Every finding on record at K & D Home Health Care Corp

An unannounced Revisit to Complaint #2021004839, was conducted on 11/19/2021 at K & D Home Health Care Corp, Home Health Agency provider. The Home Health Agency was not in compliance with 42 CFR, Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

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 interview, the Home Health Agency failed to ensure the patient's Plan of Care was followed for 3 of 3 sampled patients (Patient #1, #2, and #3). The findings include: 1) Review of the clinical record on 11/18/21 reveals Patient #1 began receiving care and services from the Home Health Agency and had traumatic wounds to the left head and right forearm. Review of Patient #1's "prescription for Home Health," dated 09/13/21, documents for Home Health, (Skilled) Nursing to evaluate and treat, Physical Therapy to evaluate and treat and the patient's diagnoses as "SVT (Supraventricular Tachycardia- Fast Heartbeat), dizziness and functional decline." Review of Patient #1's "Home Health Certification and Plan of Care (HHCPOC)," for the certification period 09/20/21 to 11/18/21 includes physician's orders for Skilled Nurse (SN) visits twice weekly for 3 weeks, then weekly for 6 weeks; to assess/evaluate wound(s) at each dressing change and PRN ("as needed") for signs/symptoms of infection and assess patient for skin breakdown, pain, and neurological status. There was no evidence of documentation on the HHCPOC for the specific type of wound care to be performed by the Registered Nurse. The HHCPOC further documents for the Skilled Nurse to teach Patient #1 and their caregiver about signs of infection, skin and diabetic care, nutrition, pain and dyspnea (difficulty breathing) management, when to seek medical attention, energy conservation measures, medications, and safety. Continued review of the HHCPOC documents Home Health Aide (HHA) "5 hours daily x 6 days weekly" with no specified duration to assist with ADL's (Activities of Daily Living), showers. grooming, skin care, mouth care, and assist with transfer. A physician order dated 09/21/21, documents only, "Skilled Nursing will be performing wound care 2 times weekly times 4 weeks" without evidence of documentation of the type of wound care to be done. Review of the "Registered Nurse's Start of Care (SOC) Assessment" documents treatment to the wound on the left side of the head, "cleanse with Normal Saline, then pat dry and cover wound with dry gauze & tape and treatment to the right forearm, "Cleanse the right forearm with Normal Saline, then apply Vaseline gauze, cover wound with 4x4 dry gauze, and secure it with Kerlix (gauze wrap) and Coban (self-adherent stretch wrap)." Review of "Skilled Nursing notes," after the "Start of Care Assessment" dated 09/20/21, reveals visits were made by the Administrator, a Licensed Practical Nurse, on 09/23/21, 09/27/21, 09/29/21, 10/04/21, 10/06/21, 10/11/21, 10/13/21, 10/20/21, 10/27/21, and 11/10/21 without evidence of wound assessments and patient or caregiver teaching as physician ordered. Further review reveals here was no evidence of a "Skilled Nursing Note" for the week of 11/03/21 although Patient #1 and no documented explanation for the lack of the physician's ordered visit. Review of Patient #1's record reveals no evidence of documentation of any Home Health Aide visits as the physician ordered 5 hours daily 6 days a week 2) Review of the record reveals Patient #2 began receiving care and services from the Home Health Agency on 11/04/21 and had a chronic ulcer to the left foot with muscle necrosis (cell death). Patient #2's HHCPOC documents Skilled Nursing visits for wound care to the foot using Normal Saline, Betadine (Iodine Solution), Gentamycin (Antibiotic) ointment, Calcium Alginate with Silver (type of dressing), foam with a hole cut out, gauze and Kling (stretch-conforming gauze) to be performed once the first week, then 3 times weekly for 3 weeks, and then 1 time the following week. Further review of the patient's record on 11/18/21 at 1:21 PM reveals a "Start Of Care Assessment" on 11/04/21 documented by the Registered Nurse and "target dates" for additional Skilled Nursing visits that were all assigned to the Administrator, a Licensed Practical Nurse with no evidence of documentation of any further Skilled Nursing visits after 11/04/21. On 11/18/21 at 2:40 PM, during an interview regarding the lack of further Skilled Nursing visits for Patient #2, the Administrator stated that the visits were "showing on her computer';" Ho upon review of her "computer screen," one Skilled Nurse Visit," dated 11/08/21 was showing as "documented" with an option to "print view" and status "reopened." Upon further review, all other "Skilled Nurse Visits," listed with "target dates," between 11/10/21 and 11/17/21 continued to show with "no visit" dates and no indication or evidence those visits were conducted and the Administrator confirmed there was no evidence of completion of any further visits for Patient #2. Review of Patient #2's "Skilled Nurse Visit Note," for 11/08/21 documents the wound was cleaned with Normal Saline/Betadine, then covered with foam - Mepilex border, wrapped with Kling and secured with tape; but did not document the application of Gentamycin ointment, Calcium Alginate with Silver and foam with a hole cut out over it as ordered. Review of physician orders confirmed no new orders were obtained, since the patient's start of care, on 11/04/21. 3) Review of the record reveals Patient #3 began receiving care and services from the Home Health Agency on 10/30/21 and had a wound and cellulitis to the left upper arm. Patient #3's HHCPOC documents Skilled Nursing visits for wound care with Normal Saline, then Iodoform (Iodine infused) 1 1/2 inch gauze packing, covered with dry 4x4 gauze and secured with Kerlix and Coban (stretch wrap) to be performed once the first week, then 3 times weekly for 2 weeks, then 4 times the following week. Further review of the patient's record reveals a "Start Of Care Assessment," documented by the Registered Nurse dated 10/30/21 and "target dates" for additional Skilled Nursing visits between 11/01/21 and 11/18/21 that were all assigned to the Administrator, with no evidence of documentation those visits were conducted. During an interview, on 11/18/21 at 2:50 PM, the Administrator regarding how she keeps track of visits she has made to Patients #2 and #3 and for any notes she kept of those visits, she provided a "timesheet" for Patient #2 with dates of visits and no evidence of clinical documentation. Further review reveals documentation, by another Skilled Nurse, from September 2021 during Patient #2's previous time on service; was unable to provide any notes or evidence of visits that she, the Administrator made; stated she didn't know how it happened that she didn't enter notes for Patients #2 and #3 and was unable to provide evidence that visits for wound care, teaching, and assessments were performed as ordered.

An unannounced Complaint survey for complaint number #2020013267, #2021004839 and a Focused Infection Control survey were conducted on 04/15/2021 at K & D Home Health Care Corp., a Home Health Agency provider in Lauderhill, Florida. The allegation for Complaint #2020013267 was not substantiated. One of two allegations for Complaint #2021004839 was substantiated with deficient practice. K & D Home Health Care Corp. is not in compliance with 42 CFR Part 484, Subpart A-C, Conditions of Participation for Home Health Agencies.

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 interview, the Home Health Agency failed to provide the Skilled Nursing services as ordered in the physician's "Plan of Care for 1 of 2 sampled patients, Patient #1 and to consult the physician for clarification of incomplete orders for 1 of 2 sampled patients, Patient #2 (Patient #1 and #2). The findings included: 1) Review of the record reveals Patient #1's "Start of Care," with the Home Health Agency began on 06/11/20 for diagnoses that required the Home Health Agency's care and services. Patient #1's "Home Health Certification and Plan of Care" for 06/11/20 to 08/09/20, signed by Podiatrist A on 06/26/20, documents, "Orders and Treatments" for 2 nurse visits the first week then nurse visits every other day for 6 weeks and 2 PRN ("as needed") visits for wound complications. Further review reveals this "Home Health Certification and Plan of Care" includes the wound care order to remove and discard the old dressing, cleanse left ... (lower extremity) with Normal Saline Solution 0.9%, pat dry then apply Santyl ointment (prescription medicine that removes dead tissue from wounds) and Adaptic (non-adhering dressing) with 4x4 gauze and secure with Coban (self-adherent elastic wrap) every other day. Continued review reveals Podiatrist A's "Physician Progress Note Details" for 06/09/20 documents Patient #1's wound care orders as cleansing the wound with Normal Saline, apply Santyl, Adaptic, 4x4s, roller gauze, and Coban, and to change the dressing every 48 hours. Patient #1's "SN (Skilled Nurse) Wound Care Visit Note," for 06/12/20 documents the wound was cleansed with Normal Saline Solution 0.9%, then Mupirocin (antibiotic) ointment applied to wound bed, instead of Santyl ointment, covered with 4x4 gauze, instead of non-adherent Adaptic and secured with Kerlix (gauze wrap) and Coban. Further review of Patient #1's next two "SN Wound Care Notes," on 06/13/20 and 06/14/20, documented daily instead of every other day as the physician ordered, reveals the Skilled Nurse documented continued use of Mupirocin ointment instead of Santyl and covering the wound with 4x4 gauze instead of non-adherent Adaptic before securing it with Kerlix & Coban. Patient #1's "SN Wound Care Notes" for 06/15/20, 06/16/20 and 06/17/20 each document that after cleansing the patient's wound with Saline, Santyl ointment was applied, the wound covered with 4x4 gauze, instead of Adaptic and secured with Kerlix and Coban. Podiatrist A's "Physician Progress Note Details" for 06/16/20 document Patient #1's wound care orders as before: "to clean wound with Normal Saline, apply Santyl, Adaptic, 4x4s, Roller gauze and Coban and to change the dressing every 48 hours. Patient #1's "SN Wound Care" note for 06/18/20 documents after the wound was cleansed, Mupirocin ointment was applied to the wound bed instead of Santyl, covered with 4x4 gauze, instead of Adaptic and secured with Kerlix & Coban. There is no evidence of documentation of any coordination with the physician or a change in the "Plan of Care." The "Transfer Summary," dated 06/19/20 documents Patient #1 went to the hospital. Patient #1 resumed Home Health Care and services care on 07/01/20 and the "Post Hospital Order," dated 07/01/20 documents for daily (Skilled) Nurse visits for 5 days; "wound care frequency changes according to weekly wound care clinic order" and wound care as, after discarding the old dressing to cleanse left ... (lower extremity) with Normal Saline Solution 0.9%, pat dry then apply Mupirocin ointment 2% and Adaptic with 4x4 gauze and secure with Coban every other day. Continued review of the patient's record reveals Skilled Nurse visits were made to Patient #1 on 07/02/20, 07/03/20, 07/04/20, daily, with each corresponding "SN Wound Care Note" documenting Mupirocin Ointment applied to wound bed, covered with 4x4 gauze, instead of Adaptic and secured with Kerlix and Coban. Patient #1's "SN Wound Care Note" for 07/06/20 documents Santyl ointment instead of Mupirocin applied to the wound bed, covered with 4x4 gauze instead of Adaptic and secured with Kerlix and Coban. There is no evidence of documentation of any coordination with the physician or a change in the "Plan of Care." Telephone interview on 4/15/21 at approximately 3:58 PM was attempted but unable to be conducted with the Director of Nursing, who documented the wound care visits. During telephone interview with the Administrator on 04/16/21 beginning at 10:12 AM, she acknowledged Patient #1's wound care should have been done every other day and wound care treatment orders were not always followed. 2) Documentation on a "Medication List" dated 03/23/21 reveals Patient #2's diagnoses and review of Patient #2's "Service Agreement," reveals evidence that it was signed on 03/26/21. Review of the patient's "Electronic Clinical Record" reveals no evidence of documentation of Patient #2's initial assessment, completed Skilled Nurse visits or a physician's "Plan of Care." Review of Patient #2's "Prescription for Home Health Care," dated 03/25/21 documents RN (Registered Nurse) for wound care for ... (diagnosis) and to cleanse the wound with Normal Saline; tap dry; assess for sign of infection; apply Alginate dressing on top and to call if any suggestions for new orders. Further review reveals no evidence of documentation on the "prescription" of how often the Skilled Nurse should visit to perform the wound care. During interview on 04/15/21 at 11:45 AM, the Administrator stated the Director of Nursing did Patient #2's "Start of Care" on 03/26/21 but did not enter it in the computer that a "Plan of Care" was never created and that the Director of Nursing visited the patient and performed wound care on 03/29/21 and 03/31/21; the Administrator explained they are "behind on documentation" due to the "pandemic" and staffing shortage. The Administrator provided handwritten "notes" on a paper document as evidence of the nurse's "Initial Assessment" which did not reveal a patient's name, visit date or time and a "Medication Schedule." Review of the "Medication Schedule" documents, "skin tear to R (right) ... (upper extremity) cleanse c (with) NS (Normal Saline 0.9%) then apply 4x4 dry gauze & Kerlix" with no evidence of documentation of when or how often wound care should be performed. The Administrator provided a "Timesheet" with the names of the nurse and Patient #2, documenting dates and/or days of the week with the visit for 3/29 documented as "Monday" between the other dates, no times of visits or further documentation, as evidence of subsequent visits. Review of a "Physician Order," dated 03/30/21 at 10:00 AM, after the nurse's third visit to Patient #2, documents, under "Orders, Requesting frequency for wound care..." The "Fax "Confirmation" was requested but not provided. There was no evidence of documentation of physician contact, after the patient's initial visit to complete the Plan of Care and/or obtain a frequency for nurse visits and wound care before the Skilled Nurse's subsequent visits. During interview on 04/15/21 at 12:49 PM, the Administrator stated that she just spoke to the Director of Nursing (DON) on the telephone and the DON stated she called the physician to advise she had made 3 visits to Patient #2 on 03/26/21, 03/29/21, and 03/31/21 that the "... (patient's spouse)" put services "on hold" until they would call to resume and that she requested a physician's order for the frequency of nurse visits but did not get a response or verbal order.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to coordinate care to assure a physician's ordered wound care frequency of visits for 1 of 2 sampled patients (Patient #2). The findings included: Documentation on a "Medication List" dated 03/23/21 reveals Patient #2's diagnoses and review of Patient #2's "Service Agreement," reveals evidence that it was signed on 03/26/21. Review of the patient's "Electronic Clinical Record" reveals no evidence of documentation of Patient #2's initial assessment, completed Skilled Nurse visits or a physician's "Plan of Care." Review of Patient #2's "Prescription for Home Health Care," dated 03/25/21 documents RN (Registered Nurse) for wound care for ... (diagnosis) and to cleanse the wound with Normal Saline; tap dry; assess for sign of infection; apply Alginate dressing on top and to call if any suggestions for new orders. Further review reveals no evidence of documentation on the "prescription" of how often the Skilled Nurse should visit to perform the wound care. During interview on 04/15/21 at 11:45 AM, the Administrator stated the Director of Nursing did Patient #2's "Start of Care" on 03/26/21 but did not enter it in the computer that a "Plan of Care" was never created and that the Director of Nursing visited the patient and performed wound care on 03/29/21 and 03/31/21; the Administrator explained they are "behind on documentation" due to the "pandemic" and staffing shortage. The Administrator provided handwritten "notes" on a paper document as evidence of the nurse's "Initial Assessment" which did not reveal a patient's name, visit date or time and a "Medication Schedule." Review of the "Medication Schedule" documents, "skin tear to R (right) ... (upper extremity) cleanse c (with) NS (Normal Saline 0.9%) then apply 4x4 dry gauze & Kerlix" with no evidence of documentation of when or how often wound care should be performed. The Administrator provided a "Timesheet" with the names of the nurse and Patient #2, documenting dates and/or days of the week with the visit for 3/29 documented as "Monday" between the other dates, no times of visits or further documentation, as evidence of subsequent visits. Review of a "Physician Order," dated 03/30/21 at 10:00 AM, after the nurse's third visit to Patient #2, documents, under "Orders, Requesting frequency for wound care..." The "Fax "Confirmation" was requested but not provided. There was no evidence of documentation of physician contact, after the patient's initial visit to complete the Plan of Care and/or obtain a frequency for nurse visits and wound care before the Skilled Nurse's subsequent visits. During interview on 04/15/21 at 12:49 PM, the Administrator stated that she just spoke to the Director of Nursing (DON) on the telephone and the DON stated she called the physician to advise she had made 3 visits to Patient #2 on 03/26/21, 03/29/21, and 03/31/21 that the "... (patient's spouse)" put services "on hold" until they would call to resume and that she requested a physician's order for the frequency of nurse visits but did not get a response or verbal order.