Every finding on record at Glhha, LLC

Recertification survey completed. Standard level deficiencies cited. Abbreviations: BP = Blood Pressure HR = Heart Rate RN = Registered Nurse SOC = Start of Care SN = Skilled Nurse POC = Plan of Care MD = Medical Doctor Pt./Pts. = Patient/Patients > = greater than < = less than AM = morning PM = afternoon

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: A. Based on the clinical record review and Staff interview, it was determined the Agency Staff did not conform to the Physician’s orders. This was found in 4 of 7 (Pts. #2, 4, 5 and 6) clinical records reviewed. 3. Pt. #5. SOC 03/09/20. Primary Diagnosis: Pressure Ulcer of the Left Hip, Stage 3. The clinical record was reviewed on 01/18/23 at 2:30 PM. The record contained Plans of Care with certification periods of 10/25/22 to 12/23/22 and 12/24/22 to 2/21/23. The Plans of Care required: “Notify MD for…BP >160/90 120, The “Skilled Nursing Visit Note” dated 12/29/22 recorded Pt. #5’s pulse at 45. The record lacked documentation MD was notified the pulse was out of the patient’s normal range. The “Aide Visit Note” dated 11/28/22 recorded Pt. #5’s pulse at 47 and the “Aide Visit Note” dated 01/09/23 recorded a blood pressure of 89/65 and a pulse of 49. The record lacked documentation the Home Health Aide reported to the nurse the vital signs that were out of range, and the POC was not modified. 4. Pt. #6. SOC 06/24/22. Primary Diagnosis: Unspecified Dementia, Unspecified Severity. The clinical record was reviewed on 01/18/23 at 3:00 PM. The record contained Plans of Care with certification periods of 6/24/22 to 8/22/22 and 8/23/22 to 10/21/22. The Plans of Care required: “Notify MD for HR >120 The “Skilled Nursing Visit Note” dated 07/14/22 recorded Pt. #6’s pulse at 128. The record lacked documentation the MD was notified the pulse was out of normal range. The “Aide Visit Notes” dated 07/15/22, 07/18/22 and 07/21/22 lacked documentation of the patient’s pain assessment, blood pressure, and that skin care/shampoo were provided, and the POC was not modified. 5. An interview with the Administrator, Alternate Administrator and Director of Clinical Services was conducted on 01/19/23 at 9:00 AM to 11:15 AM. During the same interview the above findings were confirmed. Findings include: 1.Pt. #2 SOC 11/03/20 Primary Diagnoses: Lymphedema and Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease. The clinical record was reviewed on 01/17/23 at 9:30 AM. The plan of care dated 12/23/22 required the RN to assess the patient’s blood glucose. The RN visit notes lacked the assessment of the blood glucose on 01/10/23 and the POC was not modified. 2. Pt. #4 SOC 09/08/22 Primary Diagnoses: Multiple Sclerosis and Other Muscle Spasm. The clinical record was reviewed on 01/10/23 at 10:30 AM. The Plan of care dated 01/06/23 required the Aide to assess the patient’s vital signs. The Aide visit notes dated 01/09, 01/12, and 01/16/23 lacked documentation of the patient’s vital signs and the POC was not modified.

12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This STANDARD is not met as evidenced by: A. Based on the review of In-service records and Staff interview, it was determined that the Agency failed to ensure the Aides received 12 hours of in-service training for each 12 month period. This was found for 2 of 2 Aides (Employees # 4 and 10) that provided patient care. Findings include: 1. The Agency’s in-services were reviewed on 01/19/23 at 11:00 AM and lacked the required 12 hours of In-services during 2021 and 2022 for: Employee #4 Date of hire: 01/23/17 Employee #10 Date of hire: 07/24/12 2. The findings were confirmed during the interview, with the Administrator, Alternate Administrator and Director of Clinical Services, on 01/19/23 at 11:15 AM.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: A. Based on the review of the clinical records and Staff interview, it was determined that the Agency failed to ensure the RN supervised the Aide every 2 weeks. This was found in 2 of 3 (Pts. # 4 and 5) Aide clinical records reviewed. 2. Pt. #5. SOC 03/09/20. Primary Diagnosis: Pressure Ulcer of Left Hip, Stage 3. The clinical record was reviewed on 01/18/23 at 2:30 PM. The POC dated 10/25/22 required Home Health Aide visits of 2 times a week for 9 weeks and, the RN visits of 2 times a week for 9 weeks. The record included documentation the Home Health Aide provided services on 11/28/22, 12/01/22, 12/05/22, 12/18/22 and 12/12/22. As of 01/18/23, the record lacked documentation an RN conducted any Home Health Aide Supervision between 11/28/22 to 12/14/22 (more than 2 weeks). 3. On 01/19/23 between 9:00 AM to 11:15 AM, interviews were conducted with the Administrator, Alternate Administrator and Director of Clinical Services. During the same interview, the above findings were confirmed. Findings include: 1. Pt. #4 SOC 09/08/22. Primary Diagnoses: Multiple Sclerosis and Other Muscle Spasm. The clinical record was reviewed on 01/10/23 at 10:30 AM. The Plan of Care dated 11/07/22 included the Aide services 2 times a week and the RN services 2 times a month. The RN failed to document the Aide supervision every two weeks. As of 01/18/23, the last Aide supervisory visit was documented by the RN on 12/12/22 (more than 2 weeks).