Every finding on record at Medcare Home Health Services, Inc.

A Complaint Survey for Complaints 2024002008, 2024000859, 2024000002, 2023016884 was conducted on March 12, 2024 to March 13, 2024 at Medcare Home Health Services. The home health agency was in non-compliance with 42 CFR (Code of Federal Regulations) Subpart A-C, Requirements for Home Health Agencies.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to have written service schedules provided to the patients in 4 (SP#1, SP#6, SP#7 and SP#8.) out of 8 Sampled Patients reviewed. Findings include: The surveyor conducted closed record reviews on 03/12/2024 to 03/13/2024. The surveyor identified 4 out of 8 Sampled Patients (SP). SP#1, SP#6, SP#7 and SP#8 did not receive written visit schedules from the home health agency that was consistent with their respective Plan of Cares. The surveyor conducted an interview with the Director of Nursing on 03/13/2024 at 12:00pm, the Director of Nursing acknowledged that SP#1, SP#6, SP#7 and SP#8 did not receive written visit schedules as listed in the Plan of Care.

A Complaint Survey for complaint #2023007502, #2023010041 was conducted on September 14, 2023 at Medcare Home Health Services Inc. The provider was found to be in non-compliance with 42 CFR 484 Subpart A-C requirements for Home Health Agencies.

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on record review and interview, the Provider failed to show coordination of care for2 out of 9 (#1, #2) sample patients (SP) of care during treatment. Findings include: A review of SP#1’s clinical record revealed skilled nursing evaluation and skilled nursing discharged were conducted on 09/02/2023. Physical therapy evaluation and discharge was conducted on 09/05/2023. SP#1 clinical record does not have documentation as to why physical therapy evaluation was conducted three days after the initial assessment and no documentation showing SP#1 was notified of the delay. Further review of SP#1 clinical record revealed no documentation showing SP#1 was notified of the termination of services. A review of SP#2’s clinical record revealed physical therapy evaluation was conducted on 8/23/2023. Physical therapy services were conducted between 08/23/2023 – 09/07/2023. On 09/07/2023, SP#2 was discharged from physical therapy services for goals met. SP#2’s clinical record includes a physician order dated 09/08/2023 for physical therapy evaluation. According to the notes, SP#2 received physical therapy evaluation on 09/12/2023. Further clinical record review revealed no documentation showing the reason for the delay in services and no documentation showing SP#2 was notified of the delay of services. According to the Provider's policy and procedure for coordination of patient care, “The Agency must…Coordinate care delivery to meet the patient's needs, and involve the patient, representatives (if any) and caregiver (s), in the coordination of care activities.” On 09/14/2023 at 3:37PM, the director of nursing acknowledged SP#1’s and SP#2’s clinical records did not include documentation as to why there were a delay in services, no documentation showing SP#1 and SP#2 were notified of the delay in services and no documentation showing SP#1 was notified of the termination of services.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, the Provider failed to ensure written patient care instructions were provided for 1 out of 9 (#3) sample patients (SP). Findings include: A review of SP#3’s clinical record revealed home health aide services were provided between 07/25/2023 – 09/05/2023. Further record review revealed no documentation showing written patient care instructions were provided for SP#3 for home health aide services. On 09/14/2023 at 3:37PM, the director of nursing acknowledged SP#3’s clinical record did not include documentation showing written patient care instructions were provided for SP#3 for home health aide services.

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 interview, the home health agency failed to ensure that an onsite visit to the patient's home no less frequently than every 14 days is conducted for supervision of the Home Health Aide (HHA) by a Registered Nurse or other appropriate skilled professional for 1 out of 9 Sampled Patients (SP). (SP#5) Findings included: Clinical record review of active SP#5 contained a Plan of Care with a Certification Period of 08/12/23 to 10/10/23 that revealed the patient is receiving Skilled Nursing (SN) and Home Health Aide (HHA) services, further review of the plan of care reads “supervise aide every 14 days”. The HHA started providing care to SP#5 on 08/16/23. The home health agency failed to demonstrate that HHA supervisions were conducted every 14 days between date range 08/16/23 and 09/14/23, which is an interval of 29 days. Review of the home health agency’s policy and procedures titled “Home Health Aide Supervision” reads “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 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 the visit”. An interview was conducted with the Director of Nursing on 09/14/23 at 2:10 PM. The Director of Nursing reviewed the electronic clinical record and confirmed no supervision completed for scheduled visit 08/29/23.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record review and interview, the Provider failed to ensure that 3 out of 9 (#1, #2, #3) sample patients (SP) clinical records included pertinent information. Findings include: A review of SP#1’s clinical record revealed skilled nursing evaluation and skilled nursing discharged were conducted on 09/02/2023. Physical therapy evaluation and discharge was conducted on 09/05/2023. SP#1 clinical record does not have documentation as to why physical therapy evaluation was conducted three days after the initial assessment and no documentation showing SP#1 was notified of the delay. Further review of SP#1 clinical record revealed no documentation showing SP#1 was notified of the termination of services. A review of SP#2’s clinical record revealed physical therapy evaluation was conducted on 8/23/2023. Physical therapy services were conducted between 08/23/2023 – 09/07/2023. On 09/07/2023, SP#2’s was discharged from physical therapy services for goals met. SP#2’s clinical record includes a physician order dated 09/08/2023 for physical therapy evaluation. According to the notes, SP#2 received physical therapy evaluation on 09/12/2023. Further clinical record review revealed no documentation showing the reason for the delay in services and no documentation showing SP#2 was notified of the delay of services. A review of SP#3’s clinical record revealed home health aide services were provided between 07/25/2023 – 09/05/2023. Further record review revealed no documentation showing written patient care instructions were provided for SP#3 for home health aide services and no documentation showing the type of home health aide services that were provided to SP#3 during the visits that occurred between 07/25/2023 – 09/05/2023. On 09/14/2023 at 3:37PM, the director of nursing acknowledged SP#1’s and SP#2’s clinical records did not include documentation as to why there were a delay in services, no documentation showing SP#1 and SP#2 were notified of the delay in services and no documentation showing SP#1 was notified of the termination of services; the director of nursing acknowledged that SP#3’s clinical record did not include documentation showing written patient care instructions were provided for SP#3 for home health aide services nor did SP#3’s clinical record included the type of home health aide services that were provided during the home visits that took place between 07/25/2023 – 09/05/2023.

A complaint survey (complaint numbers 2023002464, 2023002922, 2023004104 and 2023006622) was conducted on 06/20/2023 to 06/21/2023 at Medcare Home Health Services Inc. The home health agency was in non-compliance with 42 CFR 484 Subpart A-C, Requirements for Home Health Agencies.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on record review and interview, the home health aide failed to document the service(s) provided as included in the plan of care for 1 out of 3 Sampled Patients (SP). (SP#6) Findings include: Review of the clinical record for SP#6 revealed that the patient is receiving skilled nursing and home health aide services. Further review revealed that the home health aide service notes for date(s) 05/18/23, 05/20/23, 05/22/23 and 05/24/23 were blank notes. The home health aide failed to document the service(s) provided to SP#6 as included in the aide care plan dated 05/16/23. An interview was conducted with the Director of Nursing on 06/21/23 at 12:10 PM. The Director of Nursing reviewed the home health aide notes, and confirmed they were left blank.

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 interview, the home health agency failed to ensure that an onsite visit to the patient's home no less frequently than every 14 days is conducted for supervision of the Home Health Aide (HHA) by a Registered Nurse or other appropriate skilled professional for 1 out of 3 Sampled Patients (SP). (SP#6) Findings included: Clinical record review of active SP#6 contained a Plan of Care with a Certification Period of 05/16/23 to 07/14/23 that revealed the patient is receiving Skilled Nursing (SN) and Home Health Aide (HHA) services, further review of the plan of care reads “supervise aide every 14 days”. The HHA started providing care to SP#6 on 05/18/23. The home health agency failed to demonstrate that HHA supervisions were conducted every 14 days between date range 05/18/23 and 06/17/23, which is an interval of 30 days. Review of the home health agency’s policy and procedures titled “Home Health Aide Supervision” reads “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 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 the visit”. An interview was conducted with the Director of Nursing on 06/21/23 at 12:10 PM. The Director of Nursing reviewed the electronic clinical record and confirmed no supervision scheduled before 06/17/23.

A complaint survey (complaint number 2022010106) was conducted on 01/25/2023 to 01/26/2023 at Medcare Home Health Services Inc. The home health agency was in non-compliance with 42 CFR 484 Subpart A-C, Requirements for Home Health Agencies.

Patient's or legal representative's signature CFR(s): 484.50(a)(2) Obtain the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities. This ELEMENT is not met as evidenced by: Based on record review and interview, the home health agency failed to demonstrate it had obtained the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities for 1 out of 6 Sampled Patients (SP). SP#2 Findings include: Clinical record review was conducted from 01/25/23 to 01/26/23 of SP#2. The record for SP#2 revealed that patient was admitted to service with a start of care date of 12/06/22 to provide skilled nursing service and physical therapy service. Further review of the clinical record contained a service consent dated 12/06/22 with an “X” on the “patient’s signature”. On 1/26/23 at 3:15 pm and interview was conducted with the Director of Nursing (DON). The DON reviewed the consent for SP#2 and confirmed findings of consent noting “X” on the “patient’s signature”. Telephone interview conducted with the SP#2 on 01/27/23 at 4:28 pm. The SP#2 confirmed that he has completed the physical therapy visits, and currently only receiving daily visits by nurse for wound care. As per patient, he was provided with a booklet at start of service, but the staff are the ones to document and sign in the folder. The patient states that he does not remember signing any form for the agency. When informed of consent with an “X” as his signature, patient stated that was not possible, he does not sign like that, that his signature is personalized to him and does not sign with an “X”.

A complaint survey for complaint #2021016355, was conducted on January 31, 2022 at Medcare Home Health Services, Inc. The facility was in non-compliance with Code of Federal Regulations (CFR) 42, Part 484.22, Subpart A-C, Requirements for Home Health Agencies.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on record review and interview, the home health agency failed to demonstrate the staff(s) prepare and record clinical notes for 1 out of 3 Sampled Patients (SP). SP#3 Findings include: Electronical clinical record review conducted on 01/31/22 of SP#3 revealed the patient was receiving daily visits for skilled nursing care and five times a week home health aide service. Further review of the electronic clinical record revealed the registered nurse has not completed the scheduled visit notes of date(s) range from 12/02/21 to 12/12/21 and 01/14/22 to 01/28/22. The registered nurse scheduled visit notes all revealed status as “Save” and "Not Started". The Home Health Aide has not completed the notes for the scheduled visit notes for 11/25/21, 11/26/21, 11/30/21 and 12/01/21, further review all revealed status as “Returned for Review” and "Not Started". Interview conducted with the Director of Nursing on 01/31/22 at 3:20 and 3:45 PM acknowledged findings made by the surveyor, failure of the provider to have a complete clinical record with all the notes for care rendered by the registered nurse and home health aide. The Director of Nursing stated that the home health aide made the visit for scheduled dates11/25/21, and 11/26/21 but did not document the task completed on the visit, therefore the notes were returned for aide to fix the documentation. The Director of Nursing confirmed that the registered nurse is behind on the documentation of visits. Review of the agency’s policy titled “Timely Submission of Patient Documentation” reads under the procedure section “2. All patient visit notes from all personnel must be submitted within fourteen (14) days from the date of the visit.”

A Complaint Survey for complaints #s 2020015524, 2021004496, 2021005252, 2021005339 , was conducted on May 11, 2021 to May 13, 2021 at Medcare Home Health Services Inc. The Home Health Agency was not in compliance with 42 CFR 484 Subpart A-C requirements for Home Health Agencies.

Treatment or care CFR(s): 484.50(e)(1)(i)(A) (i)(A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; and This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to promptly furnish the Home Health Aide (HHA) services to 2 out of 5 Sampled Patients (SP). SP#4 and SP#5 Findings Include: Review of SP#4’s record revealed a physician’s order dated 04/05/2021 that contained the following: “Home Health Physical Therapy/ needs daily assistance, RN Eval and Treat.” Further record review revealed SP#4 was admitted on 04/08/2021. Additional record review revealed the agency provided the first Home Health Aide (HHA) services to the patient on 04/14/2021, six days after he was admitted. During an interview conducted on 05/11/2021 at 4:49 PM, SP#4 stated that he needed the HHA’s assistance with bathing and other activities because his right arm is fractured, and he is right-handed. Furthermore, SP#4 stated that he really needed the services, however it took the agency two weeks to coordinate his care. During an interview conducted on 05/13/2021 at 1:10 PM, the Director of patient services acknowledged that the agency did not provide the HHA services in a timely manner to SP#4. Review of SP#5’s record revealed a physician’s order dated 03/04/2021 that contained the following: “Home Health Services requested PT, OT, HHA, Skilled Nursing Services.” Further record review revealed SP#5 was admitted on 03/06/2021. Additional record review revealed no documentation that the agency provided the HHA services to SP#5 as ordered. During an interview conducted on 05/12/2021 at 1:42 PM, the patient’s spouse stated that the agency never offered nor provided the HHA services to SP#5. During an interview conducted on 05/13/2021 at 1:13 PM, the Director of patient services acknowledged that the agency did not provide the HHA services to SP#5 as ordered by the physician.

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 record review, interview and policy review, the Home Health Agency failed to ensure that a comprehensive assessment was conducted within five calendar days after the start of care for 1 out of 5 Sampled Patients (SP). (SP#1) Findings Include: Review of SP#1’s record revealed a physician order dated 09/10/2020 that contained the following: “Indicated HH to PT/OT evaluation and treatment. Add Personal care while is receiving PT.” Further record review revealed SP#1 was admitted on 09/11/2020. Additional record review revealed the Occupational Therapist (OT) evaluated the patient on 09/17/2020. During an interview conducted on 05/13/2021 at 12:48 PM, the Director of patient services acknowledged that SP#1’s comprehensive assessment was not conducted within five calendar days after the start of care. A review of the agency's policy on “Completion of the Comprehensive Assessment” revealed, "Must be completed in a timely manner consistent with the patient's needs, but no later than five (5) calendar days after the start of care."

Coordination of Care CFR(s): 484.60(d) Standard: Coordination of care. The HHA must: This STANDARD is not met as evidenced by: Based on record review, interview and policy review, the Home Health Agency failed to coordinate care delivery for 1 out of 5 Sampled Patients (SP). SP#1 Findings Include: Review of SP#1’s record revealed a physician’s order dated 09/10/2020 that contained the following: “Indicated HH to PT/OT evaluation and treatment. Add Personal care while is receiving PT.” Further review of SP#1’s record revealed she was admitted on 09/11/2020. Additional record review revealed that the agency provided the first Home Health Aide (HHA) services to SP#1 on 09/14/2020. During an interview conducted on 05/12/2021 at 11:43 AM, SP#1’s daughter stated that the patient needed the HHA services to start on 09/14/2020; however, the agency was unable to find the staff to provide the services. During an interview conducted on 05/13/2021 at 12:25 PM, the Director of patient services acknowledged that the agency did not coordinate care delivery to provide the HHA services to SP#1 in a timely manner. A review of the agency's policy on “Coordination of Patient Care” revealed, "Procedure 1. The agency must: Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any) and caregiver (s), as appropriate, in the coordination of care activities.”

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on interview and record review, the Home Health Agency failed to ensure that an Occupational Therapist was promptly available to work/ carry out the physician’s order for 1 out of 5 Sampled Patients (SP). SP#4 Findings Include: During an interview conducted on 05/11/2021 at 4:49 PM, SP#4 stated that the physician ordered Physical Therapy (PT) and Occupational Therapy (OT) services on 05/05/2021. On 05/11/2021 at 5:42 PM, a review of the prescription sent by SP#4 revealed that the orthopedic surgeon ordered PT and OT services on 05/05/2021. A review of SP#4’s record revealed that the patient was evaluated by the Occupational Therapist on 05/10/2021. During two interviews conducted on 05/13/2021 at 11:19 AM and 11:23 AM respectively, the Occupational Therapist stated that she received the referral to evaluate SP#4 on Thursday (05/06/2021) but she does not work Friday, Saturday, and Sunday; therefore, she evaluated the patient the following Monday (05/10/2021) which is four days after she received the referral. During an interview conducted on 05/13/2021 at 1:07 PM, the Director of patient services acknowledged that the agency did not ensure that the Occupational Therapist was promptly available to work/ carry out the physician’s order concerning SP#4. The Director of patient services stated that she wasn’t aware that the Occupational therapist does not work on Fridays, Saturdays, and Sundays.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to provide services that are ordered by the physician or allowed practitioner as indicated in the plan of care for 1 out of 5 Sampled Patients (SP). SP#5 Findings Include: Review of SP#5’s record revealed a physician’s order dated 03/04/2021 that contained the following: “Home Health Services requested PT, OT, HHA, Skilled Nursing Services.” Further record review revealed SP#5 was admitted on 03/06/2021. Additional record review revealed SP#5 was evaluated by the Physical Therapist (PT) on 03/09/2021. Continued record review revealed the agency did not provide any PT services/treatments to the patient during the week of 03/14/2021 to 03/20/2021. During an interview conducted on 05/12/2021 at 1:42 PM, the patient’s spouse stated that SP#5 never refused the PT services, she just never heard from the agency during the week of 03/14/2021 through 03/20/2021. In addition, the patient's spouse stated that it was the worst service that SP#5 ever received from an entity. During an interview conducted on 05/13/2021 at 1:13 PM, the Director of patient services acknowledged that the agency did not provide the PT services/ treatments to SP#5 during the week of 03/14/2021 to 03/20/2021 as indicated on the plan of care.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to communicate accurate information to 1 out 5 Sampled Patients (SP)’s physician related to the current plan of care. SP#5 Findings Include: Record review revealed SP#5 was admitted on 03/06/2021. Additional record review revealed SP#5 was evaluated by the Physical Therapist on 03/09/2021. Continued record review revealed the agency did not provide any PT services/treatments during the week of 03/14/2021 to 03/20/2021. Review of the communication note dated 03/10/2021 revealed the following, “Revision of plan of care: Patient requested placed physical therapy on hold until next week, resume on 03/24/2021. PT frequency: as of 03/24/2021 3 WK2.” During an interview conducted on 05/12/2021 at 1:42 PM, the patient’s spouse stated that SP#5 never refused the PT services, she just never heard from the agency during the week of 03/14/2021 through 03/20/2021. In addition, the patient's spouse stated that it was the worst service that SP#5 ever received from an entity. During an interview conducted on 05/13/2021 at 1:14 PM, the Director of patient services acknowledged that the agency did not provide the PT services/ treatments to SP#5 and that the information that was communicated to the physician on 03/10/2021 was inaccurate.

Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency failed to coordinate care delivery for 1 out 5 Sampled Patients (SP). SP#2 Findings Include: Review of SP#2’s record revealed a physician’s order dated 03/28/2021 that contained the following: “HHC PT, Evaluate and treat; HHC skilled RN, Review medications, vitals, teaching, and home safety.” Further review of SP#2’s record revealed the patient was admitted on 03/29/2021. Additional review of the Start of Care (SOC) dated 03/29/2021 revealed that the Registered Nurse (RN) documented under “Disciplines/ Frequency/ Duration: SN 1 da 1; PT: 1 wk 1 for eval.” Additional review of SP#2’s record revealed the episode started on 03/29/2021 and ended on 04/05/2021. however, there was no documentation that SP#2 was evaluated by a Physical Therapist. During an interview conducted on 05/13/2021at 1:05 PM, the director of patient services acknowledged that SP#2 was not evaluated by a PT between 03/29/2021 to 04/05/2021. The director of patient services stated that the physician was notified on 03/30/2021, however she could demonstrate how/when the communication was sent to the physician’s office.