Every finding on record at Buchanan Country Hospice

An unannounced Medicare/Medicaid Home Health recertification survey was conducted at the above noted agency 05/09/2022 to 05/10/2022 by two (2) Medical Facilities Inspectors from the Virginia Department of Health Office of Licensure and Certification. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 the Conditions of Participation: Emergency Preparedness for Home Health Agencies.

An unannounced Medicare/Medicaid Home Health recertification survey was conducted at the above noted agency 05/09/2022 to 05/10/2022 by two (2) Medical Facilities Inspectors from the Virginia Department of Health Office of Licensure and Certification. The agency reported 32 unduplicated admissions during the last 12 months. In conjunction with the survey, the clinical records of seven (7) patients, one (1) personnel file (one (1) new hire since last survey), COVID-19 vaccination requirement, agency admission packet, complaint log, organizational chart, and CLIA (Certified Laboratory Improvement Amendments) waiver were reviewed. Three (3) home visits and multiple staff interviews were conducted. The agency was found not to be in compliance with 42 CFR 484, the Medicare Conditions of Participation for Home Health Agencies. Deficiencies were identified and cited.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record review and staff interview it was determined the Registered Nurse (RN) failed to develop an individualized aide care plan. Specifically, the aide care plan failed to include which tasks specifically must be performed and the specific frequency of these tasks for five (5) of seven (7) clinical records in the survey sample. Five (5) of five (5) clinical records in the survey sample of patient’s receiving home health aide services. Findings: Seven (7) clinical records were reviewed in the agency by two (2) Medical Facilities Inspectors on 05/10/2022 with the following findings: 1. Clinical record #2 was reviewed for the certification period of 04/25/2022 to 6/23/2022. According to patient #2’s plan of care the patient was to receive home health aide services two (2) times per week for nine (9) weeks. Patient #2’'s clinical record contained a document titled "Special Care Hospice and Home Health Home Health Aide Care Plan." The following tasks were included on the aide care plan were assigned with a frequency of "Q [every] visit as requested: shower, shampoo hair, linen change and assist with ambulation. The aide care plan also included the statement, "Provide care based on patient and/or caregiver request". The Registered Nurse (RN) failed to develop an individualized aide care plan that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient/caregiver is cognitively and functionally able to choose and perform each task in which “as requested” was identified. 2. Clinical record #4 was reviewed for the certification period of 03/09/2022 to 05/07/2022. According to patient #4’s plan of care the patient was to receive home health aide services one (1) time a week for one (1) week then two (2) times per week for eight (8) weeks. Patient #4’'s clinical record contained a document titled "Special Care Hospice and Home Health Home Health Aide Care Plan." The following tasks included on the aide care plan were assigned with a frequency of "Q [every] visit as requested: partial/sponge bath, shampoo hair, linen change and assist with ambulation. The aide care plan also included the statement, "Provide care based on patient and/or caregiver request". The Registered Nurse (RN) failed to develop an individualized aide care plan that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient/caregiver is cognitively and functionally able to choose and perform each task in which “as requested” was identified. 3. Clinical record #5 was reviewed for the certification period of 04/29/2022 to 6/27/2022. According to patient #5’s plan of care the patient was to receive home health aide services two (2) times per week for eight (8) weeks effective the week of 05/02/2022. Patient #5’'s clinical record contained a document titled "Special Care Hospice and Home Health Home Health Aide Care Plan." The following task were included on the aide care were assigned with a frequency of "Q [every] visit per req [request] partial/sponge bath, shave, lotion, shampoo hair and linen change. The Registered Nurse (RN) failed to develop an individualized aide care plan that included what tasks were specifically to be performed and the specific frequency of these tasks. The aide care plan also included the statement, "Provide care based on patient and/or caregiver request". The RN also failed to document that the patient/caregiver is cognitively and functionally able to choose and perform each task in which “as requested” was identified. In addition, according to the "Special Care Hospice and Home Health Home Health Aide Care Plan" aide was to perform range of motion and assist with transfer q [every] visit. Aide notes for 05/03/2022 and 05/05/2022 failed to contain documentation transfer and assist with ambulation was performed or an explanation as to why the tasks were not performed as ordered. Also, the above noted aide notes contained documentation the aide assisted with dressing and cleaned area which were not included on the agency's aide care plan. 4. Clinical record #6 was reviewed for the certification period of 03/10/2022 to 05/08/2022. According to patient #6’s plan of care the patient was to receive home health aide services one (1) time a week for one (1) then two (2) times per week for eight (8) weeks. Patient #6’'s clinical record contained a document titled "Special Care Hospice and Home Health Home Health Aide Care Plan. All tasks included on the aide care were assigned with a frequency of "Q [every] visit as requested, bed bath, tub bath, shower, partial/sponge bath, nail care, skin care, mouth care, shave, lotion, shampoo hair, comb hair, prepare snack, assist with elimination, range of motion, assist with transfer, assist with ambulation and other. The aide care plan also included the statement, "Provide care based on patient and/or caregiver request". The Registered Nurse (RN) failed to develop an individualized aide care plan that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient/caregiver is cognitively and functionally able to choose and perform each task in which “as requested” was identified. 5. Clinical record #7 was reviewed for the certification period of 03/15/2022 to 05/13/2022. According to patient #7’s plan of care the patient was to receive home health aide services two (2) times per week for nine (9) weeks. Patient #7’'s clinical record contained a document titled "Special Care Hospice and Home Health Home Health Aide Care Plan. All tasks included on the aide care were assigned with a frequency of "Q [every] visit as requested, bed bath, tub bath, shower, partial/sponge bath, nail care, skin care, mouth care, shave, lotion, shampoo hair, comb hair, prepare snack, assist with elimination, range of motion, assist with transfer, assist with ambulation and other. The aide care plan also included the statement, "Provide care based on patient and/or caregiver request" The Registered Nurse (RN) failed to develop an individualized aide care plan that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient/caregiver is cognitively and functionally able to choose and perform each task in which “as requested” was identified. The above noted findings were acknowledged by the Administrator prior to and during the exit conference conducted in the agency on 05/10/2022.