Every finding on record at Diversified Enterprises, Inc.

A recertification survey for compliance with 42 CFR Part 483, Subpart G, Subsection 484.102, Emergency Preparedness Requirements for Home Health Agencies, was conducted from 3/14/22 through 3/16/22. Interim Healthcare was found in compliance.

A recertification survey for compliance with 42 CFR Part 484, Subparts B-C, requirements for home health services, was conducted from 3/14/22 through 3/16/22. Interim Healthcare was found not in compliance with the following requirements: G572 and G1012.

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, interview, and policy review, the provider failed to ensure missed home visits had been reported to the physician in a timely manner for one of seven sampled patients (3). Findings include: 1. Review of patient 3's Home Health Certification and Plan of Care for the certification period of 4/16/21 to 6/14/21 revealed: *Occupational therapy (OT) was to conduct home visits one to two times weekly for five weeks starting 4/24/21. *Physical therapy (PT) was to conduct home visits three times weekly for four weeks starting 4/16/21. Review of patient 3's April 2021 and May 2021 client calendars for home visits revealed for the: *First week for April 17 through April 23, 2021 the physical therapy assistant (PTA) missed one home visit. *Second week for April 24 through April 30, 2021 the physical therapist missed a home visit due to the patient's unavailability due to medical appointments. *Third week for May 1 through May 7, 2021 two PT missed home visits and one OT missed home visit: -Due to the patient having bladder surgery and a scheduling conflict with the PTA for the second home visit for the week. -With no documented reason for the missed OT home visit. Review of the 5/27/21 facsimile form sent to the physician the home visits on 4/21/21, 5/3/21, and on 5/5/21 had been reported as missed home visits. There was no documentation for the missed PT home visit on 4/26/21. Interview on 3/15/22 at 2:00 p.m. with registered nurse/chief clinical officer A confirmed: *There was no documentation the physician had been notified of the missed PT home visit on 4/26/21. *The above missed home visits should have been reported to the physician the week the home visits had been missed. *The physician had been notified of the missed visits after patient 3 had been discharged on 5/25/21. Review of the provider's 4/2/21 Variances from the Plan of Care/Service policy revealed: *The purpose of the policy was to ensure the patients received care/services they required at the frequency and duration as ordered. *The physician or allowed practitioner decided whether the visit should have been skipped or if additional intervention was required due to the impact on the patient.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record review, interview, and policy review, the provider failed to coordinate patient care with all disciplines as requested by one of seven sampled patients (3). Findings include: 1. Review of patient 3's Home Health Certification and Plan of Care for the certification period of 4/16/21 to 6/14/21 revealed: *Three as needed home visits by the registered nurse (RN) to assess disease exacerbation, falls, signs or symptoms of infection, lab results, skin integrity or discharge planning. *Physical therapy (PT) was to conduct home visits three times weekly for four weeks starting 4/16/21. Review of the 5/14/21 PT visit note revealed the patient had questions about the frequency of the nursing visits. The visit note indicated the physical therapist would contact the home health agency and would have them reach out to the patient. Further review of the medical record revealed no documentation to support the RN had contacted patient 3. Interview on 3/15/22 at 2:00 p.m. with the RN/chief clinical officer A confirmed there was no documentation in patient 3's medical record to support the coordination of care as requested by the patient. Review of the provider's 4/2/21 Coordination of Care/Services policy revealed: *"The DHCS [director of health care services] establishes guidelines for communication and liaison among interdisciplinary care/service providers that ensure continuity, consistency, efficiency and appropriateness of care/service delivery, and supports objectives of the plan of care/service plan." *"The DHCS establishes processes for the documentation of interdisciplinary coordination of care/services in the patient/client record." *"When more than one discipline is ordered, the Clinical Manager coordinates care/services among disciplines to ensure that care/service provided is complementary, timely, and appropriate to the needs of the patient/client."