Every finding on record at Mc Home Health Services, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey, from 4/12/2023 to 4/14/2023, at this location: 6700 Fallbrook Avenue, Suite 265, West Hills, CA 91307. Representing the California Department of Public Health: Surveyor ID #22303, Health Facilities Evaluator Nurse Surveyor ID #44186, Health Facilities Evaluator Nurse Unduplicated admissions: 13 Active patients: 16 Sample Size: 7 Home Visits: 3

Develop EP Plan, Review and Update Annually CFR(s): 484.102(a) §403.748(a), §416.54(a), §418.113(a), §441.184(a), §460.84(a), §482.15(a), §483.73(a), §483.475(a), §484.102(a), §485.68(a), §485.542(a), §485.625(a), §485.727(a), §485.920(a), §486.360(a), §491.12(a), §494.62(a). The [facility] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must develop establish and maintain a comprehensive emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements: (a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be [reviewed], and updated at least every 2 years. The plan must do all of the following: * [For hospitals at §482.15 and CAHs at §485.625(a):] Emergency Plan. The [hospital or CAH] must comply with all applicable Federal, State, and local emergency preparedness requirements. The [hospital or CAH] must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. * [For LTC Facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. * [For ESRD Facilities at §494.62(a):] Emergency Plan. The ESRD facility must develop and maintain an emergency preparedness plan that must be [evaluated], and updated at least every 2 years. . This STANDARD is not met as evidenced by: Based on interview, and record review, the Home Health Agency (HHA) failed to ensure the emergency preparedness training for all staff was conducted at least annually. This failure had the potential to result in the HHA staff lacking the knowledge to readily and effectively respond during an emergency crisis situation. A review of the agency's Emergency Preparedness Program indicated there was no documented evidence an Emergency Preparedness training was provided to all HHA staffs. On 1/13/23, at 11:30 a.m., during an interview with the Director of Patient Care Services (DPCS), DPCS stated she did not conduct Emergency Preparedness training for all staffs. The HHA's undated policy and procedure titled, "Emergency Preparedness Plan" indicated the plan uses the term "All hazard" to address all types of incidents. The incidents which may require action by home care and emergency service personnel to prevent or minimize loss of life or damage to property and environment.

The following reflects the findings of the California Department of Public Health during a Recertification Survey, from 4/12/2023 to 4/14/2023, at this location: 6700 Fallbrook Avenue, Suite 265, West Hills, CA 91307. Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID #22303 Health Facilities Evaluator Nurse, Surveyor ID #44186 Unduplicated admissions: 13 Active patients: 16 Sample Size: 7 Home Visits: 3 The following Conditions of Participation not met: 484.55 Comprehensive Assessment of Patients

Comprehensive Assessment of Patients CFR(s): 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. This CONDITION is not met as evidenced by: Based on observation, interviews, and record review, the Home Health Agency (HHA) failed to meet the Condition of Participation for Comprehensive Assessment of Patients by failing to assess the patient’s continuing need for home care services for five of 7 sampled patients (Patients 1, 2, 5, 6 and 7). (Refer to G 532) The cumulative effect of this systemic practice resulted in the home health agency's inability to ensure the provision of quality health care services in a safe manner. .

Continuing need for home care CFR(s): 484.55(c)(3) The patient's continuing need for home care; This ELEMENT is not met as evidenced by: Based on observation, interviews and record review, the Home Health Agency (HHA) failed to assess the patient's continuing need for skilled nursing services for five of seven sampled patients, (Patients 1, 2, 5, 6 and 7). This deficient practice resulted in the provision of unnecessary home health services to patients who did not need skilled nursing services. Findings: c. A review of Patient 5's clinical record indicated a start of care date (SOC) of 1/05/22, with diagnoses which included Alzheimer’s disease (a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks), and essential hypertension. A review of Patient 5's Home Health Certification and Plan of Care for the certification period starting from 12/31/22 to 2/28/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to observe and assess homebound status and medical necessity, patient’s physical and mental function, cardiovascular status, pulmonary status, hydration/nutrition status, medication compliance and perform vital signs check every visit. The POC indicated to notify the physician if blood pressure (Bp) is below 90/60 or above 160/90, heart rate is below 60 beats per minute (bpm) or above 90 bpm, and pain above 6 on a pain scale 1-10 (0: no pain, 10: unbearable pain). The goal included patient’s mental and cardiovascular status will stabilize with current medication regimen, will demonstrate compliance with medications, maintain Bp in range of 120-150/60-90 mm Hg, and patient/caregiver will keep physician appointments and will be maintained at place of residence without episodes of hospitalization. Discharge planning indicated to discharge when goals are met, medical condition is stable, when patient no longer in need of skilled services, and when patient reaches maximum functional potential. On 4/13/23, at 2:40 p.m., a home visit was conducted to Patient 5's residence with the DPCS Designee. Patient 5 was observed sitting in a wheelchair, alert and confused, accompanied by the patient’s caregiver (FM 1). On 4/13/23 at 2:55 p.m., during an interview with FM 1, she stated that she assists Patient 5 in all his needs. FM 1 stated Patient 5 takes his medications daily as scheduled, have no wounds, no falls, and no hospitalization for the past 18 months. FM 1 stated Patient 5 does not complain of pain, and she brings Patient 5 to his physician regularly. A review of Patient 5's Clinical Nursing Notes from 1/02/23 to 2/06/23 indicated Patient 5’s blood pressure ranging from 125-138 systolic and 74-88 diastolic. The rest of the patient's vital signs (temperature, pulse rate and respiratory rate) were within a normal range. There were no admissions to the hospital, no episodes of falls, no wound care performed, and any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continuous skilled nursing services. d. A review of Patient 6's clinical record indicated a start of care date (SOC) of 3/09/21, with diagnoses which included essential hypertension (high blood pressure) and type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar [glucose]). A review of Patient 6's Home Health Certification and Plan of Care (POC) for the certification period starting from 12/29/22 to 2/26/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to observe and reassess homebound status, cardiovascular status, endocrine status, hydration/nutrition status, medication compliance and perform vital signs check. The POC indicated to notify the physician if blood pressure (Bp) is below 90/60 or above 155/90, heart rate is below 60 beats per minute (bpm) or above 100 bpm, and pain above 7 on a pain scale 1-10 (0: no pain, 10: unbearable pain). The goal included patient will demonstrate compliance with medications, maintain Bp in range of 120-150/60-90 mm Hg, demonstrate home safety measures, and skin integrity will be maintained without any form of infection or skin breakdown. Discharge planning indicated to discharge when goals are met, when patient no longer in need of skilled services, and when patient reaches maximum functional potential. On 4/13/23, at 1:40 p.m., a home visit was conducted to Patient 6's residence with the DPCS Designee. Patient 6 was observed alert, oriented and ambulatory using a cane. On 4/13/23 at 2:00 p.m., during an interview with Patient 6, he stated that he takes his own medications regularly, monitors his blood sugar daily, and goes to his physician every couple of months. He also stated that he does not have any body ache, headache or pain, no falls, no hospitalization, and does his activities of daily living (ADLs, like bathing, toileting, dressing, eating, mobility) independently and/or with assistance by a family member. A review of Patient 6's Clinical Nursing Notes from 1/02/23 to 2/06/23 indicated Patient 6’s blood pressure ranging from 122-141 systolic (top number) and 74-82 diastolic (bottom number). The rest of the patient's vital signs (temperature, pulse rate and respiratory rate) were within a normal range. There were no admissions to the hospital, no episodes of falls and any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continuous skilled nursing services. e. A review of Patient 7's clinical record indicated a start of care date (SOC) of 1/05/22, with diagnoses which included polyosteoarthritis (related to the process of aging characterized by joint pain and stiffness), chronic bronchitis (a type of COPD [chronic obstructive pulmonary disease], a group of lung diseases that make it hard to breathe), and essential hypertension. A review of Patient 7's Home Health Certification and Plan of Care for the certification period starting from 12/31/22 to 2/28/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to observe and assess homebound status and medical necessity, cardiovascular status, pulmonary status, hydration/nutrition status, medication compliance and perform vital signs check every visit. The POC indicated to notify the physician if blood pressure is below 90/60 or above 160/90, heart rate is below 60 beats per minute (bpm) or above 90 bpm, and pain above 6 on a pain scale 1-10. The goal included patient’s cardiovascular status will stabilize with current medication regimen, will demonstrate compliance with medications, maintain Bp in range of 120-150/60-90 mm Hg, and patient/caregiver shall demonstrate knowledge of acute respiratory distress management. Discharge planning indicated to discharge when goals are realized. On 4/13/23, at 2:15 p.m., a home visit was conducted to Patient 7's residence with the DPCS Designee. Patient 7 was observed awake, alert, oriented and ambulatory using a walker with a steady gait, accompanied by the patient’s caregiver (FM 1). On 4/13/23 at 2:30 p.m., during an interview with FM 1, she stated that she was the caregiver for Patient 7. FM 1 stated Patient 7 takes her medications daily as scheduled, have no wounds, no falls, and no hospitalization. FM 1 stated Patient 7 goes to her attending physician regularly. FM 1 stated she lives with Patient 7 and had been helping her such as cooking, doing laundry, grocery shopping and ADL care. A review of Patient 7's Clinical Nursing Notes from 1/02/23 to 2/20/23 indicated Patient 7’s blood pressure ranging from 126-142 systolic and 75-80 diastolic. The rest of the patient's vital signs (temperature, pulse rate and respiratory rate) were within a normal range. There were no admissions to the hospital, no episodes of falls, no wound care performed, and any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continuous skilled nursing services. On 4/14/2023 at 12:30 p.m., during an interview with the Director of Patient Care Services Designee (DPCS Designee), she stated Patient’s 5, 6 and 7 vital signs have been stable, no change in condition of the patient, no falls, no hospitalization, no wound care, and should have been discharged. A review of the agency’s undated policy and procedure titled, "Client Discharge Process", indicated discharge planning is initiated for every home care client at the time of the client’s admission for home care. Client shall be discharged from home health services on the basis of reasonable criteria which includes the client has reached defined goals and is no longer in need of home care. a. A review of Patient 1's clinical record indicated a start of care date (SOC) of 4/21/19, with diagnoses which included hypertensive heart disease (changes in the left ventricle, left atrium, and coronary arteries as a result of chronic blood pressure elevation). A review of Patient 1's Home Health Certification and Plan of Care for the certification period starting from 1/30/23 to 3/30/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to observe and assess homebound status and medical necessity, patient’s physical and mental function, cardiovascular status, pulmonary status, hydration/nutrition status, medication compliance and perform vital signs check every visit. The POC indicated to notify the physician if blood pressure (Bp) is below 90/60 or above 160/90, heart rate is below 60 beats per minute (bpm) or above 90 bpm, and pain above 6 on a pain scale 1-10 (0: no pain, 10: unbearable pain). The goal included patient’s mental and cardiovascular status will stabilize with current medication regimen, will demonstrate compliance with medications, maintain BP in range of 120-150/60-90 mm Hg, and patient/caregiver will keep physician appointments and will be maintained at place of residence without episodes of hospitalization. Discharge planning indicated to discharge when goals are met, medical condition is stable, when patient no longer in need of skilled services, and when patient reaches maximum functional potential. A review of Patient 1's Clinical Nursing Notes from 1/30/23 to 3/24/23 indicated Patient 1’s blood pressure ranging from 125-135 systolic and 75-80 diastolic. The rest of the patient's vital signs (temperature, pulse rate and respiratory rate) were within a normal range. There were no admissions to the hospital, no episodes of falls, no wound care performed, and any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continuous skilled nursing services. b. A review of Patient 2's clinical record indicated a start of care date (SOC) of 4/15/22, with diagnoses which included osteoporosis (a condition in which bones becomes weal and brittle). A review of Patient 2's Home Health Certification and Plan of Care for the certification period starting from 2/9/23 to 4/9/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to observe and assess homebound status and medical necessity, patient’s physical and mental function, cardiovascular status, pulmonary status, hydration/nutrition status, medication compliance and perform vital signs check every visit. The POC indicated to notify the physician if blood pressure (BP) is below 90/60 or above 160/90, heart rate is below 60 beats per minute (bpm) or above 90 bpm, and pain above 6 on a pain scale 1-10 (0: no pain, 10: unbearable pain). The goal included patient’s mental and cardiovascular status will stabilize with current medication regimen, will demonstrate compliance with medications, maintain BP in range of 120-150/60-90 mm Hg, and patient/caregiver will keep physician appointments and will be maintained at place of residence without episodes of hospitalization. Discharge planning indicated to discharge when goals are met, medical condition is stable, when patient no longer in need of skilled services, and when patient reaches maximum functional potential. A review of Patient 2's Clinical Nursing Notes from 2/9/23 to 3/23/23 indicated Patient 2’s blood pressure ranging from 120-134 systolic and 74-76 diastolic. The rest of the patient's vital signs (temperature, pulse rate and respiratory rate) were within a normal range. There were no admissions to the hospital, no episodes of falls, no wound care performed, and any evidence of the need for skilled nursing services to continue. The patient was re-certified for another 60 days for continuous skilled nursing services. On 4/14/2023 at 11:30 a.m., during an interview with the Director of Patient Care Services Designee (DPCS Designee), she stated Patient’s 1 and 2 needed more monitoring for fall, patient teaching for her medications and for any change of conditions that may occur.

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 Home Health Agency (HHA) failed to ensure interventions and reassessment for pain were implemented in accordance with the plan of care for four of 7 sampled patients (Patient 1, 2, 5 and 7). This deficient practice had the potential to result in ineffective pain management. Findings: c. A review of Patient 5's clinical record indicated a start of care date (SOC) of 1/05/22, with diagnoses which included Alzheimer’s disease (a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks), and essential hypertension (high blood pressure). The recertification OASIS (Outcome and Assessment Information Set, is the patient-specific, standardized assessment used in home health care), dated 2/24/23, indicated Patient 5 was experiencing intermittent lower back pain with an intensity of 6/10 (scale of 0-10, 0 being no pain and 10 being the worst pain). The pain is relieved with rest, repositioning, and medication (not specified). A review of Patient 5's Home Health Certification and Plan of Care for the certification period starting from 12/31/22 to 2/28/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to check pain levels using scale (0-10) and report to the physician if pain is greater than 6/10, implement pain relief measures, evaluate effectiveness of interventions, and report to the physician if unrelieved with pain medication. The goal included patient will verbalized pain controlled and maintained within 0-2 (0-10 scale) with rest and proper or timely administration of pain medications and alternative pain management. A review of Patient 5's Clinical Nursing Notes dated 1/23/23, 2/06/23 and 2/13/23 indicated Patient 5 was experiencing pain 3/10 to left leg and left knee. On 1/30/23, Patient 5 had 4/10 pain on left leg and knee. There was no documented evidence of interventions and reassessment done for the pain. d. A review of Patient 7's clinical record indicated a start of care date (SOC) of 1/05/22, with diagnoses which included polyosteoarthritis (related to the process of aging characterized by joint pain and stiffness), chronic bronchitis (a type of COPD [chronic obstructive pulmonary disease], a group of lung diseases that make it hard to breathe), and essential hypertension. The recertification OASIS dated 2/24/23, indicated Patient 7 was experiencing intermittent left and right knee pain with an intensity of 7/10 (scale of 0-10, 0 being no pain and 10 being the worst pain). The pain is relieved with rest, massage, diversion, and medication (not specified). A review of Patient 7's Home Health Certification and Plan of Care for the certification period starting from 12/31/22 to 2/28/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to check pain levels using scale (0-10) and report to the physician if pain is greater than 6/10, implement pain relief measures, evaluate effectiveness of interventions, and report to the physician if unrelieved with pain medication. The goal included patient will verbalized pain controlled and maintained within 0-2 (0-10 scale) with rest and proper or timely administration of pain medications and alternative pain management. A review of Patient 7's Clinical Nursing Notes dated 1/02/23, 1/30/23, 2/06/23 and 2/20/23 indicated Patient 7 was experiencing pain 3/10 on her right hip. On 1/23/23, Patient 7 had 4/10 pain on her right hip. There was no documented evidence of interventions and reassessment done for the pain. On 4/14/2023 at 12:30 p.m., during an interview with the Director of Patient Care Services Designee (DPCS Designee), she stated pain assessment should include pain intervention that was implemented and the effectiveness of the intervention. The DPCS Designee acknowledged in the case for Patient 5 and Patient 7, it was not done. A review of the agency’s undated policy and procedure titled, "Pain Assessment and Management", indicated any pan experienced by a patient will be assessed and managed, according to physician’s orders, at each skilled visit which the patient is experiencing pain. The purpose is to provide patients receiving care and/or services with an effective pain management process thereby promoting positive patient outcomes. A review of the agency’s undated policy and procedure titled, "Plan of Care", indicated a written Plan of Treatment/Plan of Care shall be established for each patient whose care requires medical orders. The purpose is to ensure that a Plan of Care is written and regularly approved by a physician and serves as a measurable guideline to care given by all professional disciplines involved in client care. a. A review of Patient 1's clinical record indicated a start of care date (SOC) of 4/21/19, with diagnoses which included hypertensive heart disease (changes in the left ventricle, left atrium, and coronary arteries as a result of chronic blood pressure elevation). The recertification OASIS (Outcome and Assessment Information Set, is the patient-specific, standardized assessment used in home health care), dated 1/30/23, indicated Patient 1 was experiencing intermittent lower back pain with an intensity of 4/10 (scale of 0-10, 0 being no pain and 6 being the worst pain). The pain is relieved with rest, repositioning, and medication (not specified). A review of Patient 1's Home Health Certification and Plan of Care for the certification period starting from 1/30/23 to 3/30/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to check pain levels using scale (0-10) and report to the physician if pain is greater than 6/10, implement pain relief measures, evaluate effectiveness of interventions, and report to the physician if unrelieved with pain medication. The goal included patient will verbalized pain controlled and maintained within 0-2 (0-10 scale) with rest and proper or timely administration of pain medications and alternative pain management. A review of Patient 1's Clinical Nursing Notes dated 2/24/23, 3/3, 3/10 and 3/17/23, indicated Patient 1 was experiencing intermittent pain 3/10 to right knee. There was no documented evidence of interventions and reassessment done for the pain. b. A review of Patient 2's clinical record indicated a start of care date (SOC) of 4/15/22, with diagnoses which included osteoporosis (a condition in which bones becomes weal and brittle). The recertification OASIS (Outcome and Assessment Information Set, is the patient-specific, standardized assessment used in home health care), dated 2/9/23, indicated Patient 2 was experiencing intermittent lower back pain with an intensity of 6/10 (scale of 0-10, 0 being no pain and 8 being the worst pain). The pain is relieved with rest, repositioning, and medication (not specified). A review of Patient 2's Home Health Certification and Plan of Care for the certification period starting from 2/9/23 to 4/9/23, included an order for the skilled nurse (SN) frequency of visits of once a week for 9 weeks, to check pain levels using scale (0-10) and report to the physician if pain is greater than 6/10, implement pain relief measures, evaluate effectiveness of interventions, and report to the physician if unrelieved with pain medication. The goal included patient will verbalized pain controlled and maintained within 0-2 (0-10 scale) with rest and proper or timely administration of pain medications and alternative pain management. A review of Patient 1's Clinical Nursing Notes dated 2/23/23, 3/9, 3/16 and 3/23/23, indicated Patient 2 was experiencing intermittent pain 4/10 to left hip and lower back. There was no documented evidence of interventions and reassessment done for the pain.

Protection of records CFR(s): 484.110(d) Standard: Protection of records. The clinical record, its contents, and the information contained therein must be safeguarded against loss or unauthorized use. The HHA must be in compliance with the rules regarding protected health information set out at 45 CFR parts 160 and 164. This STANDARD is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency failed to ensure the patient's medical records were stored and safeguarded against loss and or unauthorized use. This deficient practice placed the patient's clinical records at risk to be seen by unauthorized users. On 4/12/23, at 10 a.m., a recertification survey was conducted at the agency. During an initial tour of the agency, there were eight boxes of discharge patient's medical records(4 boxes for 2021 and 10 boxes for 2022) that were stacked in a pile from the ground and in the medical record room. The steel cabinets that stored the agency's active patient's clinical records had no keys to lock the cabinets. At 10:20 a.m., during an interview with Office Manager 1, he stated he could not find the keys for the cabinets at this time. He also stated that the discharge boxes should be stored in a locked place to prevent unauthorized personnel having access to patient's files. A review of the agency's policy "Protection of Records," indicated medical records should be stored in locked cabinets if not in use.