Every finding on record at Firstat Nursing Services- Ft Lauderdale

During the Recertification survey conducted on 09/18/2023 through 09/21/2023 at Firstat Nursing Services-Ft Lauderdale, a Home Health Agency, Emergency Preparedness was reviewed. Firstat Nursing Services-Ft Lauderdale is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Recertification survey was commenced on 09/18/2023 and concluded on 09/21/2023 at Firstat Nursing Services-Ft Lauderdale, Home Health Agency provider. The provider was not in compliance with 42 CFR (Code of Federal Regulations), Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This ELEMENT is not met as evidenced by: Based on record review and interview the Home Health Agency failed to inform 5 of 12 sampled active patients of expected coverage of charges for services or of any expected patient responsibilities before the initiation of care (Patient #1, #2, #4, #7, and 11). The findings include: 1) Review of the Home Health Agency's "Bill of Rights Statement," in the patient "Start of Care packet documents, “The patient has the right to: …Be advised of: (i) the extent to which payment for HHA (Home Health Agency) services may be expected from Medicare, Medicaid or any other federally funded or federal aid program known to the agency, (ii) The charges for services that may not be covered by Medicare, Medicaid or any other federally funded or federal aid program known to the agency, (iii) The charges the individual may have to pay before care is initiated, and (iv) Any changes to the information provided when they occur. Our Agency must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit.” Review of Patient #1’s “Client Service Agreement” dated 09/13/23 reveals it does not document whether there are expected patient charges for services. 2) Review of Patient #2’s record reveals a Start of Care on 07/27/23 with physician's orders for Skilled Nursing. Patient #2’s “Client Service Agreement” dated 07/27/23 documents the patient is to receive Skilled Nursing services but does not document the expected payment source or whether there are any expected patient charges. 3) Review of Patient #4’s record reveals a Start of Care on 08/29/23. Review of Patient #4’s “Client Service Agreement” dated 08/29/23 reveals no evidence of documentation of the payor source or whether there are expected charges for services. 4) Review of Patient #7’s record reveals a Start of Care on 08/17/23. Review of Patient #7’s “Client Service Agreement” dated 08/17/23 reveals no evidence of documentation of the payor source or whether there are expected charges for services. 5) Review of Patient #11’s record reveals a Start of Care on 08/04/23. Review of Patient #11’s “Client Service Agreement” dated 08/04/23 reveals no evidence of documentation of the payor source or whether there are expected charges for services. During interview on 09/21/23 at 5:05 PM the Director of Nursing confirmed the findings and stated that there are no completed Service Agreements elsewhere in the patients’ records.

An unannounced Complaint survey, #2022015523, was conducted on 04/20/2023 at Firstat Nursing Services-Ft. Lauderdale, Home Health Agency provider. The provider is not in compliance with 42 CFR 484, Subpart A-C, Conditions of Participation for Home Health Agencies.

Retrieval of records CFR(s): 484.110(e) Standard: Retrieval of clinical records. A patient's clinical record (whether hard copy or electronic form) must be made available to a patient, free of charge, upon request at the next home visit, or within 4 business days (whichever comes first). This STANDARD is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to provide their patients with a copy of their requested clinical records within the mandated extended Federal deadline of 10 business days for 2 of 3 sampled patients (Patient #1 and #2). The findings include: 1) Review of the Center for Medicare and Medicaid Services (CMS) Home Health Agencies: CMS Flexibilities to Fight COVID-19, Page 5 documented under clinical records, In accordance with section 1135 (b)(5) of the Act, CMS extended the deadline for completion of the requirement at 42 CFR 484.110 (e), which requires HHAs to provide a patient a copy of their medical record…during the next visit or within four business days CMS has allowed HHAs ten business days…instead of four. CMS will end this waiver at the conclusion of the COVID-19 PHE (Pandemic Health Emergency- 05/11/23). Review of the HHA’s Grievance/Complaint log, dated 10/04/22 documented Patient #1’s written complaint included a request for a copy of the patient’s complete clinical record. On 04/20/23 at 2:35 PM, an interview was conducted with the Director of Nursing (DON) who stated that once the HHA gets a request for a copy of the patient’s medical (clinical) record, she sends the request to the HHA’s Privacy Officer; the DON added that the Privacy Officer then gives the DON an okay to forward the request to the Medical Records department; the DON stated that once the medical record is consolidated, then it is forwarded to the requestor; the DON stated that Patient #1’s Power of Attorney (POA) sent a request for a complete record on 10/04/22 via e-mail; the DON stated she responded to the e-mail request on 10/04/22 to acknowledge the receipt of his request and informed the POA that she was currently out of the office and asked if he was available the following day to discuss; the DON stated the POA did not respond until 10/18/22 and the DON stated she responded the same day and told the POA she will check with the team to see where they were in the process. On 04/20/23 at 2:35 PM, during an interview, the DON stated Patient #1’s medical record was e-mailed to the POA on 10/27/22; the DON stated that the HHA’s policy stated that they have 30 days to send a patient medical record from the date of the request. On 04/20/23 at 3:16 PM, during the review and interview, the DON stated that Patient #1 record was uploaded on 10/04/22 and sent to the POA on 10/27/22 and the DON stated the record was sent 17 days after the request date on 10/04/22. 2) Review of Patient #2’s clinical record documented a Start of Care for home care services on 01/08/21 and a discharge date on 1/26/21. On 04/20/23 at 4:07 PM, during a joint telephone interview with Staff A and the DON, Staff A stated she received a request from Patient #2 for a copy of their medical record on 10/17/22 and the record was uploaded on 11/01/22 then sent to medical records to process the request; Staff A was asked about the delay on uploading the patients’ medical records and stated that sometimes she was out or did not get the request right of way; Staff A added that sometimes she had to look at different places or different electronic records systems; Staff A stated she had to make sure she gathered all the information for the specific dates requested; Staff A stated Patient #2’s record was from 2021 and it took a little bit of time to look in the different electronic record systems; Staff A was asked if she knew what the regulation deadline was once a copy of a patient record was requested and stated she did not remember; the DON stated that everyone (staff) in the HHA was following the deadline of 30 days. On 04/20/23 at 3:36 PM, during the review, the DON stated Patient #2 record was uploaded 11 days after the request and was sent to the patient on 11/03/22. The DON was apprised that the HHA took 13 days to provide Patient #2’s a copy of the medical record.