Every finding on record at Greater Manchester Homecare, LLC

Unannounced visits were concluded at Visiting Nurse and Health Services of Connecticut on 4/03/24 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits concluded on 4/03/24 at Visiting Nurse and Health Services of Connecticut in Vernon for the purpose of re-licensure and recertification. Standard-level deficiencies were identified.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record review, review of agency policies and interview with agency personnel, for one of five patients (Patient #12) requiring weight monitoring for diuretic therapy and/or a diagnosis of congestive heart failure, the agency nurses failed to ensure a comprehensive care plan. The findings include: Patient #12 had a start of care date of 1/23/24 and diagnoses that included paroxysmal atrial fibrillation, atherosclerotic heart disease, acute respiratory failure with hypoxia and chronic obstructive pulmonary disease. The physician's orders for the certification period of 1/23/24 through 3/22/24 included nursing services once weekly for assessments and weight monitoring, with notification to the physician of a greater than three-pound weight gain in a day or a five-pound weight gain in a week. On 2/27/24, the patient was transferred to the hospital for a low sodium level, weakness and bilateral edema and returned on 3/04/24 with a diagnosis of hyponatremia and congestive heart failure. i. Interview and review of the physician’s orders dated 3/23/24 with the Administrator and Quality Manager on 4/03/24 at 11:10 AM identified skilled nursing services for weight monitoring with notification to the physician of a greater than three-pound weight gain in a day or a five-pound weight gain in a week, although, review of the nursing summary indicated that the patient was unable to ambulate and stand on a scale and failed to ensure a comprehensive care plan for alternate methods to monitor edema and weight gain. Review of agency policies for Delivery of Service directed a written care plan is developed for each client admitted to service. The care plan is comprehensive and reflects collaborative planning by the client/family/staff involved in the care to the client.

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 clinical record review and interview with agency personnel, for one of five patients (Patient #12) requiring weight monitoring for diuretic therapy and/or a diagnosis of congestive heart failure, the agency nurses failed to provide the necessary assessments. The findings include: Patient #12 had a start of care date of 1/23/24 and diagnoses that included paroxysmal atrial fibrillation, atherosclerotic heart disease, acute respiratory failure with hypoxia and chronic obstructive pulmonary disease. The physician's orders for the certification period of 1/23/24 through 3/22/24 included nursing services once weekly for four weeks for assessments and weight monitoring with notification to the physician of a greater than three-pound weight gain in a day or a five-pound weight gain in a week. i. Interview and review of the nursing notes dated 1/26/24, 2/01/24, 2/06/24, 2/08/24, 2/11/24, 2/16/24 and 2/18/24 with the Administrator and Quality Manager on 4/03/24 at 11 AM failed to identify weight monitoring during the nursing visits and failed to follow physician’s orders.