Every finding on record at Green Light Home Health, Inc

The following reflects the findings of the California Department of Public Health during the investigation of a complaint. Complaint Number: 71226 Representing the Department: Health Facilities Evaluator Nurse, 44802 The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. One deficiency was identified for the complaint number: 71226 (Refer to G602)

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to ensure the physician was notified of HHA services held indefinitely for one of three patients (Patient 1). This failure had the potential to result in Patient 1 not receiving the care and services ordered to meet their needs and achieve their patient care goals. A review of Patient 1’s Plan of Care (POC) indicated as Start of Care (SOC) date on 3/22/2022 with diagnoses that included diabetes mellitus (DM, a chronic condition that affects the way the body processes blood sugar), hypertensive heart disease (heart conditions caused by high blood pressure), chronic obstructive pulmonary disease (COPD, a condition involving constriction of the airways and difficulty or discomfort in breathing). The POC for certification period 5/21/2022 to 7/19/2022, included an order for a Skilled Nurse (SN) to visit once a week for nine weeks to perform comprehensive skilled assessment, observation and evaluation of all body systems and to assess vital signs, pain level, and ability to perform activities of daily living (ADL) tasks. A review of Patient 1’s Communication Note to Physician 1, dated 6/11/2022, indicated LVN reported that Patient 1 requested to hold services. A review of SN notes, dated 6/11/2022, indicated communication to physician, supervisor and registered nurse (RN) that Patient 1 wanted to be on hold from home health. A reivew of Patient 1's Discharge Summary, dated 7/16/2022, indicated Patient 1's reason for discharge was that pateint was non-compliant. During an interview on 7/19/2022 at 2:55pm, LVN 1 stated Patient 1 changes her mind about whether she wants us to come for a SN visit. LVN 1 stated a visit will be scheduled and she will call us to cancel the appointment. LVN 1 stated Patient 1 wanted to cancel all services, but when we tried to discharge her, Patient 1 did not want us or the physician to come to her house to do a formal discharge. During an interview on 9/9/2022 at 1:52 pm, Medical Doctor (MD 1) stated he recommended Patient 1 to go to a Physical Therapy Center, but the Patient 1 refused and wanted to use Green Light home health agency. MD 1 put the order in for Patient 1’s home health services in 5/2022 and next saw Patient 1 on 7/18/2022. MD 1 stated Patient 1’s record showed an order for home health services in May 2022 and a notification that Patient 1 was discharged in July 2022. When asked if Physician 1 received an order from the HHA on 06/11/2022 to put Patient 1’s HHA services on hold, MD 1 stated he did not have any record of it. During an interview on 9/14/2022 at 11:00am, the Director of Nursing (DON) stated Patient 1’s services were held once Patient 1 asked us to put it on hold. The SN assigned to Patient 1 called Physician 1’s office and let them know that the patient wanted to put her services on hold. The DON stated the HHA did not communicate with or go see Patient 1 after 6/11/2022. The DON stated SN communicated with the Physician 1’s office and did not have documentation that Physician 1 was notified. The agency was not able to provide an order to hold services starting 6/11/2022 signed by the physician. A review of the HHA’s undated policy, Care Planning Process, indicated clinicians will inform the patient’s physician (or other authorized licensed independent practitioner)of any changes that suggest a need to alter the plan of care. Changes must be written, dated, and signed by the professional making the changes. A review of the HHA’s undated policy, Change of Condition, indicated that based on the findings of the reassessment, change/verbal orders will be generated and forwarded to the physician (or other authorized licensed independent practitioner) as needed. The policy indicated the physician will be notified to verify any changes in medications, including over-the-counter medications (which might interact or be duplicative with other patient medications), and treatment/interventions that require physician approval. A review of the HHA’s undated policy, Discharge Criteria and Process, indicated services will be terminated when the patient meets one or more of the discharge criteria: A. A change in the patient's medical or treatment program that requires a change to a different level of care. B. A change in the patient’s condition requires care or services other than that provided by the organization. If the patient’s acuity requires another level of care that the organization cannot provide, the organization shall arrange for a safe and appropriate transfer to another organization that can provide the needed level of care. C. If appropriate, the physician (or other authorized licensed independent practitioner) and the organization agree that the goals of home care have been attained or are no longer attainable. D. The patient or family/caregiver refuses or discontinues care. E. The patient or family/caregiver refuses to cooperate in attaining the objectives of home care. F. Conditions in the home are no longer safe for the patient or organization personnel. G. The patient and/or family display disruptive, abusive, and uncooperative behavior.