Every finding on record at Fni Healthcare, Inc

An unannounced Medicare/Medicaid Home Health recertification survey was conducted at the above noted agency 05/23/2022 to 05/25/2022 by two (2) Medical Facilities Inspectors from the Virginia Department of Health Office of Licensure and Certification. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found not to be in compliance with 42 CFR 484.102 the Conditions of Participation: Emergency Preparedness for Home Health Agencies. Deficiencies were identified and cited.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on document review and staff interview it was determined the agency failed to maintain documentation of evidence of the staff’s ability to demonstrate knowledge of agency’s emergency preparedness plan. Findings: The agency's emergency preparedness plan was reviewed in the agency on 05/24/2022. The plan failed to include evidence of the staff’s ability to demonstrate knowledge of the agency emergency preparedness plan. On 05/24/2022 at 2:00 pm the Medical Facilities Inspector (MFI) requested any documentation that demonstrated the employee’s knowledge on the emergency preparedness plan. The QAPI Manager stated they don’t do quizzes or anything to test the staff’s knowledge but the employees participate in the agency's emergency preparedness drills. The MFI requested to see a sign in sheet. The QAPI Manager stated, “There's not a sign in sheet”. The failure to maintain documentation of the staff’s ability to demonstrate knowledge of the agency’s emergency plan was acknowledged by the QAPI Manager/Alternate Administrator during the review of the agency’s emergency preparedness plan and again during the exit conference conducted in the agency on 05/25/2022.

An unannounced Medicare/Medicaid Home Health recertification survey was conducted at the above noted agency 05/23/2022 to 05/25/2022 by two (2) Medical Facilities Inspectors from the Virginia Department of Health Office of Licensure and Certification. The agency reported 98 unduplicated admissions during the last 12 months. In conjunction with the survey, the clinical records of seven (7) patients, ten (10) personnel files, COVID-19 vaccination status and policy, agency admission packet, complaint log, organizational chart, and CLIA (Certified Laboratory Improvement Amendments) waiver were reviewed. Three (3) home visits and multiple staff interviews were conducted. The agency was found not to be in compliance with 42 CFR 484, the Medicare Conditions of Participation for Home Health Agencies. Deficiencies were identified and cited.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on document review and staff interview it was determined the agency failed to ensure patients were notified of the disciplines that would furnish care and/or the purposed visit frequency in advance of providing care for five (5) of seven (7) clinical records reviewed in the survey sample (Clinical records #1, #2, #4, #5, and #6). Findings: Seven (7) clinical records were reviewed in the agency on 05/24/2022 with the following findings: 1. The clinical record of patient # 1 with a start of care date of 04/11/2022 was reviewed in the agency on 05/24/2022. The clinical record contained a form titled “Plan of Care-Patient Summary” which is included in the agency's admission packet and per the QAPI manager is used to notify patient of disciplines that will furnish care and the frequency of visits. The visit schedule and frequency section of the form was incomplete and failed to contain the disciplines that will furnish care and the frequency of visits. 2. The clinical record of patient #2 with a start of care date of 05/07/2021 was reviewed in the agency on 05/24/2022. The clinical record contained a form titled “Plan of Care-Patient Summary” which is included in the agency's admission packet and per the QAPI manager is used to notify patient of disciplines that will furnish care and the frequency of visits. The visit schedule and frequency section of the form failed to contain to contain the disciplines that will furnish care and the frequency of visits. 3. The clinical record of patient # 4 with a start of care date of 01/27/2022 was reviewed in the agency on 05/24/2022. The clinical record contained a form titled “Plan of Care-Patient Summary” which is included in the agency's admission packet and per the QAPI Manager is used to notify patient of disciplines that will furnish care and the frequency of visits. The visit schedule and frequency section of the form was incomplete and failed to contain the proposed frequency of skilled nursing visits. 4. The clinical record of patient # 5 with a start of care date of 02/01/2022 was reviewed in the agency on 05/24/2022. The clinical record contained a form titled “Plan of Care-Patient Summary” which is included in the agency's admission packet and per the QAPI Manager is used to notify patient of disciplines that will furnish care and the frequency of visits. The visit schedule and frequency section of the form was incomplete and failed to contain to contain the disciplines that will furnish care and the frequency of visits. 5. The clinical record of patient #6 with a start of care date of 04/03/2022 was reviewed in the agency on 05/24/2022. The clinical record contained a form titled “Plan of Care-Patient Summary” which is included in the agency's admission packet and per the QAPI Manager is used to notify patient of disciplines that will furnish care and the frequency of visits. The visit schedule and frequency section of the form was incomplete and failed to contain to contain the disciplines that will furnish care and the frequency of visits. The failure to notify the patient of the disciplines that will furnish care and the proposed visit frequencies of each discipline in advance of providing care was acknowledged by the QAPI Manager during the clinical record reviews and again during the exit conference conducted in the agency on 05/25/2022.

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 clinical record review and staff interview, it was determined the agency failed to ensure each patient received home health services as ordered by the physician in the patient's individualized plan of care for five (5) of seven (7) clinical records in the survey sample (Clinical records #1, #2, #3, #5 and #6). Findings: Seven (7) clinical records were reviewed in the agency on 05/24/2022 with the following findings: 1. The clinical record of patient #1 was reviewed for the certification period 04/11/2022 to 06/09/2022. According to patient #1's plan of care (POC), the physician ordered skilled nurse frequency as one (1) time a week for nine (9) weeks. The POC contained a physician's order to report a pulse rate of less than 60 or greater than 100. The clinical record contained documentation on the 04/11/2022 SN visit the patient's pulse was 109. The clinical record failed to contain documentation/evidence the patient's physician was notified of above finding. In an interview conducted during the clinical record reviews the QAPI Manager stated, "Staff are good about calling the physician but sometimes they [staff] sometimes forget to document". 2. The clinical record of patent #2 was reviewed for the certification period 05/02/2022 to 06/30/2022. The plan of care contained a physician's order for Physical Therapy (PT) to continue with physical therapy services. The plan of care failed to contain the frequency of PT visits, treatments to be administered or PT goals. The clinical record contained documentation of physical therapy visits two (2) times a week through 05/18/2022. In an interview conducted during the clinical record reviews the QAPI manager stated she thought since physical therapy evaluated in the prior recertification period and the agency had a signed physician order they didn't need to include the order on the patient's new plan of care for the current certification period. 3. The clinical record of patient #3 was reviewed for the certification period 10/10/2021 to 12/08/2021. The plan of care contained a physician's order for skilled nursing visits one (1) time a week for eight (8) weeks. The clinical record failed to contain documentation of a SN visit or physician notification of a SN missed visit for the week of 11/07/2021 to 11/13/2021. 4. The clinical record of patent #5 was reviewed for the certification period 04/02/2022 to 05/31/2022. The plan of care (POC) contained a physician's order for Physical Therapy (PT) to continue with physical therapy services. The plan of care failed to contain the frequency of PT visits, treatments to be administered or PT goals. The clinical record contained documentation of physical therapy visits two (2) times a week through 05/20/2022. In an interview conducted during the clinical record reviews the QAPI manager stated she thought since physical therapy evaluated in the prior recertification period and the agency had a signed physician order they didn't need to include the order on the patient's new plan of care for the current certification period. Also, the POC contained a physician's order to report diastolic blood pressure outside of 90-60. The clinical record contained documentation during physical therapy visit conducted on 04/08/2022 the patient's blood pressure was 120/55 (diastolic). The clinical record failed to contain documentation/evidence the patient's physician was notified of the above noted finding. In an interview conducted during the clinical record reviews the QAPI Manager stated, "Staff are good about calling the physician but they [staff] sometimes forget to document". In addition, the clinical record contained skilled nurse (SN) documentation a venipuncture for INR (international normalized ratio) was performed during the 04/21/2022 SN visit. The plan of care failed to include a physician's order for an INR to be collected on 04/21/2022. In an interview conducted during the clinical record reviews the QAPI manager stated she thought since they had a signed physician order that was obtained in a prior certification period agency didn't need to include the order on the patient's current plan of care. 5. The clinical record of patient #6 was reviewed for the certification period 04/03/2022 to 06/01/2022. The plan of care contained a physician's order for Skilled Nursing (SN) visits two (2) times a week for one (1) week then one (1) time a week for eight (8) weeks. The clinical record failed to contain documentation of a SN visit or physician notification of a SN missed visit for the week of 05/01/2022 to 05/07/2022. In addition, the patient's primary diagnosis on the plan of care was listed as chronic diastolic congestive heart failure (CHF). The plan of care failed to contain interventions/goals to address CHF, which was reported as the primary diagnosis and the primary reason for for home care. Also, the patient's plan of care included a secondary diagnosis of Type 2 Diabetes without Complications The plan of care failed to include blood sugar parameters that should be reported to the physician. The clinical record contained skilled nurse documentation the patient's blood sugar was reported as 330 mg/dl on 04/14/2022 and 263 mg/dl on 05/11/2022. The agency's policy titled "Emergencies In The Home/Reporting Patient Problems" was reviewed in the agency on 05/24/2022 select portions reads as follows: A moderate emergency may include but is not limited to: 5) Blood sugar via glucometer greater than 250 or less than 60 (or anything abnormal for the patient In the event of a MODERATE EMERGENCY: 5) Inform physician office of event by end of business The clinical record failed to contain documentation/evidence the patient's physician was notified above the noted blood glucose readings. In an interview conducted during the record reviews the QAPI Manager stated, "Staff are good about calling the physician but they [staff] some times forget to document". The above noted findings were acknowledged by the QAPI Manager/Alternate Administrator during the clinical record reviews and again during the exit conference conducted in the agency on 05/25/2022.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on clinical record review and staff interview, it was determined the agency failed to ensure patient discharge summaries were sent to the physician within five (5) business days of discharge as required for two (2) of two (2) discharge records in the survey sample (Clinical records #3 and #4). Findings: Seven (7) clinical records were reviewed in the agency on 05/24/2022 with the following findings: The clinical record for patient #3 was reviewed for the certification period of 10/10/2021 to 12/08/2021. The record revealed the patient was discharged from the agency on 12/08/2021. Per fax confirmation the discharge summary was not sent to the physician until 12/20/2021. The clinical record for patient #4 was reviewed for the certification period of 01/27/2022 to 03/27/2022. The record revealed the patient was discharged from the agency on 03/16/2022. Per fax confirmation the discharge summary was not sent to the physician until 04/01/2022. The QAPI Manager/Alternate Administrator acknowledged the agency failed to send a discharge summary to the patient’s physician within five (5) business days as required during the clinical record reviews and again during the exit conference conducted in the agency on 05/25/2022.