Every finding on record at Care Central VNA & Hospice Inc

An Emergency Preparedness survey was conducted at GVNA Healthcare, Inc. from 12/14/21 through 12/16/21 for compliance with § 484.22 Emergency Preparedness for Home Health Agencies (HHA's) and the following deficiencies were cited:

HHA- Procedures for Follow up Staff/Pts. CFR(s): 484.102(b)(3) §484.102(b)(3) Condition of Participation: [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. At a minimum, the policies and procedures must address the following:] (3) The procedures to follow up with on-duty staff and patients to determine services that are needed, in the event that there is an interruption in services during or due to an emergency. The HHA must inform State and local officials of any on-duty staff or patients that they are unable to contact. This STANDARD is not met as evidenced by: Based on document review and interview, the agency failed to ensure the Emergency Preparedness (EP) plan included procedures to inform State and local officials of any on-duty staff or patients that they are unable to contact. Findings include: Review of the agency's EP plan indicated it did not include any procedures to inform State and local officials of any on-duty staff or patients that the agency were unable to contact. During an interview on 12/16/21 at 9:10 A.M., the Compliance Officer said, after reviewing the EP plan with the surveyor, that it did not include procedures for informing officials of any staff or patients that the agency were unable to contact during an emergency.

Policies/Procedures-Volunteers and Staffing CFR(s): 484.102(b)(5) §403.748(b)(6), §416.54(b)(5), §418.113(b)(4), §441.184(b)(6), §460.84(b)(7), §482.15(b)(6), §483.73(b)(6), §483.475(b)(6), §484.102(b)(5), §485.68(b)(4), §485.625(b)(6), §485.727(b)(4), §485.920(b)(5), §491.12(b)(4), §494.62(b)(5). [(b) Policies and procedures. The [facilities] must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years [annually for LTC facilities]. At a minimum, the policies and procedures must address the following:] (6) [or (4), (5), or (7) as noted above] The use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency. *[For RNHCIs at §403.748(b):] Policies and procedures. (6) The use of volunteers in an emergency and other emergency staffing strategies to address surge needs during an emergency. *[For Hospice at §418.113(b):] Policies and procedures. (4) The use of hospice employees in an emergency and other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency. This STANDARD is not met as evidenced by: Based on document review and interview, the agency failed to ensure the Emergency Preparedness (EP) plan included policies and procedures for the use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency. Findings include: Review of the agency's EP plan indicated it did not include any policies or procedures for the use of volunteers during an emergency. During an interview on 12/16/21 at 9:15 A.M., the Compliance Officer said, after reviewing the EP plan with the surveyor, that it did not include procedures for the possible use of volunteer during an emergency.

Methods for Sharing Information CFR(s): 484.102(c)(4)-(5) §403.748(c)(4)-(6), §416.54(c)(4)-(6), §418.113(c)(4)-(6), §441.184(c)(4)-(6), §460.84(c)(4)-(6), §441.184(c)(4)-(6), §460.84(c)(4)-(6), §482.15(c)(4)-(6), §483.73(c)(4)-(6), §483.475(c)(4)-(6), §484.102(c)(4)-(5), §485.68(c)(4), §485.625(c)(4)-(6), §485.727(c)(4), §485.920(c)(4)-(6), §491.12(c)(4), §494.62(c)(4)-(6). [(c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (4) A method for sharing information and medical documentation for patients under the [facility's] care, as necessary, with other health providers to maintain the continuity of care. (5) A means, in the event of an evacuation, to release patient information as permitted under 45 CFR 164.510(b)(1)(ii). [This provision is not required for HHAs under §484.102(c), CORFs under §485.68(c)] (6) [(4) or (5)]A means of providing information about the general condition and location of patients under the [facility's] care as permitted under 45 CFR 164.510(b)(4). *[For RNHCIs at §403.748(c):] (4) A method for sharing information and care documentation for patients under the RNHCI's care, as necessary, with care providers to maintain the continuity of care, based on the written election statement made by the patient or his or her legal representative. *[For RHCs/FQHCs at §491.12(c):] (4) A means of providing information about the general condition and location of patients under the facility's care as permitted under 45 CFR 164.510(b)(4). This STANDARD is not met as evidenced by: Based on policy review and interview, the agency did not ensure a method for sharing information and medical documentation for patients under the agency's care, as necessary, with other healthcare providers to maintain the continuity of care during an emergency. Findings include: Review of the agency's Emergency Preparedness (EP) plan indicated there was not a method to share patient medical documentation for patients under the facility's care with other health providers to maintain the continuity of care, during and emergency. During an interview on 12/16/21 at 9:20 A.M., the Compliance Officer said the EP plan did not include the agency's method of sharing pertinent patient medical information.

A recertification survey was conducted at GVNA Healthcare Inc., from 12/14/21 through 12/16/21, for compliance with the Federal Conditions of Participation Governing Home Health Agency and the following deficiencies were cited:

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to follow the physician's order for one Patient (#9) out of a total sample of ten patients. Findings include: For Patient #9, the agency failed to follow the physician's order for an Occupational Therapist (OT) evaluation. Patient #9 was admitted to the agency in November of 2021. Review of the physician's order, certification period 11/4/21 through 1/2/22, indicated an order, dated 11/14/21, for the OT to evaluate for services and develop a plan of care. Record review indicated the OT did not perform an evaluation as ordered. Review of OT #1's note, dated 12/6/21 (22 days after the order), indicated she called the patient and discussed the need for an evaluation. The patient declined. During and interview on 12/15/21 at 1:21 P.M., the Director of Therapy said there was no documentation to support the reason why the OT did not complete the evaluation.

Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This ELEMENT is not met as evidenced by: Based on policy review, record review and interview, the agency failed to offer and administer the Influenza vaccine during the Influenza season for one Patient (#7) out of a total sample of ten patients. Findings include: During an entrance interview on 12/14/21 at 9:15 A.M., the Clinical Nurse Manager said the agency administered the Influenza vaccine to their patients requiring and/or requesting it. She said the agency had an Influenza Vaccine Policy with procedures for staff to follow when addressing vaccination status and administration of the vaccine. Review of the agency's Administering Influenza Vaccine to Adults policy, dated 9/28/21, indicated the following: -Where allowed by state law, standing orders enable eligible nurses, pharmacists and other healthcare professionals to assess the need for vaccination and to vaccinate adults who meet any of the criteria. -All adults are recommended to receive the Influenza vaccination each year. -People who do not recall whether they received the Influenza vaccine in the current vaccination season should be vaccinated. -Because protecting patients against Influenza is an important element of home care practice, clinicians should: *Ask patients about their Influenza immunization status beginning in September (when vaccine usually becomes available) through March (when Influenza becomes less of a risk). *If the patient has not had an Influenza vaccination during the flu season, the clinician should; encourage the patient to obtain a vaccination, and determine where and how the patient will be vaccinated. Patient #7 was admitted to the agency in November 2021. Review of the clinical record indicated no documentation of the patient's Influenza vaccination status and whether or not staff offered to administer the vaccine, when the patient was admitted to the agency for home care. During an interview on 12/16/21 at 12:10 P.M., Nurse Supervisor #1 said there was no documented evidence that the admitting clinician obtained the patient's Influenza vaccination status and/or offered to administer the vaccine. She said the staff member should have offered the vaccine based on the agency's Influenza vaccine policy.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure ongoing interdisciplinary assessment of one Patient (#7) out of a total sample of ten patients. Findings include: Patient #7 was admitted to the agency in November 2021. Review of the clinical record indicated the patient had been receiving both occupational and physical therapy services since being admitted. Further review of the clinical record indicated the patient received a one time nursing visit upon admission, for a comprehensive evaluation. Review of the clinical record indicated no documented evidence of interdisciplinary team assessments of the patient's care and ongoing services. During an interview on 12/16/21 at 12:10 P.M., the Director of Therapy said there was no documented evidence of interdisciplinary care coordination amongst the entities providing services.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the content of the clinical record included accurate physician orders for physical and occupational services, for one Patient (#7) out of a total sample of ten patients. Findings include: Review of the Physical Therapy (PT) note (evaluation), dated 11/18/21, indicated the following relative to the frequency of visits and expected duration of service: one (1) time (X) a week (WK) x 1 WK , two (2) Xs a WK X 1 WK, three (3) Xs a WK x 1 WK, 2 Xs a WK x four (4) WKs and an anticipated discharge date of 12/30/21. Review of the clinical record indicated the following physician's order, date signed 11/22/21, PT (Effective 11/14/21), 2Every2WK, 3WK1, 2WK4. Review of the Occupational Therapy (OT) note (evaluation), dated 11/29/21, indicated the following relative to the frequency of visits and expected duration of service: 2 Xs a WK x 2 WKs, with reassessment at that time. Review of the clinical record indicated the following physician's order, date signed 11/30/21, OT (Effective 11/28/21), 2EVERY2WK, 2WK1. Review of the clinical record indicated PT and OT services were provided as indicated in the PT and OT evaluations. During an interview on 12/16/21 at 12:45 P.M., the Director of Therapy said the PT and OT physician's order for services were incorrect and should have been documented as indicated in both therapy evaluations.