Every finding on record at Extended Health Care, LLC

An Emergency Preparedness recertification and re-licensure survey was conducted on 6/20/2023-6/23/2023. The facility meets all of the requirements for Emergency Preparedness. There were no deficiencies identified.

A recertification survey was conducted on 6/20/2023-6/23/2023. An entrance conference was held on 6/20/2023 at 11:10 AM, with the Administrator. An exit conference was held on 6/23/2023 at 6:15 PM, with the agencies administration.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on policy review, medical record review, and interview, the agency failed to update the medication profile for 3 of 3 (Patient #2, #3, and #4) patients reviewed. The findings include: 1. Review of the undated “Physician’s Plan of Treatment Verbal Orders, Recertification” policy revealed “…A Physician's Plan of Treatment is a written guide for the delivery of care ordered by the physician and incorporated as a part of the patient's permanent clinical record. Standing orders may be developed in conjunction with individual physicians, but must be signed by the physician for the individual client/patient. The nurse, therapist and other appropriate company personnel shall participate in the development of the plan, which shall include…Medications…The plan shall be reviewed and revised by the attending physician in consultation with the Company's professional staff at such intervals as the severity of the client's/patient's illness requires, but at least every sixty (60) days. At the time the renewal of services is indicated, a written summary regarding the client's/ patient's condition and the services being provided is submitted with the plan of treatment to the physician for his review..." 2. Review of the medical record revealed Patient #2 was admitted to the agency on 6/24/2016 with diagnoses of Hemiplegia Following Cerebral Infarction, and End Stage Renal Disease with Dependence on Renal Dialysis. Review of the Home Health Certification and Plan of Care for Patient #2 revealed “…7/1/2015…Docusate Sodium [stool softener] 50 mg [milligram] daily po [by mouth]…7/1/2015…Tylenol [analgesic] 500 mg Q [every] 6-8 HRS [hours] prn [as needed]…4/5/2019…Calcium Carbonate (TUMS)…2-4 tablets…as needed…Finasteride [treats urinary retention]…[no date ordered, dose or route]…9/16/2022…Plavix [anticoagulant]…75 mg QD [every day] po…” Review of Patient #2’s home medications revealed over the counter (OTC) Black Elderberry 2000 mg. During an interview with Patient #2’s daughter on 6/21/2023 at 8:45 AM, she stated “…the calcium carbonate was discontinued and never heard of the Finasteride…” During an interview with the Administrator on 6/21/2023 at 8:50 AM, she stated “…8/31/2020 Clopidogrel generic name for Plavix] 15 mg twice daily order should be discontinued…” 3. Review of the medical record revealed Patient #3 was admitted to the agency on 2/3/2021 with diagnoses of Stage 4 Right and Left Buttock Pressure Ulcer, Neuromuscular Disfunction of the Bladder, Neurogenic Bowel, and Complete Lesion at C4 Level of Cervical Spine. Review of the Home Health Certification and Plan of Care for Patient #3 revealed “… [no start date] Melatonin [hormone] 3 mg prn HS… [no start date] Albuterol [bronchodilator]…2 puffs…Q 6 hours prn po… [no start date] Acetaminophen…650 mg q 6 hr prn pain…” During an interview with Patient #3’s caregiver, she stated “…Haven’t used it [Melatonin] in a while. Don’t have it in the house…Don’t use no more [Albuterol], discontinued…” During an interview with the Administrator on 6/21/2023 at 9:35 PM, confirmed Patient #3’s medication needed to be updated. 4. Review of the medical record revealed Patient #4 had been admitted to the agency on 8/3/2021 with diagnoses of Stage 4 Right and Left Buttock Pressure Ulcer, Acquired Absence of Right and Left Leg Above the Knee, Obstructive and Reflux Uropathy, and Atherosclerotic Heart Disease. Review of the Home Health Certification and Plan of Care for Patient #4 revealed “…8/3/2021…Ferrous Sulfate [iron supplement] …325 mg HS po…11/9/2021…Loperamide [treats diarrhea] 2 mg QID [four times daily] po…4/28/2023…Pantoprazole [treats reflux]…40 mg…daily…po…4/28/2023…Losartan [antihypertensive] 50 mg…1 tab po daily…5/3/2023…Nitrofurantoin [antibiotic] 100 mg qd po…4/28/2023…Pantoprazole 40 mg daily po…11/9/2021…Xanax [antianxiety] 2 mg BID [twice daily] po..” Review of Patient #4’s home medications revealed “…3/21/2023…Atorvastatin [treats high cholesterol] 10 mg qd po…6/8/2023…Ondansetron 4 mg po qd as needed…5/12/2023…Amlodipine [antihypertensive] 10 mg po qd…4/10/2023…Diphenoxylate/Atropine [bronchodilator] 2.5 mg po qid prn…” During an interview with Patient #4’s caregiver on 6/21/2023 at 7:20 AM, stated “…he doesn’t take the Zinc or Multivitamin…has been off for a while…” She was asked if he takes everything on his bedside table. She stated “Yes….Not taking the Pantoprazole or Losartan either. The ER [emergency room] doctor discontinued it…” During an interview with the Administrator on 6/21/2023 at 7:45 AM, confirmed Patient #4’s medications needed to be reconciled.

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 policy review, medical record review, and interview, the facility failed to provide the home health services that were written in the individualized plan of care for 2 of 5 (Patient #1 and #6) sampled patients reviewed. The findings included: 1. Review of the medical record revealed Patient #1 was admitted to the agency on 3/22/2020 with diagnoses of Stage 3 Necrotizing Enterocolitis in Newborn, Congenital Subglottic Stenosis, Tracheostomy, and Gastrostomy. Review of the Home Health Certification and Plan of Care for Patient #1 dated 3/7/2023 thru 5/5/2023, revealed “…Private Duty Home Health Nurse 140 hours a week…” Review of the Home Health Certification and Plan of Care for Patient #1 dated 5/6/2023 thru 7/4/2023, revealed “…Private Duty Home Health Nurse 168 hours a week…” Review of the Letter of Medical Necessity dated 6/14/2023, revealed “…This member continues to require Private Duty Nurse Services 140 hours per week…” Review of the Schedules, Unverified, Visits Listing revealed the following number of hours of visits for Patient #1: week of 3/12/2023 received 79.17 Private Duty Nurse (PDN) hours, which was -60.83 hours short of the physician orders; week of 3/19/2023 received 95.50 PDN hours, which was short 44.50 hours short; week of 4/3/2023 received 79.0 PDN hours, which was 61.0 hours short of the physician orders; on week 4/9/2023 received 93.0 PDN hours, which was short 47.0 hours short of the physician orders; on week 4/16/2023 received 95 PDN hours, which was short 45.0 hours short of the physician orders; on week 4/23/2023 received 95.0 PDN hours, which was 45.0 hours short of the physician orders; on week 4/30/2023 received 95.0 PDN hours, which was 45.0 hours short of the physician orders; on week 5/7/2023 received 80.0 PDN hours, which was 80.0 short of the physician orders; on week 5/14/2023 received 79.0 PDN hours, which was 81.0 hours short of the physician orders; on week 5/21/2023 received 79.0 PDN hours, which was short 81.0 hours of the physician orders; and on week 5/28/2023 received 79.5 PDN hours, which was 80.5 hours short of the physician orders. During an interview with the Administrator on 6/21/2023 at 3:30 PM, she stated “…I don’t have an electronic recertification and not able to find the paper certification at this time for the prior recert to 4/23/2023..." Review of the Home Health Certification and Plan of Care dated 4/23/2022 thru 6/21/2022, revealed “…PDN 14 hours per week…HHA 49 hours per week…” During an interview with the Operations Officer on at 3:40 PM, she stated “…We did receive the discharge order for the nurse on 12/2/21 but we failed to trap [discharge] the LPN [Licensed Practical Nurse] order on the recertification dated 4/23/2022 through 6/21/2022..." During an interview with the Administrator on 6/22/2023 at 11:20 AM, stated “…what can I say…I’m not gonna [going to] lie…we have not been able to staff all of the hours ordered…the parent cares for the patient when we are not there…” 2. Review of the medical record revealed Patient #6 was admitted to the agency on 11/2/2022 with diagnoses of Epilepsy. Review of the Physician Order dated 12/2/2021 revealed, "... Continue HHA [Home Health Aide] 49 hours per week for personal care assistance, ADLs, universal safety, and fall prevention. Discontinue 14 hours per week of skilled nurse visits..." Review of the Physician Order dated 5/9/2022 revealed, "... Continue Private Duty Aide Services 49 hours per week for 52 weeks to assist with ADL's and personal hygiene..." Review of the Physician Order dated 5/17/2022, revealed “…Continue Private Duty Aide Services 49 hours per week for 52 weeks to assist with personal hygiene and ADLs [activities of daily living] …” There was no documentation of a recertification order or Plan of care for private duty aide staffing prior to 4/23/2022. Per the Administrator, the last Aide Note was dated 8/13/2022. During an interview with the Administrator on 6/21/2023 at 2:20 PM, she stated “…we are in the middle of changing the electronic medical records system and we are locked out of the old system so I can’t get the prior certification and plan of care for [Named Patient #6]. We have gone to paper right now and busy scanning in all of the notes into the new system…We were unable to provide staff for this patient, and to discharge the patient…”

Infection control education CFR(s): 484.70(c) Standard: Education. The HHA must provide infection control education to staff, patients, and caregiver(s). This STANDARD is not met as evidenced by: Based on personnel files and interview the facility failed to provide annual job specific infection control education to 5 of 5 [Administrator, Registered Nurse (RN) #1, Certified Nursing Assistant (CNA) #1, and Licensed Practical Nurse (LPN) #1] staff personnel files reviewed. The findings included: Review of the Administrator’s personnel file revealed no documentation of job specific infection control education was received annually. Review of the RN #1’s personnel file revealed no documentation of job specific infection control education was received since 2020. Review of the CNA #1’s personnel file revealed no documentation of job specific infection control education was received since 2021. Review of the LPN #1’s personnel file revealed no documentation of job specific infection control education was received since 2021. During an interview with the Administrator on 6/21/2023 at 2:10, she stated “…I know those personnel files were up to date…we do education and update licenses in January…I’m really thinking a past employee which I had to terminate because of her job performance, took and/or destroyed them…”

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on medical record review and interview, the facility failed to complete a Discharge Summary within 5 days after discharge and send to the primary physician for 1 of 2 [Patient #6] sampled patients reviewed. The findings included: 1. There was no documentation of the agency's Discharge Policy provided when the surveyor requested to review the policy. 2. Review of the medical record revealed Patient #6 was admitted to the agency on 11/2/2020 with diagnoses of Epilepsy. Review of the Communication Note [Physician Information Update] dated 8/22/2022, revealed “…Received a call from…MD [Medical Doctor] office today…regarding unsigned orders. She stated doctor is refusing to sign any orders for patient due to no visit at office in over 2 years. Patient needed to be scheduled an appointment for a Well-Child exam…” Review of the Communication Note dated 9/6/2022, revealed “…Received a call from Case Manager…Client has found another agency since we were unable to staff. Last day is 9/7/2022…” There was no documentation of a Discharge Order for Patient #6. During an interview with the Administrator on 6/21/2023 at 1:51 PM, she stated “…I wrote the discharge order to discharge from the agency to another Home Health Agency but there was no Discharge Summary for this patient…The Discharge Summary wasn’t sent to the physician…”