Every finding on record at Coastal Kids Care

During the Health Recertification survey conducted from 03/18/2024 to 03/20/2024 at Coastal Kids Care, a Home Health Agency, Emergency Preparedness was reviewed. Coastal Kids Care is not in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.542(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to comply with the Florida State regulation and ensure their Comprehensive Emergency Management Plan was revised and submitted, as required, to the Florida Department of Health Division of Emergency Preparedness and Community Support for revision and approval annually, evidenced by the HHA's last "Approval Letter" dated 07/23/21. The findings included: During an interview, on 03/18/24 at 9:30 AM, the HHA's Director of Nursing (DON) was asked to provide the HHA’s Comprehensive Emergency Management Plan (CEMP) annual "Approval Letter" from the Florida Department of Health Division of Emergency Preparedness and Community Support (DOH). On 03/18/24 10:55 AM, during an interview, the DON was asked again for the DOH’s CEMP "Approval Letter" and stated she was "still looking for it." Review of the HHA’s CEMP "Approval Letter" from the Florida Department of Health Division of Emergency Preparedness and Community Support provided by the DON documents that the HHA CEMP was last approved on 07/23/21. On 03/20/24 at 11:27 AM, a joint interview was conducted with the Administrator and the DON; the DON stated she contacted Florida’s Department of Health Division of Emergency Preparedness and Community Support regarding the HHA's CEMP "Approval Letter" and was told that there was a submission of the CEMP for 2022 but the "Approval Letter" was not sent, and they were not able to explain why a letter was not sent out. Further review reveals the HHA did not have an "Approval Letter" for their CEMP for the year 2022 or the year 2023.

An unannounced Recertification survey was conducted on 03/18/2024 to 03/20/2024 at Coastal Kids Care, Home Health Agency provider. The provider was not in compliance with 42 Code Of Federal Regulations (CFR) Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to complete and transmit an OASIS (Outcome and Assessment Information Set) assessment or 1 of 1 sampled patient who is over 18 years of age requires the OASIS assessment (Patient #5). The findings included: Review of Patient #5’s clinical record documents a "Start of Care" on 08/18/08 with a Home Health Certification and Plan of Care for the certification period from 02/21/24 to 04/20/24 that documents a date of birth of 08/08/04 and a physician's order for Skilled Nursing to be provided 12 hours a day, Monday through Sunday. Further review reveals the clinical record lacks written evidence of an OASIS assessment completed and transmitted when the patient turned 18 years of age, as required. On 03/19/24 at 2:35 PM, during an interview, the Director of Nursing (DON) was to provide Patient #5’s OASIS assessment and the DON stated she did not have an OASIS for Patient #5; the DON stated she read about OASIS, but the HHA did not have an "electronic OASIS program." On 03/20/24 at 11:21 AM, a joint interview was conducted with the Administrator and the DON; the Administrator stated that she has researched and was quite familiar with the OASIS; stated the HHA did not have an "OASIS account;" stated that the HHA's patients have a Case Manager and that once the patient turns 18 years of age, the "Insurance Case Manager" has to look for another Home Health Agency (for the patient); added that then the HHA gives the patient a "letter of discharge placement;" the DON stated she had not had a telephone call from the patient’s "Case Manager" regarding discharge placement, for Patient #5, due to the patient being over 18 years of age and the Administrator and the DON were apprised that Patient #5 will be 20 years of age in 2024.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on the Home Health Agency (HHA)'s Policy review, record review and interview, the HHA failed to ensure that their patients receive the services, as per the Physician's Plan of Care and failed to notify the patient’s physician that their patients did not receive the services in the Plan of Care, as the physician ordered for 6 of 7 sampled patients (Patient #2, #3, #4, 5, #6 and #7). The findings included: 1) Review of the HHA’s policy provided by the Director of Nursing titled, “Medical Policies and Physician’s Orders” effective 08/1992 documents, “…the physician is informed in a timely manner of …status that suggest a need to alter the plan of care or that suggest that measurable outcomes are not being achieved…the professional documents all communication with the physician…”. Review of Patient #2's Home Health Certification and Plan of Care for the period from 01/22/24 to 04/21/24 documents the physician's orders for the discipline of Skilled Nurse 24 hours daily seven days a week. On 03/18/24 at 2:40 AM, an interview and a side-by-side review of Patient #2's record was conducted with the HHA's Director of Nursing (DON) who stated that the HHA received an insurance authorization to provide a Skilled Nurse 24 hours every day and the "Start of Care was on 04/02/18; the DON stated that Patient #2 did not have insurance coverage from 01/03/24 to 02/14/24 and Skilled Nurse service was not provided during that time; the DON stated the Skilled Nurse service was resumed on 02/14/24 without obtaining or conducting a Skilled Nursing assessment and without obtaining new physician's orders; the DON stated that the HHA did not notify Patient #2’s physician of the loss of the patient's insurance and that they were not providing the Skilled Nursing visits as per the Plan of Care. Review of Patient #2’s record reveals a lack of a written "Skilled Nurse Shift Note" on the following dates: 01/04/24 through 02/13/24; 02/15/24- 7:00 AM to 8:00 PM shift; and 02/16/23 7:00 AM- to 7:00 PM shift. Further review of the patient’s record reveals the lack of written notification of the "missed Skilled Nursing shift visits" to the physician. On 03/18/24 at 3:44 PM, during a joint interview with the HHA Staffing Coordinator and the DON; the Staffing Coordinator stated that his responsibilities were to inform the nurses about their schedule and inform the parents of the nurse's schedules; the Staffing Coordinator stated that he was able to cover 70 to 75 % of the Skilled Nursing shifts; he stated that if he was not able to cover a shift for any patient in the home setting, he would inform the parent, and if the patient was in a group home, he will inform the HHA Administrator; the Staffing Coordinator stated he does not do written documentation to keep in the patient’s clinical record regarding "missed shifts," nor does he call the physician to inform them of "missed shifts;" the DON added that she was aware of "missed shifts" by a "word of mouth;" they send a "text" to the Administrator. 2) Review of Patient #3's Home Health Certification and Plan of Care for the period from 11/30/23 to 01/28/24 and 01/29/24 to 03/28/24 documents physician's orders for the discipline of Skilled Nurse 12 hours daily Monday to Friday and 24 hours Saturday and Sunday. Review of Patient #3’s record reveals the lack of a written "Skilled Nurse Shift Note" on the following dates: 12/31/23- 7:00 PM to 7:00 AM shift; 01/13/24- 7:00 AM to 7:00 PM shift; 01/14/24- 7:00 AM to 7:00 PM shift; 01/27/24- 7:00 AM to 7:00 PM shift; 01/28/24- 7:00 AM to 7:00 PM shift; 02/10/24- 7:00 AM to 7:00 PM shift; 02/11/24- 7:00 AM to 7:00 PM shift; 02/24/24- 7:00 AM to 7:00 PM shift and 02/25/24- 7:00 AM to 7:00 PM shift. Further review of the patient’s record reveals the lack of written notification of the "missed shift visits" to the physician. On 03/18/24 at 2:09 PM, during an interview and a side-by-side review of Patient #3's record was conducted with the HHA's DON who stated the patient's "Start of Care" was done on 06/08/17; the DON was asked if the physician was notified and stated she was not aware that she had to do that; the DON added that she was informed of the "missed shift visits" after the fact by either the Nurse or the Staffing Coordinator. 3) Review of Patient #4's Home Health Certification and Plan of Care for the period from 12/21/23 to 02/18/24 documents physician's orders for the discipline of Skilled Nurse 10 hours Saturday and Sunday and additionally 10 hours daily Monday to Friday for Skilled Nurse to accompany (the patient) to school on school days. Review of Patient #4’s record reveals the lack of a written "Skilled Nurse Shift Note" on the following dates: 12/02/23- Saturday- 10 hours shift; 12/04/23- Monday- 20 hours shift; 12/07/23- Thursday- 10 hours shift; 12/09/23- Saturday- 10 hours shift; 12/11/23- Monday- 20 hours shift; 12/14/23- Thursday- 10 hours shift; 12/16/23- Saturday- 10 hours shift; 12/18/23- Monday- 20 hours shift; 12/21/23- Thursday- 10 hours shift; 12/23/23- Saturday- 10 hours shift; 12/25/23- Monday- 10 hours shift; 12/28/23- Thursday- 10 hours shift; 12/30/23- Saturday- 10 hours shift; 01/01/24- Monday- 10 hours shift; 01/04/24- Thursday- 10 hours shift; 01/06/24- Saturday- 10 hours shift; 01/08/24- Monday- 10 hours shift; 01/11/24- Thursday- 10 hours shift; 01/13/24- Saturday- 10 hours shift; 01/15/24- Monday- 20 hours shift; 01/18/24- Thursday- 10 hours shift; 01/20/24- Saturday- 10 hours shift; 01/21/24- Sunday- 20 hours shift; 01/25/24- Thursday- 10 hours shift; 01/27/24- Saturday- 10 hours shift and 01/29/24- Monday- 20 hours shift. Further review of the patient’s record reveals the lack of written notification of the "missed shift visits" to the physician. On 03/20/24 at 3:03 PM, during an interview and a side-by-side review of Patient #4’s record was conducted with the HHA's DON who stated the patient's "Start of Care" was done on 07/16/13; the DON stated that on those days that the patient had a 20 hour shift missed visit, the patient was not able to go to school because the patient needed a nurse to go with the patient; during the review, the DON stated that she did not notify Patient #4’s physician regarding the missed Skilled Nurse Shifts and added she communicated with the Case Manager and thought the Case Manager will communicate it to the physician. 4) Review of Patient #5's Home Health Certification and Plan of Care for the period from 12/19/23 to 02/20/24 and 02/21/24 to 04/20/24 documents physician's orders for the discipline of Skilled Nurse 12 hours daily seven days a week. Review of Patient #5’s record reveals the lack of a written "Skilled Nurse Shift Note" on the following dates: 01/08/24- 8 hours shift; 01/09/24- 8 hours shift; 01/14/24- 8 hours shift;01/18/24- 4 hours shift;02/04/24- 4 hours shift;02/18/24- 4 hours shift;02/25/24- 8.5 hours shift, and 02/27/24- 4 hours shift. Further review of the patient’s record reveals the lack of written notification of the "missed shift visits" to the physician. On 03/19/24 at 3:23 PM, during an interview and a side-by-side review of Patient #5’srecord was conducted with the HHA's DON who stated the patient's "Start of Care "was on 08/18/08; the DON stated that she didn't notify Patient #5’s physician regarding the "Missed Skilled Nurse Shifts. On 03/20/24 at 8:19 AM, during an interview, the DON stated that the HHA was actively hiring nurses and had recently hired two nurses that are currently doing the "onboarding process." On 03/20/2024 at 10:22 AM, a joint interview was conducted with the HHA’s DON and the Administrator; the Administrator stated that she was notified of the patients that were under her care's "missed visit," Patient #2, via text but was not notified of the other patient's "missed visits." 5) Review of Patient #6's clinical record documents a "Start of Care" on 09/26/09 and a discharge date on 10/18/23. Review of the patient’s Home Health Certification and Plan of Care for the period from 07/23/23 to 09/20/23 documents physician's orders for the discipline of Skilled Nurse 12 hours daily seven days a week overnight and 8 hours on school days. Review of Patient #6’s record reveals the lack of a written Skilled Nurse Shift Note on the following dates: 08/15/23- 8 hours shift (school shift); 08/28/23- 8 hours shift (school shift);08/29/23- 8 hours shift (school shift); 08/30/23- 8 hours shift (school shift) and 08/31/23- 8 hours shift (school shift). On 03/20/24 at 3:33 PM, during an interview and a side-by-side review of Patient #6’s record was conducted with the DON who stated Patient #6 had many "missed skilled nurse shifts" to accompany the patient to school during the month of August 2023; the DON added the patient was transferred to another agency per the ... (parent)'s request. 6) Review of Patient #7's clinical record documents a "Start of Care" on 12/01/20 and a discharge date on 08/20/23. On 03/20/24 at 12:45 PM, an interview and a side-by-side review of Patient #7’s record was conducted with the DON who stated that the patient was transferred to another agency on 08/20/23 per the ... (parent)'s request. Review of the patient’s Home Health Certification and Plan of Care for the period from 05/26/23 to 07/24/23 and 07/25/23 to 09/22/23 documents physician's orders for the discipline of Skilled Nurse 24 hours daily seven days a week. Review reveals that Patient #7’s 24 hours daily "Skilled Nursing" service was not provided as per the physician’s order; the DON stated that Patient #7 received only 8 out of 24 hours of Skilled Nursing services on the following dates: 06/01/23, 06/02/23, 06/03/23, 06/04/23, 06/05/23, 06/06/23, 06/08/23, 06/09/23 through 06/13/23; 06/15/23, 06/16/23, 06/17/23, 06/18/23; 06/20/23, 06/21/23, 06/22/23, 06/23/23, 06/24/23, 06/25/23, 06/26/23, 06/27/23, 06/29 and 06/30/23; 07/04/23, 07/06/23 through 07/19/23, 07/20/23, 07/23/23, 07/27/23 through 07/29/23. Further review revealed that Patient #7 did not receive any Skilled Nurse Shift" visits on 07/02/23 and 07/20/23. During the review, the DON stated that on 08/11/23 she spoke with Patient #7’s ... (parent) who requested for the patient to go back to the day care center because of the lack of a skilled nurse to go to school with ... (the patient); the DON stated she did not communicate that with the patient’s physician and review reveals a lack of written documentation of notification to the physician regarding Patient #7’s many missed "Skilled Nurse" shifts.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on the Home Health Agency (HHA)'s Policy review, record review and interview, the HHA failed to promptly notify/alert the patient’s physician of changes to the Plan of Care for 1 of 1 sampled patient as evidenced by Patient #2 not receiving Skilled Nurse visits as per the physician's Plan of Care from 01/03/24 to 02/14/24. The findings included: Review of the HHA’s policy provided by the Director of Nursing titled, “Medical Policies and Physician’s Orders” effective 08/1992 documents, “…the physician is informed in a timely manner of all significant changes …or status that suggest a need to alter the plan of care or that suggest that measurable outcomes are not being achieved… the professional documents all communication with the physician…Resume services and new or changed orders shall be obtained following interruption of (HHA’s name) service…”. Review of the HHA’s policy provided by the Director of Nursing titled, “Termination Policies” effective 10/1998 documents, “Services by ... (HHA’s name) will be terminated when any of the following conditions prevail…there is no source of payment and the (HHA’s name) administrative staff decide that the care should be terminated…the staff member completes a discharge summary, a physician order and /or Interdisciplinary report at the time of discharge…”. Review of Patient #2's Home Health Certification and Plan of Care for the period from 01/22/24 to 04/21/24 documents physician's orders for the discipline of Skilled Nurse 24 hours daily seven days a week. Review of Patient #2’s "Nursing Assessment," dated 02/15/24 documents under medications, “See POC (Plan of Care)."Further review of the patient’s record reveals the lack of physician's orders to resume Skilled Nurse services on 02/14/24. On 03/18/24 at 2:40 AM, an interview and a side-by-side review of Patient #2's record was conducted with the HHA's Director of Nursing (DON); the DON stated that the HHA received an "Insurance Authorization" to provide a Skilled Nurse 24 hours daily seven day a week and the "Start of Care" was 04/02/18; the DON added that Patient #2 did not have "Insurance Coverage" from 01/03/24 to 02/14/24 and that the last "Skilled Nurse Shift" was on 01/03/24; the DON stated that Patient #2 did not receive any "Skilled Nurse" service from 01/04/24 to 02/13/24 and that the service was resumed on 02/14/24 without obtaining new physician's orders and before conducting a new nursing assessment; the DON stated that the HHA did not notify Patient #2’s physician of the patient's loss of insurance and that Patient #2 did not receive any "Skilled Nurse" service from 01/04/24 to 02/13/24; that the service was resumed on 02/14/24 without obtaining new physician's orders and before conducting a new nursing assessment. On 03/20/24 at 2:45 PM, a side-by-side review of the HHA's Termination Policy was conducted with the DON.

Ensures qualified pre-designated person CFR(s): 484.105(b)(2) When the administrator is not available, a qualified, pre-designated person, who is authorized in writing by the administrator and the governing body, assumes the same responsibilities and obligations as the administrator. The pre-designated person may be the clinical manager as described in paragraph (c) of this section. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to designate, in writing, an Alternate Administrator as evidenced by the lack of a signed written Alternate Administrator Job Description and written designation. The findings included: On 03/18/24 at 10:45 AM, an interview was conducted with the Home Health Agency’s (HHA) Director of Nursing (DON) who stated she was the Alternate Administrator for the agency; the DON was asked to provide a signed "Job Description" and a written designation for the position; the DON stated she had not signed one and the DON was asked to provide her personnel file. Review of the DON 's personnel file provided lacked evidence of documentation of a signed "Job Description" for the HHA's Alternate Administrator position, and the file did not include the HHA's Alternate Administrator's written designation. On 03/20/2024 at 10:22 AM, a joint interview was conducted with the HHA’s DON and the Administrator; the Administrator stated that the CEO (Chief Executive Officer) was the Alternate Administrator; the DON stated that she changed the Alternate Administrator when she completed the HHA's license renewal application because it needed a licensed person and she documented herself as the HHA Alternate Administrator; the Administrator was apprised that a written designation of the HHA 's Alternate Administrator designation and a "Job Description" was not on the DON’s personnel file; the Administrator stated the HHA's renewal license application was filed on 02/16/24 and was currently in review.