Every finding on record at Gentle Hands Care Agency,LLC The

Extended Substantial Allegation Survey Substantial Allegation 70949 and 103635 The following deficiencies are based upon the extended substantial allegation 70949 and 103635 completed on 02/07/24. Gentle Hands Care Agency 369128, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B,C for Home Health Agency. An entrance conference was conducted on 02/06/24 at 3:30 PM with Administrator, an exit conference was conducted on 02/07/24 5:00 PM with Administrator. Gentle Hands Care Agency is precluded from providing its own home health aide training and competency testing or competency evaluation program for a period of two years from the date of the receipt of the deficiency report (2567) for this survey.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on medical record review, review of a current census, review of a 30 day notice to stop services, and staff interview, the agency failed to properly advise the client and/or physician of the discharge. This affected two, Pt #1 and Pt #3, of the four patients reviewed. Census at the time of survey was 26. 1) Review of the medical record for Pt #1 revealed no documentation related to any discharge and no documentation the physician was notified of a discharge. Pt. #1 was not currently on the census. Interview with Staff A on 02/07/24 at 11:30 AM revealed the agency did not have sufficient staffing to cover the shifts for PT #1. Staff A further stated the agency had attempted to discharge the client in October of 2023 and had given a 30 day notice. Staff A stated the case manager had requested the agency to continue services as they had not been able to find another agency to accept the client. Staff A stated the agency did continue services as able through 01/20/24. . 2) Review of the medical record for Pt #3 revealed no documentation the physician was notified and involved in a discharge. The patient was not on the current census. Review of a discharge notice dated 09/07/23 revealed Pt #3 was provided a 30 day notice of stop of services due to a lack of employees. The end date with the agency would be 10/07/23. Interview with Staff A on 02/07/24 at 11:30 AM revealed the agency did not have sufficient staffing to cover the shifts for PT #3.

Comprehensive Assessment of Patients CFR(s): 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. This CONDITION is not met as evidenced by: Based on medical record review and staff interview, the agency failed to have the initial assessment completed by a Registered Nurse (G514) and failed to complete the comprehensive assessment with in five calendar days after the start of care (G520). The cumulative effects of these systemic problems resulted in the agency's inability to ensure the patient's assessed needs would be met. .

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed have initial assessments completed by a Registered Nurse (RN). This affected two (Pt #1 and Pt #3) patients the four records reviewed. Census at the time of survey was 26. The medical record review for Pt #1 failed to reveal an initial assessment was done by a RN. The medical record review for Pt #3 failed to reveal an initial assessment was done by a RN Interview with Staff A on 02/07/24 at 11:30 AM revealed the agency did not have a RN to be able to perform the initial assessment. The agency opened the cases without the assessments being done.

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 medical record review and staff interview, the agency failed to complete comprehensive assessment within the five days after the start of care. This affected two (Pt #1 and Pt #3) patients of four patients reviewed. Census at the time of survey was 26. 1) The medical record review for Pt #1 failed to reveal a comprehensive assessment was completed within five days of the start of care. 2) The medical record review for Pt #3 failed to reveal a comprehensive assessment was completed within five days of the start of care. Interview with Staff A on 02/07/24 at 11:30 AM revealed the agency did not have a Registered Nurse to be able to perform the initial assessment. As the initial assessments were not done the complete comprehensive assessments were not completed within the five days after the start of care. Staff A stated the agency opened the cases without the assessments being done.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on medical record review and staff interview, the facility failed to have a written plan of care (G572) and a plan of care only as ordered by a physician (G580). The cumulative effects of these systemic practices resulted in the agency's inability to ensure patient care would be provided as ordered by the physician on an individualized basis. Based on document review and staff interview the facility failed to have a written Plan of Care G-572, A Plan of Care that conforms to the Physician Orders G578, a plan of care only as ordered by a physician G-580. The cumulative effects of these systemic problems resulted in the Home Health Agency inability to ensure a physician ordered plan of care was developed.

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 medical record review and staff interview, the agency failed to have a written plan of care. This affected two (Pt #1 and Pt #3) of the four records reviewed. Census at the time of survey was 26. 1) The medical record review for Pt #1 failed to reveal a written plan of care had been developed. 2) The medical record review for Pt #3 failed to reveal a written plan of care had been developed. Interview with Staff A on 02/07/24 at 11:30 AM verified the agency did not have a written plans of care for these patients.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to have physician orders for services provided. This affected two (Pt #1 and Pt #3) of the four records reviewed. Census at the time of survey was 26. 1) The medical record review for Pt #1 failed to reveal physician orders for services provided. 2) he medical record review for Pt #3 failed to reveal physician orders for services provided. Interview with Staff A on 02/07/24 at 11:30 AM verified the agency never contacted a physician to obtain orders for the services being provided. The agency opened the cases without physician orders.