Every finding on record at Lighthouse Home Health Agency LLC

During the Recertification and Complaint survey #2021014455, commenced on October 20, 2021 and concluded on October 22, 2021 at Lighthouse Home Health Agency LLC, a Home Health Agency, Emergency Preparedness was reviewed. Lighthouse Home Health Agency LLC is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.102, Condition of Participation for Home Health Agencies.

An unannounced Complaint survey, #2021014455, and subsequent recertification survey, was conducted on 10/20/21 through 10/22/21 at Lighthouse Home Health Agency, LLC. The agency is not in compliance with 42 CFR Part 484, Subpart A-C, Conditions of Participation for Home Health Agencies. There was one Condition of Participation identified in Non-Compliance: 42CFR Part 484.50 Patient Rights (G0406). In addition, there were two Federal standard level deficiencies found not in compliance: 42CFR Part 484.50(c)(2) Be free from abuse (G0430) and 42CFR Part 484.50(e)(2) Immediate Reporting of abuse by all staff (G0488). The following is a description of the non-compliance: Patient #1, a medically fragile, vulnerable child, was physically abused and neglected, while under the care of Staff A, a Licensed Practical Nurse (LPN) on 08/30/21. The Administrator and Director of Nursing (DON) allowed Staff A, the LPN, to remain in the home for approximately 2 hours to finish her 7 AM to 7 PM shift on 08/31/21, after becoming aware of the incident, thus failing to ensure the patient was free from further abuse and neglect. The Administrator and DON failed to report the incident to the Department of Children and Families (DCF) as per state law. The Administrator failed to ensure a complete and thorough investigation with follow up education to further ensure the protection of the patients. As a result of the Home Health Agency's failure to act to prevent further abuse, the health and safety of all of the Home Health Agency's patients were at risk for abuse and neglect. The cumulative effect of these systemic problems resulted in a situation in which the health and safety of all the patients were put in further risk and the finding of ongoing Immediate Jeopardy began as of 08/31/21. The Administrator was notified of the Immediate Jeopardy on 10/21/21 at 1:25 PM. As of 10/22/21, the exit date of the survey, the Administrator had not provided a Removal Plan, and the Immediate Jeopardy was ongoing and not abated.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: This condition is not met as evidenced by: Based on interview, record review, and policy review, the Home Health Agency (HHA) failed to ensure patients were free from abuse and neglect, and protected from further abuse (G430); and failed to report an incident or circumstance of mistreatment or abuse in accordance with state law (G488). State law mandates (39.201, F.S.) that any person who knows, or has reasonable cause to suspect, that a child is abused, shall immediately report such knowledge or suspicion to the department (Department of Children and Families/DCF). Patient #1, a medically-fragile, vulnerable child, was physically abused and neglected, while under the care of Staff A, a Licensed Practical Nurse (LPN) on 08/30/21. Review of video by the family revealed fourteen times the family observed the child was handled inappropriately. The Administrator and Director of Nursing (DON) allowed Staff A, the LPN to remain in the home for appoximately 2 hours, after viewing the video on 08/31/21, to allow the LPN to finish her 7 AM to 7 PM shift. The Administrator and DON became aware of the incident on 08/31/21 and failed to report the incident to the Department of Children and Families (DCF). The cumulative effect of these systemic practices resulted in the agency's inability to ensure the patient's right to be free from further abuse would be met.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on interview, record review, and policy review, the Home Health Agency (HHA) failed to ensure 1 of 3 sampled patients was free from further abuse and neglect. Patient #1, a medically fragile, vulnerable child, was physically abused and neglected, while under the care of Staff A, a Licensed Practical Nurse (LPN) on 08/30/21. Review of video by the family revealed fourteen times the family observed the child was handled inappropriately. The Administrator and Director of Nursing (DON) allowed Staff A, the LPN to remain in the home for approximately 2 hours, after viewing the video on 08/31/21, to allow the LPN to finish her 7 AM to 7 PM shift. The Administrator failed to ensure a complete and thorough documented investigation, along with educational follow up after the abuse of Patient #1. The findings included: Review of the policy "Identifying and Reporting Possible Victims of Alleged/Suspected Abuse, Neglect or Exploitation" revised March 2019 documented, "Purpose: To define the processes for identifying and reporting possible victims of alleged/suspected abuse, neglect or exploitation. ... Procedure: ... 7. Staff will immediately report an assessment of patient's condition which might indicate exploitation, abuse or neglect to the Director of Clinical Services, who will assign a supervisor to assess the patient for abuse, neglect and/or exploitation. 8. The Director of Clinical Services will communicate assessment findings to the physician and the appropriate agency according to state regulations/laws. All findings and communications will be documented in the patient's medical record. ... 10. Agency staff receives ongoing education regarding: signs and symptoms indicative of possible victims of abuse, neglect or exploitation; community agencies for reporting possible victims of abuse or neglect; state laws regarding the reporting of possible victims of abuse, neglect or exploitation; role of staff. ... 12. The Agency immediately investigates all alleged violations involving anyone furnishing services on behalf of the Agency and immediately takes action to prevent further potential violations while the alleged violation is being verified. investigations and/or documentation of all alleged violations are conducted. 13. The Agency takes appropriate corrective action in accordance with state law if the alleged violation is verified by administration or an outside body having jurisdiction, e.g., accrediting organization, the state survey agency or local law enforcement agency. 14. The patient has a right to be free from abuse from Agency staff and others in his or her home environment. ... Agency will also immediately remove staff from patient care if there are allegations of misconduct related to abuse." Review of the Administrator’s Job Description signed 09/01/12 documented, "Responsibilities/essential functions: ... 13. Monitor and take reasonable steps to ensure: a patient rights are exercised; b. Compliance with applicable Federal, State and Local laws and professional standards are maintained; c. Compliance with established policies and procedures." Review of the record revealed Patient #1, a medically fragile, vulnerable child, was admitted to the Home Health Agency (HHA) on 10/15/20. Review of the initial Plan of Care for the certification period of 10/15/20 through 12/13/20 documented the principle diagnosis was attention to gastrostomy (a surgical opening into the stomach used for feeding), with other pertinent diagnoses to include, but not limited to, preterm newborn, extremely low birth weight newborn, and disorders of calcium metabolism (related to bone density). Review of the Plan of Care for the certification period of 08/11/21 through 10/09/21 revealed the HHA was to provide skilled nursing services for 10 to 12 hours per day, seven days per week. Safety measures documented on this Plan of Care included 24-hour supervision, fall/safety precautions, hazard-free environment, safe in movements, and safety in ADLs (activities of daily living). During an interview on 10/20/21 at 12:50 PM, the Director of Nursing (DON) explained Patient #1 was born at 25 weeks with a genetic condition and spent her first seven months in the hospital. The DON stated Patient #1 was then admitted to the HHA with "issues with her muscles, growth, and was developmentally delayed." The DON explained the 18-month-old child, was about the size of a 9-month-old upon discharge from the HHA on 09/10/21. During the continued interview on 10/20/21 beginning at 12:50 PM, the DON was asked when she was made aware of any concerns with the care of Patient #1. The DON explained she received a call from the child's mother on 08/31/21 at about 4 or 4:30 PM. The DON stated the mother explained that the previous day the father had "dropped into the security camera and felt there had been rough handling" of Patient #1 by Staff A, a Licensed Practical Nurse/LPN. The DON stated, "mom was unsure at first and dad had addressed it with the LPN" the previous day. The DON stated that the mother explained that the father had "addressed it with the LPN on Monday (08/30/21) to let the LPN know he had seen her on the camera and was concerned about some of what he saw." The DON stated she asked the mother for the video and received it about 5 or 5:30 PM that same evening. The DON stated she then shared the video with the Administrator, who was also a Registered Nurse (RN). When asked if Staff A, the LPN, was in the home at the time she received the video on 08/31/21, the DON confirmed she was in the home doing a 7 AM to 7 PM shift. The DON stated they allowed the LPN to finish out her shift as she "only had about an hour left." The DON explained as soon as the LPN left the home, she was asked to come into the office the following morning. The DON stated the Administrator met with Staff A at 9 AM on 09/01/21. During the continued interview on 10/20/21 beginning at 12:50 PM, the DON was asked if there was just the one incident of concern from 08/30/21, related to the care of Patient #1. The DON explained the parents had a security camera and the mother reviewed it over the next several days. The DON stated it took about a week or so, and that the mother would send a video clip or two at a time via text. The DON stated they later obtained the videos via a USB/flash drive, and there were "about fourteen or so clips over about a five-day period from 08/25/21 until 08/31/21, of what the family identified as rough treatment of (name of Patient #1) by (name of Staff A, the LPN)." (The timeframe of 08/25/21 through 08/31/21 was actually seven days). The DON was asked to provide evidence as to when she was initially made aware of the concerns voiced by the parents of Patient #1. On 10/20/21 at 2:53 PM, the Administrator provided evidence of a text message from the DON to himself, of the first video provided to the HHA. The date and time of the text message with the video was 08/31/21 at 4:51 PM. The DON wrote in the text message to the Administrator, "This is from yesterday with (initials of Patient #1). Mom and dad feel (name of Staff A, the LPN) was way too rough in her handling of (initials of Patient #1)." The Administrator was asked if he could recall the video and he replied yes. When asked what was on the video, the Administrator stated it was a video of the "LPN picking up the child by the wrists (demonstrated by grabbing his own wrists), turning (demonstrated by turning about a quarter of a circle), and forcefully setting the child down on the floor (demonstrated by a forceful downward motion toward the floor). The LPN did not just set the child on the floor, but forcefully put her on the floor." The Administrator stated it was at that point (when he saw the video) that he knew she would not be allowed back into the home. During a subsequent interview on 10/20/21 at 3:05 PM, the Administrator was asked about an investigation of the incident. The Administrator stated there was no need for an investigation as they had the video and knew what happened. The Administrator stated, "the intent was to get her (Staff A, the LPN) out of there (the patient's home) and not have her take care of other patients." When told of the concern related to keeping Staff A, the LPN in the home for the rest of her shift on 08/31/21, the Administrator stated it was (okay) because mom and dad where in the home at the time. When asked if there was any type of timeline of events or any other documentation related to the investigation of the incident, the Administrator referred the surveyor to the scanned document in the electronic record. Review of a document titled "Timeline of Event" (a one page typed out summary) documented a brief description of the incident as verbalized by both the DON and Administrator but lacked any specific times the events took place. This "timeline" documented the LPN's response, the parent's contacting legal authorities with subsequent finding of "grounds for criminal misconduct," and that the LPN is no longer employed with the Agency. This timeline of events lacked evidence of a complete and thorough investigation and lacked any type of follow up by the HHA to ensure the safety of other patients. During an interview on 10/21/21 at 10:33 AM, the DON was asked if she asked or advised the parents to have the child examined by appropriate medical professionals to ensure no underlying injuries had occurred or may emerge as a result of the physical abuse. The DON stated that she did not as the child's mother told her, "She appears perfectly normal and doesn't appear to have anything going on." When asked if she thinks having the child examined would have been an appropriate intervention, the DON stated, "No, since she didn't have any apparent injury." During the continued interview on 10/21/21 beginning at 10:33 AM, the DON stated that she would not call the first video abuse. The surveyor reiterated how the Administrator described the first video as the LPN grabbing the child by the wrists, turning, and forcefully putting the child on the floor. The DON did not respond but asked, what is the definition of abuse? The DON further stated if she saw that in the grocery store or somewhere she would not consider that abuse. During the continued interview on 10/21/21 beginning at 10:33 AM, the DON was asked if she reviewed the other 14 videos provided by the family. The DON stated that she did. The DON explained there was a video where the LPN appears to flick (name of Patient #1) in the ear after the child dropped a toy off the side of the couch. There was another video were the LPN reached behind the child and did something that made her cry. The DON stated there was another video of (name of Patient #1) rolling on the couch and nearly rolled off, while the LPN was doing something on her phone. The DON explained the LPN grabbed the child as she was falling. The DON stated she feels that is neglect. A phone interview was held on 10/21/21 at 11:58 AM with Staff B, another LPN who cared for Patient #1. After being told the child's name, description, and timeframe the HHA had the child under their care, Staff B confirmed she recalled the child. Staff B stated she had cared for the child a couple of weekends. When asked if it would be appropriate to pick up this child by the wrists, turn, and put her down on the floor, the LPN stated, “No, she was a little baby with a tube feeding. Why would I take a chance of pulling her arms out of her sockets? I would pick her up under her arms (holding on to her body) like you should any baby." As per a Department of Children and Families (DCF) report of 10/15/21, Patient #1 had "started having weird behaviors. She has developed an aversion to people coming at her, touching her in her face and trying to start an IV. She has also been touching her ears a lot lately. ... (name of Staff A, the LPN), was interviewed by law enforcement, and on 10/14/21 was arrested and charged with child neglect. The nurse turned in her license."

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on interview, record review, and policy review, the Home Health Agency (HHA) failed to report an incident or circumstance of mistreatment or abuse of 1 of 1 sampled patients, in accordance with state law (Patient #1). State law mandates (39.201, F.S.) that any person who knows, or has reasonable cause to suspect, that a child is abused, shall immediately report such knowledge or suspicion to the department (Department of Children and Families/DCF). Patient #1, a medically fragile, vulnerable child, was physically abused, while under the care of Staff A, a Licensed Practical Nurse (LPN) on 08/30/21. The Director of Nursing (DON) and Administrator became aware of the incident on 08/31/21 and failed to report the incident to DCF. The findings included: Review of the policy "Identifying and Reporting Possible Victims of Alleged/Suspected Abuse, Neglect or Exploitation" revised March 2019 documented, "Purpose: To define the processes for identifying and reporting possible victims of alleged/suspected abuse, neglect or exploitation. ... Procedure: ... 2. Any Agency staff in the normal course of providing services to patients, who identifies, notices or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual and/or physical abuse, ... must report these findings immediately (within 24 hours) to the Agency and other appropriate authorities in accordance with state law. ... 8. ... The Agency will report allegations, observations and suspected cases of exploitation, abuse and/or neglect to appropriate authorities. Review of the record revealed Patient #1, a medically fragile, vulnerable child, was admitted to the Home Health Agency (HHA) on 10/15/20. Review of the initial Plan of Care for the certification period of 10/15/20 through 12/13/20 documented the principle diagnosis was attention to gastrostomy (a surgical opening into the stomach used for feeding), with other pertinent diagnoses to include, but not limited to, preterm newborn, extremely low birth weight newborn, and disorders of calcium metabolism (related to bone density). Review of the Plan of Care for the certification period of 08/11/21 through 10/09/21 revealed the HHA was to provide skilled nursing services for 10 to 12 hours per day, seven days per week. Safety measures documented on this Plan of Care included 24-hour supervision, fall/safety precautions, hazard-free environment, safe in movements, and safety in ADLs (activities of daily living). During the continued interview on 10/20/21 beginning at 12:50 PM, the DON was asked when she was made aware of any concerns with the care of Patient #1. The DON explained she received a call from the child's mother on 08/31/21 at about 4 or 4:30 PM. The DON stated that the mother explained that the father had "addressed it with the LPN on Monday (08/30/21) to let the LPN know he had seen her on the camera and was concerned about some of what he saw." The DON stated she asked the mother for the video and received it about 5 or 5:30 PM that same evening. The DON stated she then shared the video with the Administrator, who was also a Registered Nurse (RN). When asked if Staff A, the LPN, was in the home at the time she received the video on 08/31/21, the DON confirmed she was in the home doing a 7 AM to 7 PM shift. The DON stated they allowed the LPN to finish out her shift as she "only had about an hour left." The DON explained as soon as the LPN left the home, she was asked to come into the office the following morning. The DON stated the Administrator met with Staff A at 9 AM on 09/01/21. During the continued interview on 10/20/21 beginning at 12:50 PM, the DON was asked if there was just the one incident of concern from 08/30/21. The DON explained the parents had a security camera and the mother reviewed it over the next several days. The DON stated it took about a week or so, and that the mother would send a video clip or two at a time via text. The DON stated they later obtained the videos via a USB/flash drive, and there were "about fourteen or so clips over about a five-day period from 08/25/21 until 08/31/21, of what the family identified as rough treatment of (name of Patient #1) by (name of LPN)." (The timeframe of 08/25/21 through 08/31/21 was actually seven days). The DON was asked to provide evidence as to when she was initially made aware of the concerns voiced by the parents of Patient #1. The DON stated they "worked in conjunction with the family as to how to proceed." The DON stated they determined the family wanted to report it to DCF and to the police department. On 10/20/21 at 2:53 PM, the Administrator provided evidence of a text message from the DON to himself, of the first video provided to the HHA. The date and time of the text message was 08/31/21 at 4:51 PM. The DON wrote in the text message to the Administrator, "This is from yesterday with (initials of Patient #1). Mom and dad feel (name of Staff A, the LPN) was way too rough in her handling of (initials of Patient #1)." The Administrator was asked if he could recall the video and he replied yes. When asked what was on the video, the Administrator stated it was a video of the "LPN picking up the child by the wrists (demonstrated by grabbing his own wrists), turning (demonstrated by turning about a quarter of a circle), and forcefully setting the child down on the floor (demonstrated by a forceful downward motion toward the floor). The LPN did not just set the child on the floor, but forcefully put her on the floor." The Administrator stated it was at that point (when he saw the video) that he knew she would not be allowed back into the home. The Administrator confirmed they worked with the family for about a week or so, discussing the incident and gathering video. When asked if the HHA contacted DCF, the Administrator stated, "No because the family had already done so within a day or so" of his knowledge of the event. During a subsequent interview on 10/20/21 at 3:05 PM, the Administrator stated he spoke with the parents on Wednesday 09/01/21 as to the options of reporting to DCF and the police. The Administrator was asked why he did not call DCF upon receipt of the first video on 08/31/21. The Administrator stated because the first video was a "gray area" as to whether it was DCF territory or just disciplinary action on the part of the HHA. During an interview on 10/21/21 beginning at 10:33 AM, the DON stated that she would not call the first video abuse. The surveyor reiterated how the Administrator described the first video as the LPN grabbing the child by the wrists, turning, and forcefully putting the child on the floor. The DON did not respond but asked, what is the definition of abuse? The DON further stated if she saw that in the grocery store or somewhere she would not consider that abuse. During the continued interview on 10/21/21 beginning at 10:33 AM, the DON was asked if she reviewed the other 14 videos provided by the family. The DON stated that she did. The DON explained there was a video where the LPN appears to flick (name of Patient #1) in the ear after the child dropped a toy off the side of the couch. There was another video were the LPN reaches behind the child and did something that made her cry. The DON stated at that point she would have called DCF, but the family had already done so. The DON stated that by the time they received and reviewed the additional videos, DCF had already contacted them about the child. The DON stated there was another video of (name of Patient #1) rolling on the couch and nearly rolled off, while the LPN was doing something on her phone. The DON explained the LPN grabbed the child as she was falling. The DON stated she feels that was neglect and would have called that in as well.