Every finding on record at Friman Home Health Services

A Medicare recertification and focused infection control survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 2/7/2022 through 2/10/2022 at: Friman Home Health Services PLC. 42000 Koppernick Rd. Ste. A-7 Canton, MI 48187 This was a standard survey. Emergency Preparedness was not reviewed.

A Medicare recertification and focused infection control survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 2/7/2022 through 2/10/2022 at: Friman Home Health Services PLC. 42000 Koppernick Rd. Ste. A-7 Canton, MI 48187 For this survey no home visits were available (Patients refused). 2 active records without a home visit and 5 discharged records were reviewed. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the conditions of participation for home health agencies at: 42 CFR Part 484.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to have a registered nurse (RN) perform a comprehensive drug review in 5 of 5 (MR #1, 2, 3, 4 and 5) records in which therapy only cases were assigned, resulting in the potential for harmful medication effects for all patients currently serviced by this agency. Findings include: MR #1: The patient was admitted on 9/8/20 for physical therapy (PT) only services, with a diagnosis of osteoarthritis. During record review on 2/7/22, it was discovered that the start of care (SOC) comprehensive assessment was performed and signed by PT#1. On 2/8/22, a medication reconciliation was requested. During review of the medication reconciliation it was discovered that no signature was documented. During an interview with the administrator (Adm#1) on 2/10/22, Adm#1 was asked if an RN reviewed the medications. Adm#1 stated, "The physical therapist did the medication review." There was no documentation in the record that an RN did a medication reconciliation. MR #2: The patient was admitted on 11/24/21 for physical therapy (PT) only services, with a diagnosis of osteoarthritis, diabetes and falls. During record review on 2/7/22, it was discovered that the SOC comprehensive assessment was performed and signed by PT#2. On 2/8/22, a medication reconciliation was requested. During review of the medication reconciliation it was discovered that no signature was documented. During an interview with the administrator (Adm#1) on 2/10/22, Adm#1 was asked if an RN reviewed the medications. Adm#1 stated, "The physical therapist did the medication review." There was no documentation in the record that an RN did a medication reconciliation. MR #3: The patient was admitted on 10/6/21 for physical therapy (PT) only services, with a diagnosis of osteoarthritis, tremors, weakness and falls. During record review on 2/7/22, it was discovered that the SOC comprehensive assessment was performed and signed by PT#1. On 2/8/22, a medication reconciliation was requested. During review of the medication reconciliation it was discovered that no signature was documented. During an interview with the administrator (Adm#1) on 2/10/22, Adm#1 was asked if an RN reviewed the medications. Adm#1 stated, "The physical therapist did the medication review." There was no documentation in the record that an RN did a medication reconciliation. MR #4: The patient was admitted on 10/5/21 for physical therapy (PT) only services, with a diagnosis of osteoarthritis, back and shoulder pain. During record review on 2/8/22, it was discovered that the SOC comprehensive assessment was performed and signed by PT#3. On 2/8/22, a medication reconciliation was requested. During review of the medication reconciliation it was discovered that no signature was documented. During an interview with the administrator (Adm#1) on 2/10/22, Adm#1 was asked if an RN reviewed the medications. Adm#1 stated, "The physical therapist did the medication review." There was no documentation in the record that an RN did a medication reconciliation. MR #5: The patient was admitted on 10/6/21 for physical therapy (PT) only services, with a diagnosis of osteoarthritis, weakness, falls and schizophrenia. During record review on 2/8/22, it was discovered that the SOC comprehensive assessment was performed and signed by PT#1. On 2/8/22, a medication reconciliation was requested. During review of the medication reconciliation it was discovered that no signature was documented. During an interview with the administrator (Adm#1) on 2/10/22, Adm#1 was asked if an RN reviewed the medications. Adm#1 stated, "The physical therapist did the medication review." There was no documentation in the record that an RN did a medication reconciliation. During an interview on 2/10/22, The administrator (Adm#1) acknowledged the above findings.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to ensure the plan of care (POC) included all safety measures to prevent injury in 4 of 7 records, from a total of 7 records reviewed, resulting in the potential for harm to agency patients. Findings include: MR #2: The start of care (SOC) was dated 11/24/21, with diagnoses that included osteoarthritis, diabetes and falls. During review of the POC on 2/7/22, it was discovered that no blood sugar parameters, diabetic precautions or fall precautions were documented. MR #5: The SOC was dated 10/6/21 with diagnoses that included osteoarthritis, diabetes, schizophrenia and falls. During review of the POC on 2/7/22, it was discovered that no blood sugar parameters or diabetic precautions were documented. MR #6: The SOC was dated 4/30/21 with diagnoses that included osteoarthritis, falls and congestive heart failure (CHF). During review of the POC on 2/9/22, it was discovered that no bleeding precautions (Patient is on Eliquis), or weight parameters (Patient has congestive heart failure) were documented. MR #7: The SOC was dated 9/27/21 with diagnoses that included osteoarthritis, depression and abnormal gait. During review of the POC on 2/9/22, it was discovered that no diabetic precautions were documented (Patient is a diabetic). During an interview on 2/10/22, the administrator (adm#1) acknowledged the above findings.

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 record review and interview, the agency failed to ensure that discharge and transfer summaries were sent to the physician in 4 of 4 records (MR #'s 3, 5, 6, 7) who were discharged/transferred from a total of 7 records reviewed, resulting in the potential for unidentified continuing health care concerns and unmet care needs. Findings include: MR #3: The patient was admitted on 10/6/21 for PT (physical therapy) only services, with diagnoses that included osteoarthritis, weakness, falls, and tremors. During review of the record on 2/8/22, it was discovered that there was no documentation in the record that a discharge summary was sent to the physician. MR #5: The patient was admitted on 10/6/21 for PT (physical therapy) only services, with diagnoses that included osteoarthritis, weakness, congestive heart failure (CHF), falls and schizophrenia. During review of the record on 2/9/22, it was discovered that there was no documentation in the record that a transfer summary was sent to the physician. MR #6: The SOC was dated 4/30/21 with diagnoses that included osteoarthritis, falls and congestive heart failure (CHF). During review of the record on 2/9/22, it was discovered that there was no documentation in the record that a transfer summary was sent to the physician. MR #7: The SOC was dated 9/27/21 with diagnoses that included osteoarthritis, depression and abnormal gait. During review of the record on 2/9/22, it was discovered that there was no documentation in the record that a transfer summary was sent to the physician. During an interview on 2/10/22, the administrator (adm#1) acknowledged the above findings.