Every finding on record at Epeople Healthcare Inc

Based on the findings of an unannounced onsite Medicare recertification and state re-licensure survey conducted on March 18 – 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare recertification and state re-licensure survey conducted on March 18 – 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of clinical records (CRs), agency policies, and interview with agency administrator, the agency failed to ensure that patient's care, treatments, and services were administered by agency staff in accordance with written orders of the physician in three (3) of seven (7) patients reviewed (CRs #1-3). Review conducted on March 19, 2024, at approximately 9:00 AM to 10:15 AM, of clinical records (CFs) revealed: CF#1 start of care (soc) 10/2/22, certification period 1/30/23 to 3/30/23, Discharge/transfer on 3/27/23 to a new care agency. -Physician orders are: Skilled nurse orders -- EKIDZCARE staff hours: nights 6-9.5 hours Sunday, 4-7 hours Monday – Wednesday, and 9-9.5 hours Thursday (up to 40 hours/week) and days 6-9 hours a day 3-4 days a week Monday through Friday, effective 11/22/22. Missed care visits on: -2/1/23 9:00 AM to 5:00 PM, no staff available -2/9/23 12:00 AM to 6:30 AM and 9:00 AM to 5 PM, no staff available. -2/17/23 9:00 AM to 5:00 PM, no staff available -2/24/23 9:00 AM to 5 PM, 9:00 PM to 12:00 AM, no staff available -2/27/23 8:00 AM to 5 PM staff call-off. -3/2/23 9:00 AM to 5 PM, no staff available. -3/10/23 9:00 AM to 5 PM, no staff available. -3/17/23 9:00 AM to 5 PM, no staff available. -3/22/23 2:00 PM to 4:00 PM, no staff available. -3/23/23 2:30 PM to 4 PM, no staff available. -3/24/23 9:00 AM to 5 PM, no staff available. CR#2 soc 3/5/2018, certification period 8/6/23 to 10/4/23, discharge/transfer review – discharge date 9/28/23, reason family request for new care agency. Physician orders: Skilled nursing services 6-8.5 hours /day, 1-3 days per week Monday, Thursday, and Friday Missed care visits: -8/10/23 8:00 AM to 4:30 PM, no staff available. -8/11/23 8:00 AM to 4:30 PM, no staff available. -8/25/23 8:00 AM to 4:30 PM, no staff available. -9/1/23 8:00 AM to 4:30 PM, no staff available. -9/6/23 8:00 AM to 4:30 PM, no staff available. -9/8/23 8:00 AM to 4:30 PM, no staff available. -9/11 to 15/23 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday, Friday shifts. -9/18 to 22/23 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday, Friday shifts. -9/25 to 28 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday shifts. -9/28/23 patient transferred to new agency. -CR#3 soc 9/4/22, certification period 12/28/23 to 2/25/24, active patient CR review: Physician orders: Skilled nursing care 8-10 hrs./night for 2-5 nights per week Monday through Friday (parents’ sleep); 6-8 hours/night, Saturday and Sunday; and 1-2 hrs./day on Saturday and Sunday, to be used flexibly at parents’ discretion. Missed care services: -12/29/23 10:00 PM to 12:00 AM, no staff available. -12/30/23 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -12/31/23 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/5/24 10:00 PM to 12:00 AM, no staff available. -1/6/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/7/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/8/24 12:00 AM to 8:00 AM, no staff available. -1/12/24 10:00 PM to 12:00 AM, no staff available. -1/13/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/14/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/15/24 12:00 AM to 8:00 AM, no staff available. -1/19/24 10:00 PM to 12:00 AM, no staff available. -1/20/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/21/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/22/24 12:00 AM to 8:00 AM, no staff available. -1/26/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/27/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/28/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -1/29/24 12:00 AM to 8:00 AM, no staff available. -2/2/24 10:00 PM to 12:00 AM, no staff available. -2/3/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/4/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/5/24 12:00 AM to 8:00 AM, no staff available. -2/9/24 10:00 PM to 12:00 AM, no staff available. -2/10/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/11/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/12/24 12:00 AM to 8:00 AM, no staff available. -2/16/24 10:00 PM to 12:00 AM, no staff available. -2/17/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/18/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/19/24 12:00 AM to 8:00 AM, no staff available. -2/23/24 10:00 PM to 12:00 AM, no staff available. -2/24/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. -2/25/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available. Agency can only staff care hours for services Monday – Thursday evenings 10:00 PM to 12:00 AM and nights 12:00 AM to 8:00 AM with one skilled nurse (40 hours). CR#4, soc 3/20/23, active records, certification period 1/14/24 to 3/13/24, Home Visit, no findings. CR#5, soc 9/15/23, active records, certification period 1/8/24 to 3/7/24, no findings. CR#6, soc 7/24/23, active records, certification period 1/20/24 to 3/19/24, no findings. CR#7, soc 1/24/23, active records, certification period 1/19/24 to 3/18/24, no findings. Review conducted on March 13, 2024, at approximately 11:30 AM, of agency policies revealed: -Nursing Assessment and Plan of Care, pages 2 -3, “Plan Of Care C. The RN will develop the home health plan of care in accordance with the physician’s written orders. … b. The plan of care will instruct and reflect staff efforts to: ii. Deliver services at the convenience of the patient/family and caregiver. … v. Bridge the gaps in the patient’s caregiving network. … c. The plan of care will include: … iv. Frequency and duration of visits as ordered by physician.”; -Missed Shift Policy, “Procedure: A. The Case Managers are the office staff members responsible for scheduling the field staff in the homes and for monitoring their attendance.”; -Acceptance of Patients, “eKidzCare only admits patient whose needs can be met by the services it provides and provides these services in compliance with Medicare Conditions of Participation. … Procedure: 1. Patients are accepted for treatment on the basis of a reasonable expectation that the patient’s medical, nursing, and social needs can be met adequately by the agency in the patient’s place of residence and/or school/daycare/developmental facility. … 3. The patient’s care will follow a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine at least every 60 days. … 5. If the patient’s needs were such that the eKidzCare could not adequately provide the care required, then every effort will be made to assist the patient and/or family member to secure services elsewhere.” -Job Description: Case Manager, “the Case Manager is responsible for scheduling and coordinating the day-to-day care delivered by field staff members who are working in the homes of clients. Individual will lead field staff in providing excellent customer service and quality home care with focus on delivery and coordination of client services … and on-going case management. The Case Manger will also act as a liaison between our offices and external payers, working to obtain authorizations for care, and interact with insurance companies to advocate for our clients. Duties and responsibilities – Manage a caseload of clients including staffing, scheduling, operations, and administration, Consult with clients to identify and understand the needs of patients and to provide appropriate staffing solutions, Coordinate the scheduling needs of our clients with appropriately matched caregivers schedules.” Interview conducted on March 13, 2024, at approximately 3:00 PM, with agency administrator revealed confirmation of many missed patient care visits due to inadequate skilled nurse staffing and resultant agency' non-conformance with physician orders.

Based upon the findings of an unannounced onsite Medicare recertification survey completed March 15, 2021, Ekidzcare was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare recertification survey completed March 15, 2021, Ekidzcare was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Standard: Initial assessment visit. CFR(s): 484.55(a) Standard: Initial assessment visit. This STANDARD is not met as evidenced by: Based on review of agency policy, review of clinical records, and an interview with the agency Administrator, the agency failed to complete the initial assessment visit within 48 hours of referral, or within 48 hours of the patients return home, or on the physician-ordered start of care date for four (4) of seven (7) clinical records (CR#1, CR#3, CR#6, CR#7). Findings include: Agency policy reviewed March 11, 2021 at approximately 11:00 a.m. Policy 'Admission Policy and Procedure' "procedure' section (1) states "An RN will conduct an initial assessment visit to determine the immediate care and support needs of the patient. (b) The initial assessment will be completed either within 48 hours of the referral, or within 48 hours of the patients return home, or on the physician ordered start of care date". 'Nursing Assessment and Plan of Care' 'Procedure' 'Nursing Assessment' (A) states "The initial assessment (assessment visit) is completed during any of the following:(a) Within 48 hours of a referral (b) Within 48 hours of the patients return home (post hospital) (c) On the physician ordered start of care date". A review of CRs was conducted on March 11, 2021 between approximately 9:00 a.m. and 11:00 a.m. The patients start of care (SOC) is listed below: CR#1 SOC 09/10/19: Initial Intake from "United Healthcare" for skilled nursing patient care 'Inquiry Date' 08/26/19. 'Referral Accepted Date' 09/09/19. No physician ordered start of care date specified. Documentation of initial assessment visit by registered nurse visit on 09/10/19. (15 days). CR#3 SOC 11/25/20: Initial Intake from "Aetna" for skilled nursing patient care 'Inquiry Date' 07/27/20. 'Referral Accepted Date' 11/21/20. No physician ordered start of care date specified. Documentation of initial assessment visit by registered nurse visit on 11/25/20. (121 days). CR#6 SOC 04/03/20: Initial Intake from "Care Center" for skilled nursing patient care 'Inquiry Date' 03/27/20. 'Referral Accepted Date' 03/31/20. No physician ordered start of care date specified. Documentation of initial assessment visit by registered nurse visit on 04/03/20. (7 days). CR#7 SOC 09/02/20: Initial Intake from (source not listed, "case manager") for skilled nursing patient care 'Inquiry Date' 08/20/20. 'Referral Accepted Date' 09/02/20. No physician ordered start of care date specified. Documentation of initial assessment visit by registered nurse visit on 09/02/20. (13 days). An interview conducted with agency Administrator on March 11, 2021 at approximately 11:30 a.m. confirmed the above findings.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on a review of agency policy, review of clinical records (CRs), and an interview with the agency Administrator, agency failed to have the total plan of care reviewed by the attending physician at least once every 60 days for four (4) out of seven (7) clinical records with recertifications reviewed (CR#1, CR#2, CR#5, CR#7). Findings Include: Agency policy reviewed March 11, 2021 at approximately 11:00 a.m. Policy 'Acceptance of Patients' 'Procedure' section (3) states "The patients care will follow a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine at least every 60 days". A review of CRs was conducted on March 11, 2021 between approximately 9:00 a.m. and 11:00 a.m. The patients start of care (SOC) is listed below: CR#1 SOC 09/10/2019: A recertification of the Plan of Care for the period of 01/02/2021-03/02/2021 was signed by a physician on 12/30/2020. A recertification of the Plan of Care for the period of 03/03/2021-05/01/2021 was signed by a physician on 03/01/2021. (61 days). CR#2 SOC 07/27/2017: A recertification of the Plan of Care for the period of 12/23/2020-02/20/2020 was signed by a physician on 12/17/2020. A recertification of the Plan of Care for the period of 02/21/2021-04/21/2021 was signed by a physician on 02/17/2021. (62 days). CR#5 SOC 12/04/2017: A recertification of the Plan of Care for the period of 11/01/2020-11/30/2020 was signed by a physician on 09/30/2020. A recertification of the Plan of Care for the period of 12/1/2020-01/29/2020 was signed by a physician on 12/09/2020. (70 days). CR#7 SOC 09/02/2020: A recertification of the Plan of Care for the period of 11/01/2020-12/30/2020 was signed by a physician on 10/23/2020. A recertification of the Plan of Care for the period of 12/31/2020-02/28/2021 was signed by a physician on 01/07/2021. (76 days). An interview conducted with agency Administrator on March 11, 2021 at approximately 11:30 a.m. confirmed the above findings.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on a review of agency policy, observations, staff interviews, and an interview with the agency Administrator, the agency failed to ensure that everyone entering the health care facility is screened and triaged for COVID-19 for one (1) of one (1) observations (Observation #1) and one (1) of one (1) interviews (Interview #1); the agency failed to maintain a coordinated agency-wide program for the surveillance of communicable disease by failing to ensure all staff are screened and triaged for COVID-19 for one (1) of one (1) interviews (Interview #2). Findings Include: Pennsylvania Department of Health 'Health Alert Network' dated August 7, 2020 'Subject' 'Update: Interim Infection Prevention and Control Recommendations for Patients with known or Patients Under Investigation for 2019 Novel Coronavirus (COVID-19) in a Healthcare Setting' section (I) Recommended Routine Infection Prevention and Control (IPC) Practices During the COVID-19 Pandemic' (B) 'Screen and Triage Everyone Entering a Healthcare Facility for signs and symptoms of COVID-19':....symptom screening remains an important strategy to identify those who could have COVID-19 .......". "Screen everyone (patients, healthcare personnel, visitors) entering the facility for symptoms consistent with COVID-19 .....". "Actively take their temperature and document absence of symptoms consistent with COVID-19". CMS-QSO-20-18-HHA (03/10/2020) 'Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs)' 'Guidance' states " ...... . Also, HHAs should be monitoring the health status of everyone (patients/residents/visitors/staff/etc.) in the homecare setting for signs or symptoms of COVID-19". "How should HHAs monitor or restrict home visits for health care staff? Health care providers (HCP) who have signs and symptoms of a respiratory infection should not report to work". Survey Form 'COVID-19 Focused Infection Control Survey: Acute and Continuing Care' section 'Education, Monitoring, and Screening of Staff' asks "Is the facility screening all staff at the beginning of their shift for fever and signs/symptoms of illness? Is the facility actively taking their temperature and documenting absence of illness (or signs/symptoms of COVID-19 as more information becomes available). Agency COVID-19 policy/procedures reviewed on March 11, 2021 at approximately 11:00 a.m. The agency policy 'COVID-19 Quality Control Measure Policy' doesn't address actual COVID-19 screening of employees/visitors when they enter the agency office nor field staff COVID-19 self screening documentation. Observation #1: On March 9, 2021 at approximately 9:20 a.m. the state surveyor arrived at the main office entry. No temperature screening nor symptom screening conducted. No COVID-19 screening log observed. Interview #1: On March 9, 2021 at approximately 10:00 a.m. an interview was conducted with the agency Branch Manager. The Branch Manager was asked what the agency screening protocols are for people who enter the agency office. The Branch Manager stated "The agency does not screen employees or visitors who enter the office". There were four (4) agency staff in the office and shortly thereafter one (1) employment applicant arrived. No documentation of COVID-19 screening upon entry. Interview #2: On March 9, 2021 at approximately 2:25 p.m. an interview was conducted with the agency Administrator. The Administrator was asked if agency employees in the field, who report directly to the consumers house to start their daily work shift, are self screening for COVID-19 symptoms and documenting the results. The Administrator stated "The field staff self screen prior to their shifts but do no document the screening process". An interview conducted with agency Administrator on March 11, 2021 at approximately 11:30 a.m. confirmed the above findings.

Classroom and supervised practical training CFR(s): 484.80(b)(1) Home health aide training must include classroom and supervised practical training in a practicum laboratory or other setting in which the trainee demonstrates knowledge while providing services to an individual under the direct supervision of a registered nurse, or a licensed practical nurse who is under the supervision of a registered nurse. Classroom and supervised practical training must total at least 75 hours. This ELEMENT is not met as evidenced by: Based on a review of agency policy, review of employee files (EFs), and an interview with the agency Administrator, agency failed to ensure home health aides have completed a minimum of 75 hours of classroom instruction for one (1) out of one (1) home health aide EFs reviewed (EF#10) and one (1) of one (1) interviews conducted (Interview #1). Findings Include: Agency policy/procedures reviewed March 11, 2021 at approximately 11:00 a.m. 'Home Health Aide Requirements' states "The HHA must have addressed each of the following subject areas through classroom and supervised practical training totaling at least 75 hours, with at least 16 hours devoted to the supervised training :........". 'Acceptable HHA Programs' states "Any program that was approved by the Pa. Department of Health. the certificate must state "Approved by the Pa. Department of Health". It also has to be signed by an RN". "You must also have a signature of who signed off on the training, which needs to be an RN". 'Home Health Aide (HHA) Job Description' 'Minimum Education' states "Required to be a graduate of a State approved program for Nurses Aide Certification (CNA) that is verifiable through the state Nurse Aide registry as being in good standing or Successfully completed 75 hours of a Home Health Aide Training program, with the ability to provide proof of completion". A review of EFs was conducted on March 9, 2021 at approximately 11:00 a.m. The employees date of hire (DOH) is listed below: EF#10 DOH 09/15/2020: Home health aide training documentation was requested on 03/09/21 at approximately 12:00 p.m. The agency provided a two page form titled 'Home Health Aide Requirements'. The first page included "The HHA must have addressed each of the following subject areas through classroom and supervised practical training totaling at least 75 hours, with at least 16 hours devoted to the supervised training :........". The second page included "Signature below indicates acknowledgement that the applicant has participated in the above CMS requirements to meet the training requirements of 75 hours of training, 16 of the hours devoted to supervised practical training" and included the 'Applicant Name', 'Printed Name (Administrator)', and 'Name of School/Facility/Training Center' along with the address and phone number. The 'Name of School/Facility/Training Center' section listed a local home care agency as providing the training. No documentation provided of the 75 hour training course content nor a name/signature of a registered nurse signing off on the completed training. Interview #1: An interview was conducted with the agency Administrator on 03/10/21 at approximately 2:40 p.m. The Administrator was asked what the procedure was in completing the above two page form. The Administrator stated the potential employee (aide) is asked if 75 hours of training was completed. The agency then calls and verifies with whoever is listed as the training source and that source verifies the training. No documentation is provided to prove completion of required hours/elements nor of verification of registered nurse signing off on the training. An interview conducted with agency Administrator on March 11, 2021 at approximately 11:30 a.m. confirmed the above findings.