Every finding on record at Interim Healthcare Services of NE PA, Inc.

Based on the findings of an unannounced, onsite Medicare recertification survey conducted April 23 through April 26, 2024, Interim Healthcare Services of NE PA, 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 April 23 through April 26, 2024, Interim Healthcare Services of NE PA, 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. The Medicare recertification survey was conducted for the Blakely parent office on April 23, 25 and 26, 2024 and for the Honesdale branch office on April 24, 2024.

Treatments and therapy services CFR(s): 484.60(e)(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services. This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures, documentation and clinical records and observation, and based on interview with the Director of Healthcare Services (DHCS-Employee #9), Quality Coordinator (QC-Employee #18) and Alternate Administrator (Employee #17), the agency failed to ensure written instructions regarding the type of treatments to be performed by skilled nursing (SN) were provided to two (2) of two (2) patients for whom wound care orders were included on the "Home Health Certification and Plan of Care" and for whom the admission folder/booklet was available for review. (Patients #4 and #5) Finding include: On April 26, 2024 at approximately 3:47 PM, review of the agency policy titled "Implementing the Plan of Care/Service Plan" revealed the following under "Policy": Interim Healthcare...provides...resources to achieve the care/services goals or outcomes. Patient #4: On April 25, 2024 at approximately 2:40 PM, review of the clinical record revealed SN is to provide the following wound treatment to the right and left lower extremities (legs) as documented on the "Home Health Certification and Plan of Care" for the initial certification period of April 12 through June 10, 2024: Cleanse/irrigate with normal saline solution (NSS), apply calcium alginate (wound treatment) to wound bed, moisturizer to peri-wound (area surrounding the wound), cover with ABD (thick wound dressing) and kerlix (gauze wrap) three (3) times a week and as needed. SN to perform wound care until patient/caregiver independent. During home visit conducted on April 25, 2024 at approximately 8:30 AM, the SN (Employee #3) provided wound care to the right and left leg wounds. During the home visit, review of the patient admission booklet/folder and the agency message/whiteboard revealed there was no documentation which provided evidence instructions regarding the above referenced wound care had been provided to the patient in writing. Patient #5: On April 25, 2024 at approximately 3:02 PM, review of the clinical record revealed SN is to provide the following wound treatment to the coccyx (tailbone) wound as documented on the "Home Health Certification and Plan of Care" for the initial certification period of March 19 through May 17, 2024: Cleanse/irrigate with NSS or soap and water, apply Desitin (moisture barrier cream) and apply Allevyn (self-adhesive wound dressing) every 3 days and as needed for soiling and dislodgement. During home visit conducted on April 25, 2024 at approximately 9:20 AM, the SN (Employee #4) provided wound care to the coccyx wound. During the home visit, review of the patient admission booklet/folder revealed there was no documentation which provided evidence instructions regarding the above referenced wound care had been provided to the patient in writing. During interview on April 26, 2024 at approximately 4:05 PM the DHCS, QC and the Alternate Administrator confirmed written instructions for the above referenced wound care had not been provided to the above identified patients. (Deficiency previously cited during April 2021 Medicare recertification survey.)

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on review of agency policies and procedures, clinical records and personnel files, tuberculosis (TB) screening guidance from the Centers for Disease Control (CDC), and based on interview with the Director of Healthcare Services (DHCS)-Employee #9), Quality Coordinator (QC-Employee #18) and the Alternate Administrator (Employee #17), the agency failed to ensure a TB risk assessment form was completed upon hire for eight (8) of eight (8) employees hired after April 23, 2021. (Employees #1, #5, #7, #10, #11, #12, #13 and #14) Finding include: On April 26, 2024 at approximately 3:45 PM, review of the agency policy titled "Tuberculosis (TB) Prevention and Surveillance" revealed the following under "Purpose": To establish TB prevention, surveillance and early detection for employees at risk for occupational exposure to TB... On April 26, 2024 at approximately 4:01 PM, review of the CDC webpage (https://www.cdc.gov/tb/topic/infectioncontrol/healthcarepersonnel-faq.htm) titled "Frequently Asked Questions" revealed the following under "Which health care personnel should be screened for TB?": CDC and the National TB Controllers Association (NTCA) recommend that all U.S. health care personnel be screened for TB upon hire (i.e., pre-placement). Pre-placement screening should include a TB risk assessment, a TB symptom screen, and a TB test. These recommendations should be used for people who work or volunteer in health care settings, including... home-based health care...settings... On April 26, 2024 at approximately 12:04 PM, review of the agency employee TB screening form revealed the bottom portion of the TB screening form included a TB risk (symptom) screen and an area to document TB skin testing. There was no documentation which provided evidence the employee TB screening form included a TB risk assessment. Patient #1 (Branch Office): On April 24, 2024 at approximately 1:00 PM, review of the clinical record revealed a registered nurse (RN-Employee #1) and an occupational therapist (OT-Employee #12) provided patient care in April 2024. Patient #2 (Branch Office): On April 24, 2024 at approximately 1:30 PM, review of the clinical record revealed a physical therapist (PT-Employee #2) and a home health aide (HHA-Employee #14) provided patient care in April 2024. Patient #6: On April 26, 2024 at approximately 10:12 AM, review of the clinical record revealed a HHA (Employee #5) provided patient care in April 2024. Patient #8: On April 26, 2024 at approximately 10:51 AM, review of the clinical record revealed PT (Employee #7) provided patient care in April 2024. Patient #14 (Discharge): On April 26, 2024 at approximately 1:38 PM, review of the clinical record revealed a licensed practical nurse (LPN-Employee #13) provided patient care in January 2024. Between April 19, 2023 at approximately 2:07 PM and April 20, 2023 at approximately 10:01 AM, review of personnel file documentation revealed the following: Employee #1: The date of hire of the RN was 09/26/2023. Employee #5: The date of hire of the HHA was 06/12/2023. Employee #7: The date of hire of the PT was 06/13/2023. Employee #10: The date of hire of the RN/Clinical Manager was 07/31/2023. Employee #11: The date of hire of the RN/Clinical Manager was 08/30/2021. Employee #12: The date of hire of the OT was 09/07/2023. Employee #13: The date of hire of the LPN was 08/10/2023. Employee #14: The date of hire of the HHA was 09/06/2023. There was no documentation in the above referenced personnel files which provided evidence a TB risk assessment form was completed upon hire. During interview conducted on April 26, 2024 at approximately 4:05 PM, the DHCS, QC and Alternate Administrator confirmed there was no documentation in the above referenced personnel files which provided evidence that the above identified employees completed a TB risk assessment upon hire.

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 the review of an agency procedure manual and clinical records, and based on interview with Director of Healthcare Services (DHCS-Employee #9), the Quality Coordinator (QC-Employee #18) and the Alternate Administrator (Employee #17), the agency failed to ensure peripherally inserted central catheter (intravenous inserted into a vein in the upper arm) assessment was completed per agency policy and procedure for two (2) of two (2) patients. (Patients #11 and #12) Findings include: On April 26, 2024 at approximately 3:34 PM, review of agency procedure included in the Elsevier manual revealed the following under Chapter 29 "Intravenous and Vascular Access Therapy": Page 892: Insertion sites require regular inspection for early...signs and symptoms of IV related complications...measurements of external catheter length provides comparison...arm measurement... Page 896 (PICC removal): Inspect catheter for intactness especially along the tip and that length is appropriate for device... Patient #11 (Discharge): On April 26, 2024 at approximately at approximately 12:09 PM revealed skilled nursing (SN) was to maintain and provide care to the PICC line as documented on the "Home Health Certification and Plan of Care" for the initial certification period of March 27 through May 25, 2024. Review of the start of care (SOC) SN visit note dated 03/27/2024 revealed a PICC line was present in the right upper extremity (arm) and that a registered nurse (RN-Employee #15) changed the PICC line dressing. There was no documentation on the SOC SN visit note which provided evidence the RN assessed right upper arm circumference nor the external length of the PICC line. Review of the SN visit note dated 04/03/2024 revealed the RN (Employee #16) discontinued (removed) the PICC line. There was no documentation on the SN visit note which provided evidence the RN assessed the PICC length after removal. Patient #12: On April 26, 2024 at approximately at approximately 12:48 PM revealed SN was to maintain and provide care to the PICC line as documented on the "Home Health Certification and Plan of Care" for the initial certification period of March 30 through May 28, 2024. Review of the SOC SN visit note dated 03/30/2024 revealed a PICC line was present in the left upper extremity. There was no documentation on the SOC SN visit note which provided evidence the RN (Employee #15) assessed left upper arm circumference. During interview conducted on April 26, 2024 at approximately 4:05 PM, the DHCS, QC and the Alternate Administrator confirmed there was no documentation in the clinical records which provided evidence that PICC line assessment was performed as per agency procedures for the above referenced patients.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures, documentation and clinical records and observation, and based on interview with the Director of Healthcare Services (DHCS-Employee #9), Quality Coordinator (QC-Employee $18) and the Alternate Administrator (Employee #17), the agency failed to ensure a registered nurse (RN) performed an onsite supervision of the home health aide (HHA) every 14 days for two (2) of four (4) patients for whom HHA services were provided for more than 14 days. (Patients #3 and #13) Finding include: On April 26, 2024 at approximately 3:48 PM, review of the agency policy titled "Supervision of Employees Who Provides Patient/Client Care/Services" revealed the following under "Policy": Employee supervisory visits are conducted in accordance with applicable law, regulation...by designated, qualified supervisors. Patient #3 (Branch Office): On April 24, 2024 at approximately 2:18 PM, review of the clinical record revealed a registered nurse (RN) developed/established the HHA plan of care (POC) on 03/25/2024. Review of HHA visit note documentation revealed HHA services were provided one (1) to two (2) times a week during the weeks beginning on 03/25, 04/01 and 04/15/2024. Review of skilled nursing (SN) visit note documentation revealed SN services were provided two (2) times a week between 03/25/2024 and 04/19/2024 and that a RN performed a HHA supervisory visit on 03/28/2024. There was no documentation in the clinical record which provided evidence an RN performed on onsite visit to supervise HHA services after 03/28/2024. Patient #13: On April 26, 2024 at approximately 1:26 PM, review of the clinical record revealed a registered nurse (RN) developed/established the HHA POC on 04/02/2024. Review of HHA visit note documentation revealed HHA services were provided one (1) to two (2) times a week between 04/02/2024 and 04/23/2024. Review of skilled nursing (SN) visit note documentation revealed SN services were provided one (1) to two (2) times a week between 04/01/2024 and 04/16/2024. There was no documentation in the clinical record which provided evidence a RN performed on onsite visit to supervise HHA services on 04/16/2024. During interview on April 26, 2024 at approximately 4:05 PM the DHCS, QC and the Alternate Administrator confirmed there was no documentation in the clinical record which provided evidence a RN performed an onsite visit to supervise the HHA every 14 days for the above identified patients.

Based on the findings of an unannounced onsite Medicare recertification survey conducted April 20 through April 23, 2021, Interim Healthcare Services of NE PA, 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 Medicare recertification survey conducted April 20 through April 23, 2021, Interim Healthcare Services of NE PA, 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.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures, clinical records and verbal order guidance from the Pennsylvania Department of Health (PA DOH), and based on interview with the home care supervisor and the alternate administrator, the agency failed to ensure a physician's counter-signature for the physician orders included on the "Home Health Certification and Plan of Care" had been obtained within 30 days for five (5) of eight (8) patients for whom more than 30 days had elapsed after receipt of the verbal recertification orders. (Patients #1, #2, #9, #11 and #15) Findings include: On April 23, 2021 at approximately 2:17 PM, review of the agency policy titled "When Orders for Care/Service Are Accepted" revealed the following: Scope...All care/service is provided under a physician's or allowed practitioner's...order. On April 23, 2021 at approximately 5:10 PM, review of the May 3, 2013 PA DOH document titled "Survey Guidelines: Home Health 28 Pa. Code §601.31 Acceptance of Patients, Plan of Treatment and Medical Supervision. (d) Conformance with Physician Orders" revealed the following: Guideline...Home health agencies may vary from the 7 day requirement for countersignature of an oral order under the following conditions: An oral order not countersigned within 7 days must be accompanied by clearly documented evidence of the agency's continuing efforts to obtain the countersignature within that timeframe. All contacts and attempts at contact with the prescriber, by any means of communication, must be documented including the date, time, and the signature of the individual making or attempting to make the contact. This notation regarding prescriber contact may be on the assessment, a case communication note, or other document maintained in the clinical record. If documentation of the attempt(s) to obtain the required countersignature is provided as stated herein, no deficiency citation will be issued, though the surveyor may make note of this lacking for a subsequent survey. A deficiency citation will be issued if there is no documentation of any attempt(s) to obtain the required countersignature as explained above. Any oral order not countersigned within 30 days of original issue, regardless of the number of attempts to obtain countersignature, will result in a citation. Patient #1: On April 20, 2021 at approximately 11:46 AM, review of the clinical record revealed the start of care date was 10/18/2020 as documented on the "Home Health Certification and Plan of Care" for the recertification period of 12/17/2020 through 02/14/2021. Review of the "Home Health Certification and Plan of Care" revealed the verbal orders for recertification were obtained by a registered nurse (RN) on 12/16/2020 and that attending physician counter-signed the recertification "Home Health Certification and Plan of Care" on 02/08/2021 which was more than 30 days after receipt of the verbal recertification orders. Patient #2: On April 22, 2021 at approximately 12:47 PM, review of the clinical record revealed the start of care date was 01/16/2021 as documented on the "Home Health Certification and Plan of Care" for the recertification period of 03/17/2021 through 05/15/2021. Review of the "Home Health Certification and Plan of Care" revealed the verbal orders for recertification were obtained by a RN on 03/12/2021 but there was no documentation which provided evidence that attending physician had counter-signed the verbal orders for recertification included on the "Home Health Certification and Plan of Care". Patient #9: On April 23, 2021 at approximately 7:47 AM, review of the clinical record revealed the start of care date was 12/31/2019 as documented on the "Home Health Certification and Plan of Care" for the recertification period of 02/23/2021 through 04/23/2021. Review of the "Home Health Certification and Plan of Care" revealed the verbal orders for recertification were obtained by a RN on 02/21/2021 but there was no documentation which provided evidence that attending physician had counter-signed the verbal orders for recertification included on the "Home Health Certification and Plan of Care". Patient #11: On April 23, 2021 at approximately 8:59 AM, review of the clinical record revealed the start of care date was 10/29/2020 as documented on the "Home Health Certification and Plan of Care" for the recertification period of 02/26/2021 through 04/26/2021. Review of the "Home Health Certification and Plan of Care" revealed the verbal orders for recertification were obtained by a RN on 02/26/2021 and that attending physician counter-signed the recertification "Home Health Certification and Plan of Care" on 03/29/2021 which was more than 30 days after receipt of the verbal recertification orders. Patient #15: On April 23, 2021 at approximately 11:18 AM, review of the clinical record revealed the start of care date was 05/07/2020 as documented on the "Home Health Certification and Plan of Care" for the recertification period of 11/03/2020 through 01/01/2021. Review of the "Home Health Certification and Plan of Care" revealed the verbal orders for recertification were obtained by a RN on 10/29/2020 and that attending physician counter-signed the recertification "Home Health Certification and Plan of Care" on 12/29/2020 which was more than 30 days after receipt of the verbal recertification orders. During interview on April 23, 2021 at approximately 3:30 PM, the home care supervisor and the alternate administrator confirmed the physician's counter-signature on the "Home Health Certification and Plan of Care" had not been obtained within 30 days as required under the May 3, 2013 PA DOH guidance.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures, documentation and clinical records, and based on interview with the home care supervisor and the altrenate administrator, the agency failed to ensure written instructions regarding visit frequencies had been provided to three (3) of four (4) patients for whom the admission folder/booklet was available for review during a home visit. (Patients #5, #6 and #8) Finding include: On April 23, 2021 at approximately 2:15 PM, review of the agency policy titled "Developing a Plan to Meet Patient/Client Needs" revealed the following: An individualized plan of care/service plan is developed for each patient receiving care/services to specify the care and services necessary to meet the patient's specific needs...The development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s)... On April 23, 2021 at approximately 3:20 PM, review of the "Statement of Patient's/Client's Rights" form documentation revealed the following: As a patient/client, you have the right to: Work with your care team to plan your care, understand what they will do...as it applies to...e. How often your care team will visit you... Patient #5: On April 23, 2021 at approximately 6:26 AM, review of the clinical record revealed the start of care date was April 9, 2021 and that the following visit frequencies were included on the "Home Health Certification and Plan of Care" for the initial certification period of April 9 through June 7, 2021: Occupational therapy (OT): One (1) time a week for one (1) week for evaluation starting 04/12/2021, then one (1) time a week for one (1) week starting 04/12/2021 followed by two (2) times a week for three (3) weeks starting 04/18/2021. Physical Therapy (PT): One (1) time a week for one (1) week for evaluation starting 04/11/2021, then one (1) time a week for one (1) week starting 04/12/2021 followed by two (2) times a week for six (6) weeks starting 04/13/2021. Review of the agency's admission booklet/folder during home visit conducted on April 22, 2021 at approximately 9:25 AM revealed there was no documentation in the booklet/folder which provided evidence that instructions regarding the above referenced OT and PT visit frequencies had been provided to the patient in writing. Patient #6: On April 23, 2021 at approximately 6:43 AM, review of the clinical record revealed the start of care date was March 28, 2021 and that the following visit frequencies were included on the "Home Health Certification and Plan of Care" for the initial certification period of March 28 through May 26, 2021: Skilled Nursing (SN): Two (2) times a week for one (1) week starting 03/28/2021 followed by one (1) time a week for eight (8) weeks starting 04/04/2021. PT: One (1) time a week for one (1) week for evaluation starting 03/29/2021, then one (1) time a week for one (1) week starting 03/28/2021 followed by two (2) times a week for eight (8) weeks starting 04/04/2021. Review of "Revision to the Plan of Care" orders revealed home health aide (HHA) services were to be provided two (2) times a week for seven weeks starting 04/12/2021. Review of the agency's admission booklet/folder during home visit conducted on April 22, 2021 at approximately 10:10 AM revealed there was no documentation in the booklet/folder which provided evidence that instructions regarding the above referenced SN, PT and HHA visit frequencies had been provided to the patient in writing. Patient #8: On April 23, 2021 at approximately 7:09 AM, review of the clinical record revealed the start of care date was April 3, 2021 and that the following visit frequencies were included on the "Home Health Certification and Plan of Care" for the initial certification period of April 3 through June 1, 2021: OT: One (1) time a week for one (1) week for evaluation starting 04/06/2021, then one (1) time a week for one (1) week starting 04/08/2021 followed by two (2) times a week for two (2) weeks starting 04/11/2021. PT: One (1) time a week for one (1) week for evaluation starting 04/09/2021, then one (1) time a week for one (1) week starting 04/04/2021 followed by two (2) times a week for six (6) weeks starting 04/11/2021. Review of the agency's admission booklet/folder during home visit conducted on April 22, 2021 at approximately 3:12 PM revealed there was no documentation in the booklet/folder which provided evidence that instructions regarding the above referenced OT and PT visit frequencies had been provided to the patient in writing. During interview on April 23, 2021 at approximately 3:30 PM, the home care supervisor and the alternate administrator confirmed that that there was no documentation in the home folders which provided evidence that written instructions regarding the above referenced frequencies had been provided to above identified patients in writing prior to the home visits performed on the aforementioned dates.

Treatments and therapy services CFR(s): 484.60(e)(3) Any treatments to be administered by HHA personnel and personnel acting on behalf of the HHA, including therapy services. This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures, documentation and clinical records, and based on staff and caregiver interview and interview with the home care supervisor and the alternate administrator, the agency failed to ensure written instructions regarding the type of treatments to be performed by skilled nursing (SN) were provided to one (1) of two (2) patients for whom wound care orders were included on the "Home Health Certification and Plan of Care" and for whom the admission folder/booklet was available for review. (Patient #5) Finding include: On April 23, 2021 at approximately 2:15 PM, review of the agency policy titled "Developing a Plan to Meet Patient/Client Needs" revealed the following: An individualized plan of care/service plan is developed for each patient receiving care/services to specify the care and services necessary to meet the patient's specific needs...The development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s)... On April 23, 2021 at approximately 3:20 PM, review of the "Statement of Patient's/Client's Rights" form documentation revealed the following: As a patient/client, you have the right to: Work with your care team to plan your care, understand what they will do... During interview conducted on April 21, 2021 at approximately 11:15 AM, a registered nurse (employee #5) reported that written instructions for wound care are not maintained in the home as some patients provide the agency with a copy of the wound care orders. Patient #5: On April 23, 2021 at approximately 6:26 AM, review of the clinical record revealed the start of care date was April 9, 2021 and that SN was to provide the following wound treatment to the bilateral buttocks wounds as documented on the "Home Health Certification and Plan of Care" for the initial certification period of April 9 through June 7, 2021: Cleanse with soap and water daily and apply Calmoseptine (moisturizing protective barrier/treatment) to buttock wound two (2) times a day. Review of SN note documentation dated 04/20/2020 revealed the right buttock wound measured 2.0 cm (centimeters) by 2.2 cm by 0.2 cm and the left buttock wound measured 1.2 cm by 1.0 cm by 0.2 cm. During interview conducted during the home visit on April 22, 2021 at approximately 9:25 AM, the patient's caregiver reported that the patient's physician had recommended that Balmex (moisturizing cream) be applied to the buttock wounds but that Calmoseptine was the current wound treatment. Review of the agency's admission booklet/folder revealed there was no documentation in the booklet/folder which provided evidence that instructions regarding the above referenced wound care had been provided to the patient in writing. During interview on April 23, 2021 at approximately 3:30 PM, the home care supervisor and the alternate administrator confirmed that a copy of the above referenced wound care orders had not been provided to the above identified patient in writing.