Every finding on record at Helping Hands Homehealthcare,Inc

An unannounced Home Health Agency recertification survey was conducted on February 05-07, 2024, by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

An unannounced Medicare/Medicaid Home Health Recertification survey was conducted at the above noted agency February 05-07, 2024 by one Medical Facilities Inspector from the Office of Licensure and Certification, Virginia Department of Health. The agency identified 204 unduplicated admissions for the past twelve (12) months. In conjunction with the survey, (7) clinical records and seven (7) personnel files were reviewed. Three (3) home visits were conducted. The agency was found to be out of compliance with the Federal requirements of 42 CFR 484, the Medicare/Medicaid Conditions for Certification of Home Health Agencies. Deficiencies were identified and cited in this report.

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 record review it was determined the agency failed to ensure patients were informed at the time of admission of the disciplines that would provide care and the frequency of visits for four (4) of seven (7) patients in the survey sample (Clinical record #'s 2, 3, 4, and 6). The findings: Seven electronic clinical records were reviewed in the agency on 2/05/2024 through 2/07/2024 with the following findings: The patient with clinical record #2 with a start of care (SOC) date of 4/19/2023 failed to contain evidence of the patient and/or caregiver having received documentation of the disciplines providing care and the frequency of planned visits. The patient with clinical record #3 with a start of care (SOC) date of 11/07/2023 failed to contain evidence of the patient and/or caregiver having received documentation of the disciplines providing care and the frequency of planned visits. The patient with clinical record #4 with a start of care (SOC) date of 11/24/2023 failed to contain evidence of the patient and/or caregiver having received documentation of the disciplines providing care and the frequency of planned visits. The patient with clinical record #6 with a start of care (SOC) date of 2/21/2022 failed to contain evidence of the patient and/or caregiver having received documentation of the disciplines providing care and the frequency of planned visits. The lack of providing patients with what disciplines would be providing care and how often was reviewed and acknowledged prior to and during the exit conference with the Administrator on 2/07/2024.

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on clinical record review, agency discharge policy review and staff interview, it was determined the agency failed to provide written notice to a patient in advance of terminating on-going care in one (1) of two (2) closed clinical records reviewed in the survey sample (Clinical record #4). Findings: Two (2) closed electronic clinical records were reviewed in the agency on 2/07/2024 with the following findings: The patient with clinical record #4 and a start of care date of 11/24/2023 was discharged from the agency on 11/27/2023. According to the transfer summary in the clinical record, the patient was admitted to the hospital on 11/27/2023 for a wound infection. The transfer summary documented by the Registered Nurse documented the patient was discharged on 11/27/2023 due to non compliance and will not be admitted back to this home health agency. The clinical record failed to contain evidence the agency provided the patient advanced, written notice of discharge. During the document review on 2/07/2024 at 10 a.m. the Administrator stated, "I wasn't here then but I would not have discharged the patient without giving a notice". On 2/07/2024 the agency's patient admission folder contained a policy titled "Agency Discharge Criteria", and read in part as follows: "The Agency will arrange a safe and appropriate discharge to other care entities when the needs of the patient exceed the Agency's capabilities." The lack of providing patients a written notice in advance of terminating on-going care was reviewed and acknowledged prior to and during the exit conference with the Administrator on 2/07/2024.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on review of clinical records, agency policy review, and staff interview it was determined the agency's staff failed to ensure home health services were provided according to the patient's individualized plan of care for one (1) of seven (7) clinical records that required a weekly wound measurement in the survey sample (Clinical record #1). The findings: Seven (7) electronic clinical records were reviewed with read only access on 2/05-07/2024 with the following findings: The clinical record for patient #1 was reviewed for the recertification period of 1/11/2024 to 3/10/2024. The patient's plan of care contained orders as follows: Skilled Nurse to measure wound every week. The clinical record failed to contain documentation that the nurse measured the patient's wound on the 1/31/2024 visit that was once a week. On 2/06/2024 at 11:00 a.m. the MFI (Medical Facilities Inspector) asked the Administrator (staff member #1) if any wound measurements were done for week 4 with Skilled Nurse visit on 1/31/2024. Staff member #1 stated, "no". On 2/06/2024 at 2 p.m. the Administrator provided the MFI with the agency's wound policy titled "Wound Care Guidelines". The policy read in part as follows: C. Wound measurements-wounds will be measured at minimum every week using a metric rule. The above noted findings were reviewed and acknowledged by the Administrator on 2/07/2024.

An unannounced Home Health Agency recertification survey was conducted on January 4-6, 2021 by one (1) Medical Facilities Inspector from The Office of Licensure and Certification, Virginia Department of Health. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies.

One (1) Medical Facilities Inspector (MFI) from the Office of Licensure and Certification, Virginia Department of Health conducted a Recertification inspection at the above noted agency January 4-6, 2021. The survey occurred both onsite and remotely due to the COVID-19 Public Health Emergency. The agency reported 164 unduplicated admissions in the last 12 months. The facility was found not to be in compliance with the Federal requirements of 42 CFR 484, the Medicare Conditions of Participation of Home Health Agencies.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on review of clinical records, home visit interviews, and staff interviews it was determined the agency's staff failed to ensure home health services were provided according to the patient's individualized plan of care for seven (7) of eight (8) clinical records that required an assessment of patient weights and wound care and were reviewed in the survey sample (Clinical record #s: #1, #3, #4, #5, #6, #7 and #8). The findings: Eight (8) clinical records were reviewed with read only access on 1/4/2021 and 1/5/2021 with the following findings: 1. The clinical record for patient #1 was reviewed for the recertification period of 6/9/2020 to 8/7/2020. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. In addition the patient's plan of care contained orders for Skilled Nurse /Patient/Caregiver to perform wound care to right great toe nail bed daily due to toe nail trauma as follows; using aseptic technique: remove old dressing and discard. Paint area with betadine daily. Skilled Nurse to measure wound weekly and prn (as needed). The clinical record failed to contain documentation that the nurse/patient/caregiver performed wound care to right great toe or assessed the patient's right great toe and no weekly wound measurements to right great toe as listed in the plan of care orders. On 1/6/2021 at 10:00 a.m. the MFI (Medical Facilities Inspector) asked the Alternate Administrator (staff member #1) what happened to the patient's documentation of the right great toe. Staff member #1 stated, the orders carried over from the previous recertification and no one documented that it had healed or discontinued the wound order. 2. The clinical record for patient #3 was reviewed for the certification period of 12/3/2020 to 1/31/2021. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. 3. The clinical record for patient #4 was reviewed for the certification period of 12/4/2020 to 2/1/2021. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. 4. The clinical record for patient #5 was reviewed for the recertification period of 12/19/2020 to 2/16/2021. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. 5. The clinical record for patient #6 was reviewed for the recertification period of 12/21/2020 to 2/18/2021. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. During the home visit on 1/5/2021 at 12:00 p.m. the MFI (Medical Facilities Inspector) asked the Skilled Nurse (staff member #3) if the patient is weighed during visits. Staff member #3 stated, no but definitely with congestive heart failure patients who keep a log of their weights. 6. The clinical record for patient #7 was reviewed for the recertification period of 11/23/2020 to 1/21/2021. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. During the home visit on 1/5/2021 at 1:15 p.m. the MFI (Medical Facilities Inspector) asked the Home Health Aide (staff member #5) if the patient is weighed during visits. Staff member #5 stated, no does not have weight scale in the home. 7. The clinical record for patient #8 was reviewed for the recertification period of 12/14/2020 to 2/11/2021. The patient's plan of care contained orders as follows: Skilled Nurse to contact MD/FNP (Medical Doctor/Family Nurse Practitioner) if weight gain > (more than) 3 lb (pound) in 1 (one) week or 5 lb loss in 1 (one) month. The clinical record failed to contain documentation that the nurse assessed the patient's weight on the above noted topic listed in the plan of care orders. In addition, on 1/5/2021 at 9:00 a.m. the MFI (Medical Facilities Inspector) showed the above care plans to the Alternate Administrator (staff member #1) and asked if any of the disciplines are assessing the patient's weight. Staff member #1 stated, they are templates. The above noted findings were reviewed and acknowledged by the Administrator, Alternate Administrator and QAPI (Quality Assurance Performance Improvement) on 1/6/2020 at 10:30 a.m.