Every finding on record at Healing Hand Home Health Care, LLC

On 3/21/22 to 3/24/22, a Medicare authorized recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs at: Healing Hand Home Health Care 5918 N. Lilley Rd., Suite 4 Canton, MI 48187 This was a standard survey. The conditions of participation for Emergency Preparedness were not reviewed.

On 3/21/22 to 3/24/22, a Medicare authorized recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs at: Healing Hand Home Health Care 5918 N. Lilley Rd., Suite 4 Canton, MI 48187 The agency has no extension sites. This survey included a review of all employee vaccinations. For this survey, 7 records were reviewed as follows; 2 discharge and 5 active. 2 home visits were completed (Only 2 visits were available). At the survey's conclusion, Healing Hand Home Health Care was found to be out of compliance at the standard level, with the requirements for participation in Medicare/Medicaid at 42 CFR §484.

Content of the comprehensive assessment CFR(s): 484.55(c) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient's status, and must include, at a minimum, the following information: This STANDARD is not met as evidenced by: Based on record review and interview, the Agency (HHA) failed to conduct a patient-specific, comprehensive assessment that accurately reflected the patient's current health status, past medical history, history of events leading to home care, baseline data for future assessments, and ascertained the patient's immediate care needs in 3 records (MR# 1, 4 and 5) from a total of 7 records reviewed, resulting in the potential for unmet care needs. Findings include: MR #1: The patient's start of care (SOC) was 4/30/21, with diagnoses that included chronic heart and kidney disease, congestive heart failure and diabetes mellitus. During a review of the clinical record on 3/21/22, it was discovered that the SOC initial comprehensive assessment dated 4/30/21, under M1021 and M1023 (Diagnoses and symptom control), only listed the diagnoses with no further information. There was no further information under the individual system assessments related to each diagnosis. The SOC assessment also had no weight parameters, for when to notify the physician, documented with a diagnosis of congestive heart failure. MR #4: The patient's SOC was 2/8/22, with diagnoses that included degenerative disc disease and arthritis. During a review of the clinical record on 3/22/22, it was discovered that the SOC initial comprehensive assessment dated 2/8/22, by the physical therapist (PT#1) was blank. MR #5: The patient's SOC was 2/24/22, with diagnoses that included degenerative disc disease, diabetes mellitus and osteoarthritis. During a review of the clinical record on 3/23/22, it was discovered that the SOC initial comprehensive assessment dated 2/8/22, had no baseline blood sugar or diabetic precautions documented with a diagnosis of diabetes. These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m.

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 record review and interview, it was determined the agency failed to ensure the plan of care (POC) included all safety measures to prevent injury, and parameters for physician notification in 3 of 7 records (MR #1, 2 and 5) from a total of 7 records reviewed, resulting in the potential for negative patient outcomes. Findings include: MR #1: The patient's start of care (SOC) was 4/30/21, with diagnoses that included chronic heart and kidney disease, congestive heart failure and diabetes mellitus. During a review of the clinical record on 3/21/22, it was discovered that the POC had no weight parameters documented, for when to notify the physician, with a diagnosis of congestive heart failure. MR #2:The patient's SOC was 8/3/21, with diagnoses that included Left hemiplegia, congestive heart failure, and diabetes. During a review of the clinical record on 3/21/22, it was discovered that the POC had no diabetic precautions documented with a diagnosis of diabetes, and no anticoagulant/blood thinner precautions documented with the patient taking Clopidogrel (blood thinner/anti platelet). MR #5: The patient's SOC was 2/24/22, with diagnoses that included degenerative disc disease, diabetes mellitus and osteoarthritis. During a review of the clinical record on 3/23/22, it was discovered that the POC had no diabetic precautions documented with a diagnosis of diabetes. These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to ensure the clinicians followed physician orders in the plan of care (POC) for 3 records (MR# 1, 3 and 4) from a total of 7 records reviewed, resulting in the potential for unmet patient needs. Findings include: MR #1: The patient's start of care (SOC) was 4/30/21, with diagnoses that included chronic heart and kidney disease, congestive heart failure and diabetes mellitus. During record review on 3/21/22, it was discovered that the POC dated 4/30/21, documented physical therapy (PT) services ordered at a frequency of 2 times a week for 5 weeks. During review of the PT visit notes, PT missed a visit during the week of 5/30/21, with no missed visit note documented in the record. MR #3: The patient's start of care (SOC) was 2/4/22, with diagnoses that included osteoarthritis, back pain, falls, and diabetes mellitus. During record review on 3/21/22, it was discovered that the POC dated 4/30/21, documented physical therapy (PT), and occupational therapy (OT) services ordered. During review of the PT and OT visit notes, it was discovered that PT's first visit was on 2/10/22, 6 days after the SOC date. OT's first visit was 2/11/22, 7 days after the start of care date. There was no documentation in the record authorizing a late SOC for either discipline. MR #4: The patient's SOC was 2/8/22, with diagnoses that included degenerative disc disease and arthritis. During a review of the clinical record on 3/22/22, it was discovered that home health aide (HHa) services were ordered for 2 times a week for 5 weeks. During review of the HHa visit notes it was discovered that only 1 visit was completed for each of the 5 weeks ordered. The HHa missed 5 of the 10 ordered visits with no missed visit notes documented in the record These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m.

Development and evaluation of plan of care CFR(s): 484.75(b)(2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s); This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to have skilled nursing (SN) and physical therapy (PT) help to develop or evaluate the plan of care (POC) in 2 of 7 records (MR# 4 and 7), from a total of seven records reviewed, resulting in the potential for unmet patient care needs. Findings include: MR #4: The start of care (SOC) date was 2/8/22. The POC documented diagnoses of degenerative disc disease and arthritis. During record review on 3/22/22, it was discovered that PT was ordered at a visit frequency of 2 times a week for 6 weeks. Further review of the record revealed no POC was submitted for this patient by the PT. The PT provided services for 44 days without submitting a POC to review with the physician. MR #7: The SOC date was 3/7/22. The POC documented diagnoses of diabetes mellitus, depression and hypothyroidism. During record review on 3/23/22, it was discovered that PT was ordered at a visit frequency of 2 times a week for 4 weeks, and SN 1 time a week for 2 weeks. Further review of the record revealed no POC was submitted for this patient by the PT or SN. The PT and SN provided services for 16 days without submitting a POC to review with the physician. These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m. .

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the registered nurse (RN#1) prepared written patient care instructions alerting the home health aide (HHa) to the safety precautions that were applicable to each patient, for 2 of 2 records reviewed (MR#'s 2 and 3) in which HHa services were provided, from a total sample of 7 records reviewed, resulting in the potential for injury to the patients receiving aide services. Findings include: MR#2: This patient was admitted to the agency on 8/3/21 with diagnoses of hemiplegia, type 2 diabetes, muscle weakness and congestive heart failure. The plan of care (POC), reviewed on 3/21/22, documented the patient was taking the following anticoagulant (antiplatelet) medication daily: Clopidogrel. During review of the aide care plan it was discovered that no anticoagulant (bleeding) or diabetic precautions were documented as safety measures to alert the aide, with nail care ordered. MR#3: This patient was admitted to the agency on 2/4/22 with diagnoses of osteoarthritis, back pain, diabetes mellitus and falls. The HHa POC, reviewed on 3/21/22, had no diabetic precautions documented as a safety measure to alert the aide, with nail care ordered. These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to ensure patient records contained all pertinent documentation to provide care for, and ascertain the needs of the patients in 3 of 7 (MR#'s 4, 6 and 7) records, from a total of 7 records reviewed, resulting in the potential for unmet care needs for all patients receiving care. Findings include: MR #4: The start of care (SOC) date was 2/8/22. During record review on 3/22/22, it was discovered that no POC was documented for this patient. During further review, it was discovered that all 9 of the physical therapy notes were blank. MR #6: The SOC date was 1/21/22. The POC documented diagnoses of degenerative disc disease and arthritis. During record review on 3/23/22, it was discovered that all 6 of the physical therapy visit notes were blank. MR #7: The SOC date was 3/7/22. The POC documented diagnoses of diabetes mellitus, depression and hypothyroidism. During record review on 3/23/22, it was discovered that all 3 physical therapy assistant (PTa) visit notes were blank. These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to include discharge summaries in the patient record and failed to document submission to the physician in 2 of 2 records (MR #'s 3 and 6) who were discharged from a total of 7 records reviewed, resulting in the potential for unidentified continuing health care concerns and unmet care needs. Findings include: MR #3: The patient's start of care (SOC) was 2/4/22, with diagnoses that included osteoarthritis, back pain, falls, and diabetes mellitus. During record review on 3/21/22, it was discovered that the registered nurse (RN) discharge summary was blank, ergo no discharge summary was sent to the physician for review. MR #6: The patient's start of care (SOC) was 1/21/22, with diagnoses that included urinary tract infection, dysphagia and diabetes mellitus. During record review on 3/22/22, it was discovered that the physical therapist's (PT) discharge summary was blank, ergo no discharge summary was sent to the physician for review. These findings were reviewed with and acknowledged by the director of nursing (DON) and the administrator (Adm#1) during an interview on 3/24/22 at 12:45 p.m.