Every finding on record at Elk Valley Professional Affiliates Inc.

An Emergency Preparedness survey was conducted from 1/07/2025 to 1/09/2025 at Home Care Solutions. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

A recertification survey was conducted from 1/07/2025 to 1/09/20225 at Home Care Solutions. Deficiencies were cited under CFR Part 484, Requirements for Home Care Organizations Providing Home Health Care.

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 review and interview, the agency failed to notify the physician of medications not available in the home for 1 patient (#6) of 10 patients reviewed. The findings included: Medical record review revealed Patient #6 was admitted to the agency on 12/10/2024 with diagnoses including Stress Fracture of the Left Femur and Malignant Neoplasm of Bladder. Medical record review of the Home Health Certification and Plan of Care (485) dated 12/10/2024 to 02/07/2025 revealed a physician’s order for the skilled nurse to administer Vitamin B12 1000mcg/ml every 2 weeks intramuscular. Medical record review of nurse’s notes dated 12/10/2024, 12/17/2024, 12/26/2024 and 01/07/2025 revealed the B12 had not been administered. The B12 medication not in the home. There was no documentation the physician had been notified the patient had not received the B12 injections as ordered. During an interview on 1/8/2025 at 1:30 PM, the Clinical Nurse Supervisor confirmed the B12 was not administered to the patient as ordered by the physician and the physician had not been notified.

An Emergency Preparedness survey was conducted from 6/15/2021 to 6/17/2021 at Home Care Solutions. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

A Recertification survey was conducted on 6/15/2021 to 6/17/2021 at Home Care Solutions. Deficiencies were cited under CFR Part 484, Requirements for Home Care Organizations Providing Home Health Care.

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 medical record review and interview, the agency failed to follow the plan of care ordered by the physician for 2 patients (#15 and #17) of 17 patients reviewed. The findings include: Patient #15 was admitted to the agency on 4/17/2021 with diagnoses including Type 2 Diabetes Mellitus and Hypertension. Medical record review of the Home Health Certification and Plan of Care dated 4/17/2021 to 6/15/2021 revealed the physician's order for Skilled Nurse (SN) visits at 1 time a week for 2 weeks. Medical record review of the nurse's note dated 4/17/2021 revealed a SN visit was completed the first week of the certification. Medical record review of a Client Coordination Note Report dated 4/22/2021 revealed the SN telephoned the patient to schedule a SN visit for 4/22/2021. Further review revealed the patient had a physician's appointment and requested the SN visit be rescheduled for 4/23/2021. Medical record review of the nurse's note for 4/23/2021 revealed a SN visit was not completed or attempted on 4/23/2021. Continued review revealed the SN visit was not completed the second week of the certification as ordered by the physician. Further review revealed no documentation the physician was notified of the missed visit. Interview with the Quality Assurance Coordinator on 6/16/2021 at 1:00 PM confirmed the plan of care regarding SN visits were not completed as ordered by the physician and no documentation the physician was notified. Patient #17 was admitted to the agency on 3/21/2021 with diagnoses including Hypertensive Heart Disease and Atrial Fibrillation. Medical record review of a nurse's note dated 4/16/2021 revealed the patient developed a Stage 2 Pressure Ulcer on his second toe of his right foot. Continued review revealed the wound's measurements were 2.2 cm in length; 1.6 cm in width; and 0.1 cm in depth. Further review revealed the wound had a small amount of serosanguineous drainage with no odor. Continued review revealed the physician was notified and wound care orders were obtained. Continued review revealed wound care was provided as ordered by the physician on 4/16/2021. Medical record review of a physician's order dated 4/16/2021 revealed a physician's order for "...SN to cleanse right 2nd toe Pressure Ulcer with soap and water. Pat dry. Apply Aquacel AG (antimicrobial dressing) and wrap with Kerlix (rolled gauze) 2 x (times) weekly and PRN (as needed) for compromised dressing..." Medical record review of nurse's notes for the week of 4/18/2021 revealed only one visit for wound care was completed and not the two as ordered by the physician. No documentation the physician was notified of the missed wound care. Medical record review of a nurse's note dated 4/27/2021 of the wound assessment revealed the wound measurements were 2.5 cm in length, 1 cm in length and 0.3 cm in depth. Continued review revealed the wound depth was necrotic. Further review revealed the wound had a moderate amount of purulent drainage with moderate odor. Continued review revealed wound care was provided as ordered by the physician on 4/27/2021. Further review revealed the patient complained of pain of the right foot/ankle which interfered with his walking. Medical record review of the patient's transfer dated 4/27/2021 revealed the patient was transferred to the hospital with wound deterioration. Interview with the Quality Assurance Coordinator on 6/16/2021 confirmed the wound care was not provided as ordered by the physician. A second SN visit to provide ordered wound care was not completed the week of 4/18/2021 and no documentation the physician was notified of the missed wound care. Continued interview confirmed the patient was admitted to the hospital on 4/27/2021 with wound deterioration.

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: Based on medical record review and interview, it was determined that the agency failed to communicate with the physician of changes in wound status and increased pain (refer to G706); and failed to provide skilled nursing services in accordance with the physician's plan of care (refer to G710). The cumulative effect of these systemic problems resulted in the agency's inability to ensure quality health care. Refer to G706 and G710.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to notify the physician of changes in wound status; need to increase Skilled Nursing (SN) visit frequency to provide wound care; missed wound care; and increased pain for 1 patient (#17) of 17 patients reviewed. The findings include: Patient #17 was admitted to the agency on 3/21/2021 with diagnoses including Hypertensive Heart Disease and Atrial Fibrillation. Medical record review of a nurse's note dated 4/16/2021 revealed the patient developed a Stage 2 Pressure Ulcer on his second toe of his right foot. Continued review revealed the wound's measurements were 2.2 cm in length; 1.6 cm in width; and 0.1 cm in depth. Further review revealed the wound had a small amount of serosanguineous drainage with no odor. Further review revealed the patient denied any pain with the right foot/ankle. Medical record review of a physician's order dated 4/16/2021 revealed a physician's order for "...SN (skilled nurse) to cleanse right 2nd toe Pressure Ulcer with soap and water. Pat dry. Apply Aquacel AG (antimicrobial dressing) and wrap with Kerlix (rolled gauze) 2 x (times) weekly and PRN (as needed) for compromised dressing..." Further review revealed no order was obtained to increase the SN frequency to provide wound care. Medical record review of nurse's notes for the week of 4/18/2021 revealed the patient only received wound care one time and not the two times as ordered by the physician. No documentation the physician was notified of the missed wound care or need to increase SN frequency. Medical record review of a nurse's note dated 4/21/2021 of the wound assessment revealed the wound measurements were 2.4 cm in length, 1.6 cm in length and 0.2 cm in depth. Continued review revealed the wound had a moderate amount of serosanguineous drainage with no odor. Further review revealed the patient complained of pain of 3 on a scale of 0-10 of the right ankle/foot and stated it interfered with the patient's activity. Further review revealed the physician was not notified of the change in the wound status; the complaint of pain of the right ankle/foot; or the need to increase SN frequency to provide the wound care. Medical record review of a nurse's note dated 4/27/2021 of the wound assessment revealed the wound measurements were 2.5 cm in length, 1 cm in length and 0.3 cm in depth. Continued review revealed the wound depth was necrotic. Further review revealed the wound had a moderate amount of purulent drainage with moderate odor. Continued review revealed the patient complained right ankle/foot pain of a 4 which interfered with his ability to walk. Medical record review of the patient's transfer dated 4/27/2021 revealed the patient was transferred to the hospital with wound deterioration. Interview with the Quality Assurance Coordinator on 6/16/2021 confirmed the physician was not notified of the need to increase SN frequency to provide wound care during report to the physician on 4/16/2021 and 4/21/2021; the missed wound care the week of 4/18/2021; the changes in wound assessment on 4/21/2021; and of the increased pain in the right foot/ankle on 4/21/2021.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to provide services ordered by the physician for 1 patients (#17) of 17 patients reviewed. The findings include: Patient #17 was admitted to the agency on 3/21/2021 with diagnoses including Hypertensive Heart Disease and Atrial Fibrillation. Medical record review of a nurse's note dated 4/16/2021 revealed the patient developed a Stage 2 Pressure Ulcer on his second toe of his right foot. Continued review revealed the wound's measurements were 2.2 cm in length; 1.6 cm in width; and 0.1 cm in depth. Further review revealed the wound had a small amount of serosanguineous drainage with no odor. Further review revealed the patient denied any pain with the foot/ankle. Continued review revealed the physician was notified and wound care orders were obtained. Medical record review of a physician's order dated 4/16/2021 revealed a physician's order for "...SN (skilled nurse) to cleanse right 2nd toe Pressure Ulcer with soap and water. Pat dry. Apply Aquacel AG (antimicrobial dressing) and wrap with Kerlix (rolled gauze) 2 x (times) weekly and PRN (as needed) for compromised dressing..." Further review revealed an order to increase SN frequency was not obtained to provide the wound care. Medical record review of nurse's notes for the week of 4/18/2021 revealed only one visit for wound care was completed and not the two as ordered by the physician. No documentation the physician was notified of the missed wound care. Medical record review of a nurse's note dated 4/21/2021 of the wound assessment revealed the wound measurements were 2.4 cm in length, 1.6 cm in length and 0.2 cm in depth. Continued review revealed the wound had a moderate amount of serosanguineous drainage with no odor. Further review revealed the patient complained of pain of 3 on a scale of 0-10 of the right ankle/foot and stated it interfered with the patient's activity. Further review revealed the physician was not notified of the change in the wound status or the complaint of pain of the right ankle/foot. Medical record review of a nurse's note dated 4/27/2021 of the wound assessment revealed the wound measurements were 2.5 cm in length, 1 cm in length and 0.3 cm in depth. Continued review revealed the wound depth was necrotic. Further review revealed the wound had a moderate amount of purulent drainage with moderate odor. Continued review revealed the patient complained right ankle/foot pain of a 4 which interfered with his ability to walk. Medical record review of the patient's transfer dated 4/27/2021 revealed the patient was transferred to the hospital with wound deterioration. Interview with the Quality Assurance Coordinator on 6/16/2021 confirmed the wound care was not provided as ordered by the physician. The order obtained from the physician on 4/16/2021 did not include increasing the SN visits to provide the wound care. A missed visit to provide the ordered wound care was not completed the week of 4/18/2021 and no documentation the physician was notified of the missed wound care.