Every finding on record at Fusion Home Health Care Agency, Inc

On 12/14/21 through 12/16/21, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Fusion Home Health Care. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey and a COVID-19 focused infection control survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 12/14/2021 through 12/16/21 at: Fusion Home Health Care 20390 Harper Ave. Harper Woods, MI 48225 This agency has no branch sites. Records reviewed: 7 discharged records without home visits (active census: 0), for a total sample of 7 records 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.

Content of the comprehensive assessment CFR(s): 484.55(c) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient's status, and must include, at a minimum, the following information: This STANDARD is not met as evidenced by: Based on document review and interview, the agency failed to conduct an initial comprehensive assessment which accurately reflected the patient's current health status, past medical history, history of events leading to home care, baseline data for future assessments, and ascertained the patient's immediate care needs in 3 of 7 records reviewed (MR#'s 2, 3, and 7) out of a total of 7 records reviewed, resulting in the potential for unmet care needs. Findings included: Agency Policy: "Comprehensive Assessment" No. 4002 (undated) stated, "To ensure that the patient's current needs and/or problems are continuously evaluated and the care and/or services provided are adjusted accordingly. Includes the following information... pertinent medical history." MR #2: The patient was admitted on 1/25/2021 with diagnoses which included diabetes-type 2, hypertension with heart failure, and chronic obstructive pulmonary disease (COPD). On 12/15/21, review of the start of care (SOC) comprehensive assessment performed by skilled nursing (SN), documented under the category of "Patient History" the following: Diabetes-poorly controlled, Localized edema-poorly controlled, Essential hypertension-poorly controlled, Heart failure-poorly controlled and COPD-poorly controlled. Three additional diagnoses were left blank concerning symptom control. In addition, all diagnoses (9 of 9) listed the same onset date of 1/21/21, which was found to be inaccurate during further medical record review. Further, information which addressed the "poorly controlled" diagnoses noted above was not found such as past medical history that included exacerbations, medical treatments and outcomes, measurable data to use as a baseline for future assessments or a history of events leading to the need for the current home care admission. MR #3: The patient's SOC was 3/2/21 with diagnoses which included hypertension, obstructive sleep apnea, and gout-unspecified. On 12/15/21, review of the referral for home care noted the following diagnoses: congestive heart failure, COPD, chronic renal failure, and chronic respiratory failure with hypoxia. Subsequent review of the SOC comprehensive assessment performed by SN on 3/2/21, failed to address any past medical history referenced in the referral for home care. No dates of past exacerbations, medical treatments with outcomes, or measurable data to use as a baseline for future assessments were evidenced. In addition, all listed diagnoses (7 of 7) had the same date of onset (2/23/21), which was found to be inaccurate upon further review. Further, under "Cardiovascular Status" SN documented non-pitting edema (swelling) for all patient extremities. No objective measurements were noted to ascertain the severity of the patient's edema. MR #7: The patient's SOC date was 4/16/2021 with diagnoses which included chronic kidney disease, hypertension, diabetes-type 2, and emphysema (condition which reduces oxygen to the body). On 12/15/21, review of the SOC comprehensive assessment performed by SN on 4/16/21, failed to address any past medical history referenced in the referral for home care. No dates of past exacerbations, medical treatments with outcomes, or measurable data to use as a baseline for future assessments were evidenced. In addition, all listed diagnoses (9 of 9) had the same date of onset (4/13/21), which was found to be inaccurate upon further review. The comprehensive assessments noted above failed to provide a complete, accurate picture of the patient's status to assist in developing the patient's plan of care. These findings were reviewed with and confirmed by the Clinical Manager (CM#1) during an interview on 12/16/21 at 11:05 AM.

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 agency failed to ensure the plan of care covered all pertinent interventions with reportable safety parameters, and objectively measurable goals specific to the needs of the patient for 5 of 7 records (MR#'s 1, 2, 4, 6 and 7) from a total sample of 7 records reviewed, resulting in patients not receiving care specific to their individual needs and the potential for poor patient outcomes. Findings included: Agency Policy: "Care Planning" Policy #2004 (undated) stated, "An individualized plan of care is developed... for each patient based upon assessment that reflects the patient's identified problems and needs... which includes at least the following information: Safety Measures; Goals and Interventions." MR #1: The patient's start of care (SOC) date was 9/10/2020 with diagnoses which included hemiplegia (paralysis affecting one side of the body) following stroke, back pain, and chronic obstructive pulmonary disease (COPD). On 12/15/21, review of the plan of care (POC) dated 9/10/20, failed to include any reportable safety parameters (vital signs, oxygen, and pain levels) in which to notify the physician in the event values were found to be outside the patient's acceptable range. In addition, 4 of 4 goals listed in the POC by skilled nursing (SN) were not objectively measurable. Examples include: "Pt (patient)/Cg (caregiver) will be knowledgeable in s/s (signs and symptoms) of infection by 9/10/2020; Pt/Cg will demonstrate knowledge of medication and diet by 10/17/2020." The POC failed to include all the required elements, as per this requirement, to meet the individualized needs of the patient. MR #2: The patient was admitted on 1/25/2021 with diagnoses which included diabetes-type 2, hypertension with congestive heart failure (CHF), and COPD. On 12/15/21, review of the POC dated 1/25/2021, noted a failure to include any reportable safety parameters such as vital signs, blood sugar levels, weight or circumference measurement increases (used to monitor heart failure exacerbation), or decreased blood oxygen levels in which to notify the physician in the event values were found to be outside the patient's acceptable range. In addition, 2 of 2 goals listed which addressed pertinent diagnoses of CHF and COPD were not written in measurable terms. Examples include: "Pt/Cg cardiac/respiratory status will remain stable by 3/25/2021; Pt/Cg will be knowledgeable in oxygen safety by 1/25/2021. MR #4: The patient was admitted on 2/4/2021 with diagnoses which included primary osteoarthritis, chronic kidney disease, and CHF. On 12/15/21, review of the POC dated 2/4/2021, failed to include any reportable safety parameters such as vital signs, acute weight gain, or decreased blood oxygen levels in which to notify the physician in the event values were found to be outside the patient's acceptable range. In addition, no goals were evidenced in the patient's POC which addressed any of the above listed diagnoses. MR #6: The patient was admitted on 6/1/2021 with diagnoses which included disturbances of salivary secretion, hypertensive urgency, anemia, chronic kidney disease, and CHF. On 12/15/21, review of the POC dated 6/1/2021, failed to include any reportable safety parameters such as vital signs, or acute weight gain in which to notify the physician in the event values were found to be outside the patient's acceptable range. Further, the POC under "Respiratory Status" ordered SN to obtain oxygen levels every visit and/or PRN dyspnea. SN noted on the SOC assessment that the patient was dyspneic (short of breath) with minimal exertion. No oxygen parameters were evidenced on the POC in which to notify the physician. All SN goals listed (3 of 3) were not written in measurable terms. Examples include: "Pt/Cg will be knowledgeable in s/s of infection by 6/1/2021; Pt/Cg will demonstrate knowledge of medication and diet by 6/26/2021." MR #7: The patient's SOC date was 4/16/2021 with diagnoses which included chronic kidney disease, hypertension, diabetes-type 2, and emphysema (condition which reduces oxygen to the body). On 12/15/21, review of the plan of care (POC) dated 9/10/20, failed to include any reportable safety parameters such as vital signs and blood oxygen levels in which to notify the physician in the event values were found to be outside the patient's acceptable range. In addition, 5 of 6 goals listed in the POC by SN were not objectively measurable. Examples include: "Pt/Cg will be knowledgeable in s/s of infection by 4/16/2021; Pt/Cg cardiac/respiratory status will remain stable by 6/13/2021." Further, no visit frequencies were found on the POC for all disciplines assigned (SN and Physical Therapy) to the patient. The above findings were reviewed and acknowledged by the Clinical Manager (CM#1) during an interview 12/16/2021 at 11:35 AM.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on document review and interview, the physical therapist (PT) failed to adequately assess and monitor the needs of the patient in 2 of 6 records (MR#'s 2 and 7) in which PT services were provided, from a total sample of 7 records reviewed, resulting in the potential for unidentified care needs. Findings included: Agency Policy: "Patient Assessment Functions and Qualifications" No. 4001 (undated) stated, "To provide appropriately qualified staff to meet patient needs for care and/or services identified during the assessment and/or reassessment process. Physical Therapy: Evaluates the patient's response to the therapy plan of care... Reassesses patients to determine their ongoing needs..." MR #2: The patient was admitted on 1/25/2021 with diagnoses which included diabetes-type 2, hypertension with heart failure, and chronic obstructive pulmonary disease (COPD). During record review on 12/15/21, the referral noted additional pertinent patient history when considering potential assessments to ascertain the patient's health status such as: "COPD... SOB (shortness of breath)/dyspnea (difficult or labored breathing). Requires max assistance/taxing effort to leave home. Heart failure-unspecified." On 12/15/21, review of the start of care (SOC) comprehensive assessment performed by skilled nursing (SN), documented under Section M1400 "Respiratory Status" the following: "Dyspnea with minimal exertion... diminished lung sounds... Cough/Sputum (dry), Using oxygen 2 liters via nasal cannula, Pulse oximetry (procedure to assess blood oxygen levels) every visit and/or PRN (as needed) dyspnea." The patient's Plan of Care (1/25/21) ordered under "Respiratory Status" to perform "Pulse oximetry every visit and/or PRN dyspnea. However, when reviewing PT's evaluation and visit notes (1/27/21 through 2/24/21), 9 of 9 opportunities to assess the patient's oxygen level due to the above noted reasons, were left blank. In addition, no documentation was evidenced in the medical record in which PT described the patient's respiratory status during or after exercising. PT failed to assess, evaluate, and perform pulse oximetry as ordered in the POC. MR #7: The patient's SOC date was 4/16/2021 with diagnoses which included chronic kidney disease, diabetes-type 2, and emphysema (condition which reduces oxygen to the body). During record review on 12/15/21, the SOC comprehensive assessment performed by SN documented the following: "Dyspnea with minimal exertion... lung sounds diminished... Oxygen 2 liters via nasal cannula intermittently... Pulse oximetry every visit and/or PRN dyspnea." The patient's Plan of Care (4/16/21) ordered under "Respiratory Status" to perform "Pulse oximetry every visit and/or PRN dyspnea. During review of PT's documentation (initial evaluation and visit notes), 10 of 10 opportunities (4/19/21 through 5/20/21) to assess the patient's oxygen level due to the above noted reasons, were left blank. In addition, no documentation was evidenced in the medical record in which PT described the patient's respiratory status during or after exercising. These findings were reviewed with and confirmed by the Clinical Manager (CM#1) during an interview on 12/16/21 at 10:35 AM. CM#1 stated, "I'll in-service physical therapy about this and make sure they assess and document oxygen levels in the future."