evening home health aide visit on 11/24/2020 and 11/30/2020 through 12/03/2020. The medical record lacked documentation of physician notification that care was not provided as ordered or the reason these services were not provided. On 02/24/21 at 10:38 AM, Staff B stated that the morning aide reported an exposure to COVID 19 on the evening of 11/12/2020 after having provided care that morning. Staff B stated that the staff member was instructed to quarantine for 14 days. Patient #1 was contacted, advised of the possible exposure, instructed on what signs and symptoms to watch for, and encouraged to get tested. Patient #1 was also informed that the home health aide services would be put on hold until the patient could be tested. Further interview with Staff B revealed that on 11/19/2020, home health aide services were resumed by the evening aide. On 11/30/2020, the evening aide went to the emergency room and tested positive for COVID 19. The evening aide was instructed to quarantine until cleared to return to work. Staff B verified that the morning aide continued to provide care in the mornings and care was not stopped after the evening aide tested positive. Staff B verified that the medical record for Patient #1 lacked documentation of any possible exposures, notification of need for testing, notification of services being held due to staff quarantining, or physician notification. An email dated 11/13/2020 at 4:42 PM from the Mansfield Branch Office Manager (Staff C) to the case manager was reviewed. This email was not part of the patient's record. The email stated the morning aide notified the agency of a direct exposure to a household member that tested positive for COVID 19. The aide was to quarantine for 14 days. This aide did work on 11/12/2020. The patient was notified of the possible exposure and it was strongly recommended the patient get tested also. The supervisor directed the agency to send no other aides to the patient's home until they had the results of the patient's test. The patient voiced understanding and the agency assisted in getting the physician order for the patient to get tested. On 02/24/21 at 11:30 AM, Staff C was interviewed by phone. Staff C stated he/she spoke to the patient in November about the testing and the patient was having trouble finding a place to get tested for COVID. He/she called the patient's physician and explained the situation. The physician then called the patient and helped arrange the testing. The patient then called later and reported his/her COVID test was negative so his/her services resumed. On 11/30/2020, the evening aide tested positive for COVID and was pulled from care for 14 days. Staff C stated this should all be documented in the patient's medical record and could not speak as to why it was not documented. He/she could not remember if he/she called the patient about the evening aide or not. On 02/25/21 at 9:42 AM, Staff B stated that both instances of staff exposure and staffs' positive tests for COVID should have been handled the same and should have been documented in the patient's medical record. Staff B also stated the in person care for the patient should have also stopped 11/30/2020 until the patient could be tested.