Every finding on record at Mount Hood Healthcare LLC

An unannounced Federal recertification survey was completed at this agency on 5/8/2023. The agency was surveyed for compliance with 42 CFR Conditions of Participation for Home Health Agencies, Part 484.102 Emergency Preparedness. An entrance conference was held on 4/24/2023 with the HR Director at 11:50 AM and with the Administrator at 12:02 PM. The purpose of the survey and the survey needs were explained. An opportunity was provided for questions, answers and comments. Definitions and abbreviations: CFR - Code of Federal Regulations HR - Human Resources

An unannounced Federal recertification survey was completed at this agency on 5/8/2023. The agency was surveyed for compliance with 42 CFR Conditions of Participation for Home Health Agencies, Part 484. An entrance conference was held on 4/24/2023 at 11:50 AM with the HR Manager and 12:02 PM with the Administrator. The purpose of the survey and the survey needs were explained. An opportunity was provided for questions, answers, and comments. Definitions and abbreviations: A&O - Alert and Oriented CFR - Code of Federal Regulations HR - Human Resources LPN - Licensed Practical Nurse PT - Patient

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on interview and record review, it was determined the agency failed to perform a complete review of medications that included checking compliance with drug therapy for 1 of 17 patient records reviewed (Patient #15). Findings: Review of the "HOME HEALTH CERTIFICATION AND PLAN OF CARE", with a certification period from 4/22/2023 to 6/20/2023 and start of care date of 11/3/2020, revealed under "Orders of Discipline and Treatments" included "RN/LPN TO REVIEW MEDICATION PROFILE AND RECONCILE MEDICATIONS AS NEEDED. RN/LPN MAY INSTRUCT AND REINFORCE MEDICATION TEACHING RELATED TO USE OF MEDICATIONS TO TREAT DISEASE PROCESSES." The document under "Medications" indicated Patient #15's medications that included "Acetaminophen extra strength 500 mg tablet; Aspirin low dose 81 mg tablet delayed release; Atorvastatin 80 mg tablet; Clopidogrel 75 mg tablet; Metformin 500 mg tablet; Metoprolol succinate ER 25 mg tablet, extended release..." During a home visit observation on 4/26/2023 at 1:00 PM, when the LPN asked Patient #15 about if there was any change with the current medication, Patient #15 stated "I don't think so." When the LPN further asked to see the medication, there were multiple piles of bubble pack medications with dates on the bubble packs dating back to 2021. When the LPN checked the medication Patient #15 was taking, it was from the expired medication pile. The LPN collected the expired bubble pack medications and placed them in two large bags, leaving the current medications out for Patient #15. Review of the "Visit Note Report" dated 3/15/2023 revealed under "Narrative" "PT A&OX2, FORGETFUL AND NEEDS PROMPTING ... PT USING BUBBLE PACK MEDS BUT IS ON WRONG DATE BY COUPLE MONTHS. PT SAYS HE JUST USES WHATEVER BUBBLE PACK HE CAN FIND AND DOESN'T PAY ATTENTION TO THE DATE. HE DOES SAY HE USUALLY TAKES MEDS AS PRESCRIBED." During an interview with Employees #1 and #3 on 5/5/2023 at 2:24 PM, the above findings were presented and they were asked if Patient #15's caregiver or family and physician were notified. Employee #2 reviewed the above documentation in the electronic medical record and stated, "I have to go back through my notes." There was no further documentation provided regarding the finding.

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 interview, review of patient medical records and review of policies and procedures, it was determined that for 1 of 17 patients (Patient #15), the agency failed to ensure a physician was promptly notified of changes in the patient's condition that suggest a need to alter the plan of care. Findings: Review of Patient #15's record revealed a SOC date of 11/3/2020. The document "Home Health Certification and Plan of Care" with the certification period of 4/22/2023 through 6/20/2023 listed the principal diagnosis as type 2 diabetes mellitus with diabetic neuropathic arthropathy. Other pertinent diagnoses included orthostatic hypotension and presence of aortocoronary bypass graft. The document also revealed under "Orders of Discipline and Treatments" included "RN/LPN TO REVIEW MEDICATION PROFILE AND RECONCILE MEDICATIONS AS NEEDED. RN/LPN MAY INSTRUCT AND REINFORCE MEDICATION TEACHING RELATED TO USE OF MEDICATIONS TO TREAT DISEASE PROCESSES." During a home visit observation on 4/26/2023 at 1:00 PM, when the LPN asked Patient #15 about if there was any change with the current medication, Patient #15 stated "I don't think so." When the LPN further asked to see the medication, there were multiple piles of bubble pack medications with dates on the bubble packs dating back to 2021. When the LPN checked the medication Patient #15 was taking, it was from the expired medication pile. The LPN collected the expired bubble pack medications and placed them in two large bags, leaving the current medications out for Patient #15. During an interview with Employees #1 and #3 on 5/5/2023 at 2:24 PM, the above findings were presented and they were asked if Patient #15's physician was notified. Employee #2 stated, "I have to go back through my notes." There was no further documentation provided. Review of the agency's policy and procedure titled "MEDICATION PROFILE" with policy number 4-024.1 revised on November 2020 revealed, "5. Based on review of the medication profile as well as the written material, changes in the plan of care may be required. 6. Any conclusions and findings of patient medication use or monitoring should be communicated to the appropriate approved medical provider, when appropriate, and other clinicians. 7. Deviations from taking medications as ordered will be documented in clinical notes, and the approved medical provider will be notified." Refer to findings identified in tag G0536 for additional information.

An unannounced on-site investigation for complaint #71926 was initiated on 12/6/2022 and completed on 1/4/2023. The agency was surveyed for compliance with 42 CFR Conditions of Participation for Home Health Agencies, Part 484. An entrance conference was held with the Executive Director on 12/6/2022 at 11:50 AM. The purpose of the investigation and the investigation needs list were explained. An opportunity was provided for questions, answers and comments. Definitions and abbreviations: CFR - Code of Federal Regulations HHA - Home Health Agency LVM - Left Voice Mail LM - Left Message NA - Not Available OASIS - Outcome and Assessment Information Set OV - Office Visit OT - Occupational Therapist PCP - Primary Care Provider PT - Physical Therapist RN - Registered Nurse SOC - Start of Care

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on interview and medical record review, it was determined the home health agency failed to hold an initial visit within 48 hours of referral for 2 of 3 patient records reviewed (Patients #2 and #3). Findings: Patient #2: A review of Patient #2's medical record received from the referring provider revealed a referral date of 7/13/2022. Review of document provided by Patient #2's provider titled "Progress Notes" with "Encounter Date: 8/3/2022" revealed "[Provider office] called [this agency's name] as PCP wanted an update on that referral. They said that patient had been denied because [Patient #2's] insurance was open card. [Provider] explained to them that no, patient has PacificSource and it is the same ID number. They asked for [Provider's office] to fax over copy of [Patient #2's] insurance card. Faxed successfully to [phone number]. I did mark urgent. [Provider office] also sent msg to nursing to follow up as this is an urgent referral." Review of Patient #2 record titled Telephone Conversation, dated August 3, 2022, and timed 6:36 PM revealed "[Telephone call] pt notified [home health agency] has accepted [them] under their care and anticipates they can start care in 1-2 weeks or even sooner." Review of a note entered by the Provider's office dated August 12, 2022, and timed 5:03 PM revealed "...TC (telephone call) from [name of agency's intake person] from [home health agency] states has home health orders and is missing documentation of diagnoses code, [states] the one facility received dizziness as primary code but for insurance purposes it is a symptom not primary code. Pt is scheduled on Monday 08/15 for orders..." Review of note entered by the home health agency's intake person on 8/12 revealed "I spoke with the PCP clinic on Friday to let them know that we needed additional documentation. Due to diagnosis being a symptom, not an actual diagnosis code. Another note entered on 8/15 revealed "I called PCP clinic again to check on the status of the documentation. LVM for ... referral specialist. Email sent to care team to let them know of the delay." The above documentation indicated that the Provider sent a referral on 8/3/2022, the home health agency contacted the Provider on "Friday," which would have been 8/5/2012 but failed to follow up again until 8/15/2022, ten days after the initial contact date. Review of telephone conversation document at the Provider's office dated August 22, 2022, timed 11:53 AM, and titled "Conversation: Health orders" revealed,"[Registered nurse] spoke with [home health agency]. [The home health agency personnel] states they received new order and everything is in place. [Patient #2] is due to have a visit this week. Informed [Patient #2] that home health states [Patient #2] should be getting a call the day before [their] visit this week. No further needs at this time." Review of a note entered by the intake person at the home health agency on August 29, 2022 at 11:56:40 AM revealed, "Orders state F2F was done on 5/25 - too old to use now. Orders were signed 7/13 - also too old to use now. I called the office to let them know that we would need new documents and the appropriate diagnosis codes, as previously requested. This is a non-admit for now and they will need to send a new referral, if needed..." As indicated in documentation, on 8/22/2022 the home health claimed they received the new referral from the Provider and Patient #2 should get a visit from the home health. However, the home health agency waited until 8/29/2022, seven days to reach out to the Provider regarding the issue with the diagnosis code even after notifying the Provider office that Patient #2 would have a visit the week of 8/22/2022. Review of another document from the Provider's office titled "Type: Provider Comments" dated 8/29/2022 and timed 7:39 PM revealed, "Text: Home health PT/OT for history of cerebellar stroke with persistent dizziness following. Referrals - please refer [this agency's name], we [the provider office] have been working with them [this agency] to try to get patient in there for months, please also contact patient and give updated address..." Review of document at the Provider's office dated 8/30/2022, timed 9:50 AM revealed "Spoke to [agency's intake person] at [this agency]: stating referral form with ICD-10 code 163.9 should work now. Referral will be faxed with recent chart note." The provider referred the patient to this home health agency again on 8/29/2022. Document titled "Type: Provider Comments" dated 8/29/2022, timed 7:39 PM, revealed "Text: Please evaluate [Patient #2's name] for admission to Home Health. Disciplines requested: Physical Therapy and Occupational Therapy. Services provide: Strengthening Exercises and Evaluate. Physician to follow patient's care (the person listed will be responsible for signing ongoing orders): PCP. Requested Start of Care Date: Tomorrow." Review of telephone conversation document from the Provider's office dated September 1, 2022, timed 9:49 AM and titled "Conversation: Care Coordination" revealed, "Finally able to speak to live scheduler at [the home health agency]. Spoke to [Intake person] in scheduling who stated patient is scheduled for appts next week. Could not see exact date during call as their system was down but could confirm patient is scheduled." Review of note entered by the Provider's office Registered Nurse on 9/7/2022 at 9:36 AM revealed, "Hi [Provider's name], [home health agency calling], requesting change in diagnostic code from CVA to 'Late effect CVA' Please advise." At 10:48 AM on 9/7/2022, the Provider replied with the following message: "Sure, that is fine, whatever they need to get [Patient #2] seen." Review of note entered by Provider's office RN on 9/7/2022 at 11:29 AM revealed, "Fax sent to [home health] fax [number] Sent over verbal for Primary IDC 10 code change to 169.30 per verbal from [the Provider] and last [office visit] from 8/29/22." Review of note entered by the Provider on 9/15/2022 at 5:10 PM revealed, "[Name of employee] and I have been in contact with [Patient #2] and [Patient #2] has still not had any phone calls from home health physical therapy and does not have any visits from them, can you please call home health PT and see what is going on...Please write us back and let us know specific date that [they] can get scheduled with them. Thank you." Review of note entered by Provider's office RN on 9/16/2022 at 10:00 AM revealed, "Attempted to contact [the home health] [phone number] NA, LM." Review of note entered by Provider's office RN on 9/20/2022 at 12:56 PM revealed, "Re-faxed HH referral and OV notes. This RN will call back to [the home health agency's intake person] with [home health] and check if the chart notes look acceptable to admit patient." Review of note entered by the Provider on 9/21/2022 at 10:19 AM revealed, "I called, talked to [name of person working at the home health agency], gave written orders to use code 'late effects of CVA' 169.398, faxed to [home health] so they can schedule patient. Patient's address in [city] provided." The documentation indicated that the home health agency again failed to reach out to the Provider on a timely manner to request an updated referral with the appropriate billing code to start service for Patient #2. Based on the above documents, the Provider's office made multiple attempts to try to contact the home health agency without a timely call back from the home health agency. During an interview with the Executive Director, Director of Clinical Quality, Interim Clinical Manager, and OASIS RN on 12/15/2022 beginning at 9:00 AM, the Director of Clinical Quality stated, "We didn't have a diagnosis code, so we were contacting the doctor to get the right code." An email received from the Executive Director on 1/4/2023 revealed, "In the case of [Patient #2], I would add that after the patient saw [their] provider on 8/29/22 and obtained new orders on 8/30/22 we still did not receive this referral (visit and order) until 9/19 as reflected on the fax cover sheet in the document packet provided." Patient #3: A review of Patient #3's medical record revealed a referral completion date of 7/7/2022. The initial SOC assessment was not completed until 7/13/2022, six days after the referral date. During an interview with the Executive Director, Director of Clinical Quality, Interim Clinical Manager, and OASIS RN on 12/15/2022 at 9:00 AM, they verified the findings. The Executive Director stated "Unfortunately, we do not have documentation regarding the delay from 7/7 to SOC on 7/13."