Every finding on record at Harmony Home Health Agency, Inc

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 05/17/24. The Agency was in compliance with the Condition, 42 CFR 484.22, Establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 05/17/24. Standard level deficiencies cited. Abbreviations: Pt. /Pts. = Patient/Patients SOC = Start of Care SN = Skilled Nurse # = number % = percent POC = Plan of Care

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on review of the OASIS Error Summary report and Staff interview, it was determined in 10 of 48 reports submitted for the last 12 months, the Agency failed to submit reports within the specified time frame, resulting in a warning. Finding include: 1. The Error Summary report for 05/01/23 -04/30/24, was reviewed on 05/16/24 at 9:30 AM. The report included error # -3330 for 10 of 48 late submissions. 20.83% of the reports submitted were more than 30 days after the M0090. 2. During an interview with the Administrator and Agency Supervisor on 05/16/24 at 9:35 AM, the Administrator and Agency Supervisor, stated that there is an outside biller that submits the reports to the State and will report any errors. During the same interview, the Agency Supervisor confimred the above findings.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on clinical records review, observation during home visits and Staff interviews, it was determined that in 3 of 7 (Pts. #1, 2 and 3) clinical records reviewed, the Agency failed to ensure that Pts. were informed in advance of the disciplines to provide care/service and frequency of visits provided by each discipline. Findings include: 1. The following clinical records were reviewed from 05/14/24 at 12:30 PM to 05/15/24 at 11:30 AM: Pt. #1 SOC 03/11/24 Pt. #2 SOC 03/25/24 Pt. #3 SOC 05/04/23 2. During home visits for Pt. #1 on 05/14/24 at 2:00 PM, for Pt. #2 at 3:00 PM and for Pt. #3 on 05/15/24 at 3:00 PM, the Patient's admission folder was observed and contained the form titled, “Service Agreement, Consent and Authorization.” The forms lacked the discipline(s) to provide service and the proposed frequency for each discipline. 3. During interviews with the Administrator and Agency Supervisor on 05/15/24 at 1:00 PM and on 05/16/24 at 9:35 AM, it was confirmed the Agency failed to ensure Pts. were informed of the proposed frequency of visits provided by each discipline.

State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This ELEMENT is not met as evidenced by: Based on a review of the Pt. admission folder, observation during home visits and staff interview, it was determined that in 3 of 7 (Pts. #1, 2 and 3) the Agency failed to ensure the contact information of “toll-free hotline” telephone number was provided to the Pt. Findings include: 1. The Pt. admission folder was reviewed on 05/14/24. The folder contained the form titled: “Service Agreement, Consent and Authorization” and lacked the “toll-free hotline” telephone number for which the Pt. / Pt. representative may call to communicate a concern or complaint about home care services. 2. The following home visits were conducted on 05/15/24 from 2:00 PM to 3:00 PM and on 05/15/24 at 3:00 PM. Pt. #1 SOC 03/11/24 Pt. #2 SOC 03/25/24 Pt. #3 SOC 05/04/23 During the home visits, Pt. admission folders were observed and lacked the “toll-free hotline” telephone number to which the Pt./ Pt. representative may call to communicate a concern or complaint about home care services. 3. During an interview with the Administrator and the Agency Supervisor on 05/16/24 at 9:35 AM, both confirmed that the Pt. admission folder lacked the contact information of “toll-free hotline” telephone number to which the Pt. / Pt. representative may call to communicate a concern or complaint about home care services.

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 the clinical record review and Staff interview, it was determined in 2 of 7 records reviewed (Pts. # 2 and 7) the Agency failed to provide the care as ordered by the physician. Findings include: 1. Pt. #2 was admitted to the Home Health Services on 03/25/24 with the diagnoses of Bilateral Primary Osteoarthritis of Knee and Type 2 Diabetes Mellitus without Complications Surgery. The clinical record was reviewed on 05/14/24. The POC dated 03/25/24 included orders for the SN to assess the blood glucose each visit. The clinical record included a SN visit note dated 03/25/24. The SN visit note lacked the assessment of the Patient’s blood glucose for 03/25/24. 2. Pt. #7 was admitted to Home Health Services on 01/04/23 with diagnoses of Primary Generalized Osteoarthritis and Type 2 Diabetes. The clinical record was reviewed on 05/15/24. The POC effective 03/05/23 to 05/03/23, required SN to perform blood glucose checks every visit. The clinical record included SN visit notes dated 04/21/24 and 04/28/24. The SN visit lacked assessment of Pt.'s blood glucose as ordered. 3. During interviews with the Administrator and Agency Supervisor on 05/15/24 at 1:00 PM and on 05/16/24 at 9:35 AM, the Agency Supervisor confirmed the above findings.

EP Testing Requirements CFR(s): 484.102(d)(2) *[For RNCHI at §403.748, ASCs at §416.54, HHAs at §484.102, CORFs at §485.68, OPO, "Organizations" under §485.727, CMHC at §485.920, RHC/FQHC at §491.12, ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility- based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d) (2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility- based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. This STANDARD is not met as evidenced by: . A. Based on review of the Agency's Emergency Preparedness Plan, policy review and staff interview, it was determined the Agency failed to perform testing and analysis of the Emergency Preparedness Plan. Findings Include: 1. The Emergency Preparedness Plan was reviewed on 5/12/2021 at 10:30AM. The plan lacked documentation of an occurrence of an emergency event/exercise since 2018. 2. The Agency policy titled, "Testing program for Emergency Operations Plan," was reviewed on 5/12/2021 at 11:00AM The policy required, " ...The Agency will conduct exercises to test the EOP at least annually... Analyze the Agency's response to and maintain documentation of drills, tabletop exercises and emergency events." 3. During an interview with the Administrator and Agency Supervisor, on 5/13/2021 at 10:30 AM, the above findings were confirmed.

Recertification survey completed. Standard level deficiencies cited. A Focused Infection Control Survey (FIC) was conducted on 5/14/2021. The facility was in compliance with the requirements for Infection Control for COVID-19. Abbreviations: AM= Morning PM= Afternoon/Evening EOP= Emergency Operations Plan PT= Physical Therapy/Therapist PTA= Physical Therapy Assistant POC/PsOC= Plan of Care/Plans of Care SOC= Start of Care Pt.= Patient Pt's= Patient's #= Number x= times

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: . A. Based on home visit observation / interview, clinical record review, Agency's policy review and staff interview it was determined that the Agency failed to ensure that patient medication profile was complete and contain all medications that the patient is currently taking. This was found in 1 of 3 clinical records review with home visits. (Pt # 3) 1. Pt. #3 SOC 04/08/2021 Diagnosis: Primary Generalized Osteo Arthritis. A home visit was conducted on 05/12/2021 at 2:30 PM with Employee #3 (PT) at Pt's #3 Residence. During the patient interview, the patient stated that she is using over the counter "pain patches" to both knees every 8 hours for several weeks. The clinical record of Pt #3 was reviewed on 5/12/2021 at 11:00 AM and on 5/13/2021 at 10:00 AM. The record contained a Medication Profile for episode period of 04/08/2021 to 06/06/2021 that lack over the counter pain patches. No modification physician orders were found in the record. 2. The Agency's policy titled "Medication Reconciliation" was reviewed on 5/13/2021 at 10:30 AM. The policy required...2..."Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication"... 3. Findings of the patient medication profile not containing all medications patient is currently taking was confirmed during an interview with the Administrator and Agency Supervisor on 05/13/2021 at 11:00 AM.

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: . A. Based on clinical record review and staff interview it was determined that Agency failed to ensure that interdisciplinary assessment / communication is maintained to coordinate patient care. This was found in 1 of 1 clinical records reviewed were PTA provided services. (Pt# 7) Findings include: 1. Pt. #7 SOC 12/08/2020 Diagnoses: Essential (Primary) Hypertension and Bilateral Primary Osteoarthritis of Knee. The clinical record was reviewed on 05/13/2021 at 10:00 AM. The Record contained a POC for certification period 02/06/2021 to 04/06/2021 that included a PT frequency of 1 x a week for 9 weeks. The clinical record contained PTA weekly visits from week 2 to week 5 of certification period. The record also contained a PT discharge visit dated 03/12/2021 (week 6). The clinical record contained continued PTA weekly visits dated 03/18/2021 (week 7) 03/25/2021 (week 8) and 04/01/2021 (week 9) of certification period. The PTA visits for week 7 to 9 were completed after PT discharged visit week 6. The record lacked interdisciplinary documentation between SN, PT and PTA after PT discharged patient week 6. 2. Findings of Agency staff not coordinating patient care was confirmed during an interview with the Administrator and Agency Supervisor on 05/13/2021 at 11:00 AM.