Every finding on record at Lhcg Cxli, LLC

Based on the findings of an unannounced, onsite home health agency complaint investigation survey completed November 21, 2022, Geisinger Home Health was found not to be in compliance with requirements of 42 CFR, Part 484, Subparts Band C, Conditions of Participation: 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 review of policy, medical records (MR) and interview with Clinical Director of the parent site location (EMP #1) the agency failed to ensure the plan of care contained vial sign parameters as part of patient care orders for one (1) of one (1) record reviewed. MR #1. Findings include: Review of policy on November 21, 2022, at approximately 3:00PM revealed: Review of policy on November 21, 2022, at approximately 3:00PM revealed: Policy 2.1.007. PLAN OF CARE; 1: POLICY: " Each patient has an individualized Plan of Care (POC) developed in consultation with the patient, physician or authorized practitioner, and staff that integrates comprehensive assessment findings to address patient problems, needs and goals, as well as to address specific services being provided". PROCEDURE: 2. "The POC includes n. all patient care orders". Review of MR #1 completed 11/21/22 between approximately11:30AM and 1:00PM contained the documentation showing a start of care date of 1/10/22; certification period: 9/7/22-11/5/22; Primary Diagnosis: Encounter for adjustment and management of Vascular Adjustment Device (VAD); Physicians orders: "Skilled nurse to evaluate patient and develop plan of care (POC) in coordination with physician... with the plan of care". "Skilled nurse to perform site care for infusion access device PICC line to left arm with opposite dressing changes once a week and PRN for loose or soiled dressing... complications of IV therapy". "Skilled nurse to monitor pain and instruct/reinforce patient regarding pharmacologic and non-pharmacologic pain control measures such as prescribed pain medication, rest and ". Orders are incomplete and there are no orders for vital signs or parameters listed. Interview with EMP #1 at approximately 2:00PM on November 21, 2022, confirmed the policy as current and above findings.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on review of policy, medical record (MR) and interview with Clinical Director of parent location (EMP #1) the agency failed to ensure staff promptly notified the physician of changes in condition for one (1) of one (1) record reviewed. MR #1. Findings include: Review of policy on November 21, 2022, at approximately 3:00PM revealed: Policy 2.1.007. PLAN OF CARE; 1: POLICY: " Each patient has an individualized Plan of Care (POC) developed in consultation with the patient, physician or authorized practitioner, and staff that integrates comprehensive assessment findings to address patient problems, needs and goals, as well as to address specific services being provided". PROCEDURE: 2. "The POC includes n. all patient care orders". Policy 2.1.011. PAIN ASSESSMENT: Policy: "The clinician will select one of the following pain assessment tools to assess pain at the present time in the patient and to initiate pain relief in the Plan of Care (POC) during each skilled visit. A score of 7 or greater on any of the pain assessment tools below is indicative of severe pain, which will require physician/authorized practitioner notification and patient appropriate interventions. All patients have the right to have their pain assessed and measures taken to reduce pain". Review of MR #1 completed 11/21/22 between approximately11:30AM and 1:00PM contained the documentation showing a start of care date of 1/10/22; certification period: 9/7/22-11/5/22; Primary Diagnosis: Encounter for adjustment and management of Vascular Adjustment Device (VAD); Physicians orders: "Skilled nurse to evaluate patient and develop plan of care (POC) in coordination with physician... with the plan of care". "Skilled nurse to perform site care for infusion access device PICC line to left arm with opposite dressing changes once a week and PRN for loose or soiled dressing... complications of IV therapy". "Skilled nurse to monitor pain and instruct/reinforce patient regarding pharmacologic and non-pharmacologic pain control measures such as prescribed pain medication, rest and ". Orders are incomplete and there are no orders for notification of the physician for a pain score greater than 7. Nursing note date 10/20/22, showed a pain scale rating of "8" on both pre/post assessment completed by the skilled nurse. Nurse documented that pain was not relieved at an acceptable level. Documentation by the nurse showed she coordinated with the patient and family regarding the pain. She later documented the patient, "verbalized decreased pain level as a result of pharmacologic pain control regimen". No documentation of physician notification per policy or documentation of pharmacologic pain control regimen used. Coordination of care documentation does not specify pain. Interview with EMP #1 at approximately 2:00PM on November 21, 2022, confirmed the policies as current and above findings.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on review of policy, medical record (MR) and interview with Clinical Director of parent location (EMP #1) the agency failed to ensure staff completely documented patient responses to physician ordered interventions including but not limited to: PICC line site care for one (1) of one (1) record reviewed. MR #1. Findings include: Review of policy on November 21, 2022, at approximately 3:00PM revealed: Policy 2.1.007. PLAN OF CARE; 1: POLICY: " Each patient has an individualized Plan of Care (POC) developed in consultation with the patient, physician or authorized practitioner, and staff that integrates comprehensive assessment findings to address patient problems, needs and goals, as well as to address specific services being provided". PROCEDURE: 2. "The POC includes i."Patient specific interventions and education; measurable outcomes and goals identified by the agency and patient". n. "all patient care orders". Policy 8.008. INFECTION TRANSMISSION PRECAUTIONS: Policy: "Staff follow appropriate precautions as needed as per Centers for Disease Control (CDC)". PROCEDURE: 4. "Standard Precautions: "To be utilized in all patient care activities, regardless of patient's known infective status or disease process". Review of MR #1 completed 11/21/22 between approximately11:30AM and 1:00PM contained the documentation showing a start of care date of 1/10/22; certification period: 9/7/22-11/5/22; Primary Diagnosis: Encounter for adjustment and management of Vascular Adjustment Device (VAD); Physicians orders: "Skilled nurse to perform site care for infusion access device PICC line to left arm with opposite dressing changes once a week and PRN for loose or soiled dressing. Using sterile technique cleanse site with alcohol swabs x3... complications of IV therapy". No documentation of cover dressing to be used at PICC site. Nursing note dated 10/20/22 showed the nurse performed site care and applied sorbaview dressing. "Patient verbalized tolerance of infusion device site care" No other documentation of interventions, or patient responses noted. Interview with EMP #1 at approximately 2:00PM on November 21, 2022, confirmed the policies as current and above findings.