Every finding on record at Mountaineer Homecare, LLC

An emergency preparedness survey was conducted at Mountaineer Homecare from 11/8/21 to 11/11/21 as part of a recertification survey conducted during the same survey period. The agency was in compliance with the Emergency Preparedness Conditions of Participation for Home Health agencies and no deficiencies were found as a result of the survey.

A recertification survey was conducted at Mountaineer Homecare from 11/8/21 to 11/11/21. The agency provides skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work and home health aide services to Kanawha County. At the time of the survey the agency had an active patient census of four hundred and seventy-four (474) and the unduplicated admissions for the past fiscal year were nine hundred and eighty-two (982). A total of seventeen (17) clinical records were reviewed and seven (7) home visits were made. Four (4) standard level deficiencies were cited at G 440 (Payment for home health services), G 514 (Initial Assessment), G 572 (Plan of Care), G 682 (Infection Control-Prevention).

Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This ELEMENT is not met as evidenced by: Based on document review and staff interview it was determined the agency failed to notify three (3) out of seventeen (17) patients in writing what their expected fees would be for services rendered by the agency (patient #5, 13, and 15). This failure has the potential to result in financial hardship for the patients receiving the services of this agency. Findings include: 1. A review of the agency document entitled "Patient Consent" for patient #5 revealed the area for financial amounts the patient may have to pay was left blank. 2. A review of the agency document entitled "Patient Consent" for patient #13 revealed the area for financial amounts the patient may have to pay was left blank. 3. A review of the agency document entitled "Patient Consent" for patient #15 revealed the area for financial amounts the patient may have to pay was left blank. 4. An interview was conducted with the Executive Director (ED) on 11/9/21 at approximately 4:00 p.m. The ED concurred the potential amounts the patient may be responsible for on the consent forms were left blank.

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 document review and staff interview it was determined the agency failed to ensure that an initial assessment was conducted within forty-eight (48) hours of the referral in two (2) out of seventeen (17) records reviewed (patients #5 and 15). This failure has the potential to delay possible life-saving services needed by the patient receiving the services of this agency. Findings include: 1. A review of the referral for patient #5 revealed it was received by the agency on 10/19/21 and the Start of Care was not performed until 10/25/21. There was no documentation the patient requested the Start of Care be delayed until 10/25/21. 2. A review of the referral for patient #15 revealed the referral was received by the agency on 10/22/21 and the Start of Care was not performed until 10/25/21. There is no documentation in the record to indicate why the referral was delayed. 3. An interview was conducted with the Executive Director (ED) on 11/9/21 at approximately 4:00 p.m. The ED concurred the Start of Care for patientS #5 and 15 were not performed within the forty-eight (48) hour required time frame.

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 document review and staff interview it was determined the patient's plan of care was not followed in two (2) out of seventeen (17) records reviewed (patients #13 and 16). This failure has the potential to negatively impact patients receiving the services of this agency. Findings include: 1. A review of the plan of care for patient #13 revealed a social worker evaluation was ordered effective 10/17/21 for one (1) week one (1). The record indicated there has never been an evaluation performed by the social worker as of 11/10/21. 2. A review of the plan of care for patient #16 revealed a social worker evaluation was ordered effective 11/7/21 for one (1) week one (1). The plan of care further states, "Medical Social Worker for evaluation/treatment on 11/7/21 to assist with community services goal to be completed by end of day on 11/7/21. Patient aware and agreeable." The record indicated there has never been an evaluation by the medical social worker as of 11/10/21. 3. An interview was conducted with the Executive Director (ED) on 11/9/21 at approximately 4:00 p.m. The ED concurred patients #13 and 16 had never received an evaluation by the medical social worker.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, document review and staff interview it was determined the facility failed to ensure the staff kept clean and dirty equipment separate and cleaned equipment after patient use for two (2) of seven (7) patients observed during home visits (patients #8 and 9). This failure has the potential to increase the transmission of communicable diseases for all patients. Findings include: 1. An observation of a home visit for patient #9 with the certified occupational therapy assistant (COTA) on 11/9/21 at 12:50 p.m. revealed the barriers had been placed on the floor and the home care bag and supplies were placed on the barriers on the floor. The patient’s cat was seen on the barriers. Clean supplies were placed on the dirty barrier. The COTA was stepping on both the clean and dirty barrier while providing care to the patient. 2. An observation of a home visit for patient #8 with the speech language pathologist on 11/9/21 at 2:00 p.m. revealed the blood pressure cuff and thermometer were not cleaned after they were used on the patient and both items were placed back in the home care bag. 3. A review of the facility protocol entitled "Home Care Bag Protocol Job Aid," last revised 5/10/21, revealed in part: “Keep bag away from pets and children. Do not place the bag on the floor.” 4. A review of the facility policy entitled "Cleaning of Reusable Equipment," last revised 11/1/20, revealed in part: “Thermometers: Disposable covers will be used with thermometers for each patient use. Digital thermometers will be cleaned after disposing of the disposable cover with a low-level disinfectant wipe after each patient use and before being returned to the staff bag. Blood pressure cuffs are cleaned with a low-level disinfectant wipe after each patient use and before being returned to staff bags." 5. An interview was conducted with the Executive Director (ED) on 11/10/21 at 3:25 p.m. The Executive Director concurred with the above findings.