Every finding on record at Extended Life Home Care, Ltd

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 03/25/21, Extended Life Home Care is in compliance with the provisions of 42 CFR Part 484.102 Conditions of Participation for Home Health Agencies.

PARTIAL EXTENDED RECERTIFICATION SURVEY COVID 19 FOCUSED INFECTION CONTROL SURVEY The following deficiencies are based on the partial extended recertification survey completed 03/25/21. Extended Life Home Care, 368417, is not in compliance with the requirements found at 42 CFR, Part 484 Subpart B,C for Home Health Agencies. A COVID 19 Focused Infection Control Survey conducted concurrently revealed the facility is in compliance with the requirements at 42 CFR Part 484.70 related to Infection Control and 42 CFR Part 484.102(b)(5) related to Emergency Preparedness.

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 staff interview, the agency failed to ensure medication management services were provided according to the plan of care. This affected two (#2 and #4) of seven patients reviewed. The active census was 10. Findings include: 1). Review of the medical record for Patient #2 revealed a start of care date of 08/09/14. Diagnoses included chronic myofascial pain, neuropathic pain, and type two diabetes mellitus. Physician orders for certification period 01/04/21 through 03/04/21 included skilled nursing services seven days per week to assist with medication compliance/management. Per the plan of care the skilled nurse was to complete a weekly medication set up to monitor compliance. Review of the skilled nurse visit notes for the certification period lacked evidence of the weekly medication set up. This finding was confirmed during an interview with Staff A on 03/25/21 at 10:22 AM. 2). Review of the medical record for Patient #4 revealed a start of care date of 10/22/14. Diagnoses included Alzheimer's disease, hypertension, depression, and type two diabetes mellitus. Physician orders for certification period 01/18/21 through 03/18/21 included skilled nursing services one to two days per week to assist with medication compliance/management. Per the plan of care the skilled nurse was to complete a weekly medication set up to monitor compliance. Review of the skilled nurse visit notes for the certification period lacked evidence of the weekly medication set up. This finding was confirmed during an interview with Staff A on 03/25/21 at 10:22 AM.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and policy review, it was determined the agency failed to ensure supplemental nutrition requirements administered through a gastrostomy tube (G-tube) were included in the plan of care. This affected one (#5) of seven patients reviewed. The active census was 10. Findings include: Review of the medical record for Patient #5 revealed a start of care date of 10/16/12 for diagnoses of cerebral palsy, legal blindness, and failure to thrive. Per the plan of care the patient had a G-tube (surgically placed device used to give direct access to the stomach for supplemental feeding, hydration, and medication). The physician orders included skilled nursing eight to ten visits weekly to change G-tube dressing, administer fluids and medications as ordered, evaluate hydration and nutrition, and complete a medical assessment. Review of the skilled nursing documentation for certification period 01/02/21 through 03/02/21 noted the nurse was checking placement for a G-tube, administering Vivonex RTF tube feeding formula, and flushing with 40 milliliters (ml) of water at each visit. Review of the plan of care failed to include the supplemental nutrition being administered through the G-tube, G-tube feeding procedures, and weight monitoring to evaluate nutritional status. This finding was confirmed during an interview with Staff A on 03/25/21 at 10:22 AM. Review of the facility policy titled "Plan of Care Policy ( C-580)" revealed home care services are furnished under the supervision and direction of the client's physician. The Plan of Care is based on a comprehensive assessment and information provided by the client/family and health team members. Planning for care is a dynamic process that addresses the care, treatment and services to be provided. The plan will be consistently reviewed to ensure that client needs are met, and will be updated as necessary. The purpose is to provide guidelines for agency staff to develop a plan of care individualized to meet identified needs and to include specific dietary needs and nutritional requirements.