Every finding on record at Memorial Home Health Services

An unannounced Complaint survey #2022005493 was commenced on 05/05/2022 and concluded on 05/06/2022 at Memorial Home Health Services, 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.

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 record review and interview the Home Health Agency failed to promptly notify the physician of missed visits for 4 of 4 sampled patients (Patient #1, #2, #3 and #4). The findings included: 1) Review of the record reveals Patient #1 started care on 02/17/22 and had physician orders effective 02/20/22 for Physical Therapy twice a week for 4 weeks. Further review of Patient #1's record reveals they received 2 Physical Therapy visits for the week of 02/20/22 to 02/26/22, one Physical Therapy visit on 03/04/22 for the week ending 03/05/22, 2 Physical Therapy visits for the week ending 03/12/22, and one Physical Therapy visit on 03/15/2 for the week ending 03/19/22. Patient #1's physician's order dated 03/18/22 documents the "Order Description" as "Physical Therapy to continue 2x (times) weekly for 2 weeks to continue for impaired balance, decreased strength" but under "calendar frequency" retroactively changes P.T. (Physical Therapy) to one visit effective the week of 03/13/22 to 03/19/22, without evidence the physician was notified a P.T. visit had already been missed that week, then 2 visits weekly for the following 2 weeks. There was also no "Missed Visit Note" or evidence the physician was notified of Patient #1's missed P.T. visit on 03/02/22 for the week of 02/27/22 to 03/05/22. Patient #1's “Notice of Medicare Non-Coverage for Medicare Services,” dated 4/4/22 and signed as Patient #1 documents coverage of “Home Care Services” will end on 04/06/22. However, there was no evidence of documentation that a Physical Therapist attempted to make a discharge visit to evaluate Patient #1 on 04/06/22; a Physical Therapist documented on 04/09/22 that Patient #1's family member requested to reschedule the P.T. appointment for Monday 04/11/22 and that they want the patient re-evaluated because they felt the patient was not ready for discharge. However, there was no evidence of documentation that a Physical Therapist attempted to make a visit on 04/11/22 or during that week. An "order" dated 04/15/22, which documents it was not a "verbal order" given by a physician and was sent to the physician to sign, documents to change the P.T. discharge to the week of 04/17/22 due to "inability to coordinate care" and under "calendar frequency" retroactively changed the P.T. visit frequency to once every 2 weeks effective 04/10/22, without evidence the physician was notified of the missed visit. On 04/27/22, an Occupational Therapist documented Patient #1 was discharged from the Home Health Agency on 04/17/22, without evidence of a Physical Therapist's attempt to conduct a P.T. re-evaluation/discharge visit. During telephonic interview on 05/06/22 at 12:57 PM, Physical Therapist, Staff A reported she called Patient #1's family member about doing the discharge evaluation on 04/09/22 but they had a conflict and wanted to reschedule the Physical Therapy evaluation to 04/11/22. Staff "A" denied knowing who should have conducted that visit as Staff "A" only "covers that area on weekends." During telephonic interview on 05/06/22 at 12:37 PM with Occupational Therapist, Staff B, who completed Patient #1's Home Health Agency discharge, was unable to answer why a Physical Therapy re-evaluation was not conducted but stated the "agency discharge" was assigned to her so she had to complete it based on the last level of functioning in the chart. During interview with the Administrator on 05/06/22 at 2:20 PM, she reported the patient's Physical Therapy discharge visit was scheduled for 04/17/22, which was the last day of the patient's "certification period" and they had no Physical Therapist to send to the patient since this patient uses nebulizer treatments and the only available Physical Therapist that day had not been "fit tested" for an N95 mask. During interview with the Director of Nursing on 05/06/22 at 4:16 PM, she could provide no evidence that a Physical Therapist made any attempt to do a discharge/re-evaluation visit for Patient #1 but stated staff try to make the visits because that is how they get paid. 2) Review of the record reveals Patient #2 started care on 03/06/22 and had orders dated 03/11/22 for one Physical Therapy visit for evaluation the first week, then 2 visits weekly for 3 weeks, then one visit a week for one week. Patient #2 also had orders dated 03/07/22 for Occupational Therapy visits twice weekly for 4 weeks. Further review of the record reveals documentation of "missed visits" for both Physical Therapy and Occupational Therapy on Monday, 03/14/22 and that both of these disciplines visited Patient #2 on Wednesday, 03/16/22. However, there was no evidence of an attempt to reschedule the "missed visits" during that week. "Internal Missed Visit Notes" by Clinical Liaison, Staff C, dated 03/21/22 document the "missed visits" on 03/14/22 for Occupational and Physical therapies, that the MD (physician) was notified by fax, and that the reason was "inability to coordinate care." During an in-person interview on 05/06/22 at 1:33 PM, Clinical Liaison, Staff C was unable to provide further clarification as to why the visits were missed but explained after each week is completed, the "scheduler" identifies visits that were "missed" and the "scheduler" or himself notify the physician. 3) Review of the record reveals Patient #3 started care on 03/31/22 and had orders dated 04/12/22 effective 04/10/22 for Physical Therapy twice weekly for 3 weeks. A Physical Therapy visit was documented for 04/12/22 and a "missed visit" was documented for Physical Therapy on Thursday, 04/14/22. An "Internal Missed Visit Note" by Staff C, dated 04/15/22 documents the "missed visit" on 04/14/22 for Physical Therapy, that the physician was notified by fax, and that the reason was "inability to coordinate care." Patient #3's "Calendar Report" documents Home Health Aide and Occupational Therapy visits were made to Patient #3 on 04/14/22 at 12:45 PM and 1:24 PM, respectively, and an "Occupational Therapy Note" documents Patient #3 had a doctor's appointment that morning. There was no evidence of documentation of an attempt to make the Physical Therapy visit that afternoon or on another day. 4) Review of the record reveals Patient #4 started care on 02/12/22 and had an order dated 03/16/22 for Physical Therapy twice weekly visits for 1 week, effective on 03/27/22. Patient #4's "Calendar Report" documents a Physical Therapy Assistant visited Patient #4 on 03/29/22. A "Missed Visit Notification" dated 04/02/22 documents the Physical Therapist missed a visit on 03/29/22 due to "inability to coordinate care due to staffing for physical therapists" and the physician was notified by fax. A Physical Therapist's Note dated 03/31/22 documents the family member reported Patient #4 was too tired for a visit and requested to reschedule it for the following morning. There was no evidence of documentation of attempt to make the visit Friday as requested and an "Internal Missed Visit Note" by a "Clinical Liaison," dated 04/06/22 documents a "missed Physical Therapy visit "on 04/01/22 due to "inability to coordinate care" and the physician was notified by fax. Patient #4 did not receive another P.T. visit until 04/18/22. During in-person interview on 05/06/22 at 4:16 PM, the Director of Nursing reported that physicians are automatically notified of missed visits by fax at the time missed visit notes are entered; that if the physician responds that they want them to make up the visit now, they would do so; and that they would expect the physician to contact them if they wanted to change orders; during this interview, the Director of Nursing also explained attempts to reschedule visits would be documented in the "Coordination Notes."