Every finding on record at Grateful Hands Services, Inc

An unannounced complaint survey for complaint number 2024012631 was conducted on 11/5/2024 at Independence Home Health of Central Florida, a Home Health Agency. The provider was not in compliance with Code of Federal Regulations (CFR) 42, Part 484, Conditions of Participation for Home Health Agencies.

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: G570-CoP; Care Planning, coordination, quality of care Based on a patient record review, nurse visit notes, an agency policy, and a staff interview, the provider failed to provide services to ensure the Plan of Care (POC) was followed according to physician/practitioner orders. (refer to G572) Refer to G572

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 a patient record review, nurse visit notes, an agency policy, and a staff interview, the provider failed to ensure the Plan of Care (POC) was followed according to physician/practitioner orders for the feeding regimen for one (#1) patient of one patient record reviewed. (refer to G576) Findings included: A patient record review of the Plan of Care for Patient #1 with a Start of Care (SOC) date 9/12/2024 under Nutritional Requirements revealed orders for Gastrostomy Tube (GT) Feeding regimen: Bolus feeds Elecare 26kcal 55ml q3 hours during the day and continuous 18ml/hour overnight 2000-0800. Nurse visit notes for patient #1 were reviewed, 5 nurse visit notes out of 5 reviewed, revealed documentation of gastrostomy tube feedings that were given that did not match the physician/practitioner order. The nurse visit note dated 9/12/2024 12-hour day shift revealed Elecare 26kcal continuous at 20ml/hour The nurse visit notes for 9/13/2024, 9/14/2024, and 9/15/2024 12-hour day shift revealed Elecare 26kcal 60ml q3 hours during the day. The nurse visit note for 9/13/2024 12-hour night shift revealed Elecare 26kcal continuous at 20ml/hr. An agency policy titled Plan of care-CMS #485 and Physician/Practitioners Orders, revised Feb 2023 (7 pages) on page 9.10.5, line number 20 revealed “Care and services will be provided according to physician/practitioner orders.” An interview was conducted on 11/5/2024 at 2:00 p.m. with the Administrator regarding providing care and services according to doctor orders in the Plan of Care for Patient #1. She stated, “there is no physician/practitioner order to support the nurse’s documentation, I only have the admitting orders.”

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 an agency policy, a staff interview, and a record review, the provider failed to ensure all orders are current, updated, and recorded in the Plan of Care for one (#1) patient of 1 patient record reviewed. (refer to G580) Findings included: An agency policy titled Plan of care-CMS #485 and Physician/Practitioners Orders, revised Feb 2023 (7 pages) on page 9.10.5, line number 20 revealed “Care and services will be provided according to physician/practitioner orders. Orders are current and updated.” An interview was conducted on 11/5/2024 at 2:00 p.m. with the Administrator regarding providing care and services according to doctor orders in the Plan of Care for Patient #1. She stated, “there is no physician/practitioner order to support the nurse’s documentation, I only have the admitting orders.” A medical record review of the Plan of Care for Patient #1 with a Start of Care (SOC) date 9/12/2024 under Nutritional Requirements revealed orders for the Gastrostomy Tube (GT) Feeding regimen: Bolus feeds Elecare (Infant Formula) 26kcal 55ml q3 hours during the day and continuous 18ml/hour overnight 2000-0800. The nurse visit note dated 9/12/2024 12-hour day shift revealed Elecare 26kcal continuous at 20ml/hour. The nurse visit notes for 9/13/2024, 9/14/2024, and 9/15/2024 12-hour day shift revealed Elecare 26kcal 60ml q3 hours during the day. The nurse visit note for 9/13/2024 12-hour night shift revealed Elecare 26kcal continuous at 20ml/hr.

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 a patient record review, agency policy, and staff interviews, the provider failed to ensure the Feeding regimen was completed in accordance with the physician/practitioner orders for one (#1) patient of one patient record reviewed. Findings included: A medical record review of the Plan of Care for Patient #1 with a Start of Care (SOC) date 9/12/2024 under Nutritional Requirements revealed orders for Gastrostomy Tube (GT) Feeding regimen: Bolus feeds Elecare (Infant Formula) 26kcal 55ml q3 hours during the day and continuous 18ml/hour overnight 2000-0800. The nurse visit note dated 9/12/2024 12-hour day shift revealed Elecare 26kcal continuous at 20ml/hour. The nurse visit notes for 9/13/2024, 9/14/2024, and 9/15/2024 12-hour day shift revealed Elecare 26kcal 60ml q3 hours during the day. The nurse visit notes for 9/13/2024 12-hour night shift revealed Elecare 26kcal continuous at 20ml/hr. An agency policy titled Plan of care-CMS #485 and Physician/Practitioners Orders, revised Feb 2023 (7 pages) on page 9.10.5, line number 20 revealed “Care and services will be provided according to physician/practitioner orders.” An interview was conducted on 11/5/2024 at 2:00 p.m. with the Administrator regarding providing care and services according to doctor orders in the Plan of Care for Patient #1. She stated, “there is no physician/practitioner order to support the nurse’s documentation, I only have the admitting orders”

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on a patient record review, agency policy, and staff interviews, the provider failed to ensure the Feeding regimen was completed in accordance with the physician/practitioner orders for one (#1) patient of one patient record reviewed. Findings included: A medical record review of the Plan of Care for Patient #1 with a Start of Care (SOC) date 9/12/2024 under Nutritional Requirements revealed orders for Gastrostomy Tube (GT) Feeding regimen: Bolus feeds Elecare (Infant Formula) 26kcal 55ml q3 hours during the day and continuous 18ml/hour overnight 2000-0800. The nurse visit note dated 9/12/2024 12-hour day shift revealed Elecare 26kcal continuous at 20ml/hour. The nurse visit notes for 9/13/2024, 9/14/2024, and 9/15/2024 12-hour day shift revealed Elecare 26kcal 60ml q3 hours during the day. The nurse visit note for 9/13/2024 12-hour night shift revealed Elecare 26kcal continuous at 20ml/hr. An agency policy titled Plan of care-CMS #485 and Physician/Practitioners Orders, revised Feb 2023 (7 pages) on page 9.10.5, line number 20 revealed “Care and services will be provided according to physician/practitioner orders.” An interview was conducted on 11/5/2024 at 2:00 p.m. with the Administrator regarding providing care and services according to doctor orders in the Plan of Care for Patient #1. She stated, “there is no physician/practitioner order to support the nurse’s documentation, I only have the admitting orders”