Every finding on record at Healing Home Health Care, L L C

On 11/2/21 through 11/5/21, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at The Care Team. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

The following standard level deficiencies were identified during the Medicare authorized recertification survey conducted by the Michigan Department of Licensing and Regulatory Affairs on 11/2/21 through 11/5/21 at: The Care Team 30600 Northwestern Highway, Suite 245 Farmington Hills, MI 48334 At the time of the survey, the agency did not operate any branch offices or subunits. Clinical records reviewed for this survey included 7 records with home visits, and 10 records without home visits for a total of 17 records reviewed. At the conclusion of the survey the agency was found to not be in substantial compliance with the conditions of participation for home health agencies at: 42 CFR Part 484.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to ensure the initial assessment visit was conducted within 48 hours of referral. within 48 hours of facility discharge or on the specific ordered date in 4 of 17 records reviewed (MR #11, 12, 14, and 17) out of a total sample of 17 records reviewed, resulting in the potential for unmet patient needs or negative patient outcomes. Findings include: MR #11: During the 11-4-21 review of the referral documents, it was noted the referral date was 10-1-21. The initial assessment visit was documented by the physical therapist on 10-8-21, 7 days after the referral date. There was no documentation in the record that the physician ordered the initial visit to be delayed until 10-8-21. During an interview on 11-5-21 at 11:45 AM RN-B stated, "There is no documentation to explain or justify the delay in the start of care." MR #12: During the 11-4-21 review of the referral documents, it was noted the referral date was 9-30-21. The initial assessment visit was documented by the physical therapist on 10-4-21, 4 days after the referral date. There was no documentation in the record that the physician ordered the initial visit to be delayed until 10-4-21. During an interview on 11-5-21 at 11:45 AM RN-B stated, "There is no documentation to explain or justify the delay in the start of care." MR #14: During the 11-3-21 review of the referral documents, it was noted the referral date was 5-17-21. The initial assessment visit was documented by the registered nurse on 5-22-21, 5 days after the referral date. There was no documentation in the record that the physician ordered the initial visit to be delayed until 5-22-21. During an interview on 11-5-21 at 11:45 AM RN-B stated, "There is no documentation to explain or justify the delay in the start of care." MR #17: During the 11-2-21 review of the referral documents, it was noted the referral date was 10-8-21. The initial assessment visit was documented by the registered nurse on 10-11-21, 3 days after the referral date. There was no documentation in the record that the physician ordered the initial visit to be delayed until 10-21-21. During an interview on 11-5-21 at 11:45 AM RN-B stated, "There is no documentation to explain or justify the delay in the start of care."

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: Based on record review and interview, the agency failed to ensure a registered nurse conducted a review of the patient's medications for any potential adverse effects such as: side effects, drug interactions, and duplicate drug therapy for 3 of 5 (MR# 3, 6, 7, 11 and 12) records reviewed with therapy only services. This deficient practice results in the potential for unrecognized adverse effects due to medications that could negatively affect all 211 current patients. Findings include: MR #11: The plan of care dated 10-8-21 stated the patient was admitted for physical therapy services with diagnoses that included urinary tract infection, kidney failure, weakness and hemiplegia. The start of care comprehensive assessment was completed by the physical therapist on 10-8-21. The medical record contained a "Client Medication Report", dated 10-8-21, that included a list of the patient's medications and a medication review acknowledgement statement signed by the physical therapist. There was no documented evidence the patient's medications were reviewed by a registered nurse. During an interview on 11-5-21 at 11:30 AM, CM-C stated, "There is no documentation that the medications were reviewed by a registered nurse." MR #12: The plan of care dated 10-4-21 stated the patient was admitted for physical therapy services with diagnoses that included polyosteoarthritis, repeated falls, alzheimer's disease, weakness, difficulty walking and hypertension. The start of care comprehensive assessment was completed by the physical therapist on 10-4-21. The medical record contained a "Client Medication Report", dated 10-4-21, that included a list of the patient's medications and a medication review acknowledgement statement signed by the physical therapist. There was no documented evidence the patient's medications were reviewed by a registered nurse. During an interview on 11-5-21 at 11:30 AM, CM-C stated, "There is no documentation that the medications were reviewed by a registered nurse." MR#3: This patient was admitted to the agency on 6/11/21 with diagnoses of scoliosis, sciatica, and paraplegia. The comprehensive assessment was completed by the physical therapist (PT) on 6/11/21. Record review on 11/3/21, indicates the patient's medical record contains a "Patient Medication Record" that lists the patient's medications and a medication review acknowledgement statement signed by the PT on 6/11/21. There was no documented evidence that the patient's medications had been reviewed by a registered nurse (RN). During an interview on 11/5/21 at 9:00 a.m., the clinical manager (CM-C) acknowledged the findings and confirmed that the medications were not reviewed by an RN. MR#6: This patient was admitted to the agency on 10/26/21 with diagnoses of post operative left total knee joint replacement, osteoarthritis, and high blood pressure. The comprehensive assessment was completed by the PT on 10/26/21. Record review on 11/3/21, indicates the patient's medical record contains a "Client Medication Report" that lists the patient's medications and a medication review acknowledgement statement signed by the PT on 10/26/21. There was no documented evidence that the patient's medications had been reviewed by a registered nurse. During an interview on 11/5/21 at 9:00 a.m., CM-C acknowledged the findings and confirmed that the medications were not reviewed by an RN. MR#7: This patient was admitted to the agency on 10/21/21 with diagnoses of a recent right hip joint replacement and a subsequent fall. The comprehensive assessment was completed by the PT on 10/21/21. Record review on 11/3/21, indicates the patient's medical record contains a "Client Medication Report" that lists the patient's medications and a medication review acknowledgement statement signed by the PT on 10/22/21. There was no documented evidence that the patient's medications had been reviewed by a registered nurse. During an interview on 11/5/21 at 9:00 a.m., CM-C acknowledged the findings and confirmed that the medications were not reviewed by an RN. The agency failed to follow its own policy, PC2.54 Medication Review and Reconciliation (no date), which states, "In therapy only cases, the patient's therapist will submit a list of patient medications, which the therapist must collect during the comprehensive assessment for RN review and follow up as needed."

At discharge CFR(s): 484.55(d)(3) At discharge. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the comprehensive assessment was updated at the time of discharge from the agency for 1 of 5 (MR#8) discharge records reviewed, resulting in a lack of information regarding the patient's health status and progress towards goals. Findings include: MR#8: This 90-year-old patient was admitted to the agency on 9/15/21 with diagnoses of pressure ulcers of the left hip and lower back, Parkinson's disease, and dementia. The patient received skilled nursing services. Record review on 11/04/21 indicates the patient was referred to hospice care on 10/30/21. There was no documented evidence to indicate what happened with this patient after 10/30/21. The nurse failed to complete an OASIS (outcome and information set) discharge that summarized the patient's progress in meeting care plan goals. During an interview on 11/5/21 at 9:00 a.m., the clinical manager (CM-C) reviewed the medical record and confirmed that an OASIS discharge visit was scheduled but the nurse failed to complete the visit.

Discharge or Transfer Summary Content CFR(s): 484.58(b)(1) Standard: Discharge or transfer summary content. The HHA must send all necessary medical information pertaining to the patient's current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility or health care practitioner to ensure the safe and effective transition of care. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure a discharge or transfer summary was sent to the receiving agency for 1 of 2 (MR#8) patients in which care was transferred to another agency, resulting in the potential for unsafe and ineffective transition of care for this patient. Findings include: MR#8: This 90-year-old patient was admitted to the agency on 9/15/21 with diagnoses of pressure ulcers of the left hip and lower back, Parkinson's disease, and dementia. The patient received skilled nursing services. Record review on 11/04/21, indicates there is a physician order dated 10/8/21 which states the patient is discharged to hospice care. There was no documented evidence the skilled nurse prepared a discharge or transfer summary with all necessary medical information pertaining to the patient's pressure ulcers and treatments to the receiving hospice agency. During an interview on 11/5/21 at 9:00 a.m., the clinical manager (CM-C) reviewed the medical record and confirmed that a discharge or transfer summary was not documented and not sent to the receiving hospice agency.

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, it was determined the agency failed to ensure the written instructions for the Home Health Aide included safety precautions in 3 of 5 records reviewed in which Aide services were provided (MR #9, #16 and #17) out of a total sample of 17 records reviewed, resulting in the potential for patient injury during the provision of home health aide services. Findings include: MR #9: The plan of care, dated 9-5-21, stated the patient was admitted for nursing, physical therapy, occupational therapy and home health aide services with diagnoses that included hypertensive kidney disease, heart disease, and history of falling. The Plan of Care included the following "Safety Measures": slow position change; mobility safety; support during transfer and ambulation; safe utilities management; anticoagulant precautions (bleeding precautions); safety in ADL's; seizure precautions; fall precautions; use of assistive devices; standard precautions/infection control; cardiac precautions; and skin precautions. The Aide plan of care did not include instructions for the aide to follow any of the above safety measures. During an interview on 11-5-21 at 11:00 AM, RN-B stated, "The safety precautions for the plan of care are not on the Aide care plan, they should be." MR #16: The plan of care, dated 10-27-21, stated the patient was admitted for nursing, physical therapy, occupational therapy and home health aide services. The Plan of Care included the following "Safety Measures": anticoagulation precautions; emergency plan; medication precautions; and universal precautions.. During an interview on 11-5-21 at 11:00 AM, RN-B stated, "The safety precautions for the plan of care are not on the Aide care plan, they should be." MR #17: The plan of care, dated 10-11-21, stated the patient was admitted for nursing, physical therapy, occupational therapy, speech therapy and home health aide services with diagnoses that included urinary tract infection, heart disease, diabetes, altered mental status, and seizure disorder. The Plan of Care included the following "Safety Measures": adequate lighting; clean technique;clear pathways; disposal of medical waste; emergency plan; medication precautions; seizure precautions; and universal precautions. The Aide plan of care did not include instructions for the aide to follow any of the above safety measures. During an interview on 11-5-21 at 11:00 AM, RN-B stated, "The safety precautions for the plan of care are not on the Aide care plan, they should be."

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 ensure a discharge summary was sent to the primary care practitioner within 5 business days of discharge for 1 of 5 (MR#3) discharge records reviewed, resulting in the potential for unmet patient care needs for all patients transferred or discharged from the agency in the past 12 months. Findings include: MR#3: This patient was admitted to the agency on 6/11/21 with diagnoses of scoliosis, sciatica, and paraplegia. Record review on 11/3/21 reveals that an OASIS (outcome and information set) discharge was completed by the physical therapist on 8/8/21. The fax stamp on the discharge summary indicates the summary was sent to the physician on 8/31/21, which is 13 days after the patient was discharged from the agency. The findings were reviewed with and acknowledged by the clinical manager (CM-C) during an interview on 11/5/21 at 9:00 a.m.