Every finding on record at Hometown Care LLC

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 11/15/21, Community Caregivers of Cuyahoga Falls is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

PARTIAL EXTENDED RECERTIFICATION SURVEY The following deficiencies are issued as a result of the partial extended recertification survey completed on 11/15/21. Community Caregivers of Cuyahoga Falls 368447, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the agency failed to identify duplicate drug therapy during medication review for one of seven patients reviewed (Patient #3). This could affect all patients receiving services from the agency. The agency census was 118. Findings include: Review of the medical record for Patient #3 and the medication profile, last updated 09/09/21, revealed Diphenhydramine HCL (Benadryl) 25 milligrams (mg) 1-2 tablets every 4-6 hours as needed for allergies and itching and Diphenhydramine HCL (Banophen) 25mg one capsule twice a day for allergies. Per interview on 11/09/21 at 3:58 PM Staff C confirmed this duplicate medication had not been identified.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure patients received services as written in the plan of care for three of seven patients reviewed (Patient #3, #6 and #7). This could affect all patients receiving services from the agency. The agency census was 118. Findings include: 1. Review of medical record for Patient #3 and the physician ordered plan of care dated 09/14/21 revealed the HHA was to assist with personal care up to 14 hours per week. Review of HHA visit sheets from 09/14/21 to 10/23/21 revealed no evidence HHA visits had been made the weeks of 09/26/21 and 10/03/21. There was no documentation the physician had been notified services were not provided as ordered. Per interview on 11/09/21 at 4:38 PM Staff C confirmed this finding and stated he/she was unaware that the HHA missed visits needed to be reported to the physician. 2. Review of medical record for Patient #6 and the physician ordered plan of care dated 08/17/21 revealed the home health aide (HHA) was to provide services up to two hours per week. Review of the HHA visit sheets from 08/17/21 to 08/25/21 revealed the HHA worked five hours the weeks of 08/17/21 and 08/23/21. There was no documentation the physician had been notified of the change in plan of care. 3. Review of medical record for Patient #7 and the physician ordered plan of care dated 08/11/21 revealed Physical Therapy (PT) was to evaluate and treat. Review of therapy notes and visits lacked documentation that PT did an evaluation and plan of care for treatment as ordered. Per interview on 11/10/21 at 2:15 PM Staff B confirmed PT had not started yet and there was no order for the delay in PT service and confirmed the physician had not been notified.

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 record review and staff interview, the agency failed to ensure the individualized plan of care included the frequency and duration of visits to be made for five of seven patients reviewed (Patient #1, #2, #3, #5, #6). The agency census was 118. Findings include: Review of agency policy titled, “Plan of Care CMS #485 and Physician’s Orders” revised 03/2019, revealed the individualized Plan of Care must include the frequency and duration of visits to be made. 1. Review of medical record for Patient #1 and the physician ordered plan of care dated 09/12/21 revealed the home health aide (HHA) was to assist with activities of daily living (ADL's) up to 14 hours per week. The physician ordered plan of care did not include the frequency or duration of the HHA visits. 2. Review of medical record for Patient #2 and the physician ordered plan of care dated 11/07/21 revealed the HHA was to assist with personal care and ADL’s each visit. The physician ordered plan of care did not include the frequency or duration of the HHA visits. 3. Review of medical record for Patient #3 and the physician ordered plan of care dated 09/14/21 revealed the HHA was to provide services up to 14 hours per week. The physician ordered plan of care did not include the frequency or duration of the HHA visits. 4. Review of medical record for Patient #5 and the physician ordered plan of care dated 09/19/21 revealed the HHA was to assist with ADL's/personal care. The physician ordered plan of care did not include the frequency or duration of the HHA visits. 5. Review of medical record for Patient #6 and the physician ordered plan of care dated 08/17/21 revealed the HHA was to assist with ADL's up to two hours per week. The physician ordered plan of care did not include the frequency or duration of the HHA visits. Per interview on 11/09/21 Staff C confirmed there were no frequencies or durations of the HHA visits specified on the physician ordered plans of care.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure home health aides provided services included in the plan of care for one of five patients reviewed who were receiving home health aide services (Patient #5). The total sample was seven. The agency census was 118. Findings include: Review of the medical record for Patient #5 and the physician ordered plan of care dated 09/19/21 revealed the HHA was to assist with ADL's/personal care. Review of aide visit sheets from 09/22/21 to 10/20/21 revealed no evidence that personal care was provided on 09/22/21, 09/24/21, 09/29/21, 10/01/21, 10/06/21, 10/08/21, 10/13/21 and 10/20/21. Per interview on 11/09/21 at 4:38 PM Staff C confirmed the findings.