Every finding on record at Boca Home Care Inc

During the Recertification survey conducted on 09/11/23 through 09/14/23 at Boca Home Care, Inc., a Home Health Agency, Emergency Preparedness was reviewed. Boca Home Care, Inc., is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was commenced on 09/11/23 and concluded on 09/14/23 at Boca Home Care, Inc., Home Health Agency provider. The provider was not in compliance with 42 CFR, Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This ELEMENT is not met as evidenced by: Based on record review and interview the provider failed to include the services to be provided and expected source of payment on the service agreement for 3 (Patients #5, 7, and 11) of 12 active patients. Findings included: 1) Review of Patient #5’s record in the home revealed they started care on 09/08/23. Patient #4’s “Service Agreement/Admission Consent” dated 09/08/23 documents “The initial service(s) and visit frequencies are as follows:” but does not indicate any services to be provided; and includes under “Authorization for Payment” spaces to indicate expected payor source(s) for home care services and any charges but none of these areas are filled in. 2) Review of Patient #7’s record revealed they started care on 08/23/23. Patient #7’s “Service Agreement/Admission Consent” dated 08/23/23 documents “The initial service(s) and visit frequencies are as follows:” and includes a table by which to indicate the services, costs, insurance coverage and private pay responsibilities, as well as an area to document “expected payer source(s) for my home care services are: …”; however, no services, cost information, or expected payment sources are indicated. 2) Review of Patient #11’s record revealed they started care on 07/12/23. Patient #11’s “Service Agreement/Admission Consent” dated 07/12/23 documents “The initial service(s) and visit frequencies are as follows:” and includes a table by which to indicate the services, costs, insurance coverage and private pay responsibilities, as well as an area to document “expected payer source(s) for my home care services are: …”; however, no services, cost information, or expected payment sources are indicated. During interview 09/14/23 at 3:40 PM the Administrator acknowledged the findings.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview the provider failed to request and/or obtain copies of advance directives for 7 (Patients #2, 3, 5, 7, 9, 10, and 11) of 12 active patients. Findings included: 1) Review of Patient #2’s record reveals they started care on 07/02/23. Patient #2’s “Service Agreement/Admission Consent” dated 07/02/23 documents under Advance Directives that Patient #2 had made an Advance Directive, the type “Living Will”, and a name of a Health Care Surrogate; however, does not indicate a copy was requested or received. Review of Patient #2’s EHR (Electronic Health Record) since admission revealed no evidence of copies of Advance Directives. 2) Review of Patient #3’s record reveals they started care on 09/10/22, 01/24/23, and 08/02/23. Review of Patient #3’s “Service Agreement/Admission Consent” dated 09/10/22 documents under Advance Directives that Patient #2 had made an Advance Directive, the type “Living Will”; however, does not indicate a copy was requested or received. Review of Patient #3’s EHR on 09/14/23 for these 3 starts of care revealed no copy of a living will or that a copy was requested. A copy of Patient #3’s living will was requested from the Administrator on 09/14/23 at 1:10 PM but was not provided by 5:40 PM on 09/14/23. 3) Review of Patient #5’s record reveals they started care on 09/08/23. Patient #5’s “Service Agreement/Admission Consent” dated 09/08/23 documents under Advance Directives no indication of whether Patient #5 had made any Advance Directives or of whether copies were requested or received. 4) Patient #7’s record documents they started care on 08/23/23. Review of Patient #7’s “Service Agreement/Admission Consent” dated 08/23/23 reveals no documentation under Advance Directives for whether Patient #7 had made any Advance Directives and review of Patient #7’s EHR revealed no copies of Advance Directives. Review of Patient #7’s Home Health Certification and Plan of Care for the certification period 08/23/23 to 10/21/23 documents under Advance Directives “Advanced Care Plan () Surrogate Decision Maker” and is unclear whether Patient #7 had made any Advance Directives. 5) Review of Patient #9’s record reveals they started care on 08/12/23. Review of Patient #9’s “Service Agreement/Admission Consent” dated 08/12/23 documents under Advance Directives that Patient #9 had made an Advance Directive but does not specify the type, and next to “if applicable the name/phone number of the Health Care Surrogate” documents a first name and relationship; but does not indicate a copy of any Advance Directives were requested or received. Review of Patient #9’s EHR (Electronic Health Record) revealed no evidence of copies of Advance Directives. Review of Patient #9’s Home Health Certification and Plan of Care for the certification period 08/12/23 to 10/10/23 documents under Advance Directives “Advanced Care Plan () Surrogate Decision Maker” and is unclear whether Patient #9 had made any Advance Directives. 6) Review of Patient #10’s record reveals they started care on 08/16/23. Review of Patient #10’s “Service Agreement/Admission Consent” documents under Advance Directives no answer to whether Patient #10 had made an Advance Directive and no indication that a copy was requested or received but an “X” in the box for Health Care Surrogate Designation. Review of Patient #10’s EHR (Electronic Health Record) revealed no evidence of a copy of any Advance Directives. 7) Review of Patient #11’s record reveals they started care on 07/12/23. Review of Patient #11’s “Service Agreement/Admission Consent” dated 07/12/23 documents under Advance Directives no answer to whether Patient #11 had made an Advance Directive and no indication that a copy was requested or received but a checkmark in the box for Living Will. Review of Patient #11’s EHR (Electronic Health Record) revealed no evidence of a copy of any Advance Directives. During interview on 09/14/23 at 1:10 PM the Administrator was asked for copies of Advance Directives or evidence they were requested for Patients #1, 2, and 6. During further interview 09/14/23 at 3:40 PM, the Administrator reported she was unable to find copies of Advance Directives or evidence they were requested for Patients #1, 2, and 6 and stated some staff seem not to read the rest of the directions on the document to request copies.