Every finding on record at Custom Care Healthcare, Inc

A recertification survey was initiated on 11/22/2022. The census was: LCHH-0 The agency was in substantial compliance with 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies.

A recertification survey was initiated on 11/22/2022. The census was: LCHH-0 Total agency census: Abbreviations RN-Registered Nurse EMR-electronic medical record OASIS-The Outcome and Assessment Information Set HR-Human Resources dba-doing business as SOC-Start of Care POC-Plan of Care NPI-National Provider Identifier

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 the patient’s right to receive the NOMNC written notice at least two days in advance of terminating on-going care in 4 (Patient 1, 5, 6, and 8) of 7 discharged records reviewed whose reason for discharge was “goals met.” This failure prevented the identified patient from exercising their right to appeal the discharge decision if they chose to appeal. Findings include: DISCHARGED PATIENT 1: Record review of the EMR contained a POC dated 11/19/2020-1/17/2021 with a SOC date of 11/19/2020. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 12/14/2020 ..." The form was signed and dated by Patient 1 on the discharge date of 12/14/2020. The record failed to contain any documentation that Patient 1 had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. DISCHARGED PATIENT 5: Record review of the EMR contained a POC dated 5/19/2020-07/18/2020 with a SOC date of 5/19/2020. The EMR failed to contain any documentation that Patient 5 had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. DISCHARGED PATIENT 6: Record review of the EMR contained a POC dated 12/7/2020-2/4/2021 with a SOC date of 12/7/2020. The EMR failed to contain any documentation that Patient 6 had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. DISCHARGED PATIENT 8: Record review of the EMR contained a POC dated 3/17/2020-5/15/2020 with a SOC date of 3/17/2022. The EMR contained the CMS form titled, "Notice of Medicare Non-Coverage." The form read in part, " ...The effective date coverage of your ...services will end: 5/12/2020 ..." The form was signed and dated by Patient 8 on the discharge date of 5/12/2020. The record failed to contain any documentation that Patient 8 had been notified in advance that services would be ending and provided with the NOMNC with instruction on how to appeal the discharge decision. An interview was conducted on 11/29/2020 at 3:00 p.m. with RN 1. The surveyor reviewed the chart findings with RN 1. The surveyor asked why the NOMNC was not provided to Patient’s 1, 5, 6 or 8 at least 2 days prior to discharge. RN 1 said, “I can’t recall, it’s been too long.” RN 1 was asked what the impact could be to the patients not receiving the NOMNC timely. RN 1 said, “They may not realize they are being discharged so they could not set up other services if needed.”

Skilled services furnished CFR(s): 484.105(f) Standard: Services furnished. Skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are made available on a visiting basis, in a place of residence used as a patient's home. An HHA must provide at least one of the services described in this subsection directly, but may provide the second service and additional services under arrangement with another agency or organization. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure at least one home health service was directly performed by agency staff. At the time of the survey, 100% of the staff providing care to agency patients were contract employees. Provision of care by an entirely contracted staff could place the any future clients at risk due to the inability of the agency to provide adequate communication, coordination, and continuity of care between caregivers. Findings include: On 11/23/2022 12:18 p.m. the surveyor requested personnel files. Personnel file: The Administrator’s date of hire was 11/1/2015. The job description signed upon hire read in part…”is responsible for the overall direction of the hospices services”… The Supervising Nurse’s date of hire was 7/20/20. The job description signed upon hire read in part…”is responsible for the overall direction of hospice clinical services”… Alternate Supervising Nurse’s date of hire was 9/23/2019. The job description signed upon hire read in part…”The registered nurse plans, organizes and directs hospice care”… RN 1’s date of hire was 8/7/2019. The job description signed upon hire read in part…”The registered nurse plans, organizes and directs hospice care”… LVN 1’s date of hire was 11/23/2020. The job description signed upon hire read in part…”Participates in coordination of hospices services, appropriately reporting the identified needs to the interdisciplinary group”… MSW’s date of hire was 1/13/2020. The job description signed upon hire read in part…”Assesses the psychosocial status of patients and families/caregivers related to the patient’s terminal illness and environment and communicates findings to the registered nurse and other members of the interdisciplinary group”… CNA 1’s date of hire was 7/26/17. The job description signed upon hire read in part…”The hospice aid is responsible for”… An interview was conducted on 11/29/2022 at 10:15 a.m. with the HR Director. The surveyor explained that the personnel files provided to the surveyor were for hospice, not home health. The HR Director explained that the agency was mostly hospice and provided home health when needed. The surveyor asked if they had personnel files specifically for home health employees. The HR Director said “no.” An interview was conducted on 11/29/2022 at 10:45 am with the Administrator. The surveyor explained that all the personnel files this surveyor received from the agency were specific to hospice and asked if the staff had personnel files specific to home health as they were two separate entities/licensures. The Administrator said “no.” The Administrator explained that the legal department had worked with the State and were told they could share employees between NPI numbers if they had a shared services agreement. Surveyor asked if he was referring to a contract. The Administrator said “yes.” The Surveyor asked if each employee that worked through the contract of shared services agreement signed a contract. The Administrator said “no,” that he had signed the contract as the administrator of the home health agency. The Surveyor asked the Administrator if the agency provided any services directly or were they all contract. The Administrator said all the staff seeing patients were contract staff. Agency contract titled “Shared Service Agreement” read in part:…”Agreement effective date April 7, 2022. Service Provide 1: Keystone Hospice Care, Inc. DBA Custom Care Hospice. Address: 4811 Merlot Avenue, Suite 110, Grapevine Texas, 76051. Service Provider 2: Custom Care Healthcare, Inc., dba Custom Care Home Health. Address: 4811 Merlot Avenue, Suite 110, Grapevine Texas, 76051…1. Services. 1.1. Provision of Services. Each party is a Service Provider to the other party under this Agreement. The party receiving services is, and had the obligation of, the Agency under this agreement. The Service Provider shall provide temporary staffing (“Staff”) to agency…