Every finding on record at Caring Hearts II LLC

A recertification survey was completed on 6/29/22. Two deficiencies were cited.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the agency failed to ensure home health aides (HHAs)/certified nursing aides (CNAs) provided services included in the Plan of Care as ordered by the physician for 1 of 2 active patients who required CNA services (Patient #2). This deficiency was cited previously during a federal recertification survey on 8/8/2019. Although the facility corrected the deficiency, based on the findings below, the facility has not maintained compliance with this regulatory requirement. Cross Reference G0818 Findings include: AGENCY POLICY According to the agency policy, revised February 2021, titled, Care Planning Process,(in pertinent part): "The patient care plan for the Home Health Aide will be: -Home Health Aide assignment sheet: developed by a Registered Nurse (Physical Therapist or Speech Language Pathologist, if nursing not ordered) prior to Home Health Aide rendering care. Reviewed at least every 14 days during supervisory visit and based on patient's health status and environment." "The assignment sheet/plan of care will be communicated to the Home Health Aide by the appropriate discipline. The assignment sheet/plan of care will include: -Type of service/procedure to be provided." 1. The clinical record for Patient #2 was reviewed on 6/27/22. The plan of care for the certification period dated 5/30/22 to 7/28/22, revealed a start of care date of 6/4/21; diagnoses include hypertensive heart disease with heart failure, acute combined systolic and diastolic (congestive) heart failure; acute and chronic respiratory failure with hypoxia, emphysema, body mass index 19 or less, and gastro-esophageal reflux disease without esophagitis. Plan of care orders included skilled nursing (SN) visits one time a week for medication management, monitoring compliance with medication, congestive heart failure and chronic obstructive pulmonary disease management, education, monitoring weights, cardiopulmonary assessments and home safety; CNA visits two times a week for showering assistance and safety. a) The agency failed to ensure the CNA provided services that were included on the CNA care plan. Review of an aide care plan dated 9/20/21, revealed CNA tasks were as follows: obtain Patient #2's vital signs, assist Patient #2 with shampooing, brushing/combing her hair, apply lotion, file Patient #2's fingernails, assist Patient #2 to brush her teeth, select her clothes, assist her with dressing, provide stand-by assistance with transfers, assist Patient #2 with ambulation using a gait belt and clean the bathroom at each visit. Review of the aide care plan with a start date of 4/6/2022, revealed the CNA tasks were as follows: obtain Patient #2's vital signs, assist Patient #2 with showering, shampoo, comb/brush her hair, applying lotion, perineal care, brush teeth, select clothing, assist with dressing, encourage/prepare fluids, provide stand-by assistance for transfers and use a gait belt to assist her with ambulation and clean her bathroom at each visit. The CNA was tasked to obtain Patient #2's weight once a week and file her fingernails and toenails once per month. Review of the aide Intervention (CNA visit notes) dated 4/13/22 to 6/21/22, revealed CNA #5 and #7 failed to perform the required tasks at each visit. Specifically, documentation review of aide intervention notes written by CNA #5 and #7 failed to show either CNA had weighed Patient #2 once a week or filed her fingernails or toenails once a month. CNA #7 did document on 5/6/22 that she encouraged/prepared fluids for Patient #2 but no further documentation on the aide intervention notes from either CNA #5 or #7 showed that Patient #2 was encouraged to drink and/or provided with fluids. Review of nursing intervention (SN visit notes) dated 4/8/22 to 6/24/22, revealed registered nurses (RNs) made 11 visits to Patient #2. RN #9 documented Patient #2's weight one time (4/15/22); RN #8 documented Patient #2's weight 4 times (5/6/22; 5/27/22, 6/3/22 and 6/10/22); and RN #3 did not document Patient #2's weight. Although the RNs weighed Patient #2 six times over the course of 12 weeks, the agency failed to ensure that the CNAs followed their care plan and weighed Patient #2 weekly. Review of a Qliq (a secure text messaging application) communication note dated 4/6/22 sent at 2:29 p.m. by the director of nursing (DON) to CNAs #5 and #7, RN #9, OT #12, PT #13 and Employees #10 and #11, revealed an updated aide care plan had been created and was ready for distribution. The DON stated CNA #5 was scheduled to see Patient #2 next on 4/12/22 so the DON put the updated care plan in CNA #5's mailbox at the agency office so CNA #5 could bring the updated aide care plan to Patient #2's home. During a home visit on 6/28/22 at 11:01 a.m., Patient #2 was observed to have multiple long fingernails and the toenails on her left foot appeared to be curling down under her toes without observable redness or broken skin. During an interview on 6/29/22 at 11:16 a.m., the DON stated when a RN revised a CNA care plan, the agency expected the RN to turn the revised copy into the DON so she could review it. Once the DON approved the revised care plan, she would send the approved version of the care plan to the RN and CNA. The DON stated she would print a copy of the revised care plan and place it in the box of the employee scheduled to see the patient next so the revised copy could be left in the patient's home. The DON said she often sent the revised version to the RN and CNAs via a Qliq message. During a home visit on 6/28/22 at 11:01 a.m., CNA #7 stated she followed the care plan that was in Patient #2's home. CNA #7 showed the surveyor the care plan which was dated 9/20/21. CNA #7 stated she was not aware that a revised aide care plan was created for Patient #2 on 4/6/22 by RN #9. CNA #7 stated she was unaware that she was to weigh Patient #2 weekly or file Patient #2 fingernails and toenails monthly. CNA #7 stated she always encouraged Patient #2 to drink fluids and ensured she had fluids near her before leaving Patient #2 at the end of the visit, but she did not always document completion of that task. During an interview on 6/28/22 at 4:32 p.m., CNA #5 stated it was part of her routine to review the aide care plan in the home for all patients that had been newly assigned to her and if the care plan was not there, she would ask someone in the office to send her the care plan via a Qliq message. CNA #5 stated she remembered receiving a Qliq message about Patient #2's revised care plan, but Patient #2 canceled the 4/12/22 visit, thus CNA #5 never picked the revised care plan up as instructed by the DON. When CNA #5 went to see Patient #2 on 4/13/22, she thought the care plan in the home was the updated care plan and she had been using that care plan for guidance on treatment from 4/13/22 through the interview date of 6/28/22. CNA #5 confirmed she had never weighed or filed Patient #2's fingernails or toenails. CNA #5 stated she always offered Patient #2 fluids but did not document this as she did not realize it was on the care plan. During an interview on 6/29/22 at 9:30 a.m., RN #8 stated she had taken over as case manager for Patient #2 in early May 2022. RN #8 stated she was unaware that the aide care plan created on 4/6/22 tasked the CNAs with getting weekly weights on Patient #2, to file her fingernails and toenails monthly, or that encouraging fluids was on the CNA care plan for each visit. RN #8 further stated she was not ensuring these tasks were completed during CNA supervisory visits.

HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient's plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient's condition; and (vi) Honoring patient rights. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency's supervision of the certified nurse aides (CNAs) failed to ensure the CNAs furnished care according to the aide care plan for 1 of 2 active patients reviewed who received CNA services (Patient #2) . Cross Reference G0800 Findings include: AGENCY POLICY According to the undated agency policy titled, Home Health Aide Supervision, (in pertinent parts): "All home health aide supervisory visits will be made at least every 14 days." "To assure the appropriateness of home health aide services and to maintain quality of care" "Home Health Aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: -Following the patient's plan of care for completion of tasks assigned to a Home Health Aide by the registered nurse or other appropriate skilled professional." 1. The clinical record for Patient #2 was reviewed on 6/27/22. The Plan of Care for the certification period dated 5/30/22 to 7/28/22, revealed a start of care date of 6/4/21; diagnoses include hypertensive heart disease with heart failure, acute combined systolic and diastolic (congestive) heart failure; acute and chronic respiratory failure with hypoxia, emphysema, body mass index 19 or less, and gastro-esophageal reflux disease without esophagitis. Plan of care orders included skilled nursing (SN) visits one time a week for medication management, monitoring compliance with medication, congestive heart failure and chronic obstructive pulmonary disease management, education, monitoring weights, cardiopulmonary assessments and home safety; CNA visits two times a week for showering assistance and safety. a) Review of CNA supervisory visit notes revealed the registered nurse (RN) failed to appropriately supervise the CNA by failing to ensure that the CNA completed all tasks assigned on the aide care plan. Review of the aide care plan with a start date of 4/6/2022, revealed the CNA tasks were as follows: obtain Patient #2's vital signs, assist Patient #2 with showering, shampoo, comb/brush her hair, applying lotion, perineal care, brush teeth, select clothing, assist with dressing, encourage/prepare fluids, provide stand-by assistance for transfers and use a gait belt to assist her with ambulation and clean her bathroom at each visit. The CNA was tasked to obtain Patient #2's weight once a week and file her fingernails and toenails once per month. Review of the aide Intervention (CNA visit notes) dated 4/13/22 to 6/21/22, revealed CNA #5 and #7 failed to perform the required tasks at each visit. Specifically, documentation review of aide intervention notes written by CNA #5 and #7 failed to show either CNA had weighed Patient #2 once a week or filed her fingernails or toenails once a month. CNA #7 did document on 5/6/22 that she encouraged/prepared fluids for Patient #2 but no further documentation on the aide intervention notes from either CNA #5 or #7 showed that Patient #2 was encouraged to drink and/or provided with fluids. Review of supervisory visits showed RN #8 completed supervisory visits on 5/6/22, 5/20/22 and 6/3/22. On 5/6/22 and 6/3/22, RN #8 documented CNA #7 was following Patient #2's aide care plan and on 5/20/22 RN #8 documented CNA #5 was following Patient #2's aide care plan. During an interview on 6/29/22 at 11:39 a.m., the director of nursing (DON) stated the agency expectation for aide supervisory visits was that an RN would either access the electronic medical record to see an aide care plan or bring a paper copy to the supervisory visit to use when the RN observed the CNA providing care. The RN was expected to make sure the CNA was following the care plan and proper procedures including infection control and body mechanics for task completion. During an interview on 6/29/22 at 9:30 a.m., RN #8 stated she was responsible for completing supervisory visits for CNAs #5 and #7 with Patient #2 since May of 2022. RN #8 stated when she completed a supervisory visit she would interview both the CNA and patient separately to ensure all tasks were being completed and that the patient was happy with the care being provided. RN #8 stated she did not have a copy of the care plan with her during supervisory visits nor did she review CNAs notes compared to the aide care plan to ensure all tasks were being completed.