Every finding on record at Human Touch Home Health Care Agency, Inc

An unannounced Home Health Agency recertification survey was conducted on May 20 -22, 2024 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 Medicare/Medicaid Home Health Recertification survey was conducted at the above noted agency May 20-22, 2024 by two (2) Medical Facilities Inspectors from the Office of Licensure and Certification, Virginia Department of Health. 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. Deficiencies were identified and cited in this report.

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 clinical record review, agency procedure and staff interview, it was determined the agency failed to ensure accurate and complete medication lists were documented in one (1) of two (2) clinical records reviewed in the survey sample that required PICC (catheter inserted through a peripheral vein to deliver medications) line flushes (Clinical record for Patient #6). Findings: The clinical record for Patient #6 was reviewed for the period of April 02, 2024 to May 22, 2024. The plan of care contained orders for a PICC to the right arm with antibiotics to be delivered. The clinical record also contained skilled nursing notes of the PICC flushed with saline and heparin. On May 22, 2024 the Medical Facilities Inspector (MFI) asked the Administrator if the agency had orders or a procedure for PICC usage. The Administrator provided the MFIs (Medical Facilities Inspector) with the agency’s procedure titled “Infusion Therapy-PICC”. The procedure contained equipment to include: 10-20 ml normal saline and Heparin solution (100 units/ml or as prescribed). The medication list was reviewed and did not contain the above medications flushed through the PICC. The failure to update the patient's medication profile was reviewed with the Administrator prior to and during the exit conference on May 22, 2024.

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 a review of clinical records and staff interview it was determined the agency staff failed to ensure a plan of care contained an order for weekly labs to be drawn from a PICC (catheter inserted through a peripheral vein to deliver medications) line with its routine maintenance as ordered by the physician for one (1) of two (2) patients in the survey sample whom had a PICC line (Clinical record for Patient #6). Findings: The clinical record for Patient #6 was reviewed for the period of April 02, 2024 to May 22, 2024. The clinical record contained skilled nursing notes of weekly labs drawn beginning on the start of care. On May 21, 2024 the Medical Facilities Inspector (MFI) asked the Administrator if the agency had orders for weekly labs to be drawn. The Administrator revealed a nurse had the order in another document and had not been uploaded into the electronic records. The patient’s orders were reviewed and did not contain the above weekly lab blood draws. The failure to update the patient's orders in the electronic records was reviewed with the Administrator prior to and during the exit conference on May 22, 2024.

An unannounced Medicare/Medicaid Home Health recertification survey was conducted at the above noted agency on 01/11-14/2021 by two (2) Medical Facilities Inspectors from 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 in compliance with 42 CFR 484.102 Conditions of Participation Emergency Preparedness for Home Health Agencies revised 02/21/20. No deficencies were cited.

An unannounced Home Health Recertification survey was conducted 01/11-14/2021 at the above noted agency by two (2) Medical Facilities Inspectors (MFI) from The Office of Licensure and Certification (OLC), Virginia Department of Health. The agency identified 663 unduplicated admissions in the last twelve months. The agency operates no branches or drop sites. In conjunction with the survey the following were reviewed: Thirteen (13) clinical records, seven (7) personnel files, an admission package for patients, the complaint log for the last two years, select policies and procedures, and the infection control program to include information specific to the COVID-19 pandemic. Multiple interviews were conducted. Five (5) home visits were completed. The agency was found not to be in compliance with the federal requirements of 42 CFR 484, Conditions of Participation for Home Health Agencies, (Revised 02/21/2020).

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 may choose to include. This ELEMENT is not met as evidenced by: Based on staff interview and document review, it was determined the agency failed to ensure all patients' individualized plans of care contained the required information. Specifically, the care plans failed to include goals identified by the patient in thirteen (13) of thirteen (13) clinical records reviewed in the survey sample. Clinical records #1-13. Findings: Thirteen (13) clinical records were reviewed in the agency 01/11-14/2021 with the following findings: 1. The Medical Facilities Inspector (MFI) reviewed patient #1's clinical record for the certification period of 01/05/2021-03/05/2021. Patient #1's Plan of Care (POC) failed to contain documentation of any patient-stated goals for the period reviewed. 2. The MFI reviewed patient #2's clinical record for the certification period of 11/30/2020-01/28/2021. Patient #2's POC failed to contain documentation of any patient-stated goals for the period reviewed. 3. The MFI reviewed patient #3's clinical record for the certification period of 12/29/2020-02/26/2021. Patient #3's POC failed to contain documentation of any patient-stated goals for the period reviewed. 4. The MFI reviewed patient #4's clinical record for the certification period of 12/15/2020-02/12/2021. Patient #4's POC failed to contain documentation of any patient-stated goals for the period reviewed. 5. The MFI reviewed patient #5's clinical record for the certification period of 12/15/2020-02/12/2021. Patient #5's POC failed to contain documentation of any patient-stated goals for the period reviewed. 6. The MFI reviewed patient #6's clinical record for the certification period of 09/01/2020-10/30/2020. Patient #6's POC failed to contain documentation of any patient-stated goals for the period reviewed. 7. The MFI reviewed patient #7's clinical record for the certification period of 01/05/2021-03/05/2021. Patient #7's POC failed to contain documentation of any patient-stated goals for the period reviewed. 8. The MFI reviewed patient #8's clinical record for the certification period of 10/05/2020-12/08/2020. Patient #8's POC failed to contain documentation of any patient-stated goals for the period reviewed. 9. The MFI reviewed patient #9's clinical record for the certification period of 11/18/2020-01/16/2021. Patient #9's POC failed to contain documentation of any patient-stated goals for the period reviewed. 10. The MFI reviewed patient #10's clinical record for the certification period of 11/18/2020-01/16/2021. Patient #10's POC failed to contain documentation of any patient-stated goals for the period reviewed. 11. The MFI reviewed patient #11's clinical record for the certification period of 11/27/2020-01/25/2021. Patient #11's POC failed to contain documentation of any patient-stated goals for the period reviewed. 12. The MFI reviewed patient #12's clinical record for the certification period of 12/05/2020-02/02/2021. Patient #12's POC failed to contain documentation of any patient-stated goals for the period reviewed. 13. The MFI reviewed patient #13's clinical record for the certification period of 11/15/2020-01/13/21. Patient #13's POC failed to contain documentation of any patient-stated goals for the period reviewed. The agency's policy related to care planning was reviewed on 01/14/2021 and failed to address the need for patient-stated goals on the plan of care. An interview was conducted with the Director of Nursing on 01/13/2021 at 3:00 PM. The Director of Nursing confirmed that the plans of care did not contain patient stated goals. The Director of Nursing stated, "I didn't realize those needed to be on there." The Corporate Director of Nursing and the Director of Nursing again acknowledged the above noted care plan deficiency during the exit conference on 01/14/2021.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on staff interview and document review it was determined the agency failed to ensure that the home health aide (HHA) provided services according to the written plan of care developed by the skilled nurse or other appropriate professional in two (2) of two (2) clinical records of patients who were receiving home health aide services in survey sample. Clinical records #11 and 13. Findings: Thirteen (13) clinical records were reviewed in the agency on 01/11-14/2021 with the following findings: 1. The clinical record for patient #11 contained documentation of a home health aide plan of care developed by the registered nurse and dated 12/08/2020. According to the plan of care the patient was to receive home health aide services one to two times a week for four weeks. According to the HHA plan of care the aide was to perform the following tasks: apply and remove ace wraps [the care plan failed to include documentation of what part of the body the ace wraps were to be applied]; partial sponge bath, complete sponge bath, shampoo hair, and apply lotion. All of these tasks were marked with a frequency of "as needed". The aide care plan failed to delineate when these tasks would need to be performed or who would be responsible for determining if the task was needed on a particular visit. 2. The clinical record for patient #13 contained documentation of a home health aide plan of care developed by the registered nurse and dated 11/12/2020. According to the plan of care the aide was to remind patient to take medications "every visit as needed;" shower the patient 1-3 times per week as needed; and shampoo the patient's hair every other week as needed. The aide care plan failed to delineate when these tasks would need to be performed or who would be responsible for determining if the task was needed on a particular visit. The home health aide documented that they removed or applied the patient's ace wraps on 11/16/2020, 11/23/2020, 11/30/2020, 12/03/2020, 12/07/2020, 12/14/2020, and 12/21/2020. Applying and removing ace wraps were not a task documented in the care plan for the aide. An interview was conducted with the Corporate Director of Nursing (staff member #2) on 01/13/2021 regarding the home health aides plans of care. Staff member #2 stated the agency was aware of the issue and was in the process of switching electronic medical record programs to help with aide care plan documentation. The lack of documentation regarding the home health aide providing care according to the care plan was acknowledged by the Director of Nursing and Corporate Director of Nursing on 01/14/2021 during the exit conference.