Every finding on record at Elder Alternatives Inc

An unannounced Complaint Investigation, #2021002970 and Focused Infection Control survey was commenced on 03/03/2021 and concluded on 03/04/2021at Elder Alternatives Inc., Home Health Agency provider. The provider was not in compliance with 42 CFR Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on review of the Home Health Agency (HHA)'s own Policy and Procedure, record review and interview, the HHA failed to immediately report an allegation of abuse and neglect to the appropriate authorities, the State Of Florida's Central Abuse Hotline, as mandated by State Law, for 1 of 3 sampled vulnerable adult patients (Clients) (Client #1). The findings included: Review of the HHA's own Policy and Procedure titled, "Investigating Client Abuse, Neglect and/or Exploitation " revised on February 2020 documented " ...this HHA has developed and implemented a client abuse ...neglect ...prevention and reporting plan in compliance with the relevant Florida state statutes ...when a client reports a grievance, complaint or concern to the agency an investigation is initiated within the next business day depending on the severity of the concern ...grievances priorities are classified in three groups ...high risk- including situations of ...abuse and neglect ..". Review of the HHA's own Policy and Procedure titled, "Reporting of Negative Outcomes" revised on February 2020 documented "..if the HHA identifies a negative client care action or employee action with possible harmful consequences, the HHA will inform the accrediting body and the Florida AHCA (Agency for Health Care Administration) within the next business day" Further review reveals no evidence that the HHA's Policy and Procedure was in accordance with Federal Regulations regarding immediate reporting to the appropriate authorities, the State Of Florida's Central Abuse Hotline as mandated by State Law. Review of Client #1's record documented a start of care date on 12/16/20 for 63 hours of Home Health Aide care and services to provide assistance with personal care and 35 hours of Homemaker service for assistance with house chores and the client's diagnoses required this level of care. Review of Client #1 record documented personal care and homemaker services provided from 12/16/20 to 02/22/21 and Staff A, a Certified Nursing Assistant, provided these services to Client #1 from 12/24/20 to 02/09/21. On 03/03/21 at 1:55 PM, a side-by-side review of the HHA's documentation, for Client #1, dated 02/09/21 was conducted with the DON/Corporate Compliance Officer that reveals evidence of an allegation of possible abuse and neglect of Client #1 by Staff A. The HHA's documentation, dated 02/09/21, but signed and dated on 02/18/21, 9 days later, by the HHA's Administrator and the DON/Corporate Compliance Officer did not provide evidence of documentation that Client #1's allegation of possible abuse and neglect was immediately reported, by the HHA, to the State Of Florida's Central Abuse Hotline, as mandated by State Law. Review of the HHA's "Communication Log" from Staff B, a Registered Nurse/Case Manager and the HHA's Human Resources Manager, to Staff A dated 02/09/21, regarding the allegations of abuse and neglect, reveals no evidence that Client #1's allegation of possible abuse and neglect was immediately reported, by either Staff B or the HHA's Human Resources Manager, to the State Of Florida's Central Abuse Hotline, as mandated by State Law. On 03/03/21 at 2:45 PM, a joint interview with the HHA's Administrator and the DON/Corporate Compliance Officer was conducted; the Administrator was asked to submit evidence that documented Client #1's report of allegations of possible abuse and neglect was immediately reported to the State Of Florida's Central Abuse Hotline, as mandated by State Law and the Administrator stated that an outside party reported the allegations; the Administrator and the DON/Corporate Compliance Officer stated that they believed they (HHA) called the State Of Florida's Central Abuse Hotline the next day; that they have not called the HHA back and they were waiting on the report; the Administrator added that they usually call the State Of Florida's Central Abuse Hotline the next day if they have a case of abuse and the Administrator was asked if Client #1's "complaint" was classified as abuse and she stated at the time, they did not think it was abuse and that they were waiting on the investigation report (from the State Of Florida's Central Abuse Hotline). On 03/04/21 at 2:12 PM, a telephone interview was conducted with the RN (Registered Nurse)/CM (Case Manager/ADON (Assistant Director of Nursing) who stated that on 02/10/21 around 9:30 AM as usual, the client's RN/Case Manger (Staff B), the DON, Schedulers and herself did a quick meeting about what happened with the HHA's patients and clients from 5:00 PM to 9:00 AM, during on call hours; the RN/CM/ADON was asked for the HHA's timeline about reporting abuse and stated they should do it "right away;" the RN/CM/ADON was asked if the Client #1 complained of being abused, why was this not reported to the State Of Florida's Central Abuse Hotline) right away; she stated that because DCF (Department of Children And Families) called them (the HHA) on the same day that the client complained, they (the HHA) assumed DCF was doing the investigation; added that they assumed that DCF will call them back with a report; the RN/CM/ADON was asked how would she know that DCF was there conducting Client #1 abuse allegations reported to the HHA earlier on that date, if she did not ask them for the reason of their visit on 02/09/21 and she stated, "I don't have an answer" and the RN/CM/ADON stated that if they have an abuse complaint, they have to investigate and report the abuse. On 03/04/21 at 3:21 PM, a telephone interview was conducted with the DON/Corporate Compliance Officer. She stated that on 02/09/21 at 2:40 PM, she left a telephone message to Staff A regarding Client #1's allegations of possible abuse and neglect. The DON/Corporate Compliance Officer was asked what the HHA did between 10:11 AM on 02/09/21 and 5:30 PM on 02/09/21 when they received a call from DCF; she stated that they usually start the abuse investigation; stated that she was in the office on 02/09/21 until about 2:00 PM; added that she did not have any notes about Staff A been removed from Client #1 at the time she left the office on 02/09/21 and she then stated that on 02/09/21 at 2:40 PM, she left a telephone message to Staff A. On 03/04/21 at 3:21 PM, during the telephone interview, the DON/Corporate Compliance Officer stated that she is usually off on Wednesday's and was not in the office; stated that the RN/CM/ADON's "e-mail," was sent to her on 02/10/21, she read it on 02/11/21 in the morning; she did not call DCF because she thought they were the ones initiating the complaint about Staff A's alleged abuse to Client #1; she was aware that the HHA's Administrator verbally communicated with DCF on 02/18/21 because she thought there was an on-going investigation; it was her understanding that there was an investigation of abuse by DCF for Client #1. The DON/Corporate Compliance Officer was apprised of the lack of documentation related to Client #1's abuse allegation investigation and the failure of the HHA to immediately notify the State Of Florida Central Abuse Hotline; the DON/Corporate Compliance Officer confirmed that abuse can be reported at any time and confirmed that the HHA's policy contained the abuse hotline telephone number; stated that she can see there is not a "clear picture" and that they should have documented their attempts of contacting with DCF.