Every finding on record at Focused Home Health Agency Inc

An unannounced Complaint survey #2023018366 was commenced on 02/23/2024 and concluded on 03/05/2024 at Focused Home Health Agency Inc., Home Health Agency provider. The provider was not in compliance with 42 Code of Federal Regulations (CFR), Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

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 record review and interview, the Home Health Agency provider failed to obtain new orders or clarification from the physician when the Plan of Care could not be followed for 1 of 3 sampled patients (Patient #1). The findings include: Review of Patient #1’s Home Health Certification and Plan Of Care (HHCPOC) for 11/30/23 to 01/28/24 documents she is 5 years old and started care, with the Home Health Agency on 11/30/23 with diagnoses that include “Bronchopulmonary Dysplasia” (chronic lung disease) since around the time of birth and “dependence on respirator [ventilator] status” (needs a machine to help her breathe); that she needs 24 hour skilled nursing care 7 days a week, effective 11/30/23; that the Skilled Nurse is to “manage ventilator-dependent patient as per physician orders” followed by ventilator settings; and no evidence of documentation that the patient could be removed from the ventilator or could breathe without the ventilator. Further review of the record reveals no evidence of physician's orders that Patient #1 could be off the ventilator. During in-person interview on 02/23/24 at 2:54 PM, the Registered Nurse (RN)/Administrator stated she had assessed Patient #1 in the home, and she was not on a ventilator but had a "trach" (Tracheostomy-a tube in her neck through which she breathes), used Oxygen, and she was a very active child. Review of the record reveals Registered Nurse, Staff A cared for Patient #1 from 7 PM to 7 AM the nights of 11/30/23 and 12/01/23 and there was no evidence of documentation in her nursing notes that the patient was on a ventilator. During a telephonic interview on 03/04/24 at 12:33 PM, Registered Nurse, Staff A confirmed she took care of Patient #1, and she had a "trach" but was not on a ventilator. Review of the record reveals Registered Nurse, Staff B cared for Patient #1 from 7 AM to 7 PM on 12/02/23 and 12/03/23; from 7 PM to 7 AM the nights of 12/04/23 and 12/07/23; from 7 AM to 7 PM on 12/09/23; from 7 PM to 7 AM the nights of 12/10/23, 12/12/23, and 12/14/23; from 7 AM to 7 PM on 12/16/23; from 7 PM to 7 AM the nights of 12/28/23 and 01/02/24 and includes no evidence of documentation in her Nursing Notes that the patient was on a ventilator. During a telephonic interview on 03/04/24 at 12:08 PM, Registered Nurse, Staff B confirmed she took care of Patient #1 on several occasions, and she had a "trach" but was not on a ventilator. During telephone interview with the Administrator on 03/05/24 at 10:20 AM, she reported Patient #1 was not on a ventilator and no longer used it at night; that this was confirmed by the nurse and with the doctor; that she believed the doctor was “always aware” of this and that the ventilator was supposed to be used “as needed”, but the doctor did not give new orders and they did not change the "care plan;" and confirmed the doctor did not give an order that Patient #1 could be off of the ventilator or use it only “as needed.”