Every finding on record at Family Choice Home Healthcare Services, LLC

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 10/25/22, Family Choice Home Healthcare Services is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

PARTIAL EXTENDED RECERTIFICATION SURVEY SUBSTANTIAL ALLEGATION 71914 The following deficiencies are based on the partial extended recertification survey completed on 10/25/22. No deficiencies were cited in regard to the allegations contained in substantial allegation 71914. Family Choice Home Healthcare Services is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies.

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 and staff interview, the agency failed to include the patients underlying risk factors on the plan of care. This affected four (Patients # 1, #2, #3, and #4) of seven medical records reviewed. The agency census was 18. Findings include: 1. Review of Patient #1’s plan of care dated 09/07/22 through 11/05/22 revealed no documented evidence the patient’s risk factors were included on the plan of care. 2. Review of Patient #2’s plan of care dated 10/21/22 through 12/19/22 revealed no documented evidence the patient’s risk factors were included on the plan of care. 3. Review of Patient #3’s plan of care dated 10/17/22 through 12/15/22 revealed no documented evidence the patient’s risk factors were included on the plan of care. 4. Review of Patient #4’s plan of care dated 08/04/22 through 10/02/22 and 10/03/22 through 12/01/22 revealed no documented evidence the patient’s risk factors were included on the plan of care. During interview on 10/25/22 at 11:25 AM, Staff A 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 medical record review and staff interview the facility failed to provide home health aide services only as ordered by the physician. This affected one (Patient #3) of seven medical records reviewed. The agency census was 18. Findings include: Review of the medical record for Patient #3 revealed an admission date of 01/04/12 with the primary diagnosis of diabetes mellitus Type II. Review of the physician ordered plan of care for the certification period dated 08/18/22 through 10/16/22 and 10/17/22 through 12/15/22 indicated the patient was to receive Home Health Aide (HHA) services 60 hours a week for nine weeks. Review of Patient #3’s HHA timesheets dated 09/04/22 through 10/15/22 revealed the patient was receiving 70 hours of HHA services per week which was not as ordered by the physician. During interview on 10/24/22 at 10:15 AM, Staff A confirmed the above findings.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on medical record review and staff interview the agency failed to provide blood glucose monitoring as ordered by the physician. This affected one (Patient #2) of seven medical records reviewed. The agency census was 18. Findings include: Review of the medical record for Patient #2 revealed an admission date of 05/04/22 with the primary diagnosis of diabetes mellitus. Review of the physician ordered plan of care for the certification period dated 08/22/22 through 10/20/22 and 10/21/22 through 12/19/22 documented the patient was to receive Skilled Nurse (SN) services seven hours weekly for 60 days. Review of the patient’s plan of care revealed the SN would report all abnormal vital signs including elevated blood pressure and blood sugar levels immediately to the physician. Review of Patient #2’s skilled nursing visit notes from 10/05/22 through 10/23/22 revealed no documented evidence of blood glucose monitoring or a documented blood glucose result for monitoring. During interview on 10/24/22 at 10:15 AM, Staff A confirmed the above findings.

Laboratory services/CLIA waivers CFR(s): 484.100(c)(1) Laboratory services. If the HHA engages in laboratory testing outside of the context of assisting an individual in self-administering a test with an appliance that has been cleared for that purpose by the Food and Drug Administration, the testing must be in compliance with all applicable requirements of part 493 of this chapter. The HHA may not substitute its equipment for a patient's equipment when assisting with self-administered tests. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to maintain a current Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver. This had the potential to affect all patients receiving blood glucose monitoring by the agency staff. The agency census was 18. Findings Include: Review of the CLIA certificate and waiver revealed an effective date of 07/03/20 and expiration date of 07/02/22. During interview on 10/19/22 at 3:22 PM, Staff A stated the agency CLIA certificate and waiver was expired and there was not a current certificate. Staff currently perform glucose monitoring on patients during home visits.