Every finding on record at Lifecare Home Health Services, Inc

The following reflects the findings of the California Department of Public Health during a Recertification survey at this location: 540 E. Foothill Blvd. Ste. 200, San Dimas, California 91773. Representing the California Department of Public Health: Surveyor #44749, Health Facilities Evaluator Nurse Surveyor #25046, Health Facilities Evaluator Nurse Unduplicated admissions: 40 Current census: 39 Sample size: 7

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to accurately document the comprehensive assessment for one of 7 sampled patients (Patient 2). This failure has the potential for the patient's health status and needs will not be identified in the development of the plan of care (POC). Findings: A review of Patient 2's face sheet indicated the start of care date was on 3/30/22, with admitting diagnoses of hypertensive heart disease (narrow or blocked coronary arteries), end stage renal disease (gradual loss of kidney function), and spinal stenosis (narrowing of the spinal canal). A review of Patient 2’s plan of care indicated skilled nurse (SN) visits once per week and certified home health aide (CHHA) visits of 2x/week. On 11-14-22, at 11:15 a.m., a review of Patient 2's “Outcome and Assessment Information Set” (OASIS) for recertification period from 9/26/22 to 11/24/22 was reviewed. The following sections in the OASIS were identified as being unmarked and incomplete: Patient history and diagnoses, cognitive functioning, activities of daily living (ADL’s) and ambulation/locomotion. The assessment was also not signed and dated to indicate it was reviewed. On 11/14/22, at 2:35 p.m., an interview was conducted with DPCS. DPCS acknowledged Patient 2's assessment for recertification period from 9/26/22 to 11/24/22 was not completed and not signed. DPCS stated, it should have been thoroughly and completely filled out. A review of the agency’s policy “comprehensive patient assessment” dated 1/2/2006 indicated a through, well organized, comprehensive and accurate assessment, consistent with the client’s immediate needs will be completed for all clients.

Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This ELEMENT is not met as evidenced by: Based on interview and record review, the agency failed to perform the comprehensive assessment for 1 of 7 sample patients (Patient 6). This deficient practice has the potential to cause delay in providing continuous quality of patient care. Findings: On 11/10/2022, a review of Patient 6's clinical record disclosed a start of care dated 4/14/2021, with diagnoses which included diabetes mellitus (high blood sugar for prolonged period), chronic obstructive pulmonary disease, and hypertension (high blood pressure). A review of Patient 6’s clinical record indicated there was no documented evidence the comprehensive assessment was performed after 8/6/2022. During an interview with the Director of Patient Care Services (DPCS) on 11/14/2022, at 2:45 p.m., DPCS was not able to respond and provide the documented evidence of Patient 6's comprehensive performed after 8/6/2022. The DPCS further stated it should have been conducted every recertification period and as needed. A review of the agency’s policy titled “Comprehensive Patient Assessment” dated 1/2/2006 indicated a thorough, well-organized, comprehensive and accurate assessment, consistent with the clients’ immediate needs will be completed for all clients in a timely manner, but no later than five (5) calendar days after start of care. The depth and frequency of ongoing assessments will depend on client needs, goals, and the care treatment and services provided, but will be done at least once in every 60 days period

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 interview, and record review, the agency failed to develop the plans of care (POC) for 3 of 7 sampled patients (Patients 4, 5, and 6). This deficient practice has the potential for the patient health status and care needs will not be identified to achieve the patient care goals. Findings: a. A review of Patient 4’s clinical record disclosed a start of care dated 11/4/2022, with diagnoses which included status post right hip arthroplasty. A review of Patient 4’s clinical record indicated there was no evidence POC was developed. On 11/9/2022, at 11:30 a.m., the Owner/Licensed vocational Nurse 1 (LVN 1) was asked of Patient 4's POC, and stated the patient’s POC was not developed due to the Director of Patient Care Service (DPCS) had been sick. b. A review of Patient 5’s clinical record disclosed a start of care dated 6/9/2022, with diagnoses which included prostate cancer. A review of the Patient 5's POC from 10/7/2022 to 12/5/2022 indicated the spaces for diagnoses, orders for discipline and treatment, and goals /Rehabilitation potential/Discharge plans/referral plan/other notes, were blank and not completed. There was no evidence POC was developed for the benefit period from 10/7/2022 to 12/5/2022. On 11/14/2022, at 2: 45 p.m., during an interview with the DPCS was not able to provide the documented evidence the POC for the benefit period from 10/7/2022 to 12/5/2022 was developed. DPCS stated the Patient 5’s POC should have been developed before 10/7/2022. c. On 11/10/2022, a review of Patient 6's clinical record disclosed a start of care dated 4/14/2021, with diagnoses which included diabetes mellitus (high blood sugar for prolonged period), chronic obstructive pulmonary disease, and hypertension (high blood pressure). A review of Patient 6’s record indicated there were four POCs developed from 4/14/2021 to 11/10/2022 as follows: 1. 8/12/2021 to 10/10/2021 2. 10/11/2021 to 12/9/2021 3. 12/10/2021 to 2/1/2022 4. 8/7/2022 to 10/5/2022 During an interview with the Director of Patient Care Services (DPCS) on 11/14/2022, at 12 p.m., she was not able to respond and provide the documented evidence the POC were developed from 4/14/2021 to 11/10/2022. A review of the agency’s policy titled “Plan of Care” dated 1/2/2006 indicated the plan of care will be developed within five (5) working days or as required by agency/state guidelines.

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 interview and record review, the agency failed to develop an individualized plan of care (POC) to one of 7 patients with diagnosis of diabetes mellitus (DM- high blood sugar for prolonged period) that included visit frequency, assessment, management of disease, and parameters to notify the physician of significant blood level changes. This deficient practice placed the patient at risk for poor control of blood sugar levels and complications that could affect the patient's health status and wellbeing. Findings: On 11/10/2022, a review of Patient 6's clinical record disclosed a start of care dated 4/14/2021, with diagnoses which included DM, chronic obstructive pulmonary disease, and hypertension (high blood pressure). A review of the POC for the certification period from 8/7/2022 to 10/5/2022 indicated there was no discipline’s visit frequency, and management of DM (such as assessment of hyper/hypoglycemia, interventions, education, and acceptable parameters of vital signs and blood sugar, maintenance of glucometer). During an interview with the Director of Patient Care Services (DPCS) on 11/14/2022, at 12 p.m., stated the POC should have included the discipline’s visit frequency, and management of DM. A review of the agency’s policy titled “Plan of Care” dated 1/2/2006 indicated the Plan of Care shall be completed in full to include: · Type, frequency, and duration of all visits/services · Diagnostic tests, including laboratory and x-rays. · Prognosis · Specific dietary or nutritional requirement or restrictions

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on interview and record review the agency failed to ensure the patients plans of care were signed and dated by the physician for six of seven patients (Patients 1, 2, 3, 5, 6, and 7). This deficient practice has the potential for any decline or progress of the patients will not be identified, reviewed, and updated in the plan of care by the physician. a. A review of Patient 1's face sheet indicated she was admitted to the HHA agency on 10-18-22, with admitting diagnosis of hypertensive heart disease (narrow or blocked coronary arteries), hyperlipidemia (excess of fat in the blood), and iron deficiency (state in which a body lacks enough iron to supply its needs). A review of patient 1’s plan of care indicated skilled nurse visits of 2x/wk for 2 wks and CHHA of 1x/wk for 1 wk then 2x/wk for 8 wks. On 11-9-22 at 2:10pm a review of the agency’s policy entitled “home health certification and plan of care” for the certification period of 10-18-22 to 12-16-22 indicated that the document was unsigned by the physician. On 11-14-22 at 2:30pm, an interview with the DPCS was conducted in the agency conference room. DPCS acknowledged that the plan of care for patient 1 was not signed by the physician. She stated” if it’s not signed, it’s not complete”. b. A review of Patient 2's face sheet indicated he was admitted to the HHA agency on 3-30-22, with admitting diagnosis of hypertensive heart disease (narrow or blocked coronary arteries), end stage renal disease (gradual loss of kidney function), and spinal stenosis (narrowing of the spinal canal). A review of patient 2’s plan of care indicated skilled nurse visits once per week and certified home health aide visits of 2x/week On 11-9-22 at 2:20pm a review of the agency’s policy entitled “home health certification and plan of care” for the certification period of 3-30-22 to 5-28-22 indicated that the document was unsigned by the physician. On 11-14-22 at 2:30pm, an interview with the DPCS was conducted in the agency conference room. DPCS acknowledged that the plan of care for patient 2 was not signed by the physician. She stated” if it’s not signed, It’s not complete”. c. A review of Patient 3's face sheet indicated he was admitted to the HHA agency on 2-13-21, with admitting diagnosis of diabetes mellitus (the body’s ability to produce insulin is impaired resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood and urine). A review of patient 3’s plan of care indicated skilled nurse visits daily until 6-12-21 On 11-14-22 at 11:30am a review of the agency’s policy entitled “home health certification and plan of care” for the certification period of 4-14-12 to 6-12-21 indicated that the document was unsigned by the physician. On 11-14-22 at 2:30pm, an interview with the DPCS was conducted in the agency conference room. DPCS acknowledged that the plan of care for patient 3 was not signed by the physician. She stated” if it’s not signed, It’s not complete”. A review of the agency’s policy entitled “Plan of Care” dated 1/2/2006 indicated that an individualized plan of care signed by a physician shall be required for each client receiving home health services. The Plan of care/485 will be developed following the initial assessment and the original will be mailed or faxed to the physician for signature. d. On 11/10/2022, a review of Patient 5’s clinical record disclosed a start of care dated 6/9/2022, with diagnoses which included prostate cancer. A review of POCs indicated there were no physician’s signature for the following benefit period: 1. 6/9/2022 to 8/7/2022 2. 8/8/2022 to 10/6/2022 3. 6/20/2022 to 8/18/2022 10/7/2022 to 12/5/2022 e. On 11/10/2022, a review of Patient 6's clinical record disclosed a start of care dated 4/14/2021, with diagnoses which included DM, chronic obstructive pulmonary disease, and hypertension (high blood pressure). A review of POCs indicated there were no physician’s signature for the following benefit period: 1. 8/12/2021 to 10/10/2021 2. 10/11/2021 to 12/9/2021 3. 12/10/2021 to 2/1/2022 4. 8/7/2022 to 10/5/2022 f. On 11/14/2022, a review of Patient 7's clinical record disclosed a start of care dated 4/21/2022, with diagnoses which included open wound of right hip. A review of POCs indicated there were no physician’s signature for the following benefit period: 1. 4/21/2022 to 6/19/2022 2. 6/20/2022 to 8/18/2022 During an interview with the Owner/Licensed Vocational Nurse 1 (LVN 1) on 11/14/2022, at 10:05 a.m., she was not able to provide the documented evidence the physician had reviewed/approved the POCs for Patient 5, 6, 7 on above benefit periods. A review of the agency’s policy titled “Plan of Care” dated 1/2/2006 indicated an individualized Plan of Care signed by a physician shall be required for each client receiving home health and personal care services. The written Plan of Care must be signed by the physician and returned to the agency. The total Plan of Care shall be reviewed by the attending physician and agency personnel as often as the severity of the client’s condition requires, but at least one time every 60 days.

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the agency failed to coordinate with the physical therapist regarding provision of physical therapy services for one of 7 sampled patients (Patient 5). This deficient practice resulted in delayed provision of physical therapy. Findings: On 11/10/2022, a review of Patient 5’s Plan of care (POC) for the certification period from 8/8/2022 to 10/6/2022 indicated a start of care dated 6/9/2022, with diagnoses which included prostate cancer, and fitting and adjustment of urinary device. The Skilled Nurse (SN) visit was once a month for two months for Foley catheter assessment and follow-up. A review of the Recertification Assessment dated 8/6/2022 indicated Patient 5 was oriented and forgetful, needed partial/moderate assistance in toilet transfer and walk 50 feet. Patient 5 needed supervision in sitting to lying, sitting to standing, and walking 10 feet. A review of the physician’s order dated 10/28/2022 indicated PT evaluation authorization was received and the PT evaluation was scheduled on 10/31/2022. On 11/10/2022, at 11 a.m., during a home visit at the Patient 5’s residence with the Owner/Licensed Vocational Nurse 1 (LVN 1), Patient 5 was sitting in a chair, awake and able to communicate when he put on his hearing aide. Caregiver 1 was next to the patient. During an interview with Caregiver 1 at 11:35 a.m., stated the PT came for evaluation on 10/31/2022 and informed Caregiver 1 that PT would comeback for the service. Caregiver 1 further stated PT did not come yet. Owner/LVN 1 stated she would find out why the PT had not come yet. During an interview with Owner/LVN 1 on 11/14/2022, at 10:05 a.m., stated she called the PT and found out the PT could not provide service because when the PT called Patient 5, the patient did not answer the phone. The Owner/LVN 1 stated the PT did not know that he/she should have called Caregiver 1 instead of Patient 5 because Patient 5 could not hear the phone. The Owner/LVN 1 stated the agency did not know the PT was not provided until she called the PT on 11/11/2022. A review of the Patient 5’s clinical record indicated there was no documented evidence the SN and the physical therapy (PT) coordinated effectively. A review of the agency’s policy titled “Team/Case Conference” dated 1/2/2006 indicated the agency shall conduct multi-disciplinary Case/Team Conference for all new admission, every Recertification, Resumption of care, prior to discharge, significant change in condition and as needed. The skilled nurse, therapist, and other contract personnel will prepare a written summary of care provided including patient’s response to care furnished. Team/Case Conference should be dated and signed by the healthcare member providing the care or signed by the DPCS/Nursing supervisor in lieu of the clinicians if conference is done via telecommunication.