Every finding on record at Caring Choice Network, Inc

A Medicare approved Emergency Preparedness survey was conducted by the Michigan Department of Licensing and Regulatory Affairs (MDLARA) from 1/28/25 through 1/31/25 at: Caring Choice Network 23800 W. 10 Mile Rd. suite 155 Southfield, MI 48033 The home health agency had no additional locations at the time of the survey. For this survey 2 home visits (only 2 visits were available) with record reviews, 3 active records without a home visit and 2 discharged records were reviewed. At the conclusion of the survey the home health agency was found to be out of compliance for the conditions of participation at: 42 CFR Part 484.22, Emergency Preparedness.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.542(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, REHs at §485.542, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on document review and interview, it was determined the home health agency, failed to provide initial training in Emergency Preparedness policies and procedures to all new and existing staff, including contract employees and volunteers, and failed to maintain documentation of training, resulting in the potential for inappropriate, unprepared responses to emergencies and interruption in the provision of needed patient care and services. Findings include: On 1/31/25 at 11:00 a.m., the office manager (OM#1) was asked to provide evidence of initial training for all staff employed by the clinic yet was unable to do so. There was no indication that initial Emergency Preparedness training had been provided to all staff as required, and no staff attendance sheet was available. The home health agency failed to provide initial training in Emergency Preparedness policies and procedures to all new and existing staff, including contract employees and volunteers, and failed to maintain documentation of training. During an interview on 1/31/25 at 2:00 p.m., the Office Manager (OM#1) acknowledged the above findings.

A Medicare approved recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs (MDLARA) from 1/28/25 through 1/31/25 at: Caring Choice Network 23800 W. 10 Mile Rd. suite 155 Southfield, MI 48033 For this survey 2 home visits (only 2 visits were available) with record reviews, 3 active records without a home visit and 2 discharged records were reviewed. At the conclusion of the survey the home health agency was found to be out of compliance for the conditions of participation for home health agencies at: 42 CFR Part 484.

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, it was determined the agency failed to ensure the plan of care included all safety measures to prevent injury in 5 of 7 records (P-1, 3, 4, 5, 6) from a total of 7 records reviewed. Findings include: P-1: The SOC was dated 1/24/25, with diagnoses of surgical aftercare, diabetes, and hypertension. During review of the record on 1/28/25, it was documented that the Plan of Care (POC) showed the patient had diabetes with no diabetic precautions documented on the POC. P-3: The SOC was dated 12/14/24, with diagnoses of surgical aftercare, hip replacement, and hypertension. During review of the record on 1/28/25, it was documented that the Plan of Care (POC) showed the patient was on Clopidogrel (An antiplatelet/anticoagulant) with no antiplatelet/anticoagulant precautions documented on the POC. P-4: The SOC was dated 12/13/24, with diagnoses of surgical aftercare, diabetes, and hypertension. During review of the record on 1/29/25, it was documented that the Plan of Care (POC) showed the patient had diabetes with no diabetic precautions documented on the POC. P-5: The SOC was dated 1/17/25, with diagnoses of surgical aftercare, diabetes, and hypertension. During review of the record on 1/30/25, it was documented that the Plan of Care (POC) showed the patient had diabetes with no diabetic precautions documented on the POC. P-6: The SOC was dated 12/23/24, with diagnoses of congestive heart failure, and diabetes. During review of the record on 1/30/25, it was documented that the Plan of Care (POC) showed the patient had diabetes with no diabetic precautions documented on the POC. During an interview on 1/31/25 at 2:00 p.m., the Office Manager (OM#1) acknowledged the above findings.

On 2/14/22 through 2/17/22, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Caring Choice Network. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 2/14/22 through 2/17/22 at: Caring Choice Network 23800 W 10 Mile Rd., Suite 155 Southfield, MI 48033 This agency has no branch sites. Records Reviewed: 3 records with home visits; 4 records without home visits, for a total of 7 records reviewed. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the conditions of participation for home health agencies at: 42 CFR Part 484.

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on document review and interview, the agency failed to ensure the comprehensive assessment accurately reflected the patient's current health status for 2 of 7 (MR's #1 and 3) records reviewed, resulting in incomplete clinical information to aid in determining the needs of this patient and for measuring the patient's progress toward goals/outcomes. Findings include: MR#1: The Start of Care (SOC) was dated 2/2/22. The Plan of Care (POC) identified diagnosis of Post Right Total Knee Arthroplasty. During record review on 2/17/22, it was noted that the referral dated 2/1/22 documented a “Past Medical History Diagnosis” of Diabetes Mellitus type 2. The comprehensive assessment dated 2/2/22 under the “Endocrine/Diabetes Management” section was blank with a check mark under “No Problems identified.” The agency failed to accurately assess the patients Diabetes Management. MR#3: The Start of Care (SOC) was dated 11/22/21. The Plan of Care (POC) identified diagnosis of Post Left Total Knee Arthroplasty. During record review on 2/17/22, it was noted that the referral dated 11/19/21 documented a “Past Medical History Diagnosis” of Diabetes Mellitus type 2. The comprehensive assessment dated 11/22/21 under the “Endocrine/Diabetes Management” section was blank with a check mark under “No Problems identified.” The agency failed to accurately assess the patients Diabetes Management. The Adm#1 was questioned on 2/17/22 at 12:15 pm and confirmed the findings stating, "Yes, the comprehensive assessment was not completed accurately."

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to ensure the comprehensive assessment included a review of all medications to determine any adverse effects; failed to document the findings of the drug regime review as required in 7 of 7 sampled records reviewed (MR's #1, 2, 3, 4, 5, 6 and 7), resulting in the potential for harmful medication effects for all patients serviced by this Agency. Findings include: MR#1: The Start of Care (SOC) was dated 2/2/22. The Plan of Care (POC) identified diagnosis of Post Right Total Knee Arthroplasty. During record review on 2/14/22, section M2001 of the "Comprehensive Assessment" dated 2/22/22, completed by the Registered Nurse (RN), documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#2: The Start of Care (SOC) was dated 2/8/22. The Plan of Care (POC) identified diagnosis of Post Left Total Hip Arthroplasty. During record review on 2/14/22, section M2001 of the "Comprehensive Assessment" dated 2/8/22, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#3: The Start of Care (SOC) was dated 11/22/21. The Plan of Care (POC) identified diagnosis of Post Left Total Knee Arthroplasty. During record review on 2/14/22, section M2001 of the "Comprehensive Assessment" dated 11/22/21, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#4: The Start of Care (SOC) was dated 12/24/21. The Plan of Care (POC) identified diagnosis of Right Total Knee Arthroplasty. During record review on 2/15/22, section M2001 of the "Comprehensive Assessment" dated 12/24/21, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#5: The Start of Care (SOC) was dated 2/10/22. The Plan of Care (POC) identified diagnosis of Right Uni-compartmental Knee Arthroplasty. During record review on 2/15/22, section M2001 of the "Comprehensive Assessment" dated 2/10/22, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#6: The Start of Care (SOC) was dated 2/4/22. The Plan of Care (POC) identified diagnosis of Post Right Total Hip Arthroplasty. During record review on 2/16/22, section M2001 of the "Comprehensive Assessment" dated 2/4/22, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#7: The Start of Care (SOC) was dated 2/9/22. The Plan of Care (POC) identified diagnosis of Post Right Total Knee Arthroplasty. During record review on 2/17/22, section M2001 of the "Comprehensive Assessment" dated 2/9/22, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. The Adm#1 was questioned on 2/17/22 at 12:20 pm and confirmed the findings stating, "Yes, the medication review was not completed accurately."

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure a discharge summary was complete, that provided the patient's current health status at the time of discharge, progress toward goals, and forwarded to the physician within 5 days of discharge in 2 (MR# 3 and 4), of 2 closed records, from a total of 7 records reviewed, resulting in the potential for unidentified continuing health care concerns and unmet care needs. Findings include: MR#3: The Start of Care (SOC) was dated 11/22/21. The Plan of Care (POC) identified diagnosis of Post Left Total Knee Arthroplasty. The Physical Therapist (PT) completed a discharge OASIS on 12/3/21. During record review on 2/14/22, it was noted that there was no documented evidence a discharge summary was sent to the physician within 5 business days of the patient's discharge. MR#4: The Start of Care (SOC) was dated 12/24/21. The Plan of Care (POC) identified diagnosis of Right Total Knee Arthroplasty. The PT completed a discharge OASIS on 1/6/22. During record review on 2/15/22, it was noted that there was no documented evidence a discharge summary was sent to the physician within 5 business days of the patient's discharge. The Adm#1 was questioned on 2/17/22 at 12:35 pm and confirmed the findings stating, "I cannot say for sure if they were sent out within the 5 business days."