Every finding on record at Domain Medical Home Health & Staffing, Inc

An unannounced Home Health Agency Medicare Medicaid recertification survey was conducted at the above named agency August 8-10, 2022 by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Medicare Medicaid Home Health Agency recertification survey was conducted August 8-10, 2022 at the above captioned agency by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. The agency reported 324 unduplicated admissions in the last twelve (12) months with an active census of 23 patients. The following were completed/reviewed in conjunction with the survey: Three home visits, ten (10) clinical records, three (3) personnel files, review of selected policies and procedures, the agency's complaint log, emergency preparedness plan, and COVID vaccination records. Interviews were also conducted. Deficiencies were identified and cited in this report The agency was found to be out of compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies (HHAs).

Transfer and discharge CFR(s): 484.50(d) Standard: Transfer and discharge. The patient and representative (if any), have a right to be informed of the HHA's policies for transfer and discharge. The HHA may only transfer or discharge the patient from the HHA if: This STANDARD is not met as evidenced by: Based on a review of agency documents and an interview, it was determined the agency's staff failed to provide the patient and/or representative with a copy of the transfer and discharge policies of the agency for ten (10) of ten (10) patients whose clinical records were reviewed in the survey sample. (clinical records #1-10) The findings were: The agency admission packet was reviewed in the agency on 8/08/2022 at 11:15 AM. The admission packet failed to contain a copy of the agency's transfer and discharge policies. An interview was conducted with the alternate administrator, staff #1, on 8/10/2022 at 11 AM. The staff member stated the transfer and discharge policy was in the admission packet and would show the surveyor however, staff member #1 was unable to find the policy. and stated the current packet being used may be an old version.

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 a review of clinical records and an interview it was determined the agency staff failed to follow the plan of care for two (2) of ten (10) patients whose clinical records were reviewed in the survey sample (clinical records #4 and 5). Specifically, the staff failed to follow the visit frequency as outlined in the plan of care. The findings were: The electronic clinical records were reviewed in read only mode from 8/08/2022 to 8/10/2022. 1. Clinical record #4 was reviewed for the certification period of 6/15/2022 through 8/13/2022. The plan of care contained orders for physical therapy (PT) to visit two (2) times per week for one (1) week, three (3) times per week for one (1) week and one (1) time per week for one (1) week. The PT only made two (2) visits (6/20/2022 and 6/24/2022) the second week of care when three (3) visits were due . The clinical record failed to contain documentation of the reason for the missed visit and there was no evidence the physician was notified of the change to the plan of care. 2. Clinical record #5 was reviewed for the certification period of 7/08/2022 through 9/05/2022. The plan of care contained physician orders for physical therapy (PT) to visit one (1) time per week for one (1) week, two (2) times per week for three (3) weeks and one (1) time per week for four (4) weeks. The PT only made one (1) visit (7/27/2022) the fourth week of care when two (2) visits were due . The clinical record failed to contain documentation of the reason for the missed visit and there was no evidence the physician was notified of the change to the plan of care. An interview was conducted with the alternate administrator, staff #1 on 8/10/2022 at 11 AM related to clinical record #5. After a review of the record, staff member #1 acknowledged the visit frequency did not follow the plan of care.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on a review of clinical records and an interview it was determined the agency's staff performed care without obtaining a physicians order for one (1) of ten (10) patients in the survey sample (clinical record #2). Specifically, staff applied a dressing to a wound that was not ordered by a physician. The findings were: The electronic clinical records were reviewed in read only mode from 8/08/2022 to 8/10/2022. Clinical record #2 was reviewed for the certification period of 6/29/2022 through 8/27/2022. The plan of care contained wound care orders for an open wound on the right foot. The wound care orders read: clean with normal saline, pat dry, apply Iodosorb and cover with non-adherent silicon Mepilex, secure with ace wrap. In the skilled nursing notes for 7/08/2022 and 7/11/2022, the nurse documented using Prisma instead of the Iodosorb. The patient goes to the wound care clinic one time per week. On 8/09/2022 the alternate administrator, staff member #1 was advised of the findings and asked if the wound care clinic changed the orders and if so did the agency have a copy. The staff member was to look into it and advise the surveyor of the findings. An interview conducted with staff member #1 on 8/10/2022 at 9 AM revealed that staff member #1 failed to obtain a copy of the order to use Prisma in place of the Iodosorb. As of the exit conference on 8/10/2022, no physician order had been obtained to cover the use of Prisma.

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 a review of clinical records and an interview it was determined the agency failed to ensure clinical records contained all required elements including but not limited to clinical notes. Specifically, the clinical notes were incomplete for one (1) of ten (10) patients whose clinical record was reviewed in the survey sample (clinical record #4). The findings were: The electronic clinical records were reviewed in read only mode from 8/08/2022 to 8/10/2022. Clinical record #4 was reviewed for the certification period 6/15/2022 through 8/13/2022. The plan of care contained physician orders for physical therapy (PT) to visit two (2) times per week for one (1) week, three (3) times per week for one (1) week and one (1) time per week for one (1) week. The initial comprehensive assessment was completed on 6/15/2022. All other visits made by the PT (6/17/2022, 6/20/2022, 6/24/2022 and 6/27/2022) contained skilled notes that were incomplete to include an incomplete assessment, no interventions or goals documented for the visit and no signature by the clinician who made the visit. It was unclear in the clinical record if the patient was still active or had been discharged. An interview was conducted with the administrator alternate, staff member #1 on 8/10/2022 at 9 AM. Staff member #1 was presented with the findings and agreed to look at the clinical record. A second interview was conducted with the administrator alternate, staff member #1 on 8/10/2022 at 11 AM. Staff member #1 stated having spoken to the clinician and the clinician was to "fix" the documentation. The patient had been discharged from services. Copies of the clinical notes were obtained ant the documentation had not been completed by the exit conference on 8/10/2022.