Every finding on record at Healthpro, Inc

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION OH00121678 The following deficiency is based upon substantial allegation OH00121678 completed on 05/13/21. Healthpro Homecare and Staffing is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure skilled nursing services were provided as ordered on the physician ordered plan of care . This affected three (Patients #1, #2 and #3) of four medical records reviewed. This has the potential to affect all patients receiving skilled nursing services from the agency. The agency census was 181. Findings include: Review of Patient #1's medical record revealed a start of care date of 07/01/14 with a primary diagnosis of other cerebrovascular disease. The physician ordered plan of care for the certification period of 03/26/21 through 05/24/21 had skilled nursing services ordered four times a week for blood sugar monitoring and education. A verbal order dated 03/23/21 that was read back and verified by the physician stated to increase skilled nursing services to four times a week. Review of the nursing documentation revealed only two visits were made for the week of 03/27/21, only one visit was made for the week of 04/10/21, only two visits were made for the week of 04/17/21, and only one visit was made for the week of 04/24/21. No missed visit documentation was found in the medical record for the missed skilled nursing visits. Through email communication with Staff B on 5/12/21 at 11:38 AM with Staff B wrote "The Physician refused to sign the plan of care due to Patient #1 not keeping her appointments with him. She did go to see him and he signed the plan of care on 4/28/2021. So we started four times a week the following week." In response, the surveyor explained there was a verbal order from the physician on 03/23/21, stating the order was read back and verified with the physician. At 12:19 PM Staff B responded via email with "It looks like the previous Director of Nursing took that verbal and did not communicate to the nurse or staff that the visits had increased." 2. Review of Patient #2's medical record revealed a start of care date of 03/15/21 with a primary diagnosis of pneumonia. The physician ordered plan of care for the certification period of 03/15/21 through 05/13/21 had skilled nursing services ordered two times a week to assess the patient's health. Review of the nursing documentation revealed only one visit was made for the week of 04/03/21, only one visit was made for the week of 04/10/21, no visits were made for the week of 04/24/21, and only one visit was made for the week of 05/01/21. Through email communication with Staff B on 05/12/21, any additional nursing documentation or missed visit documentation was requested. Staff B responded with no other visits for Patient #2 and there was no missed visit documentation completed. 3. Review of Patient #3's medical record revealed a start of care date of 01/27/21 with a primary diagnosis of urinary tract infection. The physician ordered plan of care for the certification period of 03/28/21 through 05/26/21 had skilled nursing services ordered two times a week to assess the patient's health. Occupational therapy was ordered two times a week. Review of the nursing documentation revealed only one skilled nursing visit was completed for the week of 04/24/21. Review of the the occupational therapy notes revealed only one visit was completed for the week of 04/17/21. Through email communication with Staff B on 05/12/21, Staff B wrote that Patient #3's nurse went on vacation and she failed to do a missed visit report. Review of the agency policy titled "Healthpro Homecare Policy and Procedure for Missed Visits", revealed "It is mandatory that any scheduled visit that is not completed according to the physician's plan of care, be documented. You must follow the plan of care to be compliant. The field nurse is responsible for documenting the missed visit on a "Missed visit Report" within a 24 hour period. Must be reported and brought to office staff so physician can be notified." This deficiency substantiates Substantial Allegation OH00121678.

Substantial Allegation Survey Substantial Allegation OH00119998 The following deficiency is based upon substantial allegation OH00119998 completed on 02/25/21. Healthpro Homecare and Staffing is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on medical record review, staff interview, and policy review, the agency failed to ensure skilled nursing services were provided as ordered by the physician as written in the plan of care for one of three medical records reviewed (Patient #3). The agency census was 259. Findings include: Review of the agency's undated policy for physician's plan of care revealed an individualized plan of care shall be developed and implemented by each professional discipline providing services. Review of policy and procedure for missed visits (undated) revealed it was mandatory for any scheduled visit that was not completed according to the physician's plan of care be documented within 24 hours of the visit. Review of the medical record for Patient #3 revealed the patient was admitted to the agency on 09/19/17 with the primary diagnosis of cerebral infarction. Review of the certification period dated 01/01/21 to 03/01/21 revealed the patient was to receive Skilled Nursing (SN) services for medication set up once a week for nine weeks and home health aide (HHA) services 15 hours per week for nine weeks. Review of the SN notes revealed no documented evidence any nursing services were provided, including medication set up, for the week of 01/02/21 and 01/30/21 per the physician order. Review of the medical record revealed no documented evidence of physician notification for missed visits for those weeks. Review of a communication note dated 01/26/21 revealed a nurse's communication with Patient #3's family member related to changing pharmacies, cost of medication, and the anticipated arrival of medications in order to set up the patient's medications for the following week of 01/30/21. Further review of the medical record revealed no documented evidence the patient's medications arrived or were set up for that week. Interview with the Director of Nursing on 02/23/21 at 3:50 PM confirmed the above findings. This substantiates Substantial Allegation OH00119998.