Every finding on record at Mga Home Healthcare Colorado LLC

A complaint survey prompted by #CO111381 was completed on 12/31/24. Two deficiencies were cited.

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 interviews and record reviews the agency failed to protect patient rights specifically; to provide goods and/or services necessary to avoid physical harm, mental anguish or mental illness for 1 of 7 patients (Patient #1). Findings include: 1. The clinical record for Patient #1 was reviewed on 12/30/24. Plan of care orders for the certification period dated 11/7/24 to 1/5/25 revealed a start of care date of 11/13/23; diagnoses included infantile spinal muscular atrophy, gastronomy status, congenital deformities of the hip, scoliosis, deforming dorsopathy, lack of expected normal physiological development in childhood, dependence on other enabling machines and devices. Plan of care orders included skilled nursing services seven days a week for complete total care to include ventilator care, gastronomy tube feedings, airway maintenance, medication administration, and non weight bearing transfers. a. The agency failed to provide goods and/or services necessary to avoid physical harm, mental anguish or mental illness. A review of Patient #1’s record revealed the agency had stopped providing skilled nurse services on 11/8/24 and through the present day of 12/31/24. An interview was conducted on 12/31/24 at 10:18 a.m., with the vice president of clinical operations, administrator and director of nursing (DON) revealed the agency had staffing issues and did not have a skilled nurse to provide patient care. During the same interview, they admitted that the agency failed to deliver the required care, treatment, and services to Patient #1, recognizing this as a neglectful practice that they aim to rectify promptly.

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 interviews and record reviews, the agency failed to follow the plan of care, specifically by approaching the physician or allowed practitioners to reduce the frequency of services based solely on the availability of the agency staff for 1 of 7 patients. (Patient #1) Findings include: 1. The clinical record for Patient #1 was reviewed on 12/30/24. Plan of care orders for the certification period dated 11/7/24 to 1/5/25 revealed a start of care date of 11/13/23; diagnoses included infantile spinal muscular atrophy, gastronomy status, congenital deformities of the hip, scoliosis, deforming dorsopathy, lack of expected normal physiological development in childhood, dependence on other enabling machines and devices. Plan of care orders included skilled nursing services seven days a week for complete total care to include ventilator care, gastronomy tube feedings, airway maintenance, medication administration, and non weight bearing transfers. a. The agency failed to follow the plan of care, specifically by approaching the physician or allowed practitioners to reduce the frequency of services to Patient #1 based solely on the availability of the agency staff. A review of Patient #1's record revealed the agency had sent a nurse to the Patient #1's home on 11/7/24 to recertify the patient for home care skilled nurse services despite knowing the agency did not have the skilled nurse on staff to provide care. A review of the recertification documentation sent to the physician revealed the agency had documented the following "Patient to receive 80 hours a week upon obtaining authorization and identification of staff. The family is aware of the recruiting efforts of the agency." An interview was conducted on 12/31/24 at 10:20 a.m., with the vice president of clinical operations, administrator and director of nursing (DON) revealing the agency was unaware they were not allowed to approach physicians to reduce patient care hours based solely on the availability of the agency staff. They acknowledged Patient #1 was dependent on the agency's skilled nurse services for total care and they failed to follow the plan of care and physician's orders.

A complaint survey, prompted by #CO93859 was completed on 11/17/22. One deficiency was cited.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on interview and record review, the agency failed to ensure services and treatments were provided in conformance with physician orders for 2 of 6 patients records reviewed (Patients #2 and #4). Findings include: AGENCY POLICY According to the agency policy titled, "Plan of care" dated 5/5/21 read in pertinent parts: "Home care services are furnished under the supervision and direction of the client's physician, nurse practitioner, or physician assistant." 1. The clinical record for Patient #4 was reviewed on 11/14/22. The plans of care for the certification periods 8/8/22 to 10/6/22 and 10/7/22 to 12/5/22, revealed a start of care date of 6/14/21 and a discharge date of 10/21/22; diagnoses included bronchopulmonary dysplasia, chronic respiratory failure, and congenital tracheomalacia. Plan of care orders included private duty nursing (PDN) services for 144 hours per week from 8/8/22 to 10/6/22 and 144 hours per week from 10/7/22 to 12/5/22, for medication administration, ventilator care, tracheostomy care, gastrostomy (g-tube) care and feeding, provide age appropriate stimulation, bathe and provide oral care, change diapers, provide all activities of daily living during shift, and asses and monitor psychosocial needs. Patient #4 also received physical therapy (PT) services once a week for home exercise programs, range of motion exercises, and strengthening activities. a) The agency failed to ensure frequency orders for PDN services were followed for Patient #4. Review of the agencies episode calendar revealed Patient #4 received the following amount of PDN hours per week for the following weeks; -94 hours the week of 8/14/22 to 8/20/22, 50 hours short of the 144 hours ordered, -97 hours the week of 8/21/22 to 8/27/22, 47 hours short of the 144 hours ordered, -98 hours and 30 minutes the week of 9/4/22 to 9/10/22, 45 hours and 30 minutes short of the 144 hours ordered, -93 hours and 30 minutes the week of 9/11/22 to 9/17/22, 50 hours and 30 minutes short of the 144 hours ordered, -94 hours the week of 9/18/22 to 9/24/22, 50 hours short of the 144 hours ordered, -110 hours and 30 minutes the week of 9/25/22 to 10/1/22, 33 hours and 30 minutes short of the 144 hours ordered, -92 hours the week of 10/2/22 to 10/8/22, 52 hours short of the 144 hours ordered, and -102 hours the week of 10/9/22 to 10/15/22, 42 hours short of the 144 hours ordered. During the above weeks the agency failed to follow physician's orders of 144 hours of PDN services a week by as much as 52 hours. Review of the clinical record for Patient #4 did not reveal any communication with the physician regarding a reduction of PDN hours to meet the hours the agency did provide. Furthermore there was no documentation of communication with the family of Patient #4 to discuss a reduction in PDN hours to meet the hours the agency could provide. 2. The clinical record for Patient #2 was reviewed on 11/15/22. The plan of care for the certification period 9/03/22 to 11/01/22 revealed a start of care date of 1/27/18; diagnoses included paralysis of vocal cords and larynx, congenital laryngomalacia, and dysphagia. Plan of care orders included PDN services for 48 hours and 45 minutes per week from 9/03/22 until 11/01/22, for medication administration, g-tube feeding, g-tube site care, observation for signs and symptoms of infection, age appropriate play and stimulation, and vital sign assessment. a) The agency failed to ensure frequency orders for PDN services were followed for Patient #2. Review of the agency's episode calendar revealed Patient #2 received the following amount of PDN hours per week for the following weeks; -47 hours and 30 minutes the week of 9/11/22 to 9/17/22, one hour and 15 minutes short of the 48 hours and 45 minutes ordered, -46 hours and 15 minutes the week of 9/18/22 to 9/24/22, two hours and 30 minutes short of the 48 hours and 45 minutes ordered, -46 hours and 15 minutes the week of 9/25/22 to 10/1/22, two hours and 30 minutes short of the 48 hours and 45 minutes ordered, -40 hours and 45 minutes the week of 10/9/22 to 10/15/22, eight hours short of the 48 hours and 45 minutes ordered, and -47 hours the week of 10/23/22 to 10/29/22, one hour and 45 minutes short of the 48 hours and 45 minutes ordered. During the above weeks the agency failed to follow the physician's order of 48 hours and 45 minutes of PDN services a week by as much as 8 hours and 45 minutes. Review of the clinical record for Patient #2 did not reveal any communication with the physician regarding a reduction in PDN hours to meet the hours the agency did provide. Furthermore there was no documentation of communication with the family of Patient #2 to discuss a reduction in PDN hours to meet the hours the agency could provide. 3. During an interview on 11/16/22 at 4:15 p.m., the administrator stated there was no communication with the physician regarding a reduction in frequency hours. The administrator also stated the agency did not contact the parents of the patients regarding a reduction in frequency hours or to work with the parents and the physician to try to accommodate the needs of the patient with the amount of hours the agency could provide. During an interview on 11/17/22 at 9:18 a.m., the administrator stated again she could not find any communication or documentation of communication with physicians, regarding a change in frequency hours, and agreed the frequency was missed for Patients #2 and #4.