Every finding on record at Homemaker Service of the Metropolitan Area, Inc.

Based on the findings of an onsite unannounced Medicare recertification, and state relicensure survey completed January 21, 2022, Homemaker Service of Metropolitan Area 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 onsite unannounced home health agency Medicare recertification survey conducted on January 21, 2022, Homemaker Service of the Metropolitan Area, Inc. was identified to have the following standard level deficiencies that was determined to be in substantial compliance with the following requirement(s) of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on personnel file review, facility policy, interview with Administration, it was determined that the administrator failed to conduct performance evaluations and/or staff in-service education for four, (4), of ten, (10), Personnel Files, (PF), reviewed. (PF #3, 4, 6, and 10). On January 21, 2022 at approximately 2:45 p.m., a review of a second Agency Policy titled, "Contract Personnel," revealed on line 14, that "Contract personnel utilized by the agency shall be periodically evaluated by a qualified supervisor. In the event that the contract for services is with a professional group, rather than an individual, proof of an annual performance evaluation from the practicing supervisor shall be submitted to the agency and will be accepted to meet the requirements of this policy." On January 21, 2022 at approximately 2:50 p.m. a review of the Agency Policy, titled "In-Service Education/Staff Development," Subtitled, "Policy," revealed that, "In-service training or continued education programs will be provided and documented for employees....Special Instructions: All staff members providing direct Client Care will attend in-service education programs annually." On January 21, 2022 at approximately 10:50 a.m. a review for PF#3 revealed a Physical Therapist under contract since March 9, 2018. A further reviewed revealed no evidence that annual performance evaluation from the practicing supervisor had been submitted to the agency, or documentation that an in-service education program had been conducted annually through years 2019, 2020, and 2021. On January 21, 2022 at approximately 11:00 a.m. a review for PF#4 revealed a Physical Therapist under contract since July 7, 2016. A further reviewed revealed no evidence that annual performance evaluation from the practicing supervisor had been submitted to the agency, or documentation that an in-service education program had been conducted annually through years 2018, 2019, 2020, and 2021. On January 21, 2022 at approximately 11:20 a.m. a review for PF#6 revealed a Physical Therapist under contract since September 20, 2020. A further reviewed revealed no evidence that annual performance evaluation from the practicing supervisor had been submitted to the agency, or documentation that an in-service education program had been conducted annually through year 2021. On January 21, 2022 at approximately 11:00 a.m. a review for PF#10 revealed a Registered Nurse, hired under a retainer agreement since August 8, 2006. A further reviewed revealed no evidence that annual performance evaluation from the practicing supervisor had been submitted to the agency, or documentation that an in-service education program had been conducted annually from year 2006 through 2021. An interview with the Administrator and Clinical Director conducted on January 21, 2022 at approximately 3:00 PM confirmed that annual performance evaluations had not been submitted to the agency as per policy, and that in-service education programs had not been documented annually.

Ensures qualified pre-designated person CFR(s): 484.105(b)(2) When the administrator is not available, a qualified, pre-designated person, who is authorized in writing by the administrator and the governing body, assumes the same responsibilities and obligations as the administrator. The pre-designated person may be the clinical manager as described in paragraph (c) of this section. This ELEMENT is not met as evidenced by: Based on an interview with the clinical director, a review of the home health agency’s organizational chart and a review of Governing Body minutes, the home health agency failed to identify in writing who is authorized by the administrator and the Governing Body to assume the same responsibilities and obligations as the administrator. Findings include: In an interview the Clinical Director on January 21, 2022 at approximately 11:00 AM, the Clinical Director (who was hired on October 20, 2020), stated that in the absence of the administrator, she would assume the same responsibilities and obligations as the administrator. A review of the home health agency’s Organizational Chart on January 21, 2022 at approximately 11:30 AM did not contain any reference to an Alternate Administrator. On January 21, 2020 at approximately 12:00 PM, a review of the Governing Body Meeting Minutes for 10/21/2020 and 06/23/2021 found that neither sets of minutes contained written evidence of any individual authorized to assume the same responsibilities and obligations as the administrator, in the absence of same. There was no further evidence, authorized in writing by the administrator and the Governing Body, of the identification of an alternate administrator. An interview with the Administrator and Clinical Director conducted on January 21, 2022 at approximately 3:00 PM confirmed the above findings.

Clinical manager CFR(s): 484.105(c) Standard: Clinical manager. One or more qualified individuals must provide oversight of all patient care services and personnel. Oversight must include the following-- This STANDARD is not met as evidenced by: Based on an interview with the clinical director, a review of the home health agency’s Organizational Chart, and a review of a “Consulting Retainer Agreement,” the agency failed to provide evidence of a qualified individual who could assume responsibilities in the absence of the clinical director. Findings include: In an interview with the Clinical Director on January 21, 2022 at approximately 11:00 AM, the Clinical Director noted that the home health agency maintains a contractual arrangement with another registered nurse to assume responsibilities in the absence of the Clinical Director. A review of the home health agency’s Organizational Chart on January 21, 2022 at 11:30 AM did not contain reference to an alternate to serve in the absence of the clinical director. A review of a “Consulting Retainer Agreement” on January 21, 2022 at 1:00 PM between the Home Health Agency (Client) and another Registered Nurse, with a start date of January 1, 2020 and a “program duration” date of June 30, 2020 stated, “the client wishes to retain the services of the RN to provide services as Interim Clinical Director.” The agreement was not signed by the RN. An addendum to the “Consulting Retainer Agreement” was issued and intended to continue to “retain the services of the RN to provide services as Interim Clinical Director until a permanent Clinical Director is hired.” The addendum was not signed by either the home health agency nor the RN. The start date of the addendum was June 30, 2020 with a “program duration” of “until a permanent full-time Clinical Director is hired.” The permanent full time clinical director was hired in October, 2020. There was no further evidence provided by the home health agency to support that the RN would continue in an alternate capacity or that any other RN would be assigned as an alternate in the absence of the clinical director. An interview with the Administrator and Clinical Director conducted on January 21, 2022 at approximately 3:00 PM confirmed the above findings.

Must have a written agreement CFR(s): 484.105(e)(2)(i-iv) An HHA must have a written agreement with another agency, with an organization, or with an individual when that entity or individual furnishes services under arrangement to the HHA's patients. The HHA must maintain overall responsibility for the services provided under arrangement, as well as the manner in which they are furnished. The agency, organization, or individual providing services under arrangement may not have been: (i) Denied Medicare or Medicaid enrollment; (ii) Been excluded or terminated from any federal health care program or Medicaid; (iii) Had its Medicare or Medicaid billing privileges revoked; or (iv) Been debarred from participating in any government program. This ELEMENT is not met as evidenced by: Based on an interview with the clinical director and a review of agency staffing contracts, the home health agency failed to maintain written agreements with other agencies that furnish services under arrangement to the home health agency's patients. Findings include: Three (3) written contracts related to the provision of clinical services were reviewed on January 21, 2022 starting at approximately 12:00 PM. The agreement “Staffing Plus,” which provides contracted staffing services for registered nurses, licensed practical nurses, certified nursing assistants, physical therapists, occupational therapists, physical therapy assistants, and certified occupational therapy assistants, was executed on 06/22/2016. The contract did not contain language pertaining to the term of the contact, nor was there language in the contract that it was an automatically renewable contract after the first year. The home health agency failed to maintain a current written agreement with the contractor meant to furnish services under arrangement to the home health agency's patients. The agreement “Agewell PT,” which provides contracted staffing services for physical therapists and occupational therapists, was executed on 12/28/2020. The contract did not contain language pertaining to the term of the contact, nor was there language in the contract that it was an automatically renewable contract after the first year. The home health agency failed to maintain a current written agreement with the contractor meant to furnish services under arrangement to the home health agency's patients. The agreement “Rehab Solutions,” which provides contracted staffing services for physical therapists and occupational therapists, was executed on 08/01/2017. The contract was not signed by a representative of the staffing agency. The signature line was blank. The home health agency failed to maintain a fully executed written agreement with the contractor meant to furnish services under arrangement to the home health agency's patients. An interview with the Administrator and Clinical Director conducted on January 21, 2022 at approximately 3:00 PM confirmed the above findings.