Every finding on record at Homebound Health Services Inc

Based on the findings of an unannounced, onsite Medicare recertification survey conducted May 10 through May 12, 2023, Homebound Health Services, Inc. was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies-Emergency Preparedness.

Based on the findings of an unannounced, onsite Medicare recertification survey conducted May 10 through May 12, 2023, Homebound Health Services, Inc. was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Investigate complaints made by patient CFR(s): 484.50(e)(1)(i) (i) Investigate complaints made by a patient, the patient's representative (if any), and the patient's caregivers and family, including, but not limited to, the following topics: This ELEMENT is not met as evidenced by: Based on the review of agency policies/procedures, documentation and clinical records, and based on interview with the Administrator (Employee #13) and the Supervising Registered Nurse (RN-Employee #12), the agency failed to ensure one (1) of one (1) patient care complaint was investigated prior to May 10, 2023. (Patient #10) Findings include: On May 15, 2023 at approximately 2:44 PM, review of the agency policy titled "Complaints", which was received via email on 05/15/2023, revealed the following: Policy: Complaints that a received by the agency regarding patient care are directed to the Supervising Nurse and will be documented in the patient's EMR (Electronic Medical Record) by the Supervising Nurse... Purpose: To allow complaints to be made and dealt with effectively. To track trends to improve areas and strive for high levels of quality care... Procedure: 1. All complaints received by the agency will be directed to the Supervising Nurse. 2. The Supervising Nurse will listen to the complaint, then offer a resolution or intervention. 3. The complaint, intervention, resolution, and outcome are then documented in the EMR... On May 12, 2023 at approximately 1:50 PM, review of "QI Event Report" documentation revealed a complaint was reported by the family member of patient #10 on 11/29/2022. Patient #10 (Discharge): On May 12, 2023 at approximately 11:42 AM, review of the clinical record revealed the start of care date was 08/13/2022, the diagnoses included pressure ulcer of the left heel, stage 2 and pressure ulcer of right heel, stage 1, that skilled nursing (SN) was to provide wound care to the left and right heels and that SN goals included the following as documented on the "Home Health Certification and Plan of Care" for the recertification period of 10/12/2022 through 12/10/2022: Wound status will improve as evidenced by decrease in size, drainage, absence of infection and decreased pain by end-of-episode. Review of "Complaint Report" documentation dated 11/29/2022 revealed the following: A registered nurse (RN-Employee #14) reported that the family member of patient #10 was dissatisfied with the wound care being provided by the agency. During a telephone call with the Supervising RN (Employee #12), the family member reported dissatisfaction with wound care was related to the cost the patient would incur to have a skin graft of the heel and that the family member felt that SN was responsible for the wound deterioration. Documentation revealed the Supervising RN suggested that the patient be discharged from the agency since the family member was dissatisfied with the services provided by the agency so that the family member could consult another agency. The family member is documented as then stating the following: "As a whole I can not say that we are dissatisfied" and "There's a lot of positive to your agency and I don't want to disrupt it". There was no documentation on the "Complaint Report" form which provided evidence that the Supervising RN initiated a complaint investigation regarding the family member's allegations regarding SN services/wound care. During interview conducted on May 12, 2023 at approximately 4:20 PM, the Administrator and Supervising RN confirmed there was no documentation which provided evidence that the above referenced complaint allegation had been investigated by the Supervising RN prior to May 10, 2023.

Program scope CFR(s): 484.65(a)(1),(2) Standard: Program scope. (1) The program must at least be capable of showing measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care. (2) The HHA must measure, analyze, and track quality indicators, including adverse patient events, and other aspects of performance that enable the HHA to assess processes of care, HHA services, and operations. This STANDARD is not met as evidenced by: Based on review of agency policies/procedures and documentation, and based on interview with the Administrator (Employee #13) and the Supervising Registered Nurse (RN-Employee #12), the agency failed to ensure adverse patient events were analyzed (reviewed) during four (4) of four (4) the Professional Advisory Committee (PAC-Group of Professional Personnel)/Quality Assessment Performance Improvement meetings conducted between July 2022 and April 2023. (July 2022, October 2022, January 2023 and April 2023) Findings include: On May 15, 2023 at approximately 2:41 PM, review of the agency policy titled "QAPI", which was received via email on 05/15/2023, revealed the following: Policy: Homebound Health Services has a performance improvement project process in place which includes identifying opportunities and implementing measures designed to improve the quality of patient care, as well as organizational performance. On May 15, 2023 at approximately 2:45 PM, review of the agency policy titled "Patient Incidents", which was received via email on 05/15/2023, revealed the following: Policy: Patient incidents are documented by the discipline who is made aware of the incident and is visiting the patient. The agency software program (HCHB) tracks these trends. An RN (Registered Nurse) and an MD (Medical Doctor) from the PAC/QAPI will assess trends, develop interventions to decrease incidents and/or prevent them... Procedure...2. On a quarterly basis, the RN Administrator and PAC/QAPI MD will track trends and monitor statistical data... Patient #9: On May 12, 2023 at approximately 11:15 AM, review of the clinical record and agency incident documentation revealed the following: A report dated 06/27/2022 was submitted via the Pennsylvania Department of Health Event Reporting System for a "Death Due to Injury, Suicide or Unusual Circumstances While a Patient/Resident". The report indicated the patient was discovered unresponsive by a family member, that a note was present identifying the patient's funeral director, that laboratory studies revealed critical medication levels were present as identified in the patient's hospital toxicology screen and that the patient expired on 06/29/2022. On May 10, 2023 at approximately 2:35 PM, Review of "QI Event Report" documentation revealed the following adverse patient incidents occurred since 05/20/2022: -Unattended Falls Requiring Employee Intervention: 74 incidents -Other: 14 incidents. On May 10, 2023 at approximately 10:25 AM, review of "PAC/QAPI" meeting minutes documentation failed to reveal the above listed adverse patient events had been analyzed/reviewed during the "PAC/QAPI" meetings conducted in July 2022, October 2022, January 2023 and April 2023. During interview conducted on May 12, 2023 at approximately 4:20 PM, the Administrator and Supervising RN confirmed there was no documentation which provided evidence the above referenced adverse patient events had been analyzed/reviewed during the "PAC/QAPI" meetings conducted in July 2022, October 2022, January 2023 and April 2023.

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, documentation and clinical records, and based on interview with a registered nurse (RN-Employee #15), the Administrator (Employee #13) and the Supervising Registered Nurse (RN-Employee #12), the agency failed to ensure the wound and intravenous site assessment was performed as per agency policy and procedure for three (3) of five (5) patients for whom skilled nursing (SN) provided wound and/or intravenous site care. (Patients #3, #10 and #11) Findings include: On May 15, 2023 at approximately 2:48 PM, review of the agency policy titled "Initial SOC and Comprehensive Assessment" (SOC-Start of Care), which was received via email on 05/15/2023, revealed the following: Purpose...To gather the necessary information to have a holistic picture of the client's current condition... On May 15, 2023 at approximately 2:50 PM, review of the agency policy titled "Wound Record/Measuring", which was received via email on 05/15/2023, revealed the following: Policy: The skilled nurse (SN) is to complete a wound record and wound is to be measured on admission, weekly...and when there is a significant change in wound condition, whether improved or deteriorated, or on the first visit following any surgical intervention to the wound. Purpose: To keep accurate record of the wound condition which will also prompt nursing to note improvement or deterioration of the wound. Procedure...2. The wound care sheet and measuring of all wounds will also be completed weekly...4. SN to obtain wound pictures on SOC, ROC (Resumption of Care) or if there is a deterioration of the wound. On May 15, 2023 at approximately 2:46 PM, review of the agency policy titled "Peripherally Inserted Central Catheter (PICC) Line", which was received via email on 05/15/2023, revealed the following: Purpose...To maintain patency of the PICC... Procedure...6. The RN (Registered Nurse) must measure arm circumference and length of catheter exposed weekly with dressing change. These measurements must be documented in the EMR (Electronic Medical Record). Patient #3: Between May 11, 2023 at approximately 9:56 AM and May 12, 2023 at approximately 1:17 PM, review of the clinical record revealed the start of care date was 04/29/2023, the primary diagnosis is encounter for surgical aftercare following surgery of the circulatory system and that SN interventions included the following as documented on the "Home Health Certification and Plan of Care" for the initial certification period of 04/29/2023 through 06/27/2023: SN to observe and assess integumentary (skin) status to identify changes and intervene to minimize complications. Review of the SOC "Visit Note Report" dated 04/29/2023 revealed there were three (3) scabbed areas present on the sternal (chest) incision and that there were no open areas. Review of the "Visit Note Report" dated 05/08/2023 revealed the RN (Employee #1) documented a "pinpoint" open area was now present at the bottom of the sternal incision. Review of physician order documentation dated 05/11/2023 revealed the following wound care is to be provided to the sternal wound: Cleanse with soap and water, pat dry, cover with dry sterile dressing (DSD) and secure with tape daily. Review of the "Visit Note Report" dated 05/11/2023 revealed the sternal wound measured 0.3 centimeters (cm) by 0.3 cm by 0.1 cm (length (L) by width (W) by depth (D)) and that the RN (Employee #1) provided the above referenced wound care. There was no documentation in the clinical record which provided evidence that the RN (Employee #1) measured the length, width and depth of the new sternal wound on 05/08/2023. On May 12, 2023 at approximately 1:50 PM, review of "QI Event Report" documentation revealed a complaint was reported by the family member of patient #10 on 11/29/2022. Patient #10 (Discharge): On May 12, 2023 between the approximate times of 11:42 AM and 2:55 PM, review of the clinical record revealed the start of care date was 08/13/2022, the diagnoses included pressure ulcer of the left heel, stage 2 (open) and pressure ulcer of right heel, stage 1, that skilled nursing (SN) was to provide wound care to the left and right heels and that SN goals included the following as documented on the "Home Health Certification and Plan of Care" for the recertification period of 10/12/2022 through 12/10/2022: Wound status will improve as evidenced by decrease in size, drainage, absence of infection and decreased pain by end-of-episode. Review of "Complaint Report" documentation dated 11/29/2022 revealed the following: A registered nurse (RN-Employee #14) reported that the family member of patient #10 was dissatisfied with the wound care being provided by the agency. During a telephone call with the Supervising RN (Employee #12), the family member reported dissatisfaction with wound care was related to the cost the patient would incur to have a skin graft of the heel and that the family member felt that SN was responsible for the wound deterioration. Review of "Visit Note Report" documentation revealed the following: -Right Heel: Measured 1.0 cm by 1.0 cm by 0.2 cm on 0816/2022 and 4.0 cm by 2.0 cm by 0 cm on 08/30/2022. -Left Heel: Wound was activated on 09/22/2022. Review of the recertification "Visit Note Report" dated 10/10/2022 revealed the patient refused wound measurements because wound care was not due to be performed but the RN (Employee #14) documented that the "wound score shows a digression in wound healing" (deterioration). Review of "Visit Note Report" documentation for the recertification period of 10/12/2022 through 12/10/2022 revealed the following: -10/12 and 10/19/2022: The RN (Employee #15) provided wound care to the bilateral (both) heel wounds and the appearance of the heel wounds was assessed by the RN. (Physician order documentation dated 10/17/2022 revealed oral (by mouth) antibiotic treatment was ordered effective 10/16/2022 due to infection of the left heel wound. -10/21 and 10/25/2022: The RN (Employee #15) provided wound care to the right heel wound and the appearance of the right heel wound was assessed by the RN. On 10/25/2022, the RN documented the wound score had improved. (Physician order documentation dated 10/21/2022 revealed wound care was discontinued to the left heel wound due to placement of a non-removable dressing.) -Corresponding "Visit Note Reports" revealed wound measurements were due on 10/12, 10/19 and 10/25/2022 and that the RN (Employee #15) documented a response of "Yes" for the question "Were wound measurements obtained?". -A comprehensive assessment was performed by the RN (Employee #15) on 10/28/2022. (Review of physician order documentation dated 10/28/2022 revealed updated SN orders were obtained due to a significant change in patient condition and that the right heel diagnosis was downgraded from a State 1 to a Stage 2 pressure ulcer.) There was no documentation in the clinical record which provided evidence that the RN (Employee #15) assessed the length, width and depth of the right heel wound on 10/12, 10/19, 10/21, 10/25 nor 10/28/2022 as the RN documented that wound measurements were not obtained due to being unable or not due. There was no documentation in the clinical record which provided evidence that the RN (Employee #15)) assessed the length, width and depth of the right heel wound on 10/12 and 10/19/2022 as the RN documented that wound measurements were not obtained due to being unable. During telephone interview conducted on May 12, 2023 at approximately 2:54 PM, the RN (Employee #15) reported that wound measurements could not be obtained due to discomfort experienced by the patient during the wound care process and because of the physical limitations of the RN. The RN reported that photographs of the heel wounds were obtained because of the inability to measure the heel wounds when wound care was provided by the RN. On May 12, 2023 at approximately 2:55 PM, review of undated photographs revealed an open area was present on a heel and that second open area was present on an unlabeled body part. There was no documentation in the clinical record which provided evidence that wound measurements were obtained as per the aforementioned agency policy/procedure. Patient #11: On May 12, 2023 at approximately 1:25 PM, review of the clinical record revealed the start of care date was 09/16/2022 and that the diagnoses included encounter for aftercare for surgical amputation and non-pressure chronic ulcer of other part of right foot with necrosis (dead) of bone as documented on the "Home Health Certification and Plan of Care" for the recertification period of 03/15/2023 through 05/13/2023. Review of resumption of care (ROC) orders dated 04/22/2023 revealed SN was to provide PICC line maintenance and care and that SN goals included for the patient to be free of infusion (intravenous) device complications throughout therapy. Review of "Visit Note Report" documentation for the current recertification period revealed the following: -04/25/2023: PICC line dressing change was performed by the RN (Employee #11) but the circumference of the right upper arm in which the PICC line was inserted was not measured. -05/01/2023: PICC line dressing change was performed by the RN (Employee #5) but the circumference of the right upper arm was not measured. -05/01/2023: PICC line dressing change was performed by the RN (Employee #5) but the circumference of the right upper arm was not measured nor was the measurement of the external length of the PICC line completed. During interview conducted on May 12, 2023 at approximately 4:20 PM, the Administrator and Supervising RN confirmed there was no documentation in the clinical records which provided evidence that wound measurements were obtained and PICC line assessment was performed as per agency policies/procedures for the above identified patients.