Every finding on record at Home Recovery Home Aid Inc

An unannounced Home Health Agency recertification survey was conducted on June 11, 2024 - June 18, 2024 by the Virginia Department of Health, Office of Licensure and Certification. 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 June 11, 2024 - June 18, 2024 by the Virginia Department of Health, Office of Licensure and Certification. The agency identified 951 unduplicated admissions for the past twelve (12) months. In conjunction with the survey, all five (5) branch locations were visited. 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.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on clinical records review and staff interview, it was determined the agency failed to ensure the physician was notified of the patient's condition that may suggest outcomes are not being met or changes are needed in the plan of care for one (1) of (17) clinical records in the survey sample (Clinical record # 10). Seventeen electronic clinical records were reviewed on June 11, 2024, and June 17, 2024. The clinical record for Patient #10 was reviewed for the certification period of May 10, 2024, through July 8, 2024. The patient's plan of care contained orders for Skilled Nurse (SN) one (1) time a week for one (1) week. Skilled Nurse to assess vital signs at every visit and notify physician if systolic blood pressure is greater than 200 or less than 100; diastolic blood pressure is greater than 100 or less than 50. The clinical record for Patient #10 failed to contain documentation of notifying the physician of patient's blood pressure being outside of established parameters and revealed the following: May 14, 2024, the SN documented a blood pressure of 92/62. There was no documentation of physician notification for Patient #10 in the clinical record. June 06, 2024, the SN documented a blood pressure of 90/56. There was no documentation of physician notification for Patient #10 in the clinical record. The Medical Facilities Inspector interviewed the Clinical Manager, Staff Member #2 (SM #2), on June 12, 2024, at 9:30 a.m., who confirmed the physician had not been notified of Patient #10 having systolic blood pressure(s) on May 14, 2024, and June 06, 2024, that were outside of established parameters. The failure to alert physician to changes that suggest a need to alter the plan of care was reviewed with the SM # 2 on June 12, 2024, and with the Administrator , Staff Member #1 (SM #1) and SM #2 at the exit conference on June 18, 2024.

An unannounced Home Health Agency recertification survey was conducted on March 22-25, 2021 by two (2) Medical Facilities Inspectors 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 Home Health Agency recertification survey was conducted at the 816 East Third Street, Farmville VA 23901 from March 22-25, 2021 by two MFIs (Medical Facilities Inspector) from The Office of Licensure and Certification, Virginia Department of Health. This office was identified as the parent office. The survey occurred both onsite and remotely due to the COVID-19 Public Health Emergency. The agency reported 747 unduplicated admissions in the last twelve (12) months and operates the following branche office locations: All of the branches were toured by the MFIs. Appomattox - 2142 Church Street, Appomattox VA 24522-5370 Bedford - 1029 Turnpike Road, Suite H, Bedford VA 24523-0005 Blackstone - 930-C South Main Street, Blackstone VA 23824-2614 Bremo Bluff - 2781 West Bottom Road, Suite A, Bremo Bluff VA 23022-2282 Chatham - 14 North Main Street, Chatham VA 24531-5436 Lawrenceville - 129 Hicks Street, Suite A, Lawrenceville VA 23868-1807 Lynchburg - 5050 Fort Ave, Suite B, Lynchburg VA 24502-1602 The agency was found not to be in compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies (HHAs) and deficiencies were cited.

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 a review of clinical records and interviews, it was determined the agency failed to provide coordination of care in three (3) of eighteen clinical records reviewed in the survey process (clinical record #2, 6 and 8). The findings were: A review of eighteen (18) clinical records was conducted offsite as a virtual review on March 23-25, 2021. 1. The clinical record for patient #2 contained a plan of care for treatment of a foot ulcer with a wound vac to be changed three (3) times per week. A wound vac is a vacuum-assisted closure (VAC) device/method of decreasing air pressure around a wound to assist the healing. It is also referred to as negative pressure wound therapy. The nurse missed a visit on Wednesday 3/03/2021 and documented the patient had been seen by the physician. On Friday 3/05/2021, the nurse visiting the patient discovered the wound vac had not been changed at the physician appointment and the patient had the same wound vac on that was applied on Monday 3/01/2021. The nurse noted the wound had macerated and was advised by the supervisor to follow-up with the patient on Saturday. If the wound was still macerated, advise the patient to remove the wound vac and apply a normal saline wet to dry gauze. The nurse also noted they would follow-up with the physician on Monday. The nurse called the patient on Saturday and the wound was still macerated, the nurse instructed the patient to remove the wound vac and apply the wet to dry dressing. The nurse follow-up with a visit on Monday however, there is no evidence the nurse contacted the physician about the status of the wound. The patient saw the physician on Tuesday for a regular scheduled appointment at which time the physician sent the patient to the hospital for inpatient antibiotic therapy. A phone interview was conducted with the administrator on 3/25/2021 at 11:40 am. The administrator acknowledged the lack of care coordination between staff and the physician. 2. The clinical record for patient #6 contained a plan of care for treatment of an abdominal wound with a wound vac to be changed three (3) times per week. Upon admission, the nurse discovered the proper supplies (foam dressing) were not in the home to change the wound vac. The next three visits were missed with no reason documented for the missed visits. A fourth visit was missed and the nurse documented no answer when attempting to reach the patient. The next visit the patient received was on 12/14/2020, twelve (12) days after the initial visit. The wound vac was still not being used. There is no documented evidence the agency attempted to coordinate care with the supply company to check on dressing supplies. An interview was conducted with the Clinical Manager on 3/23/2021. The Clinical Manager wrote up a summary of events to include the patient's desire to discontinue the wound vac. The summary also stated the nurse with the missed visits was no longer at the agency to clarify why visits were not made and the care plan was not updated promptly to remove the wound vac until the nursing visit on 12/21/2020. During the 12/21/2020 visit, the nurse discovered the wound vac was still listed in the plan of care. The nurse reached out to the physician's office for orders. A follow-up phone interview with the administrator on 3/25/2021 was conducted at 11:40 am. The administrator acknowledged the lack of coordination between staff, patient and the supply company. 3. The clinical record for patient #8 contained a nursing note dated 12/07/2020 in which the nurse documented the family had called the physician's office to request medications over concerns patient had a urinary tract infection. The nurse documented no signs and symptoms of a urinary tract infection during that visit. No coordination of care was documented with the physician's office or follow-up with the family to see if the physician called in medication. An interview with the Clinical manager via email on 3/24/2021 at 4:24 PM revealed the same findings as noted above.