Every finding on record at Haven Home Health, LLC

A complaint investigation (# 94394) was completed on 12/21/2022 at the home health provider. The agency had 272 current patients. The complaint is substantiated. One or more of the allegations reported are verified and deficiencies were cited that are related to the allegations being investigated.

Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This ELEMENT is not met as evidenced by: Based on agency's policy, clinical record review, and interview, the agency failed to ensure that patient's be advised orally or in writing (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA in one (Record/Patient #1) of two applicable records reviewed. This deficient practice has the potential to affect the rights of all the agency's patients. Findings included: Review of the agency's undated policy numbered 1-001 and titled, “Rights/Responsibilities" showed that the patient will be informed verbally and in writing during the initial evaluation visit, in advance of furnishing care to the patient, of the following: - The cost of services that will be billed to his/her insurance and/or self. Review of the document dated 03/03/2022 and titled, “Home Health Authorization Approval,” showed that the agency received approval for 15 nursing visits to occur between the dates of 02/18/2022 and 04/18/2022. During an interview on 12/20/2022 at 1:30 PM, the administrator stated that there was no documentation to support that the agency had: - Contacted the insurance/payer to ask for additional visits prior to discharging the patient from service; or - Advised the patient that they could privately pay for services.

Investigate complaints made by patient CFR(s): 484.50(e)(1)(i) (i) Investigate complaints made by a patient, the patient's representative (if any), and the patient's caregivers and family, including, but not limited to, the following topics: This ELEMENT is not met as evidenced by: Based on agency policy, record review, and interview the agency failed to investigate complaints made by a patient in one (Record/Patient #1) of four records reviewed. This deficient practice has the potential to affect the rights of all the agency's patients. Findings included: Review of the agency's undated policy numbered 1-001 and titled, “Rights/Responsibilities" showed that the patient will be informed verbally and in writing during the initial evaluation visit, in advance of furnishing care to the patient, of the following: - The goals of care, the interventions that support those goals and the identification of staff providing service; - The right to be informed of his/her condition, participate in all aspects of care, and right to refuse all or part of his/her care to the extent permitted by law; - The cost of services that will be billed to his/her insurance and/or self; The completion of all assessments and care to be furnished based on the comprehensive assessment. The organization shall ensure that the patient receives all services outlined in the plan of care; - The expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; as well as any factors that could impact treatment effectiveness and/or current or future health care decision-making; and - The right to voice a complaint or concern regarding care, treatment or services that are (or failed to be) provided or are provided inconsistently or inappropriately without fear of reprisal for exercising this right. The right to voice grievances regarding lack of respect for property. Review of the agency's undated policy numbered 1-010 titled, “Complaint/Grievance Process,” showed that: - Any difference of opinion, dispute, or controversy between a patient or family/caregiver or patient representative and (the agency) concerning any aspect of services or the application of policies or procedures will be considered a grievance - If the patient feels his/her grievance has not been resolved after working with (the agency) personnel, he/she will be informed of his/her right to notify the state via the respective toll-free telephone numbers, or other methods such as ombudsman, legal services, or adult protective services; - Complaints and any action taken will be documented on a complaint form; and - All complaints will be logged, tracked, trended, and filed in the performance improvement office. Review of the agency's 2022 complaint log, containing six entries dated from 03/2022 to 06/2022, showed the document failed to contain documentation of any complaints related to the complainant. Review of the document dated 03/15/2022 and titled, “Patient Communication,” showed that the agency had received phone call from the payer that the patient had filed a grievance against the agency by stating that they had been told that insurance would no longer pay for further wound care on 03/01/2022. Review of the document dated 03/30/2022 and titled, “Patient Communication,” showed that the agency had received a call from the payer that the patient had called with concerns that the agency would be discharging them in a couple of weeks. The payer explained that there was no cap [limit] on the number of visits that an agency could provide to meet the needs of the patient. The payer representative stated that the patient told them that the agency would be discharging them in the next few weeks and that they were concerned that their leg will open back up, and they will end up going back to the hospital as they reported has been the case over the past eight months. The patient reported that they had no one to assist him in caring for the leg and that they are unable to wrap the leg or apply compression socks on the leg them self. The clinical director stated they would reach out to the patient’s physician and the wound clinic regarding the patient’s concerns. Review of the document dated 03/31/2022 and titled, “Patient Communication,” showed that the clinical director spoke with the nurse at the wound clinic regarding discharge planning. The plan of care was to include monitoring the wound after fully epithelialized (closed) for 30 days, and to help the patient find a way to apply and wear compression after nursing discharge to help prevent reoccurrence of wounds. During an interview on 12/21/2022 at 9:30 AM, the administrator stated that the patient had called the office with their complaint and the Home Care Program Supervisor documented the information on a tracking sheet, but failed to initiate the patient grievance process.

Patient's needs CFR(s): 484.55(c)(4) The patient's medical, nursing, rehabilitative, social, and discharge planning needs; This ELEMENT is not met as evidenced by: Based on agency policy, record review, and interview, the agency failed to ensure that the comprehensive assessment identified the patient's medical, nursing, rehabilitative, social, and discharge planning needs in one (Record/Patient #1) of four records reviewed. This deficient practice has the potential to affect the discharge planning for all of the agency's patients. Findings included: Review of the agency's undated policy numbered 1-001 and titled, “Rights/Responsibilities" showed that the patient will be informed verbally and in writing during the initial evaluation visit, in advance of furnishing care to the patient, of the following: - The goals of care, the interventions that support those goals and the identification of staff providing service; and - The expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; as well as any factors that could impact treatment effectiveness and/or current or future health care decision-making; - The right to voice a complaint or concern regarding care, treatment or services that are (or failed to be) provided or are provided inconsistently or inappropriately without fear of reprisal for exercising this right. The right to voice grievances regarding lack of respect for property RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to home health services for care of a non-surgical wound, and secondary diagnosis of lymphedema (swelling caused by impaired circulation of fluid in the lymphatic system). The patient resided in their own home. Review of the document dated 03/15/2022 and titled, “Patient Communication,” showed that the agency had received phone call from the payer that the patient had filed a grievance against the agency by stating that they had been told that insurance would no longer pay for further wound care on 03/01/2022. Review of the document dated 03/30/2022 and titled, “Patient Communication,” showed that the agency had received a call from the payer that the patient had called with concerns that the agency would be discharging them in a couple of weeks. The payer explained that there was no cap [limit] on the number of visits that an agency could provide to meet the needs of the patient. The payer representative stated that the patient told them that the agency would be discharging them in the next few weeks and that they were concerned that their leg will open back up and they will end up going back to the hospital as they reported has been the case over the past eight months. The patient reported that they had no one to assist him in caring for the leg and that they are unable to wrap the leg or apply compression socks on the leg them self. The clinical director stated they would reach out to the patient’s physician and the wound clinic regarding the patient’s concerns. Review of the physician order dated 03/07/2022 showed an order for physical therapy to evaluate for possibly lymphedema wraps and a social worker evaluation to assist with outside resources. Review of the medical social work documentation showed that: - On 03/10/2022 the MSW (Medical Social Work) Evaluation,” showed that: * The patient lived alone; * The patient transported themselves to appointments; * The patient wanted assistance with cleaning their home; * The social worker emailed the patient a list of resources that were available; and - The documentation failed to contain information regarding efforts taken by the MSW to follow up with patient regarding supportive services following discharge from care. Review of the document dated 03/31/2022 and titled, “Patient Communication,” showed that the clinical director spoke with the nurse at the wound clinic regarding discharge planning. The plan of care was to include monitoring the wound after fully epithelialized (closed) for 30 days, and to help the patient find a way to apply and wear compression after nursing discharge to help prevent reoccurrence of wounds. During an interview on 12/19/2022 at 7:45PM, the complainant stated that no one from the agency discussed referring their care to an outpatient provider at the time of discharge. They reported that they had talked with the staff multiple times that they would need compression therapy following discharge. The complainant voiced frustration that while on home health their wounds would heal, but when the compression stopped (after home health services stopped), the swelling would return and new wounds would open up. The complainant reported that they did get new wounds after discharge from this home health agency, and they asked for a referral to another agency who did arrange for outpatient services for them. During an interview on 12/21/2022 at 9:30 AM, the administrator stated that the record did not contain documentation that the staff discussed referrals to outpatient providers to manage the lymphedema after discharge with the complainant.