Every finding on record at Makavic Home Health LLC

Purpose of Visit: Recertification Survey A survey entrance conference was conducted on 03/16/2021 at approximately as:55 p.m. via telephone with the Agency Administrator, RN A, and in person with the Agency Secretary, Employee D. Census: Agency Licensed and Certified: 73 Licensed Home Health: 0 Personal Assistant Services: 0 An exit conference was conducted on 03/23/2021 at approximately 3:40 p.m. with the Agency Alternate Administrator, Employee B. The survey preliminary findings were discussed, and the agency was afforded the opportunity to provide additional information. The agency was provided with written instructions for submitting a plan of correction within ten (10) days of the receipt of the Statement of Deficiencies. Makavic Home Health LLC was found to be in compliance with §42 CFR Emergency Preparedness Requirements for Home Health Agencies.

Purpose of Visit: Recertification Survey A survey entrance conference was conducted on 03/16/2021 at approximately as:55 p.m. via telephone with the Agency Administrator, RN A, and in person with the Agency Secretary, Employee D. Census: Agency Licensed and Certified: 73 Licensed Home Health: 0 Personal Assistant Services: 0 Abbreviations: ESRD - End Stage Renal Disease hha - home health aide POC - Plan of Care RN - Registered Nurse SN - Skilled Nurse SOC - Start of Care W/C - Wheelchair An exit conference was conducted on 03/23/2021 at approximately 3:40 p.m. with the Agency Alternate Administrator, Employee B. The survey preliminary findings were discussed, and the agency was afforded the opportunity to provide additional information. The agency was provided with written instructions for submitting a plan of correction within ten (10) days of the receipt of the Statement of Deficiencies.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interviews, the agency failed to ensure an RN conducted hha supervisory visits onsite to patient's homes no less frequently than every 14 days in one (Patient # 4) of one patient records reviewed in which the patient received hha services. This failure placed agency patients at risk of inappropriate or unsafe care as the RN could not ensure the unlicensed hha was following the care plan; whether the care plan needed to be revised (due to patient's status improvement or decline); or whether the patient was satisfied with the care received by the hha. Findings Include: Clinical Record #1 A record review of the electronic discharge clinical record for Patient #4 included a POC for the certification period of 07/05/2018 to 09/02/2018. The POC was dated 07/02/2018 and electrically signed by the Administrator/Supervising Nurse. The POC included a hha frequency of one time each week for one week, then two times each week for eight weeks. A record review of the electronic discharge clinical record for Patient #1 also included a hha Care Plan dated 07/05/2018 and electronically signed by the Administrator/Supervising Nurse A. The hha Care Plan for Patient #1 included a diagnosis of Other Intervertebral Disc Degeneration, Lumbar Region and Hypertensive Heart Disease with Heart Failure. The following assigned tasks were to be completed each visit: Shower with shower chair; Personal Care; Assist with Dressing; Shampoo Hair; Skin Care, Assess Skin Condition, Assess for Reddened Areas; Foot Care; Assist with Elimination, Record Bowel Movement; Ambulation Assist: W/C, Walker, Cane; Mobility/Transfer Assist: chair, Bed, Dangle, Commode; Safety Check; Household Tasks: Wash clothes/Bed Linens, Make Bed, Change Bed Linens, Clean Bathroom. The following assigned tasks were to be completed weekly: Assist with Feeding; Shave; Oral Hygiene, Dentures. A record review of the electronic record of Patient #4 contained twice weekly visit notes of hha services provided and electronically signed by hha E effective 07/10/2018 to 09/13/2018. Further review of the electronic clinical record of Patient #4 revealed one Supervisory Visit dated 08/29/2018 and signed by the Administrator/Supervising Nurse A. The electronic record of Patient #4 did not contain evidence a hha supervisory visit was conducted no less frequently than every 14 days effective 07/05/2018. On 03/23/2021 at approximately 11:30 a.m. during a telephone interview with the Administrator/Supervising Nurse A why the agency RN had conducted only one hha supervisory visit for the certification period of 07/05/2018 through 09/02/2018. The Administrator/Supervising Nurse A stated "It should be there." The surveyor asked if the supervisory visits were completed at least every 14 days. The Administrator/Supervising Nurse A informed the surveyor the administrative staff may not have copied the hha supervisory visits from the electronic record to be incorporated into the discharge record. The surveyor asked if the hha supervisory visits were located in the electronic file. The Administrator/Supervising Nurse A stated "Yes." On 03/23/2021 at approximately 12:30 p.m., with the Alternate Administrator B present, the surveyor reviewed the discharge record of Patient #4 which was contained in a large brown envelope. There was no evidence the agency RN conducted hha supervisory visits no less frequently than every 14 days. The surveyor asked the Alternate Administrator B if there were any other patient records for Patient #4. The Alternate Administrator B shook her head "No." The agency RN failed to conduct a hha supervisory visit no less frequently than every 14 days. The agency did not dispute the survey findings and did not provide any additional documentation to explain or correct the findings. The Agency Policy titled "2.11 Employee Supervision" with a revision date of 01/29/2020 read in part: "...Home Health Aides...If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g) must make an onsite visit to the patient's home no less frequently than every 14 days..."

Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to enforce their written policy regarding coordination of services in one (Patient #6) of one record reviewed in which the patient was dependent on out-patient renal dialysis. This failure placed Patient #6 at of receiving inappropriate care. Findings include: Clinical Record #6 Review of the clinical record revealed a POC for the treatment period 02/13/2021 to 04/13/2021. The POC was dated 02/13/2021 and signed by the Administrator/Supervising Nurse. The POC included a diagnosis of ESRD and documentation the patient was dependent on renal dialysis. There was no evidence of coordination of care with the dialysis provider. On 03/19/2021 at approximately 11:30 a.m. during an interview with the Administrator/Supervising Nurse the surveyor asked where documentation of coordination of care with the dialysis provider was located in the clinical record of Patient #6. The Administrator/Supervising Nurse A stated "We call them if there is a problem." The surveyor asked if the agency contacted the dialysis provider upon the admission of Patient #6 in an effort to coordinate care. The Administrator/Supervising Nurse A stated "No." The surveyor reviewed the regulation regarding coordination of care with the Administrator/Supervising Nurse A. The agency did not dispute the survey findings and did not provide any additional documentation to explain or correct the findings. The Agency's policy titled "5.9 Monitoring Patient Care/Coordination of Care" dated 01/29/2020 read in part: "The HHA must: ...Integrate services, whether service 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..."