Every finding on record at Datahr Home Health Care, Inc (Certified)

The following statement of deficiencies represents the results of a partial extended re-certification survey of Datahr Home Health Care, Certified Home Health Agency, located at 120 Kisco Avenue, Mount Kisco, New York 10549, conducted on 09/18/2023 through 09/21/2023, to evaluate the Agency’s compliance with Federal Conditions of Participation and State requirements. A standard re-certification survey was initiated on 09/18/2023. Deficient practices were identified within Level 1 standards in Plan of Care (484.60 Condition), resulting in a partial extended survey. The Agency reported an active patient census of 22 at the entrance conference on 09/18/2023. The survey consisted of a review of seven (7) Clinical Records, including two (2) discharge records, three (3) personnel records, two (2) contracts), and three (3) observational home visits. The survey included a review of pertinent policies and procedures, Quality Improvement Meeting Minutes for the past 12 months, Patient Admission Packet, the Emergency Preparedness Plan, and Complaint Log for the past 12 months. Pre-survey activities consisted of a review on 09/10/2023 of the agency's Health Commerce System account, Quality Improvement and Evaluation System (IQIES) for the period 06/2022 to 05/2023, and the Agency's compliance with report submissions for the 2021 statistical report and the Emergency Drills conducted 08/2021 through 08/2022. The Director of Patient Services and the Rehabilitation Director were interviewed. Findings were reviewed at the exit conference on 9/21/2023. The following deficiencies are identified as a result of the survey: Federal Deficiencies: G0574 – Plan of Care must include the following G 0578 - Conformance to Physician Order G0590 – Promptly alert relevant physician of changes

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on home visit observations, clinical record reviews and staff interview, the Agency failed to establish individualized Plans of Care (POC) that include services, frequency and duration of visits that are specific to the patients' health care needs. This was evident for four (4) of seven (7) records reviewed (Patients #2, #3, # 4, and #5). Failure to establish an individualized plans of care that includes services, frequency and duration of visits that are specific to the patient’s health care needs has the potential for negative patient outcomes. The findings include: 3. Patient #4 has a start of care date of 4/29/2020 and a discharge date of 12/16/2022, with diagnoses that include Chronic Respiratory Failure, Epilepsy, Type II Diabetes Mellitus, Traumatic Brain Injury, Bipolar Disorder as documented on the “Datahr Home Health Care Plan of Care” for the Certification Period of 10/16/2022 to 12/14/2022. The “Datahr Home Health Care Plan of Care” for the Certification Period of 10/16/2022 to 12/14/2022 documents: “Skilled Nurse ( SN) medication management interventions. Reconcile all the medications. Instruct/ reinstruct patient/ caregiver. Medication actions, uses, frequency, dose, side effects, interactions of all new / change medications. SN may prepour 7- 14 days of medication in the event the patient’s schedule conflicts with the nurse’s prepour schedule. SN may prepour an extra week of medication to be used in the event of an emergency. SN to prepour medi-planner every 7 days and as needed if all medications are not available at the time of visit. Frequencies: Registered Nurse (RN) /Licensed Vocational Nurse ( LVN) once a week for nine weeks. As needed 2 visits reason change in medications/ clinical status/ medication prepour”. The "Skilled Nurse visit note" dated 11/22/22 documents: "Skilled nurse prepour medication for 7 days. Skilled nurse instructed patient re: hypoglycemia. Hypoglycemia can occur if you eat less than usual after taking diabetes medication. Blood glucose can be raised by drinking orange juice and eating carbohydrates. Patient requires instructions reinforced on subsequent visit”. The Plan of Care lacks documented evidence of clarity of the nurse frequency and duration of visits for medication prepour specific to the patient’s needs. The Plan of Care lacks document evidence of the frequency of the skilled nursing visits for adherence to medication compliance. There is no documented evidence of checking blood glucose in the plan of care There is no documented evidence of blood glucose parameters instructions in the Plan of Care. There is no documented evidence the patient is receiving hypoglycemic agents. There is no documented evidence the Plan of Care is complete and individualized to the patient’s specific needs. 4. Patient #5 has a start of care date of 12/04/2014 and a discharge date of 11/01/2022 with diagnoses that include Obsessive Compulsive Behavior, Convulsions, Intracranial Injury , Dysrhythmic Disorder as documented on the “Datahr Home Health Care Plan of Care” for the Certification Period of 10/23/2022 to 12/21/2022. The “Datahr Home Health Care Plan of Care” for the Certification Period of 10/23/2022 to 12/21/2022 documents: “Skilled Nurse ( SN) medication management interventions. Reconcile all the medications. Instruct/ reinstruct patient/ caregiver. Medication actions, uses, frequency, dose, side effects, interactions of all new / change medications. SN may prepour 7- 14 days of medication in the event the patient’s schedule conflicts with the nurse’s prepour schedule. SN may prepour an extra week of medication to be used in the event of an emergency. SN to prepour medi-planner every 7 days and as needed if all medications are not available at the time of visit. Frequencies: Registered Nurse (RN) /Licensed Vocational Nurse ( LVN) once a week for nine weeks”. The Plan lacks documented evidence of the specific time and schedule the nurse will be in the home to prepour medications. The Plan of Care lacks document evidence of the frequency of the skilled nursing visits for adherence to medication compliance. The frequency of nurse visits schedule conflicts with the days schedule for medication prepour. The Plan of Care lacks documented evidence of clarity of the nurse frequency and duration of visits for medication prepour specific to the patient’s needs. On 9/21/2023 at 12:45 PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. 1. Patient # 2 has a start of care 7/8/2004 with diagnoses of Epilepsy unspecified, Schizoaffective disorder unspecified, Unspecified Intracranial injury with Loss of Consciousness, other symptoms and signs with cognitive functions and awareness, Major Depressive Disorder-single episode-severe with psychiatric features as documented on the "Datahr Home Health Care Plan of Care" for the Certification Period of 7/29/2023 through 9/26/2023. The "Datahr Home Health Care Plan of Care" dated 7/29/2023 through 9/26/2023 documents: Skilled Nursing (SN) Medication Management Inventions: Instruct/Reinstruct Patient/ Patient Caregiver: Medication actions, uses, frequency, dose, side effects, interactions of all new/change meds. Reconcile all the medications. Registered Nurse to assess patient adherence to medication/ treatment regimen. Licensed Practical Nurse (LPN) to reinstruct patient on adherence to medication/treatment regimen. SN may prepour 7-14 days of medication in the event the patient's schedule conflicts with the nurse's prepour schedule. SN to prepour Medi-planner every 7 days and as needed (PRN) if all medications are not available at the time of the visit. Frequencies: Registered Nurse/Licensed Vocational Nurse (LVN): 1x week for 9 weeks starting 8/2/2023 (week 2). Registered Nurse/Licensed Vocational Nurse (LVN): As needed (PRN) 2 visits starting 7/29/2023 (week 2) Reason for PRN: For changes in clinical status and or recertification. The Plan of care lacks documented evidence of clarity for the Skilled Nurse frequency and duration of visits for medication prepour. The Plan of care lacks documented evidence of the frequency of the Skilled Nurse visit for adherence to medication regimen. The Plan of Care lacks documented evidence of Skilled Nurse as needed (PRN) visits for medication prepour. There is no documented evidence the Plan of Care is complete and individualized to the patient’s specific needs. 2. Patient # 3 has a start of care 7/20/2021 with diagnoses of Hypertensive Heart Disease with Heart Failure, Chronic Diastolic Heart Failure, Type 2 Diabetes Mellitus with other specified complication, Mild Intellectual Disabilities, Anxiety Disorder-unspecified, Major Depressive Disorder-single episode, Atherosclerosis of other arteries, Morbib (severe) obesity as documented on the Datahr Home Health Care Plan of Care for the Certification Period of 9/8/2023 through 11/6/2023. The Datahr Home Health Care Plan of Care dated 9/8/2023 through 11/6/2023 documents: Skilled Nursing (SN) Medication Management Interventions: Registered Nurse (RN) to assess patient adherence to medication/treatment regimen. Licensed Practical Nurse (LPN) to reinstruct patient on adherence to medication/treatment. SN may prepour 7-14 days of medication in the event the patient's schedule conflicts with the nurse's prepour schedule. SN to prepour Medi-planner every 7 days and as needed (PRN) if all medications are not available at the time of the visit. Frequencies: Registered Nurse (RN)/ Doctorate Nurse Practitioner (DNP)/ Licensed Vocational Nurse (LVN): 1x week for 9 weeks (week 2). As needed (PRN) 2 visits (week 2) Reason for PRN: For changes in clinical status and or recertification. The Plan Of Care lacks documented evidence of clarity for the Skilled Nurse frequency and duration of visits for medication prepour, in a "1x week" visit interval, as the order states "7-14 days". The Plan of Care lacks documented evidence of Skilled Nurse as needed (PRN) visits for medication prepour. There is no documented evidence the Plan of Care is complete and individualized to the patient’s specific needs. The findings and interview were conducted on 9/21/23 at 1:00 pm with the Agency's Director of Patient Services and Rehab Director. No explanation was provided.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record reviews and staff the agency failed to ensure that the Plan of Care for all patients is implemented and in conformance with physician's orders. This was evident for one (1) of seven (7) clinical records reviewed. (Patients # 4). Failure to ensure that the Plan of Care for all patients is implemented and in conformance with physician's orders has the potential for negative patient outcomes. The findings are: Patient #4 has a start of care date of 4/29/2020 and a discharge date of 12/16/2022 with diagnoses that Chronic Respiratory Failure, Epilepsy, Type II Diabetes Mellitus, Traumatic Brain Injury, Bipolar Disorder as documented on the “ Plan of Care” for the Certification Period of 10/16/2022 to 12/14/2022. The “ Plan of Care” for the Certification Period of 10/16/2022 to 12/14/2022 documents: “Skilled Nurse ( SN) medication management interventions. Reconcile all the medications. Instruct/ reinstruct patient/ caregiver. Medication actions, uses, frequency, dose, side effects, interactions of all new / change medications. SN may prepour 7- 14 days of medication in the event the patient’s schedule conflicts with the nurse’s prepour schedule. SN may prepour an extra week of medication to be used in the event of an emergency. SN to prepour medi-planner every 7 days and as needed if all medications are not available at the time of visit. Frequencies: Registered Nurse (RN) /Licensed Vocational Nurse ( LVN) once a week for nine weeks. As needed 2 visits reason change in medications/ clinical status/ medication prepour”. The ” skilled nursing visit note” document the nurse prepour medications on the following dates: 11/14/22, 11/22/22. There is no documented evidence the skilled nursing visits were conducted every 7 days. There is no documented evidence the nursing visits were conducted in accordance with the Plan of Care. On 9/21//23 at 1:00PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings

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 record reviews and staff interviews, the Agency failed to alert the physician that the plan of care should be altered to achieve desired outcomes. This was evident for four (4) of seven (7) clinical records reviewed (Patient #2, #3, #4, #5). Failure to alert the physician of the need to alter the plan of care has the potential for negative patient outcomes. The findings are: 3. Patient #4 has a start of care date of 4/29/2020 and a discharge date of 12/16/2022 with diagnoses that Chronic Respiratory Failure, Epilepsy, Type II Diabetes Mellitus, Traumatic Brain Injury, Bipolar Disorder as documented on the “Datahr Home Health Care Plan of Care” for the Certification Period of 10/16/2022 to 12/14/2022. The “Datahr Home Health Care Plan of Care” for the Certification Period of 10/16/2022 to 12/14/2022 documents: “Skilled Nurse ( SN) medication management interventions. Reconcile all the medications. Instruct/ reinstruct patient/ caregiver. Medication actions, uses, frequency, dose, side effects, interactions of all new / change medications. SN may pre pour 7- 14 days of medication in the event the patient’s schedule conflicts with the nurse’s pre pour schedule. SN may pre pour an extra week of medication to be used in the event of an emergency. SN to pre pour medi-planner every 7 days and as needed if all medications are not available at the time of visit. Frequencies: Registered Nurse (RN) /Licensed Vocational Nurse ( LVN) once a week for nine weeks. As needed 2 visits reason change in medications/ clinical status/ medication pre pour”. There is no documented evidence the nurse notified physician to clarify the plan of care for the nursing visits and schedule for medication pre-pour. The ”Skilled nursing visit note” dated 11/14/22 Documents: “Skilled nurse pre pour medications for 8 days. Patient not available on next schedule visit. Skilled nursing instructed patient re: hypoglycemia also known as low blood sugar, is a fall in blood sugar to level too low below normal. Some of the reasons why it can occur the side effects of drugs used to treat diabetes, too much insulin or other medications may cause your blood sugar level to drop too low causing hypoglycemia. Patient requires instructions reinforced on subsequent visits”. The ”Skilled Nurse visit note” dated 11/22/22 documents: ”Skilled nurse pre pour medication for 7 days. Skilled nurse instructed patient re: hypoglycemia. Hypoglycemia can occur if you eat less than usual after taking diabetes medication. Blood glucose can be raised by drinking orange juice and eating carbohydrates. Patient requires instructions reinforced on subsequent visit”. The Plan of Care lacks documented evidence the Physician was promptly alerted of any change in the patient's condition that necessitate the nurse instruction for monitoring symptoms of hypoglycemia. The Plan of Care lacks documented evidence the physician was notified that the patient requires an order for hypoglycemic agents. 4. Patient #5 has a start of care date of 12/04/2014 and a discharge date of 11/01/2022 with diagnoses that include Obsessive Compulsive Behavior, Convulsions, Intracranial Injury , Dysrhythmic Disorder as documented on the “Datahr Home Health Care Plan of Care” for the Certification Period of 10/23/2022 to 12/21/2022. The “Datahr Home Health Care Plan of Care” for the Certification Period of 10/23/2022 to 12/21/2022 documents: “Skilled Nurse ( SN) medication management interventions. Reconcile all the medications. Instruct/ reinstruct patient/ caregiver. Medication actions, uses, frequency, dose, side effects, interactions of all new / change medications. SN may pre pour 7- 14 days of medication in the event the patient’s schedule conflicts with the nurse’s pre pour schedule. SN may pre pour an extra week of medication to be used in the event of an emergency. SN to pre pour medi-planner every 7 days and as needed if all medications are not available at the time of visit. Frequencies: Registered Nurse (RN) /Licensed Vocational Nurse ( LVN) once a week for nine weeks”. There is no documented evidence the Physician was notified to obtain clarification of the conflicting order for the visit frequency and schedule of medication pre pour. On 9/21/2023 at 1:00PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. 1. Patient # 2 has a start of care 7/8/2004 with diagnoses of Epilepsy unspecified, Schizoaffective disorder unspecified, Unspecified Intracranial injury with Loss of Consciousness, other symptoms and signs with cognitive functions and awareness, Major Depressive Disorder-single episode-severe with psychiatric features as documented on the "Datahr Home Health Care Plan of Care" for the Certification Period of 7/29/2023 through 9/26/2023. The "Datahr Home Health Care Plan of Care" dated 7/29/2023 through 9/26/2023 documents: Skilled Nursing (SN) Medication Management Inventions: Instruct/Reinstruct Patient/ Patient Caregiver: Medication actions, uses, frequency, dose, side effects, interactions of all new/change meds. Reconcile all the medications. Registered Nurse to assess patient adherence to medication/ treatment regimen. Licensed Practical Nurse (LPN) to reinstruct patient on adherence to medication/treatment regimen. SN may prepour 7-14 days of medication in the event the patient's schedule conflicts with the nurse's prepour schedule. SN to prepour Medi-planner every 7 days and as needed (PRN) if all medications are not available at the time of the visit. Frequencies: Registered Nurse/Licensed Vocational Nurse (LVN): 1x week for 9 weeks starting 8/2/2023 (week 2). Registered Nurse/Licensed Vocational Nurse (LVN): As needed (PRN) 2 visits starting 7/29/2023 (week 2) Reason for PRN: For changes in clinical status and or recertification. There is no documented evidence the Physician was notified to obtain clarification of the conflicting order for the visit frequency and schedule of medication prepour. 2. Patient # 3 has a start of care 7/20/2021 with diagnoses of Hypertensive Heart Disease with Heart Failure, Chronic Diastolic Heart Failure, Type 2 Diabetes Mellitus with other specified complication, Mild Intellectual Disabilities, Anxiety Disorder-unspecified, Major Depressive Disorder-single episode, Atherosclerosis of other arteries, Morbib (severe) obesity as documented on the Datahr Home Health Care Plan of Care for the Certification Period of 9/8/2023 through 11/6/2023. The Datahr Home Health Care Plan of Care dated 9/8/2023 through 11/6/2023 documents: Skilled Nursing (SN) Medication Management Interventions: Registered Nurse (RN) to assess patient adherence to medication/treatment regimen. Licensed Practical Nurse (LPN) to reinstruct patient on adherence to medication/treatment. SN may prepour 7-14 days of medication in the event the patient's schedule conflicts with the nurse's prepour schedule. SN to prepour Medi-planner every 7 days and as needed (PRN) if all medications are not available at the time of the visit. Frequencies: Registered Nurse (RN)/ Doctorate Nurse Practitioner (DNP)/ Licensed Vocational Nurse (LVN): 1x week for 9 weeks (week 2). As needed (PRN) 2 visits (week 2) Reason for PRN: For changes in clinical status and or recertification. There is no documented evidence the Physician was notified to obtain clarification of the conflicting order for the visit frequency and schedule of medication prepour. On 9/21/23 at 1:00 pm the Director of Patient Services was interviewed and did not provide an explanation for the findings.