Every finding on record at Cuddle Me Home Care PLLC

Purpose of visit: Recertification survey Entrance: 03/23/2021 at 10:50AM Agency census: L&C-19 LHHS-35 PAS-0 Exit: 03/29/2021 An exit conference was conducted with the Administrator on 03/29/2021 at 2:30 PM. The preliminary findings were discussed. The agency was afforded an opportunity to provide additional information within two business days. Written instructions were provided via email to the Administrator for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. The agency was in compliance with 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies.

Purpose of visit: Recertification survey Entrance: 03/23/2021 at 10:50 AM Agency census: L&C-19 LHHS-35 PAS-0 Exit: 03/29/2021 An exit conference was conducted with the Administrator on 03/29/2021 at 2:30 PM. The preliminary findings were discussed. The agency was afforded an opportunity to provide additional information within two business days. Written instructions were provided via email to the Administrator for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. Abbreviation List: POC- Plan of Care DON- Director of Nurses DNR- Do Not Resuscitate HHA- Home Health Agency n/a- not applicable RN- Registered Nurse NOMNC- Notice of Medicare Non-Coverage QIO- Quality Improvement Organization hha- home health aide D/C- discharge IV- Intravenous CMS- Centers for Medicare and Medicaid Services OASIS- Outcome Assessment Information Set PICC- Peripheral inserted central catheter

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure proper written notice, no later than two days in advance of terminating on-going care for 2 (Patient #7 and #8) of 2 inactive patient records reviewed, with goals met as reason for discharge. The agency failed to provide the patient with the CMS form titled NOMNC two days prior to discharge. The form did not included the name and contact information of the QIO with instructions on how to appeal the decision to discharge. This failure prevented the patient from exercising the right to appeal the discharge decision, if desired. FINDINGS INCLUDE: An agency discharge list was provided on 03/23/2021 by the Clinical Clerk, Employee E. The list included the names of the patients and reason for discharge. The following patients were listed as "Goals Met" discharges: Patient #7 discharged 01/12/2021 and Patient #8 discharged 12/25/2020. Patient 7: Record review of the discharge clinical record included a POC dated 11/16/2020-01/14/2021. The POC included, "Discharge plans: Discharge when medical condition is stable and patient is no longer in need of skilled services." A D/C OASIS form was completed 01/12/2021 by the Administrator/DON. A NOMNC form was signed by Patient #7 and dated 01/12/2021. The form was not provided 2 days prior to discharge and did not include the QIO name and contact information to appeal the discharge decision. Patient 8: Record review of the discharge clinical record included a POC dated 10/16/2020-12/14/2020. The POC included, "Discharge plans: Discharge when medical condition is stable and patient is no longer in need of skilled services, Discharge to caregiver. Discharge when goals met." A D/C OASIS was completed 11/25/2020 by the Administrator/DON. A NOMNC form was signed by Patient #8 and dated 11/25/2020. The form was not provided 2 days prior to discharge and did not include the QIO name and contact information to appeal the discharge decision. In an interview with the Administrator on 03/29/2021 at approximately 1:30 PM, the surveyor reviewed the preliminary findings. The surveyor asked about the discharge date for Patient #8. The Administrator/DON stated the date of discharge for Patient #8 was 11/25/2020, as noted on the D/C OASIS. The surveyor asked why the discharged patients (#7 and #8) were not provided the NOMNC at least 2 days prior to discharge and were not given the contact name and number for the patients to appeal the discharge decision if the desired. The Administrator stated, "the patients were aware of getting discharged, they know with IV's and pulling the PICC line, they know it's the last day." The surveyor and Administrator discussed the NOMNC form and required timeline for providing the QIO contact name and phone number. The Administrator stated she saw where the form had a place to insert the necessary information and she needed to get the information for the QIO. Agency policy, revision date 02/12/14, quoted in part, "Discharge Process... Discharge from the Agency:... 2. The patient will receive notification of their discharge in accordance with the regulatory guidelines. If applicable, the patient receives an Advance Beneficiary Notice in accordance with Medicare guidelines...." Regulation: July 1, 2005, the new Medicare regulations, Benefits Improvement and Protection Act gave beneficiaries access to the new expedited determination process when their home health agency services were ending. There were two notices required by these regulations. The first was a generic notice called a Notice of Medicare Provider Non-coverage labeled "FORM No. CMS 10123" that the provider would be delivered at least two days prior to when a beneficiary's Medicare coverage of services was ending. The telephone number for the QIO was to be included in the notice. The second was a detailed notice, called a Detailed Explanation of Provider Non-Coverage that the provider would deliver to the beneficiary and the appropriate QIO only if the beneficiary requested an expedited review by the QIO of the decision that coverage for items and/or services should end.

Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure each of the tasks listed at 484.80(b)(3) were evaluated by observation of the home health aides' (hha) performance of the tasks for 1 of 1 hha personnel record reviewed. The competency evaluation was not completed by observation of the hha's performance of all the required tasks. This failure placed the patients that receive hha services and any future patients with assigned hha services at risk for receiving substandard or unsafe care from the home health aide. FINDINGS INCLUDE: An agency personnel roster was provided to the surveyor on 03/23/2021 by the Clinical Clerk, Employee E. The roster listed the hha, Employee D as the only hha employed by the agency and a hire date of 02/13/2021. Personnel record, hha: Review of the documents provided for personnel record review revealed a form titled, "HOME HEALTH AIDE SKILLS COMPETENCY CHECKLIST" that was signed by the hha and dated 02/12/2021. The form included the name of the hha written on the top of the page and the following multiple-choice question topics: "I. Temperature, Pulse, Respiration, Blood Pressure"- the date box for the tasks: temperature, pulse and respiration were marked "n/a" and signed by the contract agency RN, Identifier F. The task of blood pressure was blank; "II. "Bed bath"- the task of bed bath was blank; "III. Other bath- All required, A. Sponge, B. Tub, C. Shower"- the tasks of tub and shower were circled and check marked as "Satisfactory"; "IV. Shampoo- All required, A. Sink, B. Tub, C. Bed"- the task of sink was circled and check marked as "Satisfactory". Review of all the hha personnel documents provided to the surveyor did not demonstrate evidence that the hha performed or was observed providing all the required tasks for a competency evaluation. Patient #5: Review of the clinical record included a hha Care Plan completed by the Administrator/DON on 09/11/2020. The hha Care Plan included the following assigned tasks to be completed with Patient #5 every visit: "... Shower, Shampoo hair; Skin Care; Shave; Pericare; Foot Care; Nail Care and Assist to Dress..." The record included hha visit notes for the following days: 02/13/2021; 02/23/2021; 02/25/2021; 03/03/2021; 03/09/2021; 03/16/2021 and 03/23/2021. In an interview with the Administrator/DON on 03/23/2021 at approximately 1:30 PM, the surveyor reviewed the findings and asked why the agency did not ensure the hha was competency evaluated for all the required tasks. The Administrator/DON stated the agency had just recently contracted with an outside source to provide the hha staff and she did not realize the hha had not been completely "checked off." "Code of Federal Regulations 484.80(c)1... The following skills must be evaluated by observing the aide's performance while carrying out the task with a patient.... (i) Communication skills, including the ability to read, write, and verbally report clinical information to patients, representatives, and caregivers, as well as to other HHA staff; (iii) Reading and recording temperature, pulse, and respiration; (ix) Appropriate and safe techniques in performing personal hygiene and grooming tasks that include: (A) Bed bath; (B) Sponge, tub, and shower bath; (C) Hair shampooing in sink, tub, and bed; (D) Nail and skin care; (E) Oral hygiene; (F) Toileting and elimination;..." Agency Policy, original date 05/01/1997, quoted in part, "HOME HEALTH AIDE COMPETENCY EVALUATION HR. 8... PURPOSE: To establish competency evaluation checklists for both written and skills demonstration. Policy: Agency will ensure that each home health aide successfully completes a home health aide competency evaluation prior to performing care independently in accordance with federal and state laws and regulations...."