Every finding on record at Gencare Resources LLC

Complaint investigation #2022012892 was conducted on 10/10/22. Gencare Resources Home Health Care was not in compliance with 42 CFR 484, Requirements for Home Health Agencies.

Social Worker CFR(s): 484.115(m) Standard: Social worker. A person who has a master's or doctoral degree from a school of social work accredited by the Council on Social Work Education, and has 1 year of social work experience in a health care setting. This STANDARD is not met as evidenced by: Based on interview and review of the current Home Health Agency (HHA) employee listing, the HHA failed to show evidence that a Medical Social Worker was currently employed or on contract to be available for a patient's medical social needs. Review of a current employee/staff list of employed personnel for the HHA revealed no listing for a Medical Social Worker (MSW). In an interview with the HHA administrator/Chief Financial Officer on 10/10/22 at 11:45 AM, he related they currently did not have a MSW. He related in the past they had a contracted with a MSW however, it was years ago, and they had not used her previously and she had not seen patients previously. He related he was unaware of where the contract was and if it would still be honored by her. He related if a patient needed a MSW, he would try to contact her. The administrator related she did not have a current personnel file and the previous one was filed away somewhere. He related there was no current MSW in the HHA other than the previous contracted one. In an interview with the HHA administrator/Chief Financial Officer on 10/10/22 at 11:45 AM, revealed in the past the HHA had a contract with a licensed Social Worker, however they had not used her and found the patients in the past ot had not had a reason to see her. He related there was a previous contract however, he did not know where it was or if she would honor it still. He related he did not know where her personnel file was and it probably had been filed away somewhere.

Complaint investigations #2021014145 and 2021014703 were conducted on 10/27/21. Gencare Resources Home Health Care was not in compliance with 42 CFR 484, Requirements for Home Health Agencies.

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, review of patient records and facility documents, the Home Health Agency (HHA) failed to notify the patient's ordering physician for 2 (1,2) of 3 patients, that prescribed home health visitations by the nurse had been cancelled or missed. Findings: Record review of patient #1's record revealed a start of care date of 9/5/20 with a current certification date of 8/31/21-10/29/21. Date of birth was 8/27/18 and diagnosis included Preterm newborn, Double outlet right ventricle, failure to thrive, and congenital malformations of intestinal fixation with gastrostomy status. Physician orders on page 2 of the Plan of care included documentation of "Orders for discipline and treatment: SN (skilled nurse), Frequency: 24 hours 7 days per week" and continued to documented specific nursing orders and protocols for patient care. Review of patient #1's HHA "Missed Visit" log for nurse visits for the period of August through September revealed a total of 13 nursing visits that were not made to the patient. The Missed Visit log documented the following missed visits along with the reason they were missed: 8/5/21-8/6/21 Reason: Sickness, 8/6/21-8/7/21, Reason: Sickness, 8/9/21-8/10/21 Reason: No Show, 8/11/21-8/12/21 Reason: No show, 8/16/21-8/17/31 Reason: Vacation, 8/18/21-8/19/21 Reason: Vacation, 8/21/21-8/22/21 Reason: Vacation, 8/22/21-8/23/21 Reason: Vacation, 8/23/21-8/24/21 Reason: Vacation, 8/25/21-8/26/21 Reason: Vacation, 8/30/21-8/31/21 Reason: Client compatibility, 9/14/21 Reason: Sickness, and 9/30/21 Reason: Caregiver able to assist client." There was no further explanation of the missed visit found documented in the patient's record or the HHA information to clarify why the visit was missed or that the patient's physician had been notified of the variation from the order. Review of patient #2's record revealed a start of care date of 8/9/21 with a certification period of 9/9/21 to 11/7/21. Date of birth was 10/13/19 and diagnosis included Central sleep apnea in conditions classified elsewhere, Other Seizures, Chronic respiratory failure with hypoxia and hypercapnia, essential hypertension. Physician orders on page 2 of the Plan of care included documentation of "Orders for Discipline and Treatments: SN Frequency: 24 hours 7 days per week" and continued to documented specific nursing orders and protocols for patient care. Review of patient #2's HHA "Missed Visit" log for nurse visits for the period of August through September revealed a total of 17 nursing visits that were not made to the patient. The Missed Visit log documented the following missed visits along with the reason they were missed: 9/11-9/12/21 Reason: Sickness, 9/12/21-9/13/21 Reason: Sickness, 9/22/21-9/23/21 Family emergency, 9/27/21-9/28/21 Reason: Sickness. All documented "Visit tracking type-Employee." There were also missed visits documented as follows: 9/14/21-9/17/21 Reason: Client hospitalization, and documented Visit tracking type as "Client" 9/17/21 Reason: Cancellation of care, 9/18/21-9/19/21 Reason: Cancelation of care, 9/18/21 Reason: client hospitalized, 10/5/21 Reason: Cancellation of care , 10/22/21-10/23/21 Reason: Client hospitalized, 10/22/21 Reason: Client hospitalized, and 10/23-10/24/21 Reason: Client hospitalized. Documentation under "visit tracking type-Client." There was no further explanation of the missed visit found documented in the patient's record or the HHA information to clarify why the visit was missed or that the patient's physician had been notified of the variation from the order. In an interview with the Executive Director of Nurse's (EDON) on 10/27/21 at 2:30 PM, she verbalized the scheduler filled out the Missed Visit log when a visit was not made to the patient. She verified that there was no further information regarding the missed visit in the record or nurse notes. The EDON stated she was unable to further explain the missed visit log regarding the documentation of whose sickness, vacation, or client compatibility it was. The EDON agreed there was no documentation found in the records or elsewhere, that the physician had not been notified of the missed visits, and therefore a deviation from the physician order. She related the physician should have been notified. of the missed visits. She related there was no current HHA policy regarding missed visit notifications, and the noncompliance would be fixed.