Every finding on record at Nhc Homecare of South Carolina, LLC

A survey of the Home Health Agency's (HHA) Emergency Preparedness Program (EPP) was conducted from 6/7/2021 to 6/10/2021. Based on observations, record reviews, interviews, review of the HHA's EPP, and review of the HHA's policies and procedures, it was determined the HHA is in compliance with Condition at CFR 484.102 (Establishment of the Emergency Program).

A survey of the Home Health Agency's (HHA) COVID - 19 focused infection control requirements was conducted in conjunction with the HHA's Recertification Survey from 6/7/2021 to 6/10/2021. Based on observations, record reviews, interviews, and review of the HHA's policies and procedures, it was determined the HHA is in compliance with the COVID-19 focused infection control requirements and had standard level deficiencies from the Recertification Survey.

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 record review, interview, and the facility's policy and procedure, the Home Health Agency (HHA) failed to provide measurable outcomes for all identified problems listed in the patient’s Plan of Care (POC) for seven out of seven patient records reviewed (Patient 1, 2, 3, 4, 5, 6, and 7). Patient 4 On 6/8/2021 at 9:12 AM, a review of Patient 4’s chart reveals all of the patient outcomes within the POC are not measurable (Ability to perform wound care; Safe transfers, Increased independence in acitvities in daily living; and Decreased fall risk). This finding is verified by the Administrator and Regional Administrator at 10:11 AM on 6/9/2021. Patient 5 On 6/8/2021 at 10:46 AM, a review of Patient 5’s chart reveals all of the patient outcomes within the POC are not measurable ( Ability to perform wound care).This finding is verified by the Administrator and Regional Administrator at 10:22 AM on 6/9/2021. Patient 6 On 6/8/2021 at 1:32 PM, a review of Patient 6’s chart reveals all of the patient outcomes within the POC are not measurable (Ability to perform wound care). This finding is verified by the Administrator and Regional Administrator at 9:58 AM on 6/9/2021. Patient 7 On 6/8/2021 at 2:42 PM, a review of Patient 7’s chart reveals all of the patient outcomes within the POC are not measurable (Cardiac exacerbatons; Changes in skin integrity; Ability to perform wound care; and Changes is co-morbid status). This finding is verified by the Administrator and Regional Administrator at 9:43 AM on 6/9/2021. The findings are: Patient 1 On 6/8/2021 at 1:30 PM, a review of Patient 1’s chart revealed all of the patient outcomes within the POC are not measurable: Cardiac exacerbations; Changes in skin integrity. The findings were verified by the Administrator and Regional Administrator at 10:49 AM on 6/9/2021. Patient 2 On 6/8/2021 at 2:30 PM, a review of Patient 2’s chart revealed all of the patient outcomes within the POC are not measurable: Cardiac exacerbations; Changes in skin integrity. The findings were verified by the Administrator and Regional Administrator at 11:00 AM on 6/9/2021. Patient 3 On 6/8/2021 at 3:30 PM, a review of Patient 3’s chart revealed all of the patient outcomes within the POC are not measurable: Cardiac exacerbations; Changes in skin integrity. The findings were verified by the Administrator and Regional Administrator at 11:10 AM on 6/9/2021. The facility's policy and procedure titled " Development, Review, and Revisions of the Home Health Plan of Care" reads"....The plan of care includes: All pertinent known diagnoses; Identification of disciplines responsible for providing services including the frequency and duration of visits to be made; The types of services, supplies, and equipment required; All medication and treatment; Patient specific interventions and education to facilitate timely discharge; Patient identified goals; Patient specific measurable outcomes and goals identified by the agency staff and anticipated to occur as a result of the services and care coordination provided. For example: Improvement/stabilization and functional and physical health, healthcare utilization measures such as ED used and hospitalization, potentially avoidable events....".

Review and revision of the plan of care CFR(s): 484.60(c) Standard: Review and revision of the plan of care. This STANDARD is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to revise the Plan of Care (POC) for the Resumption of Care (ROC) in two out of two patients with a ROC (Patient 4 and 5). Patient 4 On 6/8/2021 at 9:12 AM, a review of Patient 4’s chart reveals the patient has a Start of Care (SOC) on 11/16/2020 with a diagnosis of Displaced Bimalleolar Fracture of Right Lower Leg, Subsequent Encounter for Open Fracture Type I or II with Routine Healing. The patient has a ROC dated 11/30/2020 with an updated diagnosis of Gastrointestinal Hemorrhage, Unspecified. The ROC POC does not show any documentation of interventions or outcomes for the updated diagnosis. This finding is verified by the Administrator and the Regional Administrator at 10:11 AM on 6/9/2021. Patient 5 On 6/8/2021 at 10:46 AM, a review of Patient 5’s chart reveals the patient has a SOC dated 9/7/2020 with a diagnosis of Type 2 Diabetes Mellitus with a Foot Ulcer. The benefit period reviewed is dated 1/5/2021 to 3/5/2021. The patient has a ROC dated 1/20/2021 with an updated diagnosis of Type 2 Diabetes Mellitus with Hypoglycemia without Coma. The ROC has one order for the skilled nurse to teach regarding the management of Diabetes and a goal for the teaching. The ROC does not contain any wound care orders for the foot ulcer. The patient had a second ROC dated 2/1/2021 with an updated diagnosis of Type 2 Diabetes Mellitus with Hyperglycemia. The ROC has only one order for the skilled nurse to provide wound care and one goal (providing wound care). The ROC does not contain any teaching for the updated diagnosis (Hyperglycemia). These findings are verified by the Administrator and the Regional Administrator at 10:22 AM on 6/9/2021. On 6/8/2021 at 2:46 PM, a review of the agency policy and procedure for the Review and Revision of the Plan of Care reveals “The individualized plan of care must be reviewed and revised… beginning with the start of care and at least at subsequent comprehensive assessment time points (Resumption of Care)… A revised plan of care must reflect current information from the patient’s comprehensive assessment.” The policy and procedure were received from the Administrator at 2:46 PM on 6/8/2021.