Every finding on record at Blue Sky Home Healthcare, Inc

An unannounced Complaint survey, #2023011403, was conducted on 08/14/2023 at Blue Sky Home Healthcare, Inc., Home Health Agency. provider. The provider is not in compliance with 42 Code Of Federal Regulations (CFR) Part 484, Subpart A-C, Conditions of Participation for Home Health Agencies.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on review of the HHA (Home Health Agency)'s Policies, record review and interview, the HHA failed to follow the physician's orders and coordinate care and services for 2 of 3 sampled patients (Patient #1 and #2). The findings included: 1) Review of the HHA's Policy provided by the Administrator titled, “2.21 Physician’s Plan of Treatment” undated policy document reveals, “…any changes in the physician’s plan of treatment shall be made in writing and signed and dated by the physician…” Review of the HHA's Policy provided by the Administrator titled, “2.36 Coordination of Services” undated policy documents reveals, “…purpose to coordinate services in order to provide comprehensive home care, and assure continuity of care…the agency coordinates care by: ensuring communication with all physicians involved in the plan of care…coordinating care delivery to meet the patient’s needs, and involve the patient…the primary functions of the agency are to: be responsible for the professional coordination of these services under the direction of the patient/client’s physician…the staff professional nurse is responsible for the following: the professional coordination of all home care services. Ensuring that the established plan of care is carried out. The on-going evaluation and assessment of the patient/client’s home care needs. Maintaining channel of communication between/among all active caregivers and documents same on patient/client record…” Review of Patient #1's Physician's orders, dated 07/15/23 for the certification period 07/15/23 to 09/12/23 documents, Home Health Aide visit five (5) times a week for five (5) weeks then three (3) times a week for one (1) week and Physical Therapy visits one (1) for one week then two (2) times per week for six (6) weeks. Review of Patient #1's Home Health Certification And Plan of Care dated 07/15/23 to 09/12/23 documents Physical Therapy visits one (1) for one week then two (2) times per week for six (6) weeks and Home Health Aide visit five (5) times a week for five (5) weeks then three (3) times a week for one (1) week. Review of Patient #1's “Communication-Initial Case Conference,” sent to the physician, dated 07/15/23 documents, “…needs aide services for personal care and ADL’s (Activities of Daily Living)…needs Aide service 5 times a week to assist with personal care and ADL’s following the Aide Care Plan…”Review of Patient #1’s electronic record’s communication lacks written evidence of communication and coordination of care and services among the patient’s physician and the HHA's staff. Further review reveals the patient’s record lacks written evidence that the patient refused care and services. Continued review reveals Patient #1 did not receive any Home Health Aide visits and the record lacked written evidence of any efforts from the HHA to accommodate the patient’s needs for Home Health Aide visits. On 08/14/23 at 11:45 AM, an interview was conducted with the HHA's Office Coordinator (OC) who stated that on 08/10/23 Staff C, Physical Therapist Assistant (PTA) called him to report that Patient #1 was refusing the PTA's visits; the OC was asked if Patient #1’s physician was notified and stated the physician was not notified; the OC stated that he did not see any written documentation regarding a notification to the physician related to the patient refusing or any missed visits; the OC stated that all therapists were supposed to call the (HHA's) office with any issues related to the patients and added that he did not know what happened. On 08/14/23 at 12:18 PM, a joint interview was conducted with the HHA's Administrator and the HHA's Office Coordinator (OC); the Administrator stated that the Physical Therapists were to inform and communicate with the agency if the patient’s visits were not completed as scheduled; the OC stated that according to the Patient #1’s assigned Home Health Aide, the patient called the (HHA's) office related to the Home Health Aide’s visit time; the Administrator stated that she spoke with the Home Health Aide assigned and informed that Patient #1 wanted the Home Health Aide visits in the morning; the Administrator added that the Home Health Aide told the patient that she could not do the visits in the morning and that the patient agreed to have the visit in the afternoon on the next day; the OC stated he only spoke with Patient #1 at the start of care, 07/15/23; explained that the HHA has only two Home Health Aides available in the afternoon and that the patient agreed with afternoon visits; the Administrator stated that the HHA staff were supposed to do a "Missed Visit" report and let the doctor know that Patient #1 was refusing Therapy; the OC stated that Staff D, Director of Nursing (DON) completed Patient #1’s "Start of Care Assessment and recommended Home Health Aide visits five (5) times a week. On 08/14/23 at 12:55 PM, a telephone interview was conducted with Staff C, PTA who stated she was an employee of the HHA; Staff C stated she visited Patient #1 one time only because she did not want more treatments; Staff C stated her last visit was on 07/18/23 at 9:00 AM; Staff C was apprised that there was no "Visit Note" in the patient’s record; Staff C stated she has not written the note but will do it today; Staff C stated the "Note" was to be submitted within 24 hrs. and that she had no excuse for not writing the "Note" timely.; Staff C stated that there were no issues during Patient #1’s first visit; Staff C stated that the following week, on 07/27/23, Patient #1 agreed with her visit in the morning and the patient did not open the door; Staff C stated she called the patient and the patient told her that she did not want to continue with therapy; told her to leave and hung up the telephone; Staff C was asked if Patient #1 had any other disciplines coming to provide services, like a Home Health Aide; Staff C stated she did not know what other services the patient had ordered; Staff C was asked how she was informed or knew of her patients’ care and services ordered by the physician and stated, usually they tell her the patient’s address and the Physical Therapist (PT) tells her to look at the “paperwork;" Staff C was asked if she called the PT or the physician’s office regarding Patient #1 refusing the visit on 07/27/23 and replied she did not call the PT; Staff C stated she let the HHA know and the office takes care of it; Staff C stated she never calls the patient’s physician; Staff C was asked if she called the HHA to inform Patient #1’s refusing the visits and replied that on 07/27/23 she called and the HHA's telephone number, it was not working and she did not call again; Staff C added that she then went on vacation and called the HHA after returning from vacation on 08/10/23. On 08/14/23 at 2:03 PM, a telephone interview was conducted with Staff D, who stated she was the HHA Director of Nursing (DON); Staff D stated she does the patient’s "Start of Care" and "Follow Up" visits; Staff D stated that she also does the Home Health Aide supervisory visits every 15 days; Staff D confirmed that she did Patient #1’s "Start of Care" on 07/15/23 and that the patient had a physician's order for a Home Health Aide five (5) days a week; Staff D stated she completed the Home Health Aide Care Plan for Patient #1 and had not done a supervisory visit; Staff D was apprised that Patient #1 did not get her Home Health Aide visits as ordered and refused the Physical Therapy visits; Staff D stated she called the patient but did not get any answer; Staff D was apprised that Patient #1’s record lacked written evidence of any communication with the patient related to the Home Health Aide "Missed Visits," refusal of the visits or coordinating care with the physician; Staff D stated she did not document her communication with the patient; Staff D stated that if the patient refuses the visit, she will report to the Administrator or the OC; Staff D stated she did not know that Patient #1 refused Physical Therapy. On 08/14/23 at 2:45 PM, during an interview, the HHA's OC was asked to contact the HHA Physical Therapist (PT) and stated that the PT was out of the country and unable to receive calls. On 8/14/23 at 2:50 PM, during an interview, the Administrator stated that Staff E, Home Health Aide was reactivated as an employee to do Patient #1’s visits. On 08/14 /23 at 2:57 pm, a telephone interview was conducted with Staff E, Home Health Aide. Staff E stated she spoke on the telephone with Patient #1’s daughter after the HHA gave her the assignment; Staff E added that the patient’s daughter told her that patient needed morning visits; Staff E stated she never spoke with Patient #1; Staff D stated she never saw Patient #1; added that she called the Administrator and told her that she could not visit the patient, because the patient wanted morning visits and she could not do the visit before 3:30 PM. On 08/14/23 at 3:05 PM, during an interview, the HHA's OC stated that he found out on 08/10/23 that the Home Health Aide did not do Patient #1’s visits; the OC was apprised that Staff C and Staff D were not aware of Patient #1 not getting a Home Health Aide visit. and the OC stated that the patient’s physician was not notified. On 0 8/14/23 at 4:06 PM, a joint interview with the HHA's OC and the Administrator was conducted; the Administrator stated that she was aware of Patient #1 refusing the Home Health Aide coming in the afternoon; the Administrator confirmed that she did not notify the patient’s physician, did not document "Missed Visits" or refusal of the Home Health Aide visit; the Administrator was apprised that the HHA did not document any other efforts to provide Patient #1’s Home Health Aide visits as ordered; the Administrator stated the HHA did not have any other Home Health Aide who could do the visits in the morning as per the patient’s request and the OC stated the HHA had only one Home Health Aide covering the patients Home Health Aide visits. 2) Review of Patient #2's physician's referral, dated 06/15/23, documents the patient lives alone and disciplines requested were Physical Therapy and Home Health Aide. Review of Patient #2's physician's orders, dated 06/16/23 for the certification period of 06/16/23 to 08/14/23 documents Physical Therapy visits one (1) for one week then two (2) times per week for five (5) weeks. Further review reveals the physician's orders sent to the physician by the HHA did not include the Home Health Aide visit frequency as per the physician's referral. Review of Patient #2's Home Health Certification and Plan of Care, dated 06/16/23 to 08/14/23 documents Physical Therapy visits one (1) for one week then two (2) times per week for five (5) and the Plan of Care sent to the physician by the HHA did not include the Home Health Aide visits frequency as per the physician's referral. Review of Patient #2's “Communication-Initial Case Conference,” sent to the physician, dated 06/16/23 did not include the Home Health Aide visits as per the physician's referral. Review of Patient #2’s electronic records communication lacks written evidence of communication and coordination of care and services among the patient’s physician and among the HHA's staff related to the Home Health Aide visit request and the patient’s record lacks written evidence that the patient declined Home Health visits as ordered by the physician. On 08/14/23 at 4:45 PM, a joint interview with the Administrator and the OC was conducted; the OC stated that he reviewed Patient #2’s "Start of Care" documentation related to the patient’s ability to do her Activities of Daily Living and noticed that the patient’s daughter was helping the patient with that; the OC was apprised that Patient #2’s referral was for Physical Therapy as well as Home Health Aide visits; the OC was apprised that the patient's record lacked written documentation related to following the physician's orders for a Home Health Aide, lacked written documentation of Patient #2’s declining the services and lack of written documentation of the physician's notification; the OC acknowledged the findings and added that the HHA has to follow physician's orders.