Every finding on record at Madlyn and Leonard Abramson Center for Jewish Life

Based on the findings of an onsite unannounced Medicare recertification survey conducted October 4, 2022, through October 6, 2022, Abramson Home Care, 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 October 4, 2022, through October 6, 2022, Abramson Home Care, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on a review of agency policy/procedure, a review of clinical records (CR), and interview with the agency's Administrator, the agency failed to ensure an initial Occupational Therapy assessment was conducted and incorporated into the Plan of Care (POC) no later than five (5) calendar days after the start of care for one (1) out of seven (7) patient clinical records (CR) reviewed (CR #3). Agency policy reviewed on 10/6/22 at approximately 10:00 AM The policy titled, "Plan of Care (POC)" states, "POC Development. The POC is developed by the Registered Nurse (RN), Physical Therapy (PT), Speech Therapist (ST), Occupational Therapist (OT)...from the OASIS assessment...developed within 5 days of the SOC (start of care) or Follow Up Assessment..." A review of CRs was completed on 10/4/22 and 10/5/22 at approximately 10:30AM. which revealed the following: CR#3 Start of Care (SOC) 9/15/22: Certification Period reviewed was 9/15/22-11/13/22. The Home Health Certification and plan of care included order for Occupational Therapy: Evaluation and Treatment. The initial Occupational Therapy evaluation visit was conducted on 10/22/22 which was seven (7) days after the start of care. An interview conducted with the agency Administrator/Director of Nursing on October 6, 2022, at approximately 1:30 p.m. confirmed the above findings.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based upon clinical record (CR) review, policy and procedure review, and an interview with the agency administrator/director of nursing, it was determined the agency failed to incorporate all new medications the patient is currently using for one (1) of seven (7) CRs reviewed (CR #4). Review of policy titled, "Medication Management" on 10/5/22 at approximately 11:00am revealed "A licensed physician shall prescribe the patient/consumer's medications...Verbal orders obtained by the nursing personnel for home care patient/consumers shall include patient/consumers name, complete name of medication, strength of the medication, prescribed dosage/rate, frequency of administration, route of administration, special instructions/precautions...all medication orders must be signed by the ordering physician within 7 days of the date of the verbal order per our agency's policy..." Review of CR on 10/4/22 and 10/5/22 at approximately 10:30AM revealed: CR#4, Start of Care:9/1/22, certification period reviewed 9/1/22-10/30/22, Diagnoses include orthostatic hypotension (form of low blood pressure that happens when you stand up from sitting or lying down). Nursing visit documentation from 9/12/22 revealed a Nurse Practitioner outside of the home health agency wrote a prescription for Midodrine 5mg TID (three times day) to "help prevent hypotension." The agency nurse did not write a verbal order for this prescription until 10/4/22 (22 days later). When the order was incorporated into the medication profile on 10/4/22 it did not include any blood pressure parameters or instructions on how to give. An interview with the agency administrator/director of nursing on 10/6/22 at approximately 1:30PM confirmed the above findings.

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, clinical records (CR) and interview with Agency Administrator/Director Nursing the agency failed to ensure the physician was notified for Occupational Therapy and Social Worker evaluation that were not completed for one (1) of seven (7) clinical records reviewed. (CR #4) and the agency failed to incorporate all new medications the patient is currently using for one (1) of seven (7) CRs reviewed (CR #4). Review of policy "Plan of Care" completed 10/5/22 at approximately 10:30AM revealed, "Plan of Care (POC) is a written plan that specifics the care and services necessary to meet the patient-specific needs identified in the comprehensive assessment, and the measurable outcomes that the agency anticipates would occur as a result of implementing and coordinating the plan of care...promptly alert the physician who is responsible for the agency plan of care to any changes in the patient's condition or needs that would suggest measurable outcomes are not being achieved...All physicians involved with the patient's care shall receive copies of all POCs and updates..." Review of policy titled, "Medication Management" on 10/5/22 at approximately 11:00am revealed "A licensed physician shall prescribe the patient/consumer's medications...Verbal orders obtained by the nursing personnel for home care patient/consumers shall include patient/consumers name, complete name of medication, strength of the medication, prescribed dosage/rate, frequency of administration, route of administration, special instructions/precautions...all medication orders must be signed by the ordering physician within 7 days of the date of the verbal order per our agency's policy..." Review of the clinical records completed 10/4/22 and 10/5/22 at approximately 10:00AM revealed: CR#4, Start of Care:9/1/22, certification period reviewed 9/1/22-10/30/22, Diagnoses include orthostatic hypotension (form of low blood pressure that happens when you stand up from sitting or lying down). Nursing visit documentation from 9/12/22 revealed a Nurse Practitioner outside of the home health agency wrote a prescription for Midodrine 5mg TID (three times day) to "help prevent hypotension." The agency nurse did not write a verbal order for this prescription until 10/4/22 (22 days later). When the order was incorporated into the medication profile on 10/4/22 it did not include any blood pressure parameters or instructions on how to give. Physician ordered OT (Occupational Therapy) and MSW (Master Social Worker) evaluation. There was no documentation of the agency providing OT or MSW visits/evaluations. In addition, there was no documentation that the agency updated or consulted the physician. An interview with the Administrator/Director of Nursing completed 10/6/22 at approximately 1:30PM confirmed the 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 agency policy, clinical records (CR), interview with administrator/director of nursing, agency staff failed to promptly alert physician to changes in patient condition for one (1) of seven (7) records reviewed. (CR # 4) and agency staff failed to obtain vital signs prior to treatment for two (2) Physical Therapy visits conducted. Review of agency policy on 10/5/22 at 11:00AM titled "Vital Signs Parameters" stated "The agency will establish vital sign parameters in the absence of physician parameters. If the MD does not specify vital sign parameters for reporting, the following parameters will be utilized by nursing staff for reporting purposes: Blood Pressure: greater than 160/90 or less than 90/60..." Review of CR on 10/4/22 and 10/5/22 at approximately 10:30AM revealed: CR#4, SOC 9/1/22; diagnoses include Pressure ulcer (skin injury) of sacral region, orthostatic hypotension (form of low blood pressure that happens when you stand up from sitting or lying down). Physician orders for certification period 9/1/22-10/30/22 for physical therapy (PT) starting 9/8/22 for one (1) time for one (1) week then starting 9/11/22 for two (2) times a week for six (6) weeks. Skilled Nursing ordered for 1-3 times per week for one (1) week, and 2 PRN (as needed) then starting 9/4/22 1-3 week for eight (8) weeks. Nursing documentation from 9/12/22 showed Nursing Practitioner (NP) outside of Home Health ordered Midodrine (medication used to increase blood pressure). Visit by SN on 9/15/22 showed Blood Pressure (BP) of 84/52 seated. Visit by PT on 9/12/22 showed BP of 81/54 seated Visit by PT on 9/14/22 showed BP of 66/44 seated Visits by PTA (Physical therapy assistant) on 9/21/22 and 9/26/22 showed no Blood Pressure taken at any point during treatment session. In the above visits there was no documentation of physician notification of the above blood pressure and no documentation to consult with the patient/family whether patient's midodrine medication was given. Interview with Administrator/Director of Nursing and Alternate Administrator/Alternate Director of Nursing on 10/6/22 at approximately 1:30 PM confirmed the above findings. Alternate Director of Nursing stated all staff must obtain complete vital signs prior to beginning treatment/assessment for every visit.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on review of agency documentation and interview with agency Administrator, the agency failed to maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases and failed to follow their own policy to conduct quarterly Infection Control Committee Meetings. Review of agency policies on 10/6/22 at approximately 10:30 A.M. Policy titled, "Quality Assessment Performance Improvement (QAPI)/Infection Control (IC) Committee" states, " As part of our QAPI program, our agency has an Infection Control committee that meets quarterly and reports to the QAPI Committee. The Agency IC committee will maintain a coordinated agency wide program for the surveillance, identification, prevention, control and investigation of infectious and communicable diseases..." Review of agency documentation on 10/5/22, at approximately 10:00 A.M. revealed that the agency did not have a mechanism to record and track patient and staff infections and did not follow their policy to conduct quarterly Infection Control Committee Meetings. An interview with the agency Administrator/Director of Nursing on 10/6/22, at approximately 1:30 P.M. confirmed the above findings.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on a review of clinical records (CRs), the agency's policy, and an interview with the administrator and director of nursing, agency failed to provide documentation that a discharge summary was sent to the physician within five (5) days of discharge for one (1) of two (2) discharge records reviewed (CR #7). Review of agency policy titled, "Discharge Planning, Discharge Summary" occurred on 10/5/22 at approximately 10:30 AM which stated, "Prior to discharge the client's attending physician will be notified. A copy of the Agency discharge summary will be sent to the physician..." A review of clinical records conducted on 10/4/22 and 10/5/22, at approximately 10:00 A.M. which revealed the following: CR#7, start of care (SOC): 6/6/22. Patient was discharged from the agency 7/13/22. There was documentation that the discharge summary was sent to the physician on 9/9/22 (58 days later). An interview with the administrator and director of nursing on 10/6/22 at approximately 1:30 P.M. confirmed the above findings.