Every finding on record at Flint Hills Health Care Services, Inc

On behave of the Center for Medicare & Medicaid Services (CMS), an unannounced on-site (Complaint) survey (#62335-H1, 104095) conducted at the above Home Health Agency (HHA) on 02/12/24 resulting in a finding of substantial compliance respective to applicable Conditions of Participation (CoP) under 42 CFR418, Subpart C through E with the following standard-level deficiencies cited.

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review, agency policy, and staff interview, it was determined the Home Health agency (HHA) failed to provide the patient with the Notice of Medicare Non-Coverage (NOMNC) at least two calendar days prior to covered services ending for 6 of 10 sample patients (Patients 1-5, & 8). This practice failed to ensure the patient had been made aware of their right to the expedited determination process and the ability to dispute the termination of services. Finding Include: Patient 1 Review of Patient 1's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 10/17/23. Review of visit notes indicated a discharge visit was made by the RN on 12/11/23. There was no documented evidence in the record of a NOMNC given to the patient or caregiver at any time prior to the discharge visit on 12/11/23. Patient 2 Review of Patient 2's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 10/25/23. Review of visit notes indicated a discharge visit was made by the PT on 11/22/23. There was no documented evidence in the record of a NOMNC given to the patient or caregiver at any time prior to the discharge visit on 11/22/23. Patient 3 Review of Patient 3's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 07/21/23. Review of visit notes indicated a discharge visit was made by the RN on 11/16/23. There was no documented evidence in the record of a NOMNC given to the patient or caregiver at any time prior to the discharge visit on 11/16/23. Patient 5 Review of Patient 5's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 11/06/23. Review of visit notes indicated a discharge visit was made by the RN on 01/31/24. There was no documented evidence in the record of a NOMNC given to the patient or caregiver at any time prior to the discharge visit on 01/31/24. Patient 8 Review of Patient 8's clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 11/14/23. Review of visit notes indicated a discharge visit was made by the RN on 01/12/24. There was no documented evidence in the record of a NOMNC given to the patient or caregiver at any time prior to the discharge visit on 01/12/24. During an interview on 02/12/24 at 2:50 PM, Staff A, Administrator, confirmed the above findings of the agency not providing the Notice of Medicare Non-Coverage (NOMNC) to the patients prior to discharge within the required timeframe.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification Survey #5EFF5-H1 at the above-named Home Health Agency, from 02/17/23-02/22/23 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.22.

On behalf of the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site Recertification survey #5EFF5-H1 was conducted at the above-named Home Health Agency (HHA) from 02/17/23 - 02/22/23 and resulted in a finding of substantial compliance respective to applicable CoP under 42 CFR 484, Subpart A through C with the following standard-level deficiency cited.

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 observations, interviews, and record reviews, the home health agency failed to ensure services were provided as per the written plan of care for 1 (Patient #7) of 17 sampled patients whose care plans were reviewed. Specifically, the facility failed to ensure the weight and edema status were assessed during home visits as per the written plan of care for Patient #7, who had a diagnosis of congestive heart failure (CHF). The failure to follow the plan of care had the potential to cause the patients not to receive needed services and to cause delays in progress toward goals. Findings Included: Review of a "Home Health Certification and Plan of Care," signed by the physician on 01/09/23, revealed Patient 7 had diagnoses which included hypertensive heart and chronic kidney disease with heart failure and acute on chronic combined systolic and diastolic heart failure. The plan of care indicated a skilled nurse was to perform a complete physical assessment at each visit with an emphasis on CHF. The skilled nurse was to educate the patient regarding daily weights and assess the weight log with each visit. The skilled nurse, patient, or caregiver were to weigh the patient every day and notify the physician of weight gain of three pounds in 24 hours or five pounds in one week. Additionally, the skilled nurse was to assess and educate the patient/caregiver regarding the signs/symptoms of CHF exacerbation, including but not limited to weight gain, fatigue, leg swelling (edema), and abdominal swelling. A review of Patient 7’s clinical record revealed there was no documentation of assessments of the patient’s weight or edema status during visits conducted by Registered Nurse (RN) 6 on 01/13/23, 02/20/23 and 02/21/23. Additionally, there was no documentation the patient's weight and edema status were assessed during visits conducted by Licensed Practical Nurse (LPN) 7 on 01/05/23, 01/16/23, 01/26/23, 02/01/23, 02/06/23 and 02/15/23. Observations during a home visit conducted by RN 6 for Patient 7 on 02/20/23 at 11:30 AM revealed the RN did not assess the patient’s weight or edema status as per the plan of care. During an interview on 02/22/23 at 11:30 AM, the Administrator stated she had spoken to RN 6 regarding the lack of assessment of Patient 7's weight and edema status. According to the Administrator, RN 6 stated she forgot to weigh the patient or do an assessment of the patient’s edema because she was reviewing the patient’s medications and making several phone calls to the doctor’s office for clarification of the medications. The Administrator was informed of the surveyor's review of Patient 7's clinical record and lack of documented assessments of Patient 7's weight and edema status during visits conducted by RN 6 and LPN 7. During a subsequent interview on 02/22/23 at 1:00 PM, the Administrator stated she had reviewed the visit notes for Patient 7 and had spoken with RN 6 and LPN 7. The Administrator indicated she felt RN 6 and LPN 7 were obviously aware of the orders/care plan to weigh Patient 7 and assess the resident's edema but felt they knew the patient and, based on their previous visits with the patient, would be aware of any changes. During a subsequent interview on 02/22/23 at 3:15 PM, the Administrator was asked if RN 6 and LPN 7 had received training on providing care to a patient with CHF. The Administrator provided copies of “Nursing Competency Assessment” checklists for RN 6 and LPN 7 and indicated care of a patient with CHF would be a skill included in the competency checks. Review of the competency checklists provided by the Administrator revealed they addressed following the plan of care as written but did not specifically address care of a patient with CHF or any other disease process.