Every finding on record at Central Home Health Services Inc

This visit was for a Federal and State complaint survey of a Home Health Agency Provider. Survey Date: September 19, 2021 Complaint #: IN00344742: Federal and State Deficiencies were cited. Facility ID: 004997 Provider #: 157576 Medicaid #: 200811610 This deficiency report reflects State Findings cited in accordance with 410 IAC 17. Quality Review completed on 09/01/2021 and by Area 3

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 record review and interview the agency failed to evidence that home health aide services were being provided as ordered per the plan of care for 7 of 8 patients. (Patient #1, 3, 4, 5, 6, 7, 8) Findings Include: 1. Review of an undated agency policy titled, "Plan of Care" C-580 revealed, "Policy: Home care services are furnished under the supervision and direction of the client's physician...Planning for care is a dynamic process that addresses the care, treatment and services to be provided...Purpose: To provide guidelines for agency staff to develop a plan of care individualized to meet identified needs..." 2. The clinical record of patient #3 was reviewed on 8/19/21 and indicated a start of care 3/7/21. The record contained a plan of are for recertification period of 5/6/21 to 7/4/2 1that indicated,"... HHA (Home Health Aide) 2 hrs(hours)/day, 3 days/week x 1 week, HHA 2 hrs/day, 7 days/week x 8 weeks, HHA 2 hrs/day 1 day/week x 1 week. HHA to assist with personal care/ADL(Activities of Daily Living) to include bathing, shower, sponge bath if refuses shower, skin care, hair care, shampoo as needed, dressing foot care, nail care, meal preparation, assist with mobility as needed/walker, and light housekeeping pertains to care to help maintain a clean and safe environment, light laundry, bed linen change, check for pressure points, toileting/hygiene, medication reminder, patient is cognitively capable of making personal care decisions..." The agency failed to evidence that home health aide visits were provided 2 hours a day 7 days a week as ordered on the plan of care. Review of agency documents titled, " Aide Visit Note" indicated the following: week two missed visits on 7/2/21 and 7/3/21, week three missed visits on 7/4/21, 7/4/21, and 7/8/21, week four missed visits on 7/12/21 and 7/17/21, week five missed visit 7/20/21, week seven missed visits on 8/4/21 and 8/6/21, and week eight missed visits on 8/10/21 and 8/13/21. 3. The clinical record of patient #6 was reviewed on 8/19/21 and revealed a start of care date of 2/26/20. The record contained a plan of care for the recertification period of 10/23/20 to 12/21/20 that indicated,"... HHA (Home Health Aide) 3 hours/day, 2 days/week x 1 week, HHA 3 hours/day, 6 days/week x 8 weeks, HHA 3 hrs (hours)/day 1 day/week x 1 week. HHA to assist with personal care/ADL(Activities of Daily Living) and light housekeeping as pertains to care to shower, sponge bath if refuses shower, dressing, hair care, foot care, hygiene/toileting, check for pressure points, med reminder, prepare meal, assist ambulation, with walker, make bed, light laundry, vacuum, take out trash, and light housekeeping pertains to care to help maintain a clean and safe environment, patient is cognitively capable of making personal care decisions..."The agency failed to evidence that home health aide visits were provided 3 hours a day 6 days a week as ordered on the plan of care. Review of agency documents titled, "Aide Visit Note" indicated the following: week eight no visits made and week 9 missed visit on 12/14/20. During an interview on 8/19/21 at 12:30 PM with Employee D, who was the Registered Nurse for patient #6, when queried about home health aide being at patient #6 home stated, " There was one time I was there for supervisory visit, and she came in late." 4. The clinical record of patient #8 was reviewed on 8/19/21 and indicated a start of care 10/19/20. The record contained a plan of are for recertification period of 2/16/21 to 4/16/21that indicated,"... HHA (Home Health Aide) 4 hrs(hours)/day, 5 days/week x 1 week, HHA 4 hrs/day, 7 days/week x 7 weeks, HHA 4 hrs/day 6 day/week x 1 week. HHA to assist with personal care/ADL(Activities of Daily Living) and light housekeeping as pertains to care to shower, sponge bath if refuses shower, dressing, hair care, foot care, hygiene/toileting, check for pressure points, med reminder, prepare meal, assist ambulation, with walker, make bed, light laundry, vacuum, take out trash, and light housekeeping pertains to care to help maintain a clean and safe environment, patient is cognitively capable of making personal care decisions..." The agency failed to evidence that home health aide visits were provided 4 hours a day 7 days a week as ordered on the plan of care. Review of agency documents titled, " Aide Visit Note" indicated the following: week one missed visit on 3/6/21, week two missed visits on 3/7/21 and 3/8/21, week four missed visit on 3/21/21, week six missed visit on 4/4/21, and week eight missed visits on 4/18/21 and 4/21/21. During an interview on 8/19/21 at 3:22 PM with Person H when queried regarding visits by home health aides for patient #8 stated, " I told the owner patient #8 cannot be left alone and I work. The aide left an hour early or was late." During an interview on 8/19/21 at 3:51 PM with Entity I when queried about Central Home Health Services and Entity I patient referrals stated, " I do not refer to that agency." During an interview on 8/19/21 during the entrance conference the administrator stated, "I understand we have a staffing issue. I have discharged a lot of patients and am discharging the rest as soon as they have agencies to go to and I help them until then, so no care is lost. I have terminated a lot of staff and only have 3-4 home health aides now and they are in the process of leaving to." 5. A review of clinical record of patient #1, evidenced this was a closed record with a start of care date on 07/17/18, revealed a plan of care for the certification period of 05/02/21 through 06/30/21 with diagnoses but not limited to dementia (a group of symptoms affecting the memory, thinking and social abilities), age-related physical debility, and anemia (low red blood cells). The plan of care indicated the patient was to receive 3 hours a day, 5 days a week of Hha (home health aide) services daily to assist with transfers, ambulation, and personal care. A review of the home health aide visit notes revealed the patient received services 4 days a week, 3 hours each day from 5/2/21 through 06/30/21. 6. A review of clinical record patient #4,evidenced this was an active record with a start of care date 04/18/16, revealed a plan of care for the certification period of 07/21/21 through 09/18/21 with diagnoses but not limited to quadriplegia all four limbs are paralyzed), muscle Weakness, and convulsions. The plan of care indicated the patient was to receive 5 hours a day, 6 days a week of Hha services to assist with personal care, dressing, transferring patient to wheelchair, and to assist with light housekeeping. A review of the home health aide visit notes revealed the patient had missed Hha visits that occurred on 07/15/21, 07/16/21 and 07/17/21. On 08/19/21 at 12:20 PM, an interview with patient #4 family member other C, stating they had been happy with services they had received up until recently, and it seems like it has gone down hill. 7. A review of clinical record patient #5, evidenced this was a closed record with a start of care date 01/04/21, revealed a plan of care for the certification period of 05/04/21 through 07/02/21 with diagnoses but not limited to Type 2 Diabetes mellitus, Heart Failure, COPD (Chronic Obstructive Pulmonary Disease a persistent respiratory disease with progressive breathlessness and cough), and Osteoarthritis. The plan of care indicated the patient was to receive 5 hours a day, 6 days a week of Hha services to assist with personal care, bathing, dressing, skin care, hair care, assist with toileting, assist with ambulation, light housekeeping, and medication reminders. A review of the home health aide visit notes revealed the patient had missed visits that occurred on the dates of 05/08/21 through 05/26/21. Patient was hospitalized 0n 05/27/21 related to COPD issues and then discharged from agency services on 06/18/21. 8. A review of clinical record patient #7, evidenced this was a closed record with a start of care date 04/09/20, revealed a plan of care for the certification period of 12/05/20 through 02/02/21 with diagnoses but not limited to Polyosteoarthritis ( loss of the cartilage of joints) and spinal stenosis (the spinal column narrows and compresses the spinal cord). The plan of care indicated the patient was to receive Hha services 3 hours a day, 7 days a week to assist with personal care, shower, shampoos, dressing, skincare hair care, and light housekeeping and attendant care 3 hours a day, 6 days a week to assist with ambulation with walker, meal prep light laundry, grocery hopping, recreational activities, and maintain a clean environment. A review of the home health aide visits revealed the patient had missed visits that occurred 01/01/21 to 01/05/21, missed visits 01/10/21 through 01/23/21. A review of the attendant care visits revealed the patient had missed visits that occurred on 01/03/21 to 01/19/21. Findings Include: 1. Review of an undated agency policy titled, "Plan of Care" C-580 revealed, "Policy: Home care services are furnished under the supervision and direction of the client's physician...Planning for care is a dynamic process that addresses the care, treatment and services to be provided...Purpose: To provide guidelines for agency staff to develop a plan of care individualized to meet identified needs..." 2. The clinical record of patient #8 was reviewed on 8/19/21 and indicated a start of care 3/7/21. The record contained a plan of are for recertification period of 5/6/21 to 7/4/2 1that indicated,"... HHA (Home Health Aide) 2 hrs(hours)/day, 3 days/week x 1 week, HHA 2 hrs/day, 7 days/week x 8 weeks, HHA 2 hrs/day 1 day/week x 1 week. HHA to assist with personal care/ADL(Activities of Daily Living) to include bathing, shower, sponge bath if refuses shower, skin care, hair care, shampoo as needed, dressing foot care, nail care, meal preparation, assist with mobility as needed/walker, and light housekeeping pertains to care to help maintain a clean and safe environment, light laundry, bed linen change, check for pressure points, toileting/hygiene, medication reminder, patient is cognitively capable of making personal care decisions..." The agency failed to evidence that home health aide visits were provided 2 hours a day 7 days a week as ordered on the plan of care. Review of agency documents titled, " Aide Visit Note" indicated the following: week two missed visits on 7/2/21 and 7/3/21, week three missed visits on 7/4/21, 7/4/21, and 7/8/21, week four missed visits on 7/12/21 and 7/17/21, week five missed visit 7/20/21, week seven missed visits on 8/4/21 and 8/6/21, and week eight missed visits on 8/10/21 and 8/13/21. 3. The clinical record of patient #6 was reviewed on 8/19/21 and revealed a start of care date of 2/26/20. The record contained a plan of care for the recertification period of 10/23/20 to 12/21/20 that indicated,"... HHA (Home Health Aide) 3 hours/day, 2 days/week x 1 week, HHA 3 hours/day, 6 days/week x 8 weeks, HHA 3 hrs (hours)/day 1 day/week x 1 week. HHA to assist with personal care/ADL(Activities of Daily Living) and light housekeeping as pertains to care to shower, sponge bath if refuses shower, dressing, hair care, foot care, hygiene/toileting, check for pressure points, med reminder, prepare meal, assist ambulation, with walker, make bed, light laundry, vacuum, take out trash, and light housekeeping pertains to care to help maintain a clean and safe environment, patient is cognitively capable of making personal care decisions..."The agency failed to evidence that home health aide visits were provided 3 hours a day 6 days a week as ordered on the plan of care. Review of agency documents titled, "Aide Visit Note" indicated the following: week eight no visits made and week 9 missed visit on 12/14/20. During an interview on 8/19/21 at 12:30 PM with Employee D, who was the Registered Nurse for patient #6, when queried about home health aide being at patient #6 home stated, " There was one time I was there for supervisory visit, and she came in late." 4. The clinical record of patient #8 was reviewed on 8/19/21 and indicated a start of care 10/19/20. The record contained a plan of are for recertification period of 2/16/21 to 4/16/21that indicated,"... HHA (Home Health Aide) 4 hrs(hours)/day, 5 days/week x 1 week, HHA 4 hrs/day, 7 days/week x 7 weeks, HHA 4 hrs/day 6 day/week x 1 week. HHA to assist with personal care/ADL(Activities of Daily Living) and light housekeeping as pertains to care to shower, sponge bath if refuses shower, dressing, hair care, foot care, hygiene/toileting, check for pressure points, med reminder, prepare meal, assist ambulation, with walker, make bed, light laundry, vacuum, take out trash, and light housekeeping pertains to care to help maintain a clean and safe environment, patient is cognitively capable of making personal care decisions..." The agency failed to evidence that home health aide visits were provided 4 hours a day 7 days a week as ordered on the plan of care. Review of agency documents titled, " Aide Visit Note" indicated the following: week one missed visit on 3/6/21, week two missed visits on 3/7/21 and 3/8/21, week four missed visit on 3/21/21, week six missed visit on 4/4/21, and week eight missed visits on 4/18/21 and 4/21/21. During an interview on 8/19/21 at 3:22 PM with Person H when queried regarding visits by home health aides for patient #8 stated, " I told the owner patient #8 cannot be left alone and I work. The aide left an hour early or was late." During an interview on 8/19/21 at 3:51 PM with Entity I when queried about Central Home Health Services and Entity I patient referrals stated, " I do not refer to that agency." During an interview on 8/19/21 during the entrance conference the administrator stated, "I understand we have a staffing issue. I have discharged a lot of patients and am discharging the rest as soon as they have agencies to go to and I help them until then, so no care is lost. I have terminated a lot of staff and only have 3-4 home health aides now and they are in the process of leaving to."