Every finding on record at Frontier Home Health LLC

A recertification survey was completed on 9/16/21. Four deficiencies were cited

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure a comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than five calendar days after the start of care for 1 of 3 discharged patient records reviewed (Patient #9). Findings include: 1. The clinical record for Patient #9 was reviewed on 9/15/21. The plan of care for the certification period dated 11/20/20 to 1/18/21, revealed a start of care date of 11/20/20; diagnosis included age-related osteoporosis without current pathological fracture, age-related osteoporosis with pathological fracture of one femur sequela, other specified arthritis unspecified site, hypoxemia, restless leg syndrome, unspecified dementia without behavioral disturbances, gastro-esophageal reflux disease without esophagitis, other malaise, generalized muscle weakness, and difficulty in walking not elsewhere classified. Plan of care orders included skilled nursing (SN) visits one time a week for one week, two times a week for two weeks and one time a week for six weeks, physical therapy (PT) two times weekly, occupational therapy (OT) one time in week one, two times for two weeks, one time for one week, and two times a week for four weeks and home health aide (HHA) two times a week. a) The agency failed to ensure the PT and OT completed a comprehensive assessment within five calendar days of Patient #9's start of care date of 11/20/20. Review of a referral dated 11/18/20 revealed Patient #9 was discharged from the facility with assessment of displaced intertrochanteric fracture of the left femur, subsequent encounter for a closed fracture with routine healing. Orders to receive home health services of SN for assessment; and PT and OT to evaluate and treat. Clinical record review on 9/15/21 revealed the Outcome and Assessment Information Set-D (OASIS) start of care comprehensive assessment for PT was completed 13 days after the start of care for the OT. During interview on 9/16/21 at approximately 9:38 a.m., Registered Nurse (RN) #3 stated she could not remember why therapy services were late; however, there was an order to start therapy services on 12/2/20 for PT and 12/3/20 for OT. The agency was unable to provide evidence or documentation why therapy services had been on hold or delayed.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure all patient care orders, including verbal orders, were recorded in the plan of care for 1 of 1 patients reviewed who received central line/port care (Patient #4). Findings include: 1. The clinical record for Patient #4 was reviewed on 9/14/21. The plan of care for the certification period dated 7/15/21 to 9/12/21 revealed a start of care date of 9/18/20; diagnosis included pressure ulcer of sacral region stage 3, traumatic compartment syndrome of right lower extremity, encounter for change or removal of nonsurgical dressing, gastrointestinal hemorrhage, chronic obstructive pulmonary disease, type II diabetes with hyperglycemia, essential hypertension, hypokalemia, insomnia, allergic rhinitis, muscle weakness, and other reduced mobility. The plan of care orders included skilled nursing (SN) services three times weekly for wound care, port care, and intravenous (IV) medication administration, home health aide (HHA) two times a week for assistance with activities of daily (ADLs) and showers, physical therapy (PT) and occupational therapy (OT) to evaluate and treat. a) The agency failed to ensure all patient care orders were included in the plan of care. Review of Patient #4’s plan of care dated 7/15/21 to 9/12/21 revealed port care and intravenous medication administration; however, the plan of care failed to have specific orders to flush the port and perform a heparin lock. Record review of RN #3’s nursing notes revealed Registered Nurse (RN) #3 performed port flushes and heparin lock on 15 visits, dated 7/15/21, 7/26/21, 7/28/21, 8/2/21, 8/4/21, 8/9/21, 8/11/21, 8/16/21, 8/18/21, 8/23/21, 8/30/21, 9/1/21, 9/6/21, 9/8/21, and 9/13/21. During interview with RN #3 on 9/16/21 at approximately 9:38 a.m., she acknowledged she did not have specific orders to flush the port or lock with heparin and stated she would ensure in the future that these orders would be obtained from the physician and would be included on the plan of care.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on interview and record review the agency failed to ensure services and treatments were provided in conformance with physician's orders for 2 of 4 patient records reviewed (Patients #4 and #9). Findings include: 1. The clinical record for Patient #4 was reviewed on 9/13/21. The plan of care for the certification period dated 7/15/21 to 9/12/21 and 9/13/21 to 11/11/21 revealed a start of care date of 9/18/20; diagnosis included pressure ulcer of sacral region stage 3, traumatic compartment syndrome of right lower extremity, encounter for change or removal of nonsurgical dressing, gastrointestinal hemorrhage, chronic obstructive pulmonary disease, type II diabetes with hyperglycemia, essential hypertension, hypokalemia, insomnia, allergic rhinitis, muscle weakness, and other reduced mobility. The plan of care orders included skilled nursing (SN) services three times weekly for wound care, port care, and intravenous (IV) medication administration, home health aide (HHA) two times a week for assistance with activities of daily living (ADLs) and showers, physical therapy (PT) and occupational therapy (OT) to evaluate and treat. a) The agency failed to ensure wound care was provided in accordance with physician orders. Review of Patient #4’s plan of care dated 7/15/21 to 9/12/21 revealed the following wound care orders: 1. Cleanse wound with wound cleanser 2. Cover with medihoney and alginate 3. Cover with mepilex dressing Record review of the nursing notes dated 3/18/21 by Licensed Practical Murse (LPN) #6 revealed LPN #6 cleaned the wound and had not applied alginate, on eight visits dated 7/23/21, 7/30/21, 8/6/21, 8/13/21, 8/20/21, 8/25/21, 9/3/21, and 9/10/21. During interview on 9/16/21 at 9:38 a.m., RN #3 stated the LPN #6 should have applied alginate to the wound. Registered Nurse (RN) #3 stated she observed LPN #6 and she had applied the alginate. RN #3 was unsure why LPN #6 had not applied the alginate on subsequent visits. 2. The clinical record for Patient #9 was reviewed on 9/15/21. The plan of care for the certification period dated 11/20/20 to 1/18/21 revealed a start of care date of 11/20/20; diagnosis included age-related osteoporosis without current pathological fracture, age-related osteoporosis with pathological fracture of one femur sequela, other specified arthritis-unspecified site, hypoxemia, restless leg syndrome, unspecified dementia without behavioral disturbances, gastro-esophageal reflux disease without esophagitis, other malaise, generalized muscle weakness, and difficulty in walking not elsewhere classified. Plan of care orders included skilled nursing (SN) visits one time a week for one week, two times a week for two weeks and one time a week for six weeks, PT two times weekly, OT one time in week one, two times for two weeks, one time for one week, and two times a week for four week and home health aide (HHA) two times a week. a) The agency failed to ensure care and services were provided as ordered by the physician for SN visits two times a week for two weeks for a period of two weeks. Clinical record review revealed orders for SN two times a week to begin on 11/22/20. Record review revealed that SN services were provided one time per week for a period of two weeks. There was no order found to discontinue or hold SN services during this period, nor was there documentation Patient #9 refused SN services. During an interview on 9/16/21 at approximately 9:38 a.m., RN #3 stated that the patient’s son was very uncooperative when discussing the patient needing a higher level of care for assistance and she was unable to recall why the frequency was not changed during this period. The alternate administrator acknowledged there was no documentation in the clinical record to hold visits during this time frame.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure clinical records contained accurate documentation of patient's clinical notes and plans of care for 1 of 2 patient records reviewed who received insulin care (Patient #1). Findings include: 1. The clinical record for Patient #1 was reviewed on 9/15/21. The plan of care for the certification period dated 6/1/21 to 7/30/21, revealed a start of care date of 6/6/20; diagnoses included type 2 diabetes mellitus with diabetic polyneuropathy, chronic obstructive pulmonary disease, and gastro-esophageal reflux disease without esophagitis. Plan of care orders included skilled nurse (SN) visits twice daily for the certification period for insulin administration and medication education, and home health aide (HHA) visits three times a week for nine weeks for assistance with bathing, personal care, skin care and assistance with dressing. a) Record review revealed the agency failed to ensure Patient #1's clinical record contained an accurate plan of care. Review of the plan of care for the certification period dated 6/1/21 through 7/30/21, revealed medication orders to inject 65 units of Lantus Solostar 100 unit/ml subcutaneously daily. Review of a verbal order dated 6/24/21 revealed orders from the physician to decrease the Lantus to 60 units daily. Review of the SN visit notes from 6/1/21 to 6/23/21, revealed the nurses who provided the Lantus injection gave 65 units daily. Review of the SN visit notes from 6/24/21 to 7/30/21 revealed the nurses provided the new medication orders of 60 units daily. Review of the updated plan of care for the certification period dated 7/31/21 through 9/28/21, revealed medication orders to inject 65 units of Lantus Solostar 100 unit/ml subcutaneously daily. However, SN visit notes from 7/31/21 to 8/31/21 revealed that the nurses continued to administer Lantus Solostar 60 units every day. Review of the medication profile for Patient #1, dated 7/31/21 to 9/28/21, revealed Lantus Solostar 100 unit/ml was to be given daily at 60 units. During interview on 9/16/21 at 8:43 a.m., Registered Nurse (RN) #7 stated when she did the recertification for the certification period 7/31/21 through 9/28/21, she reviewed the medications. She went on to state she was not aware that she put in the incorrect medication units for the Lantus Solostar. When asked how a nurse not familiar with the patient would know which was the right medication to give, RN #7 stated that the correct amount of the medication was listed on the medication profile for Patient #1 which was in the home of the patient. She further stated that the wrong amount of units on the plan of care was a mistake.