Every finding on record at Med-Care Home Health Services Inc

An unannounced Complaint survey #2023004606, 2023006067, 2023006817, and 2023007815 was commenced on 06/12/23 and concluded on 06/13/23 at Med-Care Home Health Services Inc., Home Health Agency provider. The provider was not in compliance with 42 CFR, Part 484 Subpart A-C, Conditions of Participation for Home Health Agencies.

HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator's name, business address, and business phone number in order to receive complaints. This ELEMENT is not met as evidenced by: Based on observation and interview, the Home Health Agency failed to provide accurate contact information for the Administrator to patients and/or their representatives. The findings included: Review of the Patient Handbook reveals the Administrator's name on the front cover and the phone number to the Home Health Agency's office in Plantation. During telephonic interview with a family member of Patient #2 on 06/12/23 at 10:06 AM, they reported when they called and asked for the Administrator by their name, as found on the cover of the patient booklet using the phone number below it, staff did not know who that person was and could not tell her who was in charge. During the survey, the surveyor called the number on the handbook and requested to speak to the Administrator stating his first and last name; the line went silent and when a person came to the line the request was repeated asking for the "Administrator" and stating first and last name; the call was transferred to another person and the request was repeated asking for the Administrator by first and last name; this person placed the surveyor on hold and when they returned to the phone asked if the caller was looking for a "field staff" or the Director; they denied this being the name of the Administrator but transferred the call to another person who identified herself as the Administrator of a Home Health Agency in (another county) and stated the person named is in "Corporate" and offered to transfer the call to yet another office. During interview on 06/12/23 at 1:00 PM, the Director of Nursing stated the Administrator is involved in day to day operations of the agency; that she has his number and can usually get a hold of him; that patients can reach him by calling the number on the patient booklet which goes to this office and staff can transfer the call to him; that his name is "right in front of" the receptionist and she will have to do education with staff; that he has not been in the office in a few months but has been in the office this year. During interview with the Receptionist on 06/12/23 at 1:16 PM she correctly stated the Administrator's name and reported she just got back to her desk; that she does not have a phone number or other means to reach the Administrator and transfers all of his calls to the DON; that she has worked there since January 2023; and that she has never met the Administrator. During further interview on 06/12/23 at 1:20 PM, the Director of Nursing stated when she is not in the office the Administrator does not come in or take staff calls, but staff can go to the next person in the chain of command who is a Registered Nurse who works in the office. The Administrator's phone number was obtained from the Vice-President of Operations on 06/13/23. During telephonic interview on 06/13/23 at 12:27 PM the Administrator was informed of the attempt to reach him the day before and stated he usually talks to the DON/DCS and one other person in this office; stated he and the DON/DCS coordinate that one or both of them are available; that since yesterday he talked to the DON/DCS and told her if someone wants to talk to him she may give out his number; that they will "look into" putting both of their numbers in the patient handbook; and that they will address this with staff "right away" so they know who he is and how to reach him.

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 record review and interview the provider failed to follow their policy and procedure to investigate an allegation of misappropriation of property for 1 of 1 patients (Patient #3), to protect other patients from potential misappropriation of property by removing the accused staff member from direct care until an internal investigation was completed; and the provider failed to provide training to staff regarding abuse, neglect, exploitation and misappropriation of property, for 3 of 3 staff reviewed (Staff A, B, and C). The findings included. 1. The provider's Policy and Procedure titled Identifying and Reporting Possible Victims of Alleged/Suspected Abuse, Neglect or Exploitation documents the Policy "Agency will identify and report possible victims of alleged/suspected abuse, neglect or exploitation" and under Procedure "Agency staff receives ongoing education regarding: ...state laws regarding the reporting of possible victims of abuse, neglect or exploitation. Role of Staff." and "The Agency ensures this right and investigates all alleged violations involving mistreatment; neglect; verbal, mental, sexual and physical abuse, including injuries of unknown source; and misappropriation of patient property by anyone furnishing services on behalf of the Agency. Alleged violations are reported immediately to the Administrator or appropriate designee. The Agency immediately investigates all allegations 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" and ""Misappropriation of property" is theft or stealing of items from a patient's home. Agency staff must investigate and take immediate action on any allegations of misappropriation of patient property by Agency staff and refer to authorities when appropriate." 2. Review of Patient #3's record revealed they started care on 03/15/23 with nursing services for wound care 3 times a week after the first week and these visits were made by Registered Nurse, Staff A except for "missed visits" until her last visit to Patient #3 on 04/15/23. Patient #3's nurse visit documentation, titled SN (Skilled Nurse) Wound Care, for 04/10/23 documented Patient #3 expressed concern that he couldn't find some jewelry and Staff A reassured him that it would turn up. Patient #3's SN Wound Care note for 04/12/23 documented Patient #3 was very upset he could not find 3 particular items of jewelry; that Patient #3 reported he had last worn and seen these items a month ago; that he asked Staff A to help look for them but she did not feel comfortable doing so and suggested he ask someone else; and that Patient #3's door was "always open" and his keys were in the door when she arrived. Patient #3's SN Wound Care note for 04/15/23 documented Patient #3 was still upset about the missing jewelry and asked Staff A again to help him look saying he couldn't see well and she was the only person he trusted; that she helped him look and found a necklace; that he then told her he just wanted his jewelry back and would not press charges and he was going file a police report; and that Staff A told him she would inform the Director of Nursing of this the following Monday and he would be reassigned to another nurse "PRN" (as needed). Provider documentation dated 04/17/23 documented Staff A informed the Director of Nursing on 04/17/23 that Patient #3 had talked to Staff A about missing jewelry on 04/10/23 and 04/12/23, and accused Staff A of jewelry theft on 04/15/23; that the Director of Nursing spoke with Patient #3 who reported he was happy with Staff A until this incident and that Staff A had brought a "friend" with her on a nursing visit during which Staff A was in his room alone, which was when he believed the theft to have taken place; that he was happy with the new nurse who visited on 04/18/23; and that the Director of Nursing spoke with Staff A who denied stealing anything from Patient #3 and was counseled for taking a non-staff person into a patient's home. Although Staff A was removed from the care of Patient #3, the schedule for Staff A revealed she completed visits to 2 other patients on 04/17/23, 2 patients on 04/19/23, 1 patient on 04/20/23, and 3 patients on 04/21/23, with no evidence of removing Staff A from patient care pending investigation, and that she continued to see patients 3 to 5 days weekly up to the review date of 06/12/23. During interview on 06/12/23 at 4:05 PM, the Director of Nursing reported she did not do any investigation into Patient #3's allegation of theft because she "did not believe him (the patient)" and it was in the "police's hands" and Staff A had talked to and was cooperating with the police; that the Director of Nursing has worked at the agency for 21 years and Staff A has been there longer than her and never had a complaint; that she did not call any of Staff A's other patients because there was no reason to; that Staff A was not placed on leave for investigation because no investigation was warranted; that the two problems she had with this case was that Staff A took a nonemployee into a patient's home and that she did not tell the Director of Nursing right away of his allegations; and that these two concerns were addressed with Staff A. Review of Staff A's employee file reveals she started employment on 10/24/08 and no evidence of training regarding abuse and/or exploitation or misappropriation of property. 3. Review of Licensed Practical Nurse, Staff B's employee file reveals he started employment on 11/06/14 and the most recent evidence of training regarding abuse, exploitation or misappropriation of property was documented on 07/31/17. 4. Review of Home Health Aide, Staff C's employee file reveals she started employment on 09/01/17 and no evidence of training regarding abuse and/or exploitation or misappropriation of property. 5. During interview with the Director of Nursing on 06/13/23 at 12:39 PM, she reported after the allegation of theft of Patient #3's property employee handbooks were distributed to all staff and in-services held reminding staff to report complaints and incidents to the office right away; that they did not go over abuse and exploitation; but that this is covered in their "CEUs" (continuing education units) and the employee handbook; and upon being informed no evidence of such training was found in 3 of 3 employee files, stated it was discussed but could provide no evidence of such training. Review of the Employee Handbook revealed it also contained no evidence of education regarding abuse or misappropriation of property, no documentation forbidding abuse of patients, and no notice of state laws for the reporting of possible victims of abuse, neglect, exploitation, and/or misappropriation of property. During further interview with the Director of Nursing on 06/13/23 at 4:56 PM, she stated these topics were "discussed" but could provide no evidence.