Every finding on record at Expedient Home Health Services LLC

Purpose of Visit: Licensure Complaint Investigation Entrance Date: 10/27/2021 An entrance conference was conducted with the Adm at 11:45 a.m. The Adm was informed that the purpose of the survey was for a self-reported incident investigation. L and C Census: 74 Intake # 311258 Exit Date: 10/27/2021 An exit conference was conducted at 3:45 p.m. The preliminary findings were discussed. The agency was given an opportunity to ask question and provide additional information. Additional information was not provided. Written instructions were provided to the agency for how to submit an acceptable plan of correction, within 10 days of receipt of the Statement of Deficiencies. Abbreviations L and C- Licensed and Certified Adm-Administrator/DON-Director of Nurses Off Mgr.- Office manager Registered Nurse-RN Licensed Vocational Nurse-LVN POC- Plan of Care SOC- Start of Care SN- Skilled Nursing Pt-patient PAS Attend- Personal Assistance Services Attendant APS- Adult Protective Services

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to enforce a written policy regarding coordination of services to ensure the effective exchange of information, reporting, and coordination of client services among all agency personnel providing care and services. In one of one on-site investigation of a self-reported incident with an allegation of neglect (Patient # 1), the agency failed to coordinate services to ensure reporting and coordination of care among PAS and SN services. The failure could place the agency’s patients at risk of harm and complications from exacerbation of disease processes. The failure could also cause improper SN oversight and a lack of continuity of care for the agency’s patients. The failure affected Patient # 1’s health and safety and resulted in an emergency room visit. FINDINGS INCLUDED: Review of agency policy titled “MONITORING PATIENT CARE/COORDINATION OF CARE” revised 080120 read in part: “…I. The agency will…E. Ensure that each patient/client and his or her care giver(s)…receive ongoing education and training provided by the Agency…regarding the care and services identified in the plan of care. The Agency must provide training…III. Agency staff are expected to contact the Agency to report patient/client needs and changes. This will be documented on a communication note and will serve as coordination of care…A. Effective interchange and reporting, as well as collaboration and coordination of care will occur between all Agency personnel providing care…” Review of "Consumer Rights and Services Complaint Investigation Worksheet" (Intake # 311258) dated 10/26/2021 revealed an allegation of neglect of Patient # 1 by PAS Attend A. The intake showed that Patient # 1 had been taken to the emergency room department and admitted on 10/01/2021. APS notified the agency on 10/15/2021 and 10/25/2021 of an allegation of neglect. Review of the “Intake Report Adult Protective Services” dated 10/25/2021 revealed that Patient # 1 “…had feces on him and was emaciated and dehydrated and had decubitus ulcers on his sacrum...and had tested positive for COVID-19…the [PAS Attend A]/caregiver did not notify the agency when the client was admitted to the hospital on 10/01/2021” when he was brought to the emergency room on 10/01/2021. Patient # 1’s PAS Attend A was a live-in relative of Patient # 1. Review of agency investigation report that was signed by the DON and dated 10/15/2021 read in part: “…I called the [caregiver, PAS ATTEND A] 10/15/2021] who said pt slides out of his [wheelchair] all the times. So, a day or two before he went to the hospital, while putting him on the toilet he saw a skin tear of which he went to the store got some gauze and tape to clean it and place on the wound. He never got a chance to tell, the nurse before patient was admitted to the hospital, they said patient had wounds. I told [APS worker] that I had no record of patient having a wound while on service…” Record #1: Review of Patient #1's record revealed that it contained a "HOME HEALTH CERTIFICATION AND PLAN OF CARE" with a SOC date of 04/21/2020, with a principal diagnosis of iron deficiency anemia and other diagnoses of type 2 diabetes and dependence on wheelchair. The POC for certification period of 08/14/2021 to 10/12/2021 was digitally signed by RN A on 08/09/2021. The POC contained and order for skilled nursing services one time per week for nine weeks. The POC also contained an order for the SN to “assess patient integumentary status, identify any signs and symptoms of impaired skin integrity…teach skin care due to incontinence each visit…” Review of SN notes written by LVN A and dated 08/17/2021; 08/24/2021; 08/31/2021; 09/07/2021; 09/14/2021; 09/21/2021 and 09/28/2021 revealed the following: All notes read in part: Under topic “Integumentary…dry…” was checked. Under topic “Medical Necessity for Care…Patient with unstable integumentary status…” was documented…Under “Visit Narrative…SN inspects skin and feet for skin breakdown…” was documented. The record did not show that LVN A had specifically observed Patient # 1’s sacrum during any visits. The record also did not show that LVN A had provided teaching for “skin care due to incontinence each visit” to the PAS Attend A/caregiver of Patient # 1. The record also did not show that PAS Attend A had reported the skin breakdown to LVN A and did not show that the PAS Attend A had notified the agency when the client was admitted to the hospital on 10/01/2021. During an interview on 10/27/2021 at 2:30 p.m. the surveyor discussed the above findings of why the agency had not enforced a written policy to coordinate care and services between the agency, PAS Attend A and the LVN A. The Adm replied, “We in-service them. I can’t answer that. I don’t know why he did not tell the nurse.”