Every finding on record at Home Call LLC

A recertification survey of HomeCall FrederickHome Health agency was conducted June 20-22, 2023. After the review of the agency's emergency preparedness program and plans for the three locations, the agency was found to be in non-compliance with the Conditions of Participation and related standards found at 42 CFR (Code of Federal Regulations) Part 484.102.

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.542(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on review of the agency’s Emergency Preparedness risks assessment documentation and interview with agency staff, agency staff did not accurately assess and analyze community-based risks to agency. Failure to accurately assess and analyze community-based risks placed patients and staff at risk for inadequate emergency response by the agency. Findings included: a) Frederick branch Emergency Preparedness Addendum dated 6/1/2022 notes Community-Based Risks to agency as 1) Infectious Disease, 2) Opioids, and 3) Rabies and the matching agency Community-Based Risk Assessment dated 6/1/2022 noted 1) Flooding, 2)Tornado, and 3) Transportation as the most needed events for emergency preparedness. When asked, the agency’s administrative staff was unable to provide additional information regarding the discrepancies. b) Rockville branch Emergency Preparedness Addendum dated 2/22/2021 notes Community-Based Risks to agency as 1) Opioid use, 2) Utility disruptions, and 3) Terrorism and the matching agency Community-Based Risk Assessment dated 2/22/2021 noted 1) Extended Power Outages, 2) Ice & Snow, and 3)Transportation as the most needed events for emergency preparedness. When asked, the agency’s administrative staff was unable to provide additional information regarding the discrepancies. c)Rockville branch Emergency Preparedness Addendum dated 2/1/2022 notes Community-Based Risks to agency as 1) Opioid use, 2) Utility disruptions, and 3) Terrorism and the matching agency Community-Based Risk Assessment dated 2/1/2022 noted 1) Extended Power Outages, 2) Ice & Snow, and 3)Transportation as the most needed events for emergency preparedness. When asked, the agency’s administrative staff was unable to provide additional information regarding the discrepancies.

A standard home health agency re-certification survey was conducted at HomeCall Frederick Home Health agency was conducted June 20-22, 2023. The survey included the following: a review of clinical records; a review of the complaint/incident reports; a review of on-call documentation; a review of admission documentation including patient bill of rights; a review of personnel files including professional licenses and expiration dates; a review of Quality Assurance Project Plan and Reports (QAPI) & Potentially Avoidable Event Report; a review of the organizational chart; a review of the CLIA waiver, and interviews with the agency's administrative. A total of eighteen randomly selected patient records were reviewed during the survey. The scope of services included the following: Skilled Nursing Services - 9 Physical Therapy Services - 18 Occupational Therapy Services - 15 Medical Social Worker - 2 Home Health Aide Services - 4 Speech-Language Services -4 No home visit observations were conducted during the survey. Findings in this report were based on data present in the clinical record at the time of the reviews. The agency's administrative and clinical staff were kept informed of the survey findings as the survey progressed. The agency's staff were given the opportunity to present information relative to the findings during the course of the survey. The exit conference was conducted with agency personnel on June 22, 2023. The findings of the Medicare re-certification survey were reviewed; a patient identification key-code and a signed plan of correction verification form was provided to the agency's administrator.

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 review of patient records and interview with agency staff during the survey, the agency staff did not communicate delays in start of care for 8 out 18 reviewed placing the patients at risk for adverse or negative health care outcomes. Patient: #2, #3, #5, #7, #9, #14, #15, #18 Findings included: 1.All clinical staff members have the responsibility to communicate or refer patient care related issues to other professional disciplines to ensure the provision of optimal health care services and to prevent adverse outcomes. This did not occur, as evidenced by the review of patient records on 6/20/2023, 6/21/2023, and 6/22/2023. a) On 6/22/2023, during the review of patient #2 medical record, it is documented that on 1/18/2023 the agency received and accepted a referral to provide physical and occupational therapy services for the patient. The start of care date is documented as 1/24/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the six-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. b) On 6/20/2023, during the review of patient #3 medical record, it is documented that on 5/12/2023 the agency received and accepted a referral to provide physical and occupational therapy services for the patient. The start of care date is documented as 5/15/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the three-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. c) On 6/22/2023, during the review of patient #5 medical record, it is documented that on 4/5/2023 the agency received and accepted a referral to provide skilled nursing, aide services, physical and occupational therapy services for the patient. The start of care date is documented as 4/9/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the four-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. d) On 6/22/2023, during the review of patient #7 medical record, it is documented that on 5/31/2023 the agency received and accepted a referral to provide physical and occupational therapy services for the patient. The start of care date is documented as 6/7/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the seven-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. e) On 6/22/2023, during the review of patient #9 medical record, it is documented that on 5/26/2023 the agency received and accepted a referral to provide physical and occupational therapy services for the patient. The start of care date is documented as 6/2/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the seven-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. f) On 6/21/2023, during the review of patient #14 medical record, it is documented that on 5/1/2023 the agency received and accepted a referral to provide physical and occupational therapy services for the patient. The start of care date is documented as 5/9/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the eight-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. g) On 6/21/2023, during the review of patient #15 medical record, it is documented that on 5/5/2023 the agency received and accepted a referral to provide skilled nursing, physical and occupational therapy services for the patient. The start of care date is documented as 5/9/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the four-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care. h) On 6/20/2023, during the review of patient #18 medical record, it is documented that on 1/4/2023 the agency received and accepted a referral to provide skilled nursing, physical and occupational therapy services for the patient. The start of care date is documented as 1/7/2023. There was no documentation explaining the delay in the start of care. No documentation communicating the three-day delay in the start of care to the referring physician was in the record. During the interview, the agency staff did not provide any further information or documentation for the delay in care.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on the review of patient records and interview with agency staff, the skilled nurse (SN) did not obtain physician orders for 1 out of 18 patients reviewed. Failure to obtain and clarify all physician orders has the potential to cause negative health care outcomes. Patient: #4 Findings included: 1. The SN has an obligation to follow all physician’s orders. This did not occur, as evidenced by the record review on 6/21/2023. a) On 12/14/2022, the SN visit noted that the physician ordered “mix salt into water and have patient drink it when blood pressure is below 100.” Patient blood pressure was noted as 90/40. There was no documentation of a physician order being obtained. There was no documentation of clarification being requested for the order. When asked the agency was unable to provide any additional information.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on review of patient records and interview with agency staff, the agency staff did not communicate potential negative health care issue for 1 out of 18 patients reviewed on 6/20/2023. The home health agency furnishing services must maintain communication to ensure that their efforts are coordinated effectively and support the objectives outlined in the patients plan of care. Patient: #18 Findings included: 1.All clinical staff members have the responsibility to communicate or refer patient care related issues to other professional disciplines to ensure the provision of optimal health care services and to prevent adverse outcomes. This did not occur, as evidenced by the review of patient record on 6/20/2023. a) On review of Patient #18 medical record on 6/20/2023, the Physical Therapist (PT) noted that the patient reported high levels of pain on two consecutive visits. Visit note dated 1/11/2023, the PT documented that patient reported excruciating back pain. Visit note dated 1/12/2023, the PT documented that the patient reported a pain level of 8 out 10. There was no evidence of the PT reporting the patient’s pain to the physician for either date. Failure to report the patient’s pain placed the patient at risk for inadequate care. When asked, the agency staff were unable to provide evidence of the PT reporting these findings to the physician or the agency.

Aides are members of interdisciplinary team CFR(s): 484.80(g)(4) Home health aides must be members of the interdisciplinary team, must report changes in the patient's condition to a registered nurse or other appropriate skilled professional, and must complete appropriate records in compliance with the HHA's policies and procedures. This ELEMENT is not met as evidenced by: Home health aides must be members of the interdisciplinary team, must report changes in the patient's condition to a registered nurse or other appropriate skilled professional, and must complete appropriate records in compliance with the HHA's policies and procedures. Failure to comply with regulations places patients at risk for inadequate health care. During interdisciplinary team meetings, all HHA staff involved in the patient's care must be present for, and, where appropriate, should contribute to, any discussion regarding the patient's care. This did not occur. On review of the agency’s interdisciplinary team meetings attendance records from for the Frederick 1/11/2023-6/14/2023, Rockville 1/10/2023-6/20/2023, and Hagerstown 1/12/2023-6/8/2023 branches there is no evidence of the home health aides attending. When asked, the agency staff was unable provide any documentation of the aides attending any interdisciplinary team meetings.