Every finding on record at Caring Hearts Home Health Services, Inc

Substantial Allegation Survey Substantial Allegation 103647 Post Survey Revisit (PSR) to Substantial Allegation 102485 completed on 12/18/23 An entrance conference was conducted on 02/13/24 at 9:20 AM with administrative personnel, and an exit conference was completed on 02/13/24 at 3:20 PM with administrative personnel. The following deficiency is based upon substantial allegation 103647 and PSR completed on 02/13/24. Caring Hearts Home Health Services, Inc 368052, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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: Based on medical record review, and staff interview, the agency failed to ensure patients received the home health services as written in the plan of care. for one of three medical records reviewed (Patient #1). This could affect all patients receiving services from the agency. The census was 37. Findings include: Review of the medical record for Patient #1 revealed an admission date of 03/07/23. The physician ordered plan of care plan for the certification period dated 01/01/24 to 02/29/24 included orders for home health aide services seven days a week, five to seven hours per visit, not to exceed 42 hours per week. The medical record contained documentation the week of 12/31/23 of four home health aide visits for six hours each and one home health aide visit for three hours, a total of 27 hours. The medical record contained documentation the week of 01/07/24 of one home health aide visit for six hours. The medical record contained documentation the week of 01/14/24 of four home health aide visits for six hours and one home health aide visit for five hours, a total of 29 hours. The medical record contained documentation the week of 01/21/24 of five home health aide visits for six hours, two home health aide visits for four hours, and four home health aide visits for two hours, a total of 46 hours. The medical record contained documentation the week of 01/28/24 of four home health aide visits for six hours, three home health aide visits for four hours, and six home health aide visits for two and a half hours, a total of 51 hours. The medical record lacked documentation of physician notification of care not provided as ordered or additional home health aide orders. The findings were verified in an interview on 02/13/24 at 1:30 PM with Staff B. This deficiency represents non-compliance investigated under Substantial Allegation 103647.

Substantial Allegation Survey Substantial Allegation 102485 An entrance conference was conducted on 12/18/23 at 9:40 AM with administrative personnel, and an exit conference was completed on 12/18/23 at 3:30 PM with administrative personnel. The following deficiencies are based upon substantial allegation 102485 completed on 12/18/23. Caring Hearts Home Health Services, Inc 368052, is not in compliance with the requirements at 42 CFR Part 484 Subpart B, C for Home Health Agencies.

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: Based on medical record review and staff interview, the agency failed to ensure patients received the home health services as written in the plan of care for two of four medical records reviewed (Patient #1 and #4). The agency census was 37. Findings include: 1. Review of the medical record for Patient #1 revealed an admission date of 03/07/23. The plans of care dated 09/03/23 to 11/01/23 and 11/02/23 to 12/31/23 included orders for a skilled nursing visit every 60 days and home health aide services 42 hours per week. Review of the home health aide timesheet for 10/15/23 through 10/21/23 revealed documentation of 42 hours with six hours each of the seven days that week and a line drawn through the dates of service 10/19/23, 10/20/23, and 10/21/23 with Staff C's initials. Staff C added a note that Patient #1 reported that the home health aide was ill on those dates. The home health aide timesheet for 10/29/23 through 11/04/23 noted only 41 hours of home health aide services were provided that week. The medical record lacked documentation of any home health aide services on 11/05/23, with only 36 hours provided that week. The medical record lacked documentation of physician notification of care not provided as ordered. The medical record also contained skilled nursing visits on 10/18/23, 10/20/23, 10/24/23, 10/27/23, 10/30/23, 11/03/23, 11/08/23, and 11/10/23 with no documentation of physician orders for these visits. This was verified in an interview on 12/18/23 at 1:15 PM by Staff B. 2. Review of the medical record for Patient #4 revealed an admission date of 10/26/23. The plan of care dated 10/26/23 to 12/24/23 included orders for home health aide services for 14 hours per week. The medical record lacked documentation of home health aide visits or physician notification that care was not provided. Patient #4 was discharged on 11/27/23. This was verified in an interview on 12/18/23 at 1:15 PM by Staff B. This deficiency represents non-compliance investigated under Substantial Allegation 102485.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to assure communication with all physicians involved in the patient's care for one of four medical records reviewed (Patient #2). The agency census was 37. Findings include: Review of the medical record for Patient #2 revealed consents and admission forms were signed on 11/21/23. The medical record revealed a discharge date of 12/07/23. The intake fax from the insurance company requested 15 hours per week of home health aide services and weekly nursing visits. The physician's signed face to face encounter and start of care orders indicated the patient needed nursing and home health aide services but lacked a frequency. The plan of care was incomplete. The medical record lacked documentation of a comprehensive assessment, nursing visits, home health aide visits, or communication with the physician that services were not provided. This was verified in an interview on 12/18/23 at 1:15 PM by Staff B who stated the agency was not a provider for the patient's insurance. This deficiency represents non-compliance investigated under Substantial Allegation 102485.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure the administrator was responsible for all day to day operations for one of four medical records reviewed (Patient #1). The agency census was 37. Findings include: Review of the medical record for Patient #1 revealed an admission date of 03/07/23. The plans of care dated 09/03/23 to 11/01/23 and 11/02/23 to 12/31/23 included orders for a skilled nursing visit every 60 days and home health aide services 42 hours per week. Review of the home health aide timesheet for 10/15/23 through 10/21/23 revealed documentation of 42 hours with six hours each of the seven days that week and a line drawn through the dates of service 10/19/23, 10/20/23, and 10/21/23 with Staff C's initials. Staff C added a note that Patient #1 reported that the home health aide was ill on those dates. This was verified in an interview on 12/18/23 at 1:15 PM by Staff B. On 12/18/23 at 1:00 PM, Staff C was interviewed. Staff C stated that Staff D was sick and left at 2:00 or 3:00 PM from Patient #1's home and did not return the next day. Staff C crossed those dates out on the timesheet and those hours were not billed. Staff D was pulled from Patient #1's care but she still staffed another case. Staff C stated she spoke to Staff D regarding the need to call the office when she left a patient's home early or did not work a scheduled shift. Staff C stated formal discipline was not done with Staff D. Review of the undated procedure titled, "Documentation of Service Delivery - Home Health Aide," revealed falsification of the home health aide timesheet is a "violation of company policy, a violation of the Ohio Code of Conduct, and an illegal federal offense under the HIPPA guidelines". Falsification of the home health aide timesheet will result in corrective action, up to and including termination of employment. This deficiency represents non-compliance investigated under Substantial Allegation 102485.

Substantial Allegation Survey Substantial Allegation 71820 An entrance conference was conducted with administrative staff on 10/04/22, and an exit conference was conducted with administrative staff on 10/04/22. The following deficiency is issued as a result of the substantial allegation survey completed on 10/04/22. Caring Hearts Home Health Services, Inc 368052, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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: Based on medical record review, staff interview, and policy review, the agency failed to ensure each patient received home health services as written in the plan of care for two of three medical records reviewed (Patient #1 and #3). This could affect all patients receiving services from the agency. The active census was 27. Findings include: Review of the agency policy titled, “Reporting and Recording Missed Visits,” reviewed 2021, revealed the purpose is to ensure that all services provided to the client are completed according to the physician ordered plan of care. When a home health aide’s visit cannot be completed as scheduled, the client will be contacted and asked if service hours can be rescheduled. The office will be notified of the change in schedule. The office may verify with the client that they received proper notification. The client’s physician and case manager may be notified as directed by the service plan. 1). Review of the medical record for Patient #1 revealed a start of care date of 02/17/22 for diagnoses to include type two diabetes, hypertension, and chronic pain. Physician orders for the certification period dated 08/16/22 through 10/14/22 included skilled nursing once every sixty days and home health aide services thirty-five hours weekly. Per the plan of care the aide was to assist with personal care, light housekeeping, prescription pick up, shopping, and meal preparation. Review of home health aide time sheets revealed only fifteen hours of aide services was provided the week of 09/11/22 through 09/17/22. The time sheet revealed no home health aide services was provided on 09/12/22 and only three hours was provided per day on 09/13/22 and 09/14/22. Further review revealed only twenty-one hours of aide services was provided for the week of 09/18/22 through 09/24/22. The medical record lacked evidence the physician was notified of the missed visits and that services were not provided as ordered. Per the nursing documentation the patient was discharged from the agency on 09/24/22. Staff A confirmed these findings in an interview on 10/04/22 at 1:57 PM. 2). Review of the medical record for Patient #3 revealed a start of care date of 07/22/22 with diagnoses to include intervertebral disc degeneration, osteoarthritis, and central pain syndrome. The physician orders for the certification period dated 07/22/22 through 09/19/22 included skilled nursing services once every sixty days and home health aide services fourteen hours weekly. Per the plan of care the aide was to assist with personal care, light housekeeping, prescription pick up, shopping, and meal preparation. Review of the home health aide time sheets revealed home health aide services were not provided from 08/21/22 through 08/27/22 and 09/11/22 through 09/17/22. The medical record lacked evidence the physician was notified of the missed visits and that services were not provided as ordered. Staff A confirmed these findings in an interview on 10/04/22 at 2:52 PM. This deficiency substantiates Substantial Allegation 71820.