Every finding on record at Home Health Agency - Pennsylvania, LLC

Based on the findings of an unannounced onsite Medicare Recertification and State Re-Licensure survey completed on May 31, 2022, Omni Home Care, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Condition of Participation: Home Health Agencies- Emergency Preparedness.

Based on the findings of an unannounced onsite Medicare Recertification and State Re-Licensure survey completed on May 31, 2022, Omi Home Care, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of clinical records (CR) , agency policy and procedure, home visit observation (OBS), and employee (EMP) interview, it was determined the agency failed to ensure the Plan of Care (POC) contained supplies and equipment required for three (3) of seventeen (17) CRs reviewed (CR#2 #3, & #11 ), Safety measures to protect against injury for one (10 of seventeen (17) CRs reviewed (CR#13), all medications for two (2) of seventeen (17) CRs reviewed (CR #1 & #5), and patient-specific interventions for one (1) of seventeen (17) CRs reviewed (CR#5.) Findings include: Review of policy on 5/26/2022 at approximately 2:30pm revealed: "PLAN OF CARE (POC)…PROCEDURE: …2. The POC includes: …f. Medications and treatments, g. Safety measures to protect against injury, …. Patient specific interventions and education...j. Required equipment and supplies, …All patient care orders..." HV OBS1 conducted 5/20/2022 at approximately 9:00am patient revealed to surveyor, clinician, and Executive Director the use of Glucose tablets used "if blood sugar drops." Patient revealed medication is not new and no knowledge of parameters, just "I know when I feel it, so I keep some upstairs in my bedroom and downstairs in case I am there." Surveyor review of POC and medication list at visit revealed glucose tablets to not be included. Review of CR1 conducted 5/23/2022 at approximately 1:00pm confirmed no communication to doctor post home visit to discuss patient use of medication. No evidence of addition to medication list or physician order. HV OBS2 conducted 5/20/2022 at approximately 10:30am revealed reacher/grabber in home, patient confirmed use. Review of POC at visit revealed reacher/grabber to not be on included in supplies/equipment. Review of CR 2 conducted 5/23/2022 at approximately 1:30pm revealed no addition of equipment to POC post visit. HV OBS3 conducted 5/20/2022 at approximately 11:30am revealed patient using walker to ambulate. Patient confirms need for walker and informs surveyor use of toilet chair which is kept in the bathroom upstairs. Review of POC at visit reveals omission of walker and toilet chair from POC. Review of CR 3 conducted 5/23/2022 at approximately 2:00pm revealed failure to add equipment to POC. HV OBS5 conducted 5/23/2022 at approximately 10:30am patient and caregiver informed nurse of medication change. Patient reports recent visit to Cardiologist who changed Furosemide to alternating dose of 80mg/40mg daily. Patient prescription in home 40mg tablet by mouth daily. review of POC and medication list at this time includes 40mg tablet by mouth daily. At visit patient and caregiver acknowledge fluid restriction reported as 1.5Liters/day, which is not included in POC. Review of CR 5 conducted 5/23/2022 at approximately 3:00pm confirmed no communication to doctor post home visit to discuss medication change or fluid restriction. No evidence of addition to medication list or physician order. Review of CR 11 conducted 5/25/2022 at approximately 12:00pm revealed diagnosis of Diabetes and intervention of daily blood glucose testing. No diabetic supplies included on POC Review of CR 13 conducted 5/26/2022 at approximately 9:00am revealed diagnosis of "dependence on supplemental oxygen" and medication list included Oxygen 2 Liters via nasal canula nightly and as needed during awake hours to maintain oxygen saturation below 90%. PC failed to include oxygen safety precautions. Exit interview with Executive director, Performance Improvement Coordinator x2, President and Vice President of Operations, Care Manager x2, on 5/31/2022 at approximately 11:00am confirmed the above findings. Repeat deficiency, previously cited: 5/7/2019

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 upon review of clinical record (CR) and an employee (EMP) interview, it was determined the agency failed to ensure physicians orders were carried out for one (1) of seventeen (17) CRs reviewed (CR #12). Findings include: Review of CR12 conducted on 5/26/2022 at approximately 8:30am revealed physician order for blood work (BMP(Basic metabolic panel) to be drawn. No evidence in CR that labs were obtained or resulted. Exit interview with Executive director, Performance Improvement Coordinator x2, President and Vice President of Operations, Care Manager x2, on 5/31/2022 at approximately 11:00am confirmed the above findings.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on review of clinical records (CR) , agency policy and procedure, and employee (EMP) interview, it was determined the agency failed to communicate lab results for three (3) of seventeen (17) CRs reviewed (CR7, #10, & #17.) Findings include: Review of policy on 5/26/2022 at approximately 2:30pm revealed: "COORDINATION OF CARE, FROM ADMIT THROUGH DISCHARGE...PROCEDURE...4. Coordination of are with physician: d. When results of laboratory and other tests become available... Review of CR7 conducted on 5/24/2022 at approximately 10:00am revealed blood work (CBC with diff(complete blood count with differential) obtained at nurse visit 5/18/2022 as per physician order. No evidence of lab results or communication with physician. Review of CR 10 conducted 5/25/2022 at approximately 11:30pm revealed blood work (CBC (complete blood count) obtained at nurse visit 4/29/2020 as per physician order. No evidence of lab results or communication with physician. Review of CR 17 conducted 5/26/2022 at approximately 11:00am revealed blood work (CBC (complete blood count) obtained at nurse visit 5/21/2022 as per physician order. No evidence of lab results or communication with physician. Exit interview with Executive director, Performance Improvement Coordinator x2, President and Vice President of Operations, Care Manager x2, on 5/31/2022 at approximately 11:00am confirmed the above findings.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on review of clinical records (CR) , agency policy and procedure, home visit observation (OBS), and employee (EMP) interview, it was determined the agency failed to ensure the patient was provided and accurate and up to date medication schedule for two (2) of seventeen (17) CRs reviewed (CR #1 & #5.) Findings include: Review of policy on 5/26/2022 at approximately 2:30pm revealed: "MONITORING MEDICATIONS...PROCEDURE: …2. All clinicians participating in the patient's care are responsible to assist wit maintenance of accurate patient medication information. During the patient's episode of care the following will occur: a. through a collaborative process the care team will: i. Compare medications patient is currently taking with medications ordered...b. The Physician will be notified pf discrepancies and documentation of notification must be evident in the medical record. HV OBS1 conducted 5/20/2022 at approximately 9:00am patient revealed to surveyor, clinician, and Executive Director the use of Glucose tablets used "if blood sugar drops." Patient revealed medication is not new and no knowledge of parameters, just "I know when I feel it, so I keep some upstairs in my bedroom and downstairs in case I am there." Surveyor review of POC and medication list at visit revealed glucose tablets to not be included. Review of CR1 conducted 5/23/2022 at approximately 1:00pm confirmed no evidence of communication with physician, addition to medication list or physician order. Patient medication list failed to include medication. HV OBS5 conducted 5/23/2022 at approximately 10:30am patient and caregiver informed nurse of medication change. Patient reports recent visit to Cardiologist who changed Furosemide to alternating dose of 80mg/40mg daily. Patient prescription in home 40mg tablet by mouth daily. review of POC and medication list at this time includes 40mg tablet by mouth daily. Review of CR 5 conducted 5/23/2022 at approximately 3:00pm confirmed no evidence of communication with physician, addition to medication list or physician order. Patient medication list failed to include changed medication. Exit interview with Executive director, Performance Improvement Coordinator x2, President and Vice President of Operations, Care Manager x2, on 5/31/2022 at approximately 11:00am confirmed the above findings. Repeat deficiency, previously cited: 5/7/2019

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures, clinical records (CR), and employee (EMP) interview, the agency failed to ensure the progress toward wound healing goals were assessed by the supervising clinician/registered nurse (RN) for two (2) of two (2) patients for whom non-surgical wound care orders/goals were included on the Plan of Care (POC). (CR #2 & #3) Findings include: Review of policy on 5/26/2022 at approximately 2:30pm revealed: "WOUND ASSESSMENT, DOCUMENTATION, AND PHOTOGRAPHY...PPOLICY:...Unless otherwise ordered by the physician, the Registered Nurse or Physical Therapist will assess wounds at least:...Every other week for patients receiving wound care by the agency at a frequency less than daily...PROCEDURE:...3. Document the following in the medical record: a. Wound type..., b. Location and Laterality, c. Stage or Thickness:..., Wound size:...d. Undermining and/or Tunneling:..., e. Wound Bed:..., f. Wound Edged:..., g. Drainage:..., Peri wound condition, …" Review of CR2 conducted 5/23/2022 at approximately 1:30pm revealed primary diagnosis of "Varicose veins of left lower extremity with ulcer of ankle" and interventions for wound care to be completed by nurse. Wound Record report revealed that the (LPN) Licensed Practical Nurse was managing the wound and the RN (Registered Nurse) failed to conduct an assessment every other week per agency policy. Time frame reviewed was 3/16/2022-5/23/2022. The RN conducted assessments of the wound on the following dates: 3/16/2022 4/19/2022 (35 days from previous documented RN wound assessment on 3/16/2022) 5/9/2022 (20 days from previous documented RN wound assessment on 4/19/2022) No additional RN wound assessments documented beyond 5/9/2022 with 14 days since the last documented RN wound assessment as of end review date of 5/23/22. Review of CR3 conducted 5/23/2022 at approximately 2:00pm revealed diagnosis of "Non-pressure chronic ulcer of right and left lower legs..."" and interventions for wound care to be completed by nurse. Wound Record report revealed that the (LPN) Licensed Practical Nurse was managing the wound and the RN (Registered Nurse) failed to conduct an assessment every other week per agency policy. Time frame reviewed was 2/15/2022-5/23/2022. The RN conducted assessments of the wound on the following dates: 2/12/2022 3/25/2022 (38 days from previous documented RN wound assessment on 3/16/2022) 4/12/2022 (18 days from previous documented RN wound assessment on 3/25/2022) 5/3/2022 (21 days from previous documented RN wound assessment on 4/12/2022) No additional RN wound assessments documented beyond 5/3/2022 with 20 days since the last documented RN wound assessment as of end review date of 5/23/22. Exit interview with Executive director, Performance Improvement Coordinator x2, President and Vice President of Operations, Care Manager x2, on 5/31/2022 at approximately 11:00am confirmed the above findings. Repeat deficiency, previously cited: 4/12/2016