Every finding on record at Med1care, LLC

Substantial Allegation Survey Substantial Allegations 102865, 103652, and 103734 An entrance conference was conducted on 01/03/24 at 10:00 AM with administrative personnel, and an exit conference was completed on 01/03/24 at 4:25 PM with administrative personnel. The following deficiency is based upon substantial allegation 102865 completed on 01/03/24. No deficiencies were cited related to allegation(s) contained in substantial allegations 103652 and 103734. Med1care, LLC 368362, is not in compliance with the requirements at 42 CFR Part 484 Subpart B, C for Home Health Agencies.

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 medical record review and staff interview, the agency failed to ensure patients received the home health services as written in the plan of care for two of six medical records reviewed (Patient #1 and #2). This could affect all patients receiving services from the agency. The agency census was 861. Findings include: 1. Review of the medical record for Patient #1 revealed a plan of care dated 09/28/23 to 11/26/23 with orders for home health aide services not to exceed 14 hours per week. Review of the home health aide notes revealed 15.5 to 16 hours per week were provided from 10/01/23 through 11/11/23. The medical record lacked documentation of any additional orders for the home health aide services. This was verified in an interview with Staff A on 01/03/24 at 2:45 PM. 2. Review of the medical record for Patient #2 revealed plans of care dated 09/30/23 to 11/28/23 and 11/29/23 to 01/27/24 for home health aide services not to exceed 20 hours per week. Review of the home health aide notes revealed 24.75 to 35 hours per week were ordered from 10/29/23 through 12/01/23. The medical record lacked documentation of any additional orders for the home health aide services. This was verified in an interview with Staff A on 01/03/24 at 3:02 PM. This deficiency represents non-compliance investigated under Substantial Allegation 102865.

Extended Substantial Allegation Survey Substantial Allegation Number 94171 Substantial Allegation Number 94356 An entrance conference was conducted with administrative staff on 12/07/22 at 1:45 PM, an exit conference was conducted with administrative staff of 12/09/22 at 2:55 PM. Med1care Home Health Care, 368362, was not in compliance with the requirements at 42CFR Part 484, Subpart B, C for Home Health Agencies in regards to the allegations contained in Substantial Allegation Number 94356 completed on 12/09/22.

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 medical record review and staff interview, the facility failed to complete home health aide (HHA) visits as instructed on the plan of care. This affected one patient (#3) with the potential to affect all patients cared for by this agency. The agency's current census was 831. The medical record for Patient #3 was reviewed on 12/09/22. Patient #3 had a start of care date of 07/13/22 with diagnoses of high blood pressure, chronic kidney disease and congestive heart failure. The certification periods reviewed were for 08/29/22-10/27/22 and 11/10/22-01/08/23. . Review of the occupational therapy (OT) notes revealed OT stopped services on 11/03/22. Notes from the occupational therapist on 11/03/22 stated Patient #3 required maximum assistance. Patient #3 has made minimal progress with the OT goals, remains limited by weakness and pain. Patient continues to require assistance with sponge bathing and dressing. Will discharge with daughter and aide services. Review of the certification period for 11/10/22-01/08/23 revealed the plan of care listed HHA visits were scheduled for two times per week to assist with personal care. Review of the HHA notes revealed the last HHA visit provided for personal care was on 11/04/22. Interview on 12/09/22 at 12:55 PM, Staff A verified the plan of care signed by the physician stated to complete HHA visits two times per week. Staff A verified no HHA visits were completed for this certification period with the last provided personal care by the HHA being completed on 11/04/22. Staff A provided a modified recertification order from Staff B dated 11/21/22 which stated HHA services were not recertified at this time due to occupational therapy no longer being present in the home. Staff A stated he/she believed this was a miscommunication with Staff B during an office meeting. Staff A stated staff know to follow this ordered plan of care. Interview with Staff B on 12/09/22 at 1:00 PM revealed they were told if OT was no longer coming in and they are signed off this means the patient is independent with self care and they were not to have HHAs in the home unless OT was there. Interview with Staff A on 12/09/22 at 1:15 PM verified the findings of not completing care and services for personal care per the care plan. This was non-compliance discovered during the investigation of Substantial Allegation 94356.

Emergency Preparedness At the time of the emergency preparedness survey completed on 05/05/22, Med1Care is in compliance with the provisions of 42 CFR Part 484.102.

Partial Extended Recertification Survey Substantial Allegation Survey Substantial Allegation 62604 Substantial Allegation 62983 An entrance conference was completed on 5/02/22 at 8:40 AM at the facility with the Office Manager and Director of Nursing (DON) per phone. An exit conference was completed on 5/05/22 at 5:20 PM. The following deficiencies are based on the partial extended recertification survey and the allegations contained in the substantial allegation 62983 completed on 05/05/22. Med1Care Home Health, 368362, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agency. No citations were issued regarding substantial allegation 62604,

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 medical record review, policy review, review of facility documentation, and staff interviews, the facility failed to notify the physician when a change of condition specifically elevated blood pressures (BP) were discovered. This affected one (Patient #9) out of nine patients reviewed, with the potential to affect all 874 patients care for by this agency. Findings include: Review of the medical record for Patient #9 revealed a start of care (SOC) date of 9/13/21 with a diagnosis of depression and Type II diabetes mellitus. The certification review period for 11/12/21 thru 1/10/22 revealed skilled nursing one time per week to assess, obtain vitals and medication set up. Medications included lisinopril, atenolol, and verapamil to manage the patients hypertension and cardiac status. Review of the skilled visit note on 01/10/22 for 11:40 AM to 12:40 PM revealed a nursing assessment was completed for Patient #9 by the Licensed Practical Nurse (LPN), Staff D. Listed under tasks was to obtain vitals, assess patient, and set up medications. Patient #9's vital signs were recorded as a BP of 178/90, heart rate of 103, respirations of 16, temperature 97.6 degrees Fahrenheit and oxygen saturation of 97%. A note in the vital sign box revealed Patient #9 stated she was feeling fine and did not want emergency medical services (EMS) called. The note also revealed Patient #9 had missed two doses of her medications. The assessment listed breath sounds as diminished, skin warm, dry and intact with a constant pain rating of 9 out of 10 in her knees and back. Listed under interventions were pain medication and relaxation. No documentation was recorded of physician notification or Registered Nurse (RN) communication regarding the elevated blood pressure and missed medications. Review of documentation provided by Staff A on 05/04/22 revealed the RN (Staff E) was notified via a text message from Staff D that Patient #9's BP's were 172/112 and189/95 with the patient looking flush, but her temperatures were normal. The text further revealed the last BP was 178/90 with Patient #9 stating she felt fine and did not want staff to call a squad. Staff E responded by text that he/she would send an email and see if Patient #9 had a caseworker since she was not safe at home. Staff D informed Staff E the patient had a physician appointment the next day and Staff D will try to set up transportation to get her there. Interview with Staff E on 5/05/22 revealed he/she was informed of the elevated BP as well as Patient #9 not taking her medicine correctly. Staff E stated the BPs were coming down. Staff E stated "I didn't think to call her physician since she had an appointment with them the next day." Review of the facility policy titled "Reports of Changes in Patient Conditions," revealed for skilled home care clients, the LPN will contact the supervisor or RN Case Manager to report non-life-threatening changes to determine if an additional follow up or supervisory visit is necessary. The RN will determine if changes are new to patient and if so the primary care physician will be notified of the change in condition within one business day. Interview on on 5/05/22 at 12:00 PM, Staff A verified the agency did not notify the physician when a change in condition was present with Patient #9's elevated blood pressure from the skilled visit on 01/10/22. This citation substantiates Substantial Allegation 62983.

Contents of clinical record CFR(s): 484.110(a) Standard: Contents of clinical record. The record must include: This STANDARD is not met as evidenced by: Based on medical record review, review of facility documentation, and staff interview, the facility failed to document all blood pressures (BP) taken, all assessments in the medical record, and notification of a patient's condition to supervising registered nurse (RN) in the medical record. This affected one (Patient #9) of nine patient reviewed with the potential to affect all 874 patients cared for by the agency. Findings: Review of the medical record for Patient #9 revealed a start of care (SOC) date of 9/13/21 with a diagnosis of depression and Type II diabetes mellitus. The certification review period for 11/12/21 thru 1/10/22 revealed skilled nursing one time per week to assess, obtain vitals and medication set up. Medications included lisinopril, atenolol, and verapamil to manage the patients hypertension and cardiac status. Review of the skilled visit note on 01/10/22 for 11:40 AM to 12:40 PM revealed a nursing assessment was completed for Patient #9 by the Licensed Practical Nurse (LPN), Staff D. Listed under tasks was to obtain vitals, assess patient, and set up medications. Patient #9's vital signs were recorded as a BP of 178/90, heart rate of 103, respirations of 16, temperature 97.6 degrees Fahrenheit and oxygen saturation of 97%. A note in the vital sign box revealed Patient #9 stated she was feeling fine and did not want emergency medical services (EMS) called. The note also revealed Patient #9 had missed two doses of her medications. The note did not indicate the supervising registered nurse (RN) was notified. Review of documentation provided by Staff A on 05/04/22 revealed the RN (Staff E) was notified via a text message from Staff D that Patient #9's BP's were 172/112 and189/95 with the patient looking flush, but her temperatures were normal. The text further revealed the last BP was 178/90 with Patient # 9 stating she felt fine and did not want staff to call a squad. Further review of Patient #9's skilled visit of 01/10/22 revealed the only BP recorded on the skilled visit was recorded as 178/90. There was no documentation of the first two elevated BPs and that the patient was flushed. Interview on 5/05/22 1:15 PM, Staff D revealed a visit was completed on 01/10/22. Staff D stated the patient's BP was elevated but she refused to go to the hospital when offered to call EMS. Interview on 5/05/22 at 1:30 PM, Staff E revealed Staff D sent her a text regarding the patient's elevated BP and informed Staff E the patient hadn't take her medicine correctly. Staff E reported Staff D mentioned the BPs were coming down. Interview on on 5/05/22 at 12:00 PM, Staff A verified all of Patient #9's BPs and assessments were documented in the medical record. Staff A also verified the record did not contain any documentation o the supervising RN being informed of Patient #9's condition. This citation substantiates Substantial Allegation 62983.