Every finding on record at Family Care Solutions, LLC

A Recertification Survey was conducted by the Department of Inspections, Appeals and Licensing from 1/27/25 through 2/4/25 and the home health agency was found to be operating in compliance with the requirements of the Establishment of Emergency Preparedness.

A Recertification Survey was conducted by the Department of Inspections, Appeals and Licensing from 1/27/25 through 2/4/25. The recertification survey found the agency operating out of compliance with the following standard level regulatory requirements. The agency reported a census of 33 patients at the time of the survey.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on clinical record review and agency staff interview, the agency failed to update the Plan of Care with all new physician orders for 2 of 2 sampled patients with interim orders. (Patients #4 and #6). Failure to update the Plan of Care increased the potential for medication errors in administration or inaccurate provision of care. Findings include: During an interview on 1/28/25 at 9:55 AM, Clinical Manager reported the updated plans of care are found under the communication tab in the electronic medical record for each patient. 1.Patient #4 had a start of care date of 5/20/2020. Clinical record review revealed: a. Plan of Care, dated 12/25/24 to 2/22/25, included the diagnoses of severe intellectual disabilities and cerebral palsy and orders for skilled nursing services 1-2 days/week for 8 weeks. b. Interim physician order, dated 12/26/24, to increase skilled nurse shift frequency for the weeks of 12/29/24 and 1/5/25, from 1-2 days per week to 2-3 days per week. c. Interim physician order, dated 1/13/25, to increase skilled nurse shift frequency for the week of 1/12/25, from 1-2 days per week to 2-3 days per week. During an interview on 1/29/25 at 3:55 PM, Clinical Manager reported she would review electronic medical record for updated plan of care but thinks it may not have been completed. The clinical record failed to include an updated plan of care that included the frequency changes from the interim physician orders dated 12/26/24 and 1/13/25. 2. Patient #6 had a start of care date of 8/16/19 and a discharge date of 7/19/24. Clinical record review revealed: a. Plan of Care, dated 1/22/24 to 3/21/24, included the diagnoses of noncompliance with medication regimen and major depressive disorder and orders for skilled nursing services. b. Interim physician order, dated 3/21/24, to update medication profile: discontinue Quetiapine 200 milligram (mg) tabs, add Quetiapine 400 mg tab 1 at bedtime for 7 days, then Quetiapine 400 mg tabs 1.5 tabs for 7 days, then continue at 600 mg nightly. Increase Prazosin from 1 mg at bedtime to 2 mg at bedtime. Taper off Mirtazepine 30 mg by taking 1/2 tab for 7 days then stop. Effective today 3/21/24. Increase Duloxetine from 60 mg to 90 mg daily every morning, effective tomorrow morning 3/22/24. During an interview on 2/4/25 at 11:48 AM, Clinical Manager reported she reviewed electronic medical record and the updated plan of care was missed. The clinical record failed to include an updated plan of care that included the medication changes from the interim physician order dated 3/21/24. The findings were reviewed with the Clinical Manager.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on staff interviews and clinical record reviews, the agency failed to ensure the clinical record included the patient's admission consent forms and/or annual service agreement forms for 7 of 7 sampled patients (Patients #1, #2, #3, #4, #5, #6 and #7). Failure of the agency to ensure the clinical record included all consent forms placed agency patients at risk to receive care or not receive care meeting the needs of the patient. Findings include: During an interview on 1/28/25 at 2:56 PM, Clinical Manager reported the admission consent forms and annual service agreement forms signed by patient or caregiver are not kept in the electronic medical record (EMR) system. The signed forms are uploaded into a different computer program and can be printed out for the surveyor to review. During an interview on 1/29/25 at 3:46 PM, Clinical Manager reported the admission consent forms and annual service agreement forms are easier to access in the other computer program and makes annual chart audits easier to complete. There is not a good place in the EMR to store the files that would allow the consents to be sorted by date, If a patient is on services for a long time, there are multiple forms and it can be hard to find what you are looking for. 1.Patient #1 had a start of care date of 7/14/24. Clinical record review revealed no admission consent forms in the electronic medical record. The surveyor was emailed (electronic mail) copies of the admission consent and service agreement forms, dated 7/14/24. The clinical record lacked documentation of the admission consent and service agreement forms. 2. Patient #2 had a start of care date of 7/10/23. Clinical record review revealed no admission consent or annual service agreement forms in the electronic medical record. The surveyor was emailed copies of the admission consent and service agreement forms, dated 7/10/24. The clinical record lacked documentation of the admission consent and service agreement forms. 3. Patient #3 had a start of care date of 11/15/21. Clinical record review revealed no annual service agreement forms in the electronic medical record. The surveyor was emailed copies of the service agreement forms, dated 2/1/24. The clinical record lacked documentation of the service agreement forms. 4. Patient #4 had a start of care date of 5/20/2020. Clinical record review revealed no annual service agreement forms in the electronic medical record. The surveyor was emailed copies of the service agreement forms, dated 4/25/24. The clinical record lacked documentation of the service agreement forms. 5. Patient #5 had a start of care date of 6/5/24. Clinical record review revealed no admission consent or annual service agreement forms in the electronic medical record. The surveyor was emailed copies of the admission consent and service agreement forms, dated 6/5/24. The clinical record lacked documentation of the admission consent and service agreement forms. 6. Patient #6 had a start of care date of 8/16/19 and a discharge date of 7/19/24. Clinical record review revealed no annual service agreement forms in the electronic medical record. The surveyor was emailed copies of the service agreement forms, dated 7/24/23. The clinical record lacked documentation of the service agreement forms. 7. Patient #7 had a start of care date of 10/3/23 and a discharge date of 11/11/24. Clinical record review revealed no admission consent or annual service agreement forms in the electronic medical record. The surveyor was emailed copies of the service agreement forms, dated 9/24/24. The clinical record lacked documentation of the admission consent and service agreement forms. The clinical records lacked documentation of admission consent forms and annual service agreement forms. The findings were reviewed with the Clinical Manager.

A recertification survey was conducted by the Department of Inspections and Appeals from 6/27/2022 through 6/29/2022. The survey found the agency operating in substantial compliance with the requirements of the Establishment of Emergency Preparedness.

A recertification survey was conducted by the Department of Inspections and Appeals from 6/27/2022 through 6/29/2022. The agency reported a current census of 41 patients. The recertification survey found the agency operating out of compliance with the following standard level regulatory requirements:

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 agency policy review, clinical record review, home visit observation and patient/patient caregiver and staff interview, the agency failed to ensure the accurate completion of all components comprising the Plan of Care, including the supplies and equipment required and the frequency and duration of visits to be made used by the patient for 4 of 7 sampled patients (Patients #1, #2, #3 and #6). Failure to maintain complete and accurate Plans of Care with current orders placed the patients at risk to not receive services, medications and/or treatments according to assessed needs and physician orders. Findings include: 3. Patient #2 had a start of care date of 5/20/20. Clinical record review revealed: a. The Plan of Care, dated 5/10/22 to 7/8/22, included skilled nursing orders 5-7 hours per day 3-4 days per week. b. Skilled nurse visit notes, dated 6/1/22 and 6/8/22, included a time in of 3:12 PM, a time out of 7:00 PM, approximately a 4 hour time frame of services provided. The visit notes failed to identify a reason why 5 hours of service was not provided. c. Skilled nurse visit notes, dated 6/2, 6, 9 and 10/22, included a time in of 3:15 PM, a time out of 7:00 PM, approximately a 3.75 hour time frame of services provided. The visit notes failed to identify a reason why 5 hours of service was not provided. The skilled nurses failed to provide the services according to the plan of care. 4. Patient #6 had a start of care date of 1/5/22 and a discharge date of 2/21/22. Clinical record review revealed: a. The Plan of Care, dated 1/5/22 to 3/5/22, included physical therapy orders to evaluate patient 1/6/22. b. Physical Therapy evaluation, dated 1/6/22, included orders for physical therapy once a week for 3 weeks, effective 1/9/22. c. Physical Therapy visit notes, dated 1/19/22 and 2/5/22, identified services provided. The clinical record failed to include a physical therapy visit note for the week of 1/23/22. During an interview on 6/29/22 at 1:45 PM, the Clinical Manager reported she reviewed the clinical record and was unable to find documentation in the record regarding a reason why physical therapy did not make a visit the week of 1/23/22. The Administrator and Clinical Manager received the above findings and the agency provided no additional information prior to the end of the survey. According to agency policy, titled Plan of Care Policies, dated 10/2021, the individualized plan of care must include the type, frequency, and duration of all visits/services and medical supplies/equipment required. Orders for therapy services shall include the specific procedures and modalities to be used and the amount, frequency, and duration. 1. Patient #3 had a start of care date of 12/8/2020. Clinical record review, home visit observation and accompanying interviews revealed the following: The Plans of Care, dated 2/1/22 to 4/1/22, 4/2/22 to 5/31/22 and 6/1/22 to 7/30/22, identified the following medical equipment and supplies as required to meet the patient's needs: shower grab bars, shower chair, detachable shower chair, grabber, standard walker, pedal trainer, hand weights, pill planner x2, pill cutter, washable chux pads, knee brace, and depends. During a home visit observation on 6/28/22 at 10:04 AM, with Staff C, Registered Nurse (RN) and the Clinical Manager, the surveyor observed the patient's walker had a tray on it to assist the patient with carrying items. The patient revealed having used the tray on the walker for a couple of months and stated actually had two different trays. The Plan of Care included lacked identification of the tray as equipment required to meet the patient's needs. b. During the same home visit observation on 6/28/22 at 10:04 AM, with Staff C, RN and the Clinical Manager, the surveyor observed the RN setting up medications for the patient. The nurse obtained a locked box where the patient's medications were stored. The patient revealed having the locked box since last summer. The Plans of Care included lacked identification of the locked box as equipment required to meet the patient's needs. 2. Patient #1 had a start of care date of 11/2/2014. Clinical record review, home visit observation and accompanying interviews revealed the following: The Plans of Care, dated 1/24/22 to 3/24/22, 3/25/22 to 5/23/22 and 5/24/22 to 7/22/22, identified the following medical equipment and supplies as required to meet the patient's needs: elevated toilet seat, back rest for toilet, tub/shower chair, detachable shower head, wheelchair, ceiling lift and sling for lift, kangaroo pump, intravenous pole, easy stand, stroller, Thera suit, electric wheelchair, Ipad, dynavox, pressure relieving mat, feeder seat/chair, electric razor, tube feeding supplies, depends, and chux/underpads. During a home visit observation on 6/27/22 at 12:24 PM, with Staff D, Licensed Practical Nurse and the Clinical Manager, the surveyor did not observe the presence of the Thera suit or easy stand. During telephone interview with the patient caregiver on 6/27/22 at 3:45 PM, the patient caregiver revealed the Thera suit and easy stand have not been used by the patient for a couple of years and are stored in a shed. The Plan of Care included the Thera suit and easy stand as equipment required to meet the patient's needs. The surveyors reviewed the above findings with the agency Administrator and Clinical Manager. Agency staff provided no additional information prior to the end of the survey.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on clinical record review and agency staff interview, the agency failed to update the Plan of Care with all new physician orders for 1 of 7 sampled patients with interim orders. (Patient #6). Failure to update the Plan of Care increased the potential for medication errors in administration or inaccurate provision of care. Findings include: Patient #6 had a start of care date of 1/5/22 and a discharge date of 2/21/22. Clinical record review revealed: a. Plan of Care, dated 1/5/22 to 3/5/22, included the diagnosis of compression fracture of T7-T8 (thoracic) vertebrae and orders for skilled nursing weekly, home health aide services 2-3 times a week, physical therapy and occupational therapy evaluation. b. Physical therapy evaluation, dated 1/6/22, included orders for additional therapy visits weekly for 3 weeks effective on 1/9/22. The evaluation form was signed by the physician on 1/18/22 and was scanned into the electronic clinical record. The clinical record failed to include an updated plan of care that included the additional physical therapy orders. c. Occupational therapy evaluation, dated 1/7/22, included orders for additional therapy visits twice a week for 2 weeks and weekly for 2 weeks effective on 1/9/22. The evaluation form was signed by the physician on 1/26/22 and was scanned into the electronic clinical record. The clinical record failed to include an updated plan of care that included the additional occupational therapy orders. d. Interim physician order, dated 2/2/22, included orders for skilled nursing visits weekly for 2 weeks, effective 2/6/22, and home health aide visits 2-3 times a week for 2 weeks, effective 2/6/22. The clinical record failed to include an updated plan of care that included the additional skilled nurse and home health aide visits order. e. Interim physician order, dated 2/11/22, included order for 1 additional skilled nurse visit to assess wounds. The clinical record failed to include an updated plan of care that included the additional skilled nurse visit order. f. Interim physician order, dated 2/11/22, included order for 1 additional as needed skilled nurse visit for dressing change in the event dressing becomes soiled or removed. The clinical record failed to include an updated plan of care that included the additional skilled nurse visit order. g. Interim physician order, dated 2/17/22, included order for 1 additional skilled nurse visit to complete discharge. The clinical record failed to include an updated plan of care that included the additional skilled nurse visit order. During an interview on 6/29/22 at 1:45 PM, the Clinical Manager reported skilled nursing orders have a workflow and are automatically moved to the plan of care update in the electronic medical record, this should work for frequency, intervention and medication orders. Physical therapy and occupational therapy services have their own workflow and that does not flow to the plan of care update. Clinical Manager reviewed the plan of care updates and was able to verify the medication orders flowed to the plan of care update but the skilled nurse frequency orders failed to flow to the plan of care updates. The Administrator and Clinical Manager received the above findings and the agency provided no additional information prior to the end of the survey.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record review, agency policy review, and agency staff interview, the agency failed to provide individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 3 of 5 sampled patients receiving home health aide services (Patients #4, #5, and #6). Failure to ensure agency registered nurses provided patient specific written instructions directing the care provided by the agency's home health aides for each patient increased the risk agency patient's would receive inappropriate or inconsistent home health aide services. Findings include: 2. Patient #4 had a start of date of 11/17/22. Clinical record review revealed: a. Plan of Care, dated 5/16/22 to 7/14/22, included orders for skilled nursing services weekly and home health aide services 2-3 times a week. b. Home health aide care plans, dated 5/16/22 and 6/15/22, included instructions for the aides to perform the task of skin care per patient request - see care plan. Skin care instructions: aide to apply non-medicated lotion to back, arms and legs per patient request; aide to apply thin layer of triamcinolone cream under bilateral breasts after bathing, per patient request. 3. Patient #6 had a start of care date of 1/5/22 and a discharge date of 2/21/22. Clinical record review revealed: a. Plan of Care, dated 1/5/22 to 3/5/22, included orders for skilled nursing services weekly and home health aide services 2-3 times a week. b. Home health aide care plan, dated 1/5/22 and 3/5/22, included instructions for the aide to perform the task of skin care - lotion/deodorant. Skin care instructions: assist patient to wash hard to reach areas (back, bilateral legs and feet) and thoroughly rinse body; per patient request aide to apply a thin layer of non-medicated lotion to generalized body after showers; help patient put deodorant or prompt to put deodorant on. The Administrator and Clinical Manager received the above findings and the agency provided no additional information prior to the end of the survey. According to the agency policy, titled Home Health Aide Assignment/Care Plan Policy, dated 10/2021, when the services are ordered by the physician, the designated Registered Nurse/Therapist will assign and orient the aide to the care plan. The initial assessment for need of home health services shall be determined by the authorized nurse/therapist. The assignment of tasks will be identified in the home health aide care plan/assignment sheet. 1. Patient #5 had a start of date of 3/15/22 and received weekly skilled nursing services and home health aide services 6 to 7 days per week from the agency. The Plans of Care, dated 3/15/22 to 5/13/22 and 5/14/22 to 7/12/22, documented a diagnosis of chronic kidney disease. The initial comprehensive assessment, dated 3/15/22 and the recertification comprehensive assessment, dated 5/10/22, documented the patient was able to participate in bathing self in shower or tub, but requires the presence of another person through out the bath for assistance or supervision. Clinical record review revealed: The home health aide assignments for the episodes 3/15/22 to 5/13/22 and 5/14/22 to 7/12/22, directed the aides to perform the tasks of assisting with dressing every visit (this included the application of stocking and AFO, ankle-foot orthosis, brace to left leg only and application of stocking and orthotic brace to left arm), check pressure areas every visit, comb hair every visit, assist with oral care every visit, perform peri care every visit, shampoo hair every visit, provide skin care every visit (apply thin layer of Clotrimazole-Betamethasone cream to affected area-under breast folds, bilateral groin, and under abdominal fold as directed after bathing, and shower the patient every visit, or perform partial bath if shower is refused. b. The RN assigned task to the aide of provide skin care every visit (apply thin layer of Clotrimazole-Betamethasone cream to affected area-under breast folds, bilateral groin, and under abdominal fold as directed after bathing , did not identify the specific directions to the aide as to where and when the cream should be applied. Interview on 6/28/22 at 3:14 PM with Staff F, Home Care Aide (HCA) and aide who routinely provided services to the patient, revealed the aide applied lotion all over the body for task of skin care. The aide would not but the cream on unless the nurse instructed the aide to do so by leaving a note the patient needed the cream and where specifically the aide should apply it. Interview on 6/28/22 at 3:18 PM with Staff E, Home Care Aide (HCA) and aide who routinely provided services to the patient, revealed the patient is currenly only needing lotion for skin care. The aide also stated the direction of "other areas are affected" is used when the patient really needs the cream and the patient will notify the aide when it is needed as the area will be sore. The aide assignment was not specific and individualized to meet the needs of Patient #5.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on agency policy review, clinical record review and staff interview, the agency failed to ensure home health aides provided care to agency patients only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient for 4 of 5 sampled patients receiving home health aide services (Patients #3, #4, #5 and #6). The agency reported 32 patients received care provided by a home health aide. Failure to ensure that home health aide services are provided only as ordered by the physician, permitted under state law and/or as directed by the skilled professional assigning the home health aide to the patient and according to the home health aide care plan increased the risk that patients' personal care needs were not adequately met. Findings including: 3. Patient #4 had a start of date of 11/17/22. Clinical record review revealed: a. Plan of Care, dated 5/16/22 to 7/14/22, included orders for skilled nursing services weekly and home health aide services 2-3 times a week. b. Home health aide care plans, dated 5/16/22 and 6/15/22, included instructions for the aides to perform the task of skin care per patient request - see care plan. Skin care instructions: aide to apply non-medicated lotion to back, arms and legs per patient request; aide to apply thin layer of triamcinolone cream under bilateral breasts after bathing, per patient request. c. Home health aide visit notes, dated 5/17, 19, 21, 24, 26, 28 and 31/22, and 6/2, 7, 9, 11, 14, 16 and 23/22, included documentation the task of skin care was completed but failed to identify what lotion or cream was applied. d. Home health aide visit note, dated 6/4/22, included documentation the task of skin care was completed and deodorant was applied. The note failed to identify what lotion or cream was applied and deodorant was not an assigned task under skin care. During an interview on 6/28/22 at 3:23 PM, Staff E, home health aide, reported Patient #4 did not always want both lotion and triamcinolone cream applied, patient would frequently request to have the triamcinolone cream applied and deodorant would be applied every visit per care plan. During an interview on 6/29/22 at 3:12 PM, Staff G, home health aide, reported the task of skin care included applying lotion and deodorant, triamcinolone cream is used for yeast/redness as patient requests, have not used for approximately the past 2 weeks. 4. Patient #6 had a start of care date of 1/5/22 and a discharge date of 2/21/22. Clinical record review revealed: a. Plan of Care, dated 1/5/22 to 3/5/22, included orders for skilled nursing services weekly and home health aide services 2-3 times a week. b. Home health aide care plan, dated 1/5/22, included instructions for the aide to perform the task of skin care - lotion/deodorant. Skin care instructions: assist patient to wash hard to reach areas (back, bilateral legs and feet) and thoroughly rinse body; per patient request aide to apply a thin layer of non-medicated lotion to generalized body after showers; help patient put deodorant or prompt to put deodorant on. c. Home health aide visit notes, dated 1/7, 11, 13, 14, 19, 20, 21, 25, 27 and 28/22 and 2/1, 3, 4, 8, 10, 11, 15, 17 and 18/22, included documentation the task of skin care was completed but failed to identify what tasks were performed. d. Home health aide care plan, dated 1/5/22, included instructions for the aide to perform the task of shave per patient request. e. Home health aide visit note, dated 1/27/22, included documentation the task of shave was not completed but failed to identify a reason why the task was not compelted. The Administrator and Clinical Manager received the above findings and the agency provided no additional information prior to the end of the survey. According to the agency policy, titled Home Health Aide Assignment/Care Plan Policy, dated 10/2021, when the services are ordered by the physician, the designated Registered Nurse/Therapist will assign and orient the aide to the care plan. The initial assessment for the need of home health aide services shall be determined by the authorized nurse/therapist. The assignment of tasks will be identified in the home health aide care plan/assignment sheet. Any change in the assignment must be approved by the professional managing patient's care. The patient/caregiver will be notified of all changes. All changes in the assignment will be communicated to the Home Health Aide and will be documented on a new Care Plan. Changes must reflect physician orders and be documented on the Care Plan and in the patient's chart (signed physician orders). 1. Patient #5 had a start of date of 3/15/22 and received weekly skilled nursing services and home health aide services 6 to 7 days per week from the agency. The Plans of Care, dated 3/15/22 to 5/13/22 and 5/14/22 to 7/12/22, documented a diagnosis of chronic kidney disease. The initial comprehensive assessment, dated 3/15/22 and the recertification comprehensive assessment, dated 5/10/22, documented the patient was able to participate in bathing self in shower or tub, but requires the presence of another person through out the bath for assistance or supervision. Clinical record review revealed: The home health aide assignments for the episodes 3/15/22 to 5/13/22 and 5/14/22 to 7/12/22, directed the aides to perform the tasks of assisting with dressing every visit (this included the application of stocking and AFO, ankle-foot orthosis, brace to left leg only and application of stocking and orthotic brace to left arm), check pressure areas every visit, comb hair every visit, assist with oral care every visit, perform peri care every visit, shampoo hair every visit, provide skin care every visit (apply thin layer of Clotrimazole-Betamethasone cream to affected area-under breast folds, bilateral groin, and under abdominal fold as directed after bathing, and shower the patient every visit, or perform partial bath if shower is refused. b. Home health aide visit notes completed by Staff F Home Health Aide (HHA), dated, 4/25, 4/27, 4/30, 5/4, 5/7, 5/9, 5/11, 5/13, 5/14, 5/16, 5/18, 5/20, 5/21, 5/23, 5/25, 5/27, 5/28, 5/30, 6/1, 6/3, 6/4, 6/6, 6/8, 6/10, 6/11, 6/13, 6/15, 6/17, 6/18, 6/20, 6/22, 6/24, and 6/25/22, documented the aide performed the task of skin care every visit. The aide did not specify what was done for skin care. Interview on 6/28/22 at 3:14 PM with Staff F, HHA, revealed the aide applied lotion all over the body for task of skin care. The aide would not but the cream on unless the nurse instructed the aide to do so by leaving a note the patient needed the cream and where specifically the aide should apply it. The home health aide did not identify on the visit notes the cream was not applied and lotion was used for skin care. The home health aide failed to provide services that were included in the plan of care. c. Home health aide visit notes completed by Staff E, HHA, dated, 4/26, 4/30, 5/2, 5/3, 5/10, 5/12, 5/17, 5/19, 5/24, 5/26, 5/31, 6/2, 6/7, 6/9, 6/14, and 6/16/22, documented the aide performed the task of skin care every visit. The aide did not specify what was done for skin care. Interview on 6/28/22 at 3:18 PM with Staff E, HHA revealed the patient is currently only needing lotion for skin care. The aide also stated the direction of "other areas are affected" is used when the patient really needs the cream and the patient will notify the aide when it is needed as the area will be sore. The home health aide did not identify on the visit notes the cream was not applied and lotion was used for skin care. The home health aide failed to provide services that were included in the plan of care. 2. Patient #3 had a start of date of 12/8/2020. The Plans of Care, dated 4/2/22 to 5/31/22, documented the patient received weekly skilled nursing services and home health aide services 6 to 7 days per week from the agency. Clinical record review revealed: a. The home health aide assignments for the episode 4/2/22 to 5/31/22, directed the aides to perform the tasks of assisting with dressing every visit, check pressure areas every visit, comb hair every visit, shower the patient every visit, or perform partial bath if shower is refused, and shampoo hair on Fridays per patient request. b. Home health aide visit note, dated 5/28/22, (a Saturday), documented the aide shampooed the patient's hair per patient request. The clinical record lacked evidence the HHA contacted the nurse to notify the nurse the patient requested to have the hair shampooed and obtain approval to perform the task on a Saturday.