Every finding on record at Fidelity Nursing Systems

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 101377 Fidelity Health Care was not in compliance with the requirements of 42 CFR Part 484, Subpart B, C, in regards to the allegations contained in substantial allegation 101377 completed on 10/31/23.

Within 48 hours of the patient's return CFR(s): 484.55(d)(2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This ELEMENT is not met as evidenced by: Based on record review, interview and policy review, the facility failed to ensure a start of care assessment was completed within 48 hours after a patient’s return home from a hospital admission. This affected Patient #4. The agency census was 2200. Findings include: Review of the medical record of Patient #4 revealed a facsimile cover sheet from a rehabilitation hospital dated 09/06/23. A comment on the cover sheet stated the patient was being discharged from the hospital on 09/06/23 and would need a skilled nurse, physical therapy, and a home health aide. The referral date was 09/06/23. The intake information included a copy of a physician’s history and physical (H&P). The H&P revealed the patient was admitted to the rehabilitation hospital on 08/07/23 with severe aortic stenosis status post aortic valve replacement on 08/01/23 and status post permanent pacemaker on 07/27/23. The patient had a history of type 2 diabetes mellitus, hypertension, and alcohol abuse. A nurse’s note dated 09/12/23 stated the nurse spoke to the patient’s brother and he was back in the hospital. During an interview on 10/31/23 at 2:50 P.M., Staff C stated the orders for home health care comes through an Epic interface through the facility’s electronic medical record (EMR). There are 50-70 cases a day. Once the EMR receives the order, the intake team is alerted of the order. A member of the intake team verifies the patient’s demographics and contacts the patient to make certain the patient is still interested in receiving services. The system is set up by zip codes and automatically assigns the patient to a particular team based on the patient’s zip code. Once the system selects the team, it pulls out only those clinicians that have the qualifications needed for the patient. The system automatically sends the information to the clinician’s tablet and the clinician contacts the patient to start care. According to facility policy, the clinician must start care within 48 hours. During interview on 10/31/23 at 5:15 P.M., Staff A confirmed that the referral for services of the home health agency was made on 09/06/23, however, no attempt was made to set up the care until 09/12/23, six days later.

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION OH00118476 and OH00118505 COVID 19 FOCUSED INFECTION CONTROL SURVEY At the time of the Substantial Allegation Survey completed on 01/12/21, Fidelity Health Care was found not in substantial compliance with 42 CFR Part 484, Subpart B, C for Home Health Agencies as a result of the substantial allegation survey completed on 01/12/21, in regard to allegations contained in Substantial Allegation OH00118505. 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.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician orders. This STANDARD is not met as evidenced by: Based on medical record review and staff interview it was determined that the agency failed to ensure all ordered care and services were provided according to the physician's orders. This affected one (Patient #1) of three medical records reviewed. The agency census was 2,366 on the first day of the survey. Findings include: The hospital discharge documents reveal Patient #1 was discharged on 12/15/20 and the discharge orders for dressing changes and/or treatments were written as: Please perform the following dressing changes or treatments at home. Half inch iodoform packing to right gluteal and right groin I & D site. The medical record for Patient #1 was reviewed on 01/11/21. The start of care date was 12/16/20 and the certification period reviewed was 12/16/20 through 02/13/21. The primary diagnosis was cutaneous abscess of buttock. The physician's orders for skilled nurse frequency and duration were documented as 1 day 7; 3 as needed with additional orders generated on 12/23/20 as 1 day 6, 2 week 1 and 2 as needed. Instructions for wound care were documented as one-half inch iodoform packing to right gluteal and right groin inner distal site ...provide wound treatment based on moist wound healing principals ... The clinical findings on the physician's written plan of care indicate Patient #1 was referred to homecare due to abscess to buttock and groin area. The initial assessment was completed by Staff E on 12/16/20. The initial skilled nurse visit notes dated 12/16/20 documented by Staff E reveals under M1340 Staff E documented Patient #1 had at least one observable surgical wound. On page 29-30 under wound assessment, care was performed for the right gluteus maximus as ordered, although no documentation could be found to verify the right groin wound was assessed or that wound care was provided. Interview with Staff B on 01/07/21 at approximately 1:50 PM reveals she was aware that Staff E documented care for only the right gluteus maximus. Staff B verified wound care for the right groin was not documented. This finding substantiates substantial allegation number OH00118505.