Every finding on record at Care Solutions, Inc

Recertification survey completed. Standard level deficiencies cited. Abbreviations: W = week D = day # = number SN = Skilled Nurse SOC = Start of care POC/PsOC = Plan/s of Care RN = Registered Nurse Pt./ Pts. = Patient/Patients

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: A. Based on a review of clinical records and staff interview, it was determined the Agency failed to ensure Pts. are advised of the extent of their financial liability for care, and/or services before care is initiated. This was found in 4 of 7 (Pts. #1, 2, 6 and 7) clinical records reviewed. Findings include: 1. The clinical records of the Patients listed below were reviewed on 12/27/22 at 11:00 AM to 12/29/22 at 10:00 AM. The records contained a form titled: “Patient Acknowledgement and Consent” with the section titled: “Insurance Information.” The section lacked documentation indicating the patient's financial responsibility. Pt. #1 SOC: 9/15/22 Pt. #2 SOC: 11/26/22 Pt. #6 SOC: 5/6/22 2. The above findings were confirmed during an interview with the Administrator and Director of Nursing on 12/28/22 at 9:30 AM and 12/29/22 at 10:30 AM. .

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: A. Based on clinical record review and staff interview, it was determined the Agency failed to ensure an RN performed the initial assessment within 48 hours of the Physician referral for Home Health Care services. This was found in 2 of 7 (Pts. #2 and 4) clinical records reviewed. Findings include: 1. Pt. #2. SOC 11/26/22. Principal Diagnosis: Nondisplaced Intertrochanter Fracture Left Femur. The clinical record was reviewed on 12/27/22 at 11:00 AM. The record contained the form titled, "Patient Order" which included, “Type of order: Referred for Admission. Order Date: 11/21/22. Reasons/Notes: Send an RN to admit the patient to (Agency) for skilled assessment and evaluation of all organ systems using the OASIS form.” The record also contained the form titled, "Face to Face Encounter” forms which included documentation of a physician visit dated 11/18/22 and required SN visits. The Initial comprehensive assessment was conducted by the RN on 11/26/22, which was 5 days from the date of the physician order. The record lacked documentation the Agency started care/services within 48 hours of the referral date. 2. Pt. #4. SOC 11/1/22. Principal Diagnosis: Parkinson’s Disease. The clinical record was reviewed on 12/27/22 at 1:00 PM. The record contained the form titled, "Patient Order" which included, “Type of order: Referred for Admission. Order Date: 10/28/22. Reasons/Notes: Send an RN to admit the patient to (Agency) for skilled assessment and evaluation of all organ systems using the OASIS form.” The record also contained the form titled, "Face to Face Encounter” forms which included documentation of a Physician visit dated 10/18/22 and required SN visits. The Initial comprehensive assessment was conducted by the RN on 11/1/22, which was 3 days after the Physician order date. The record lacked documentation the Agency started care/services within 48 hours of the referral date. 3. An interview was conducted with the Administrator and Director of Nursing on 12/28/22 at 9:30 AM. During the interview, the above findings were confirmed.

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 or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: A. Based on a review of clinical records and staff interviews, it was determined the Agency failed to ensure staff provide care and/or service as specified in the POC. This was found in 3 of 7 (Pts. #4, 5 and 7) clinical records reviewed. Findings include: 1. Pt. #4. SOC 11/1/22. Principal Diagnosis: Parkinson’s Disease. The clinical record was reviewed on 12/27/22 at 1:00 PM. The record contained the POC for the certification period of 11/1/22 to 12/30/22 requiring the Home Health Aide to provide service "1W9.” As of 12/27/22, the record lacked a Home Health Aide visit from 12/4/22 to 12/10/22. There was no Physician order modification for Home Health Aide visit frequency documented on the clinical record. 2. Pt. #5. SOC 10/20/22. Principal Diagnosis: Venous Insufficiency. The clinical record was reviewed on 12/27/22 at 2:30 PM. The record contained the POC for the certification period of 10/20/22 to 12/18/22 requiring the Home Health Aide to provide service “1W9”. As of 12/27/22, the record lacked Home Health Aide visits during weeks of 10/30/22 to 11/5/22 and 12/11/22 to 12/17/22. There was no Physician order modification for Home Health Aide visit frequency documented on the clinical record. 3. Pt. #7. SOC 9/9/22. Principal Diagnosis: Urinary Tract Infection. The clinical record was reviewed on 12/29/22 at 10:00 AM. The record contained the POC for certification period of 9/9/22 to 11/7/22 requiring the Physical Therapy to provide service “1D1”. The record contained a Physical therapy evaluation dated 9/13/22 (week 2). There was no Physician order modification for Physical therapy frequency documented on the clinical record. 4. During interviews with the Administrator and Director of Nursing on 12/28/22 at 9:30 AM and on 12/29/22 at 11:30 AM, the above findings were confirmed.

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: A. Based on review of clinical records, review of Agency policy and staff interviews, it was determined the Agency failed to ensure the Agency assessed the need for Pneumococcal Pneumonia and/or Influenza vaccines. This was found in 4 of 7 (Pts. # 2, 4, 6 and 7) clinical records reviewed. Findings include: 1. Pt. #2. SOC 11/26/22. Principal Diagnosis: Nondisplaced Intertrochanter Fracture Left Femur. The clinical record was reviewed on 12/27/22 at 11:00 AM. The record contained a SOC comprehensive assessment completed by the RN on 11/26/22, which included vaccination assessment, but lacked complete information on influenza and pneumonia status of Pt. #2 as required by Agency policy. The record also contained a form “Influenza/Pneumonia Vaccination Consent.” The form “Influenza/Pneumonia Vaccination Consent” for Pt. #2 included: “...I have received influenza and pneumococcal vaccines in the past...” and form requires: “Note: if checked #2, document date and place where vaccinations were administered…” 2. Pt. #4. SOC 11/1/22. Principal Diagnosis: Parkinson’s Disease. The clinical record was reviewed on 12/27/22 at 1:00 PM. The record contained a SOC comprehensive assessment completed by the RN on 11/1/22 which included vaccination assessment but lacked complete information on influenza and pneumonia status of Pt. #4 as required by Agency policy. The record also contained a form “Influenza/Pneumonia Vaccination Consent.” The form “Influenza/Pneumonia Vaccination Consent” for Pt. #4 included: “…I have received influenza and pneumococcal vaccines in the past….” and form requires: “Note: if checked #2, document date and place where vaccinations were administered…” 3. Pt. #6. SOC 5/6/22. Principal Diagnosis: Acute on Chronic Congestive Heart Failure. The clinical record was reviewed on 12/27/22 at 3:30 PM and on 12/29/22 at 9:00 AM. The record contained a SOC comprehensive assessment completed by the RN dated 5/6/22 which included vaccination assessment but lacked complete information. The record also contained a form “Influenza/Pneumonia Vaccination Consent” for Pt. #6 included: “….I have received influenza and pneumococcal vaccines in the past….” and form requires: “Note: if checked #2, document date and place where vaccinations were administered…” Thee records lacked complete information on influenza and pneumonia status of Pt. #6 per Agency policy. 4. Pt. #7. SOC 9/9/22. Principal Diagnosis: Urinary Tract Infection. The clinical record was reviewed on 12/29/22 at 10:00 AM. The record contained a SOC comprehensive assessment completed by the RN dated 9/9/22 which included vaccination assessment but lacked complete information. The record also contained a form “Influenza/Pneumonia Vaccination Consent” for Pt. #7. These records lacked complete information on influenza and pneumonia status of Pt. #7 per Agency policy. 5. The Agency Policy “Influenza and Pneumonia Vaccination” was reviewed on 12/27/22 at 3:45 PM, required: “….The consent will indicate date of offer or referral, patient response; administration….” 6. On 12/27/22 at 9:30 AM, during entrance interview with the Administrator, it was stated the assessment of Influenza and Pneumonia vaccination status are conducted during assessments and recorded in patient’s comprehensive assessments. On 12/28/22 at 9:30 AM and on 12/29/22 at 11:30 AM , during interviews with the Administrator and Director of Nursing, the above findings were confirmed.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: A. Based on a review of clinical records and staff interview, it was determined the Agency failed to ensure the RN conducted Home Health Aide supervisory visits every 14 days. This was found in 2 of 2 (Pt. #4 and 5) clinical records reviewed, wherein the Pt. received Home Health Aide services. Findings include: 1. Pt #4. SOC 11/1/22. Principal Diagnosis: Parkinson’s Disease. The clinical record was reviewed on 12/27/22 at 1:00 PM. The record included the Home Health Aide visit notes for services provided 1 time a week from 11/6/22 through 12/18/22. The record lacked documentation an RN conducted Home Health Aide Supervision from 11/9/22 to 12/18/22. 2. Pt. #5. SOC 10/20/22. Principal Diagnosis: Venous Insufficiency. The clinical record was reviewed on 12/27/22 at 2:30 PM. The record included the Home Health Aide visit notes dated 11/10/22, 11/17/22 and 12/8/22. The record lacked documentation an RN conducted any Home Health Aide Supervision between 11/10/22 to 12/8/22. 3. On 12/28/22 at 9:30 AM and on 12/29/22 at 11:30 AM, during interviews with the Administrator and Director of Nursing, the above findings were confirmed.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: A. Based on a review of clinical records, Agency policy, and staff interview, it was determined the Agency failed to ensure forms were complete and accurate. This was found in 4 of 7 (Pts. #2, 5, 6 and 7) clinical records reviewed. Findings include: 1. Pt. #2. SOC 11/26/22. Principal Diagnosis: Nondisplaced Intertrochanter Fracture Left Femur. The clinical record was reviewed on 12/27/22 at 11:00 AM. The record contained a form, "Patient Acknowledgement and Consents.” The form was signed and dated by the Pt. during SOC but lacked entries for the section titled, “Advance Directive Acknowledgement Statement.” 2. Pt. #5 SOC 10/20/22. Principal Diagnosis: Venous Insufficiency. The clinical record was reviewed on 12/27/22 at 2:30 PM. The record contained a form, “Patient Acknowledgement and Consents.” The form was signed and dated by the Pt. during SOC but lacked entries for the section titled, “Advance Directive Acknowledgement Statement.” 3. Pt. #6. SOC 5/6/22. Principal Diagnosis: Acute on Chronic Congestive Heart Failure. The clinical record was reviewed on 12/27/22 at 3:30 PM and on 12/29/22 at 9:00 AM. The record contained a form, “Patient Acknowledgement and Consents.” The form was signed and dated by the Pt. during SOC but lacked entries for the section titled, “Advance Directive Acknowledgement Statement.” 4. Pt. #7. SOC 9/9/22. Principal Diagnosis: Urinary Tract Infection. The clinical record was reviewed on 12/29/22 at 10:00 AM. The record contained a form, “Patient Acknowledgement and Consents.” The form was signed and dated by the Pt. during SOC but lacked entries for the section titled, “Advance Directive Acknowledgement Statement.” 5. On 12/29/22 at 12:00 PM, review of Agency policy….titled “Advance Directives” included “…the registered nurse conducting the initial assessment will inform patient and/or surrogate verbally and in writing…including information relating to Advance Directives…” 6. On 12/28/22 at 9:30 AM and on 12/29/22 at 11:30 AM, during interviews with the Administrator and Director of Nursing the above findings were confirmed.