Every finding on record at Divine Home Care of Ohio, LLC

Substantial Allegation Survey Substantial Allegation 71832 No deficiencies were cited related to allegations contained in substantial allegation 71832 completed on 10/19/22; however, the facility was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiencies are cited. Divine Home Care of Ohio, LLC 368156, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Eligibility for Medicare home health benefit CFR(s): 484.55(b)(2) Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. This ELEMENT is not met as evidenced by: Based on medical record review, policy review and staff interview, the facility failed to have a registered nurse complete the comprehensive assessment for four of four patients reviewed (Patient #1, #2, #3 and #4). This could affect all patients receiving services from the agency. Findings include: 1. Review of the medical record for Patient #1 revealed a start of care date of 08/17/22 with a primary diagnosis of cellulitis of the left lower leg. The certification period reviewed was for 08/17/22 through 10/15/22. Home health aide (HHA) services were ordered for three times per week. The start of care non-outcome assessment and information set (OASIS) comprehensive assessment completed on 08/17/22 was completed by a licensed practical nurse (LPN) Staff D. There were no vital signs (VS) completed during this certification and the patient's ears, nose, throat and cardiovascular were listed as within normal limits (WNL). Physician orders on the physician ordered plan of care revealed the skilled nurse (SN) was to conduct all assessments and supervision visits (SV) either in person or via phone telehealth per Medicare/Medicaid telehealth guidelines. A request was made to Staff B for a policy related to completing a start of care assessment and telehealth visits. Staff B stated no policy was in place for non-OASIS patients and provided an undated policy titled, Comprehensive Assessment of Patient. This policy states a registered nurse (RN) will complete the comprehensive assessment at the start of care and for recertification. Staff B further provided information dated May 2020 which allowed Home Health Agencies (HHA) to provide telecommunications during the Public Health Emergency (PHE) as long as such services do not substitute for in-person visits ordered on the plan of care. The non-OASIS assessment for Patient #1 was not clear if the evaluation was completed in person or per phone. A request was made to interview the LPN with Staff B stating on 10/19/22 at 2:45 PM that this nurse was ill and not available for a call. Staff B further indicated the assessments were completed by phone and not in person. 2. Review of the medical record for Patient #2 revealed a start of care of 07/13/19 with a primary diagnosis of Type II diabetes. Staff D, the LPN, completed a recertification assessment on 08/17/22 with prognosis listed as fair, height and weight stated by the patient, ears, nose, mouth, respiratory and cardiac status listed WNL. 3. Review of the medical record for Patient #3 revealed a start of care of 03/01/22 with a primary diagnosis of Type II diabetes. Review of the comprehensive assessments for the certification periods dated 06/29/22 through 08/27/22 and 08/28/22 through 10/26/22 revealed they were completed by the LPN, Staff D. 4. Review of the medical record for Patient #4 revealed the start of care comprehensive assessment was completed on 06/28/22 by the LPN, Staff D. The findings of not having an RN complete the comprehensive assessment with Patient #1, #2, #3, and #4 was verified with Staff A and B on 10/19/22 at 4:00 PM.

Non-skilled direct observation every 60 days CFR(s): 484.80(h)(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, the registered nurse must make an on-site visit to the location where the patient is receiving care no less frequently than every 60 days in order to observe and assess each aide while he or she is performing care. This ELEMENT is not met as evidenced by: Based on record review, policy review and staff interview, the agency failed to ensure that for a patient not receiving skilled care a registered nurse made an onsite visit at least every 60 days to observe the home health aide providing care for four of four patients reviewed (Patient #1, #2, #3 and #4). This could affect all patients receiving services from the agency. Findings include: 1. Review of Patient #1's medical record revealed a start of care (SOC) date of 08/17/22 with a primary diagnosis of cellulitis of the left lower leg. The certification period reviewed was for 08/17/22 through 10/15/22. The patient was to receive home health aide (HHA) services three times per week. A supervisory visit was completed on 10/13/22 for the aide by a Licensed Practical Nurse (LPN), Staff D. A request was made to Staff B for a policy related to home health aide (HHA) supervision. Staff B provided an undated agency policy titled, Nurse Supervision. This policy states that the supervising nurse will routinely review the plan of care (POC) and all subsequent orders and review notes to ensure that the POC is directly being followed and all orders have been signed by the physician. The HHA will be supervised every 60 days by a registered nurse (RN) in the patient’s home with the HHA present. 2. Review of the medical record for Patient #2 revealed a SOC of 07/13/19 with a primary diagnosis of Type II diabetes. HHA services were ordered one time a week for one week and three times a week for eight weeks. Supervisory visits were completed for the HHA on 06/20/22 and 08/17/22 by a LPN, Staff D. 3. Review of the medical record for Patient #3 revealed a SOC of 03/01/22 with a primary diagnosis of Type II diabetes. HHA were ordered five times per week. Supervisory visits were completed on 06/20/22 and 08/17/22 by a LPN, Staff D. There was no documentation the aide was present. 4. Review of the medical record for Patient #4 revealed a SOC of 06/28/22 with orders for HHA services two times per week. A supervisory visit was completed by a LPN, Staff D, on 8/25/22. Staff D wrote a note stating the aide was not present and out with an illness. The findings of not having an RN complete supervisory visits every 60 days with the aide present was verified in an interview with Staff A and B on 10/19/22 at 4:00 PM.