Every finding on record at Home Health Connection, Inc

Extended Substantial Allegation Survey Substantial Allegation 62384 The following deficiencies are based upon the substantial allegation 62384 completed on 06/02/22. Home Health Connection, Inc 368087, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies. Home Health Connection is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the exit date of this survey.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on interviews, record reviews, and policy review, the agency failed to ensure that if a state court has not adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient's representative may exercise the patient's rights (G424). The agency failed to ensure the patient had the right to participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate (G434). The cumulative effect of these systemic practices resulted in the agency's inability to ensure that the patients' rights were not violated.

Exercise of rights CFR(s): 484.50(b)(1)(2)(3) Standard: Exercise of rights. (1) If a patient has been adjudged to lack legal capacity to make health care decisions as established by state law by a court of proper jurisdiction, the rights of the patient may be exercised by the person appointed by the state court to act on the patient's behalf. (2) If a state court has not adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient's representative may exercise the patient's rights. (3) If a patient has been adjudged to lack legal capacity to make health care decisions under state law by a court of proper jurisdiction, the patient may exercise his or her rights to the extent allowed by court order. This STANDARD is not met as evidenced by: Based on interviews, record reviews, and policy review, the agency failed to ensure that if a state court has not adjudged a patient to lack legal capacity to make health care decisions as defined by state law, the patient's representative may exercise the patient's rights for nine of 15 pediatric patients reviewed (Patient #2, #3, #6, #7, #8, #9, #11, #12, and #13). This had the potential to affect all patients receiving services provided by the agency. The census was 113. Findings include: On 03/15/22 at 2:39 P.M. an interview with Staff A and Staff B revealed the agency provided services for pediatric patients in their home, and that included Progeny Family Training Center. Further interview revealed this location was an unlicensed private home that “looks like a facility,” and 18 children lived in the home. Further interview revealed the agency provided services for 15 of the 18 children living in the home. Staff A and Staff B further stated that the “House-Mom” provided the agency with signed consent forms for each patient to provide services for all 15 pediatric patients. Further interview revealed Staff A and Staff B felt the "House Mom" had the legal authority to sign as guardian for all 15 pediatric patients. On 03/16/22 at 8:55 A.M. a review of the census list of the patients receiving services confirmed the agency did provide care for 15 of the 18 children living in the home. Further review of the census list (with medical record consent information attached) revealed no concerns related to the "House Mom" having legal guardianship for six of the patients living in the home because the "House Mom" had provided copies of court-ordered custody forms or birth certificate forms to prove guardianship/legal adoption of those patients. Further review of the census list (with medical record consent information attached) revealed a form titled, Placement with Progeny for Care and Custody; Authorization for medical treatment and other services; Waiver of Liability, was also attached and signed by parent/guardian to give the “House Mom” the right to sign as legal guardian for Patient #2, #3, #6, #7, #8, #9, #11, #12, and #13; however, there were no court documents to confirm the "House Mom" had legal guardianship for those patients. On 03/17/22 at 10:10 A.M. an interview with the "House Mom" confirmed she had legal custody of six of the 15 children receiving services in the home. She stated she had legal guardianship of the other nine children living in the home. She stated she “stands-by” the legality of the forms that were used to sign consent for those nine children. She further stated that multiple hospitals and schools accepted this form for guardianship, and the form was legally binding in her opinion. On 03/21/22 at 11:09 A.M. a review of the policy titled, Informed Consent/Refusal of Treatment, revised December 2018, revealed that during the admission visit, the patient or authorized representative will sign the organizations written consent for care and services. On 03/23/22 at 12:30 P.M. an interview with Staff B confirmed the agency used the form provided by the "House Mom" to confirm that she was the patient’s legal representative. Staff B stated she thought it was ok because hospitals and schools accepted the same form as proof of guardianship. This deficiency substantiates Substantial Allegation 62384.

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 interviews, record reviews, and policy review, the agency failed to ensure the patient had the right to participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate for nine of 15 pediatric patients reviewed (Patient #2, #3, #6, #7, #8, #9, #11, #12, and #13). This had the potential to affect all patients receiving services provided by the agency. The census was 113. Findings include: On 03/15/22 at 2:39 P.M. an interview with Staff A and Staff B revealed the agency provided services for pediatric patients in their home, and that included patients living at Progeny Family Training Center. Further interview revealed this location was an unlicensed private home that “looks like a facility”, and 18 children lived in the home. Further interview revealed the agency provided services for 15 of the 18 children living in the home. They further stated that the “House-Mom” provided the agency with a signed consent form for each patient to provide services for all 15 pediatric patients. Further interview revealed Staff A and Staff B felt the "House Mom" had the legal authority to sign as guardian for all 15 pediatric patient consents. On 03/16/22 at 8:55 A.M. a review of the census list of the patients receiving services confirmed the agency did provide care for 15 of the 18 children living in the home. Further review of the census list (with medical record consent information attached) revealed no concerns related to the "House Mom" having legal guardianship for six of the patients living in the home because the "House Mom" had provided copies of court-ordered custody forms or birth certificate forms to prove guardianship/adoption of those patients. Further review of the census list (with medical record consent information attached) revealed a form titled, Placement with Progeny for Care and Custody; Authorization for medical treatment and other services; Waiver of Liability, was also attached and signed by parent/guardian to give the “House Mom” the right to sign as legal guardian for Patient #2, #3, #6, #7, #8, #9, #11, #12, and #13; however, there were no court documents to confirm the "House Mom" had legal guardianship for those patients. On 03/17/22 at 10:10 A.M. an interview with the "House Mom" revealed she had legal custody of six of the 15 children receiving services in the home. She stated she had the legal right to sign consent for services to be provided for the nine children living in the home that did not have court documentation, birth certificate or legal custodial paperwork. She stated that she “stands-by” the legality of the forms that were used to sign consent for those nine children. She stated that multiple hospitals and schools accepted this form for guardianship, and the form was legally binding in her opinion. On 03/17/22 at 11:17 A.M. an interview was completed with Staff C, D, E, and F who worked in the home. They stated they assumed the appropriate consents were documented. On 03/21/22 at 11:09 A.M. a review of the policy titled, Informed Consent/Refusal of Treatment, revised December 2018, revealed that during the admission visit, the patient or authorized representative will sign the organizations written consent for care and services. On 03/23/22 at 12:30 P.M. an interview with Staff B confirmed the agency only used the documentation provided by the "House Mom" to confirm that she was the patients' legal representative. Staff B further stated she thought it was ok because hospitals and schools accepted the same form. This deficiency substantiates Substantial Allegation 62384.