Every finding on record at Capital Healthcare Solutions, Inc.

Based on the findings of an unannounced onsite Medicare Re-Certification survey completed on January 15, 2021, Harmony Home Healthcare, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Condition of Participation: Home Health Agencies- Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare Re-Certification survey completed on January 15, 2021, Harmony Home Healthcare, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CR), and staff (EMP) interview, the agency failed to arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities for one (1) of one (1) CR reviewed. (CR3) Findings included: Review of agency Policy on January 15, 2021 at approximately 11:30AM revealed; "interruption in services/Missed Visit Policy Number C:36...PLAN TO AVOID INTERRUPTION IN SERVICE DELIVERY...The Agency will have additional direct care staff and supervisory staff to utilize to provide ordered services...PROCEDURE...The Shift Supervisor or Clinical Manager...will coordinate a replacement for the worker and be in contact with the patient/consumer regarding the replacement plan. MISSED VISITS...When an interruption occurs due to a missed visit, the following procedure should be followed: Complete a missed visit form, including why the visit did not occur per the Plan of Care (POC)...The agency must notify the responsible physician of the missed visit...Document all..." Review of agency CR's on January 14, 2021 between approximately 10:30AM and 2:00pm revealed: CR3, SOS 8/10/2020, period reviewed 10/9/2020-12/7/2020, POC revealed patient to receive 56 hours of services from 10/9/2020-10/17/2020 and 32 hours a week for the remainder of the certification period. CR contained evidence of missed visits documented on 11/19/2020, 11/20/2020, 11/21/2020, 11/24/2020, and 11/25/2020 for nurse call off. CR contained evidence of missed visits documented 12/2/2020, 12/3/2020, 12//2020, and 12/5/2020 due to not having a nurse available. No evidence that services were attempted to be covered by other nurses. No documentation of notification to doctor regarding inability to service patient. No documentation of communication with caregiver. No documentation available as evidence that agency provided care on available alternate days. No services provided 11/15-18, 11/22, 23, 26-28, 11/29-12/7. Patient was without services from agency 11/15/2020-12/7/2020 at which time a discharge was documented, no visit conducted. In an interview with on January 14, 2021 at approximately 2:00pm EMP 1 revealed that "agency was unable to staff patient, caregiver found another agency and patient was discharged." Confirms no evidence of attempts to cover, communication with physician or caregiver, or attempts to assist caregiver in finding other appropriate care for patient. Exit interview on January 15, 2021 at approximately 12:00pm with Clinical Director, RN Care Manager, Vice President, Director, and Educator confirmed 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 refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on review of agency policy, clinical records (CR), and staff (EMP) interviews, it was determined that the agency failed to notify physician of missed visits for five (5) of seven (7) clinical records reviewed. (CR 2, 3, 5, 6 & 7), failed to provide hours of sevices as ordered in the Plan of Care (POC) for four (4) of seven (7) CRs reviewed (CR 2, 3, 6, & 7) Findings included: Review of agency Policy on January 15, 2021 at approximately 11:30am revealed; "interruption in services/Missed Visit Policy Number C:36...PLAN TO AVOID INTERRUPTION IN SERVICE DELIVERY...The Agency will have additional direct care staff and supervisory staff to utilize to provide ordered services...PROCEDURE...The Shift Supervisor or Clinical Manager...will coordinate a replacement for the worker and be in contact with the patient/consumer regarding the replacement plan. MISSED VISITS...When an interruption occurs due to a missed visit, the following procedure should be followed: Complete a missed visit form, including why the visit did not occur per the Plan of Care (POC)...The agency must notify the responsible physician of the missed visit...Document all..." Review of agency Policy on January 15, 2021 at approximately 11:30am revealed; "Continuity of Care: Patients/Consumers Needs Met. Policy Number C:11...PROCEDURE: ...Patient/Consumers will be accepted for care based on the availability and suitability of our Agency's personnel to provide the required serrvices and the reasonable expectation that the patient/consumers medical, nursing, rehabilitative, and social needs can be adequately met in the patient/consumer's place of residence..." Review of agency CR's on January 14, 2021 between approximately 10:30am and 2:00pm revealed: CR2, start of services (SOS) 8/6/2020, period reviewed 12/4/2020-2/1/2021, CR failed to contain evidence of doctor notification of missed visits documented on 12/22/2020, 12/24/2020, 12/25/2020, 12/31/2020, 1/1/2021, and 1/4/2021. Plan of Care (POC) revealed patient to receive 69 hours of care each week. Visit documentation revealed 47 hours provided 12/6-12/12, 28 hours provided 12/13-12/18, 10 hours provided 12/20-12/25, 16 hours provided 12/27-1/1/2021, and 20 hours provided 1/3-1/8. CR3, SOS 8/10/2020, period reviewed 10/9/2020-12/7/2020, CR failed to contain evidence of doctor notification of missed visits documented on 11/19, 2020, 11/20/2020, 11/21/2020, 11/24/2020, 11/25/2020, 12/2/2020, 12/3/2020, 12//2020, and 12/5/2020. POC revealed patient to receive 56 hours of services from 10/9/2020-10/17/2020 and 32 hours a week for the remainder of the certification period. Visit documentation revealed 39 hours of services provided to patient from 10/9/2020-10/17/2020. 19.75 hours provided 10/18-10/24, 23.25 hours provided 11/1-11/7, and zero hours provided weeks of 11/8-11/14, 11/15-11/21, 11/22-11/28, and 11/29-12/5. CR5, SOS 3/4/2020, period reviewed 12/29/2020-2/26/2021, CR failed to contain evidence of doctor notification of missed visits documented on 1/1/2021. CR6, SOS 7/7/2020, period reviewed 11/4/2020-1/2/2021, CR failed to contain evidence of doctor notification of missed visits documented on 11/26/1010, 11/27/2020, and 12/2/2020. POC revealed patient to receive 60 hours of services each week. Visit documentation revealed 23.5 hours provided 11/8-11/14, 22.25 hours provided 11/15-11/2-, 13 hours provided 11/22-11/27, 7.5 hours provided11/29-12/4, 24 hours provided 12/6-12/11, and 21 hours provided 12/13-12/18. CR7, SOS7/3/19, period reviewed 12/24/2020-2/22/2021. CR failed to contain evidence of doctor notification of missed visits documented on 12/25/2020 and 1/1/2021. POC revealed patient to receive 10.5-11.5 hours of services/4 days a week and 10 hours of services/3 nights a week. Visit documentation revealed 12/24/20 day shift to be 7.5 hours starting at 7:00am and ending at 2:20pm. 3-day shifts provided week of 12/27/2020-1/2/2021. 1-night shift provided week of 1/3/2021-1/9/2021. Exit interview on January 15, 2021 at approximately 12:00pm with Clinical Director, RN Care Manager, Vice President, Director, and Educator confirmed findings. Repeat Deficiency: Previously cited 4/4/18