Every finding on record at Faithful Nursing

Based on the findings of an onsite unannounced home health agency Medicare recertification survey conducted June 29, 2022 through July 1, 2022, Faithful Nursing Lp 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 unannounced, on site home health agency Medicare complaint investigation survey completed July 1, 2022, Faithful Nursing Lp was found 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 policy, medical records and interview with Agency Administrator (EMP #1) and Alternate Administrator (EMP #2) the agency failed to ensure the physician was notified for each missed visit by the clinician within the certification period for four (4) of seven (7) records reviewed. MR # 3, #4, #6 and #7. Findings include: Review of policy # C-4.0 completed July 1, 2022 at approximately 3:00PM revealed, "Missed Visits/Deviation form Prescribed Frequency of Services; POLICY: Faithful Nursing operates consistent with Medicare Conditions of Participation relative to adherence to physician's orders for frequency and types of visits provided to patients in accordance with their plan of care. PURPOSE: In order to comply with federal... the attending physician is informed of any missed visits that deviate from the physician's plan of care as signed by the attending physician. PROCEDURE: 1. When any clinician misses a scheduled patient visit, a Missed visit report form will be completed by the clinician... to notify and/or adjust the visit frequency if indicated. 2. a copy of the fax confirmation sheet and completed missed visit report form will be filed in the patient's clinical record". Review of the medical records completed June 29, 2022 between approximately 11:00AM and 2:30PM and July 1, 2022 between approximately 9:30AM and 1:00PM revealed: MR #3, start of care (SOC): 1-3-2020; certification period: 12-29-2021-2-26-2022, Physician ordered frequency: three (3) hours per week. No documentation of a nursing visit within week 1 (12/29/21-1/1/22) or week 2 (1/2/22-1/8/22). No documentation of the physician being notified of the missed shifts. MR #4, SOC: 5-7-2020; certification period: 12-28-2021-2-25-2022; Physician ordered frequency: fourteen (14) hours per week for sixty (60) days. No documented nursing visits within week 2 (1/2/22-1/8/22) or week 3 (1/9/22-1/15/22). No documented nursing visits within week 8 (1/13/22-1/19/22) or week 9 (1/20/22-2/25/22). No documentation of the physician being notified of the missed shifts. MR #6, SOC: 11-22-2021; certification period: 5-21-22-7-19-22; Physician ordered frequency: Seven and a half (71/2) - twelve (12) hours per week. No documentation of nursing visit within week 1 (5/22/22-5/28/22). No documentation of the physician being notified of the missed shifts. MR #7, SOC: 8-17-2019, certification period: 6-2-2022-7-31-2022; Physician ordered frequency: one hundred twelve (112) hours per week. No documentation of nursing visits within week 4 (6/19/22-6/25/22). No documentation of the physician being notified of the missed visits. An interview with the Administrator and alternate Administrator completed July 1, 2022 at approximately 2:30PM confirmed the above findings.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on review of policy, medical records and interview with Administrator and alternate Administrator the agency failed to ensure staff followed physician orders as written on the plan of care for three (3) of seven (7) records reviewed. MR # 5, #6 and #7. findings include: Review of policy # C-2.0 completed July 1, 2022 at approximately 3:30PM revealed, ACCEPTANCE OF PATIENTS, PLAN OF TREATMANT/CARE AND MEDICAL SUPERVISION; POLICY: "Faithful Nursing operates consistent with the Medicare Conditions of Participation for acceptance of patients, plan of care and medical supervision... The care plan is developed along with the patient and when appropriate, the patient selected representative and/or significant others who are encouraged to participate in the development of the plan of care before care is started and when changes in the established plan of care are implemented". PROCEDURE: 2. "PLAN OF CARE; care follows a written plan of care established and periodically reviewed by a doctor...B. the plan of care includes, xvi. interventions.". C. Drugs and treatments i. Administered by agency staff only as directed by the physician". Review of the medical records completed June 29, 2022 between approximately 11:00AM and 2:30PM and July 1, 2022 between approximately 9:30AM and 1:00PM revealed: MR#5, start of care (SOC): 9-24-2019; certification period: 5-11-22-7-9-22; Primary Diagnosis: Cerebral Palsy, Diseases of the Stomach, Seizures; Physician's orders included: "Administer 60ml water flush after each feed"..... Nursing notes dated: 6/1/22, 6/2/22, 6/6/22, 6/7/22,6/8/22, 6/9/22, 6/10/22, 6/11//22, 6/12/22, 6/13/22, 6/14/22, 6/15/22, 6/16/22, 6/17/22, 6/20/22, 6/21/22, 6/22/22, 6/23/22, 6/24/22, 6/25/22, 6/27/22, 6/28/22 and 6/29/22 did not contain documentation of the nurse administering a 60ml water flush after each feed. MR #6, SOC: 11-22-2021; certification period: 5-21-22-7-19-22; Diagnosis: Pressure ulcer of Right Buttock, Stage 4 ; Physician orders included: ""Skilled nurse to perform/teach ulcer care to sacral area. Cleanse with NSS or warm soap and water... Cover with transparent seal. Apply wound vac with setting at 125MMHG...". Nursing notes dated 6/2/22, 6/4/22, 6/7/22, 6/10/22 6/11/22, 6/15/22, 6/16/22, 6/17/22, 6/18/22, 6/21/22 and 6/28/22 did not document any wound care or application of wound vac at 125MMHG. MR #7, SOC: 8-17-2019, certification period: 6-2-2022-7-31-2022; Diagnosis: Chronic respiratory failure; Physician orders included: "Skilled nurse to obtain O2 saturation levels every shift and PRN (as needed) for sings and symptoms of possible respiratory complications...obtain oxygen saturation level every 4 hours and as needed for changes in respiratory status". Nursing notes dated 6/16/22, 10P-6A showed the nurse obtained the oxygen levels once. 6/15/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. 6/14/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. 6/13/22, 10P-6A, the nurse obtained oxygen saturation levels once. No documentation of additional shifts. 6/12/22, 10P-6A, the nurse did not obtain the oxygen saturation levels. 6/10/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. 6/9/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. 6/8/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. 6/7/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. 6/3/22, 10P-6A, the nurse obtained oxygen saturation levels once. 6A-2P, the nurse did not obtain the oxygen saturation levels. An interview with the Administrator and alternate Administrator completed July 1, 2022 at approximately 2:30PM confirmed the above findings.