Every finding on record at Nightingale Home Health Care of Minnesota,Inc.

An abbreviated survey was conducted at Nightingale Home Healthcare on 3/22/21, through 3/23/21 to investigate complaint H8085007C/MN00070982 which was unsubstantiated, but associated tags were issued as a result of the investigation. As a result Nightingale Home Healthcare is not in compliance with requirements at 42 CFR Part 484, requirements for Home Health Agencies.

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on interview and document review, the agency staff failed to report immediately to the State Agency (SA) an allegation of sexual assault for 1 of 1 patients (P1) reviewed for patients rights. Findings include: P1's diagnoses included Parkinson's disease, aphasia, slurred speech, post traumatic stress disorder and mild cognitive impairment obtained from the plan of care for certification period 3/5/21, through 5/3/21. The physical therapy (PT) plan of care for the same period identified P1 received PT 3 times weekly for 3 weeks then 2 times weekly for three weeks with primary focus on bilateral upper and lower extremities to increase client's ability to perform recliner to/from Commode independently. During a review of a Sheriff's County Office report dated 3/12/21, on an allegation of sexual assault report indicated the agency physical therapist (PT) who had been to P1's home had massaged her legs and her lower back and during the massage, the PT had moved his hands all the way up to P1's legs to the point of where the pull up underwear was. In addition, the PT's hands were to the point where the legs meet P1's groin area. During the incident P1 indicated the PT had used Cetaphil lotion, had not done any exercises with P1 on standing and walking which was unusual. During a review of a Minnesota Adult Abuse Reporting Center (MAARC) report by the agency dated 3/16/21 it was revealed the agency had been contacted by an investigator from the Sheriff's County Office on 3/15/2021, which indicated a criminal complaint had been filed for sexual assault against a physical therapist employed by the company. The report indicated the investigator had not provided any details of the incident and did not identify the alleged victim. During further review of the agency Self-Report of Suspected Elder Abuse narrative report dated 3/15/21, it was revealed the agency had been made aware of the sexual assault allegation however, the agency did not report immediately to the SA the allegation. The report also indicated the physical therapist had been immediately advised about the report and was not allowed to see patients until the complaint was investigated. On 3/22/21, at 10:37 a.m. via telephone interview, the operation manager stated she had received the initial report from the Sheriff County Office about the sexual report on 3/15/21. The operations manager then stated upon receiving the report, the PT name had been provided and the allegation was reported to the agency legal counsel who reported it to the State Agency on 3/16/21. When asked the time she was made aware on 3/15/21, the operations manager stated she had not put the time down. The operation manager also stated on 3/15/21, the physical therapist had been contacted and instructed to not see any patients and then the report was made of 3/16/21, because the agency was going by the State abuse reporting time frame of 24 hours. On 3/23/21, at 10:19 p.m. via telephone interview, the quality assurance/clinical coordinator registered nurse (RN) stated any allegations of abuse were usually reported to co-operate and the company legal team was responsible for reporting the allegation to the State Agency. She then stated "We are going by the state timeline of 24 hours. She stated she had gotten a call about the reporting timeframe and had said "immediately was immediately" and thought the company attorney may have misinterpreted the information as well. The agency undated policy indicated the agency investigated, documented and resolved all patient grievances/complaints and documented all the results in a timely manner. Also, the policy indicated all the personnel were knowledgeable of the policies and procedures for handling a grievance/complaint/concerns. In addition, the policy indicated "Complaints investigation for vulnerable adult maltreatment or abuse investigation is initiated immediately. Notification to patient/family/and/or caregiver is subject to who the complaint is against and may not be made where the caregiver is the individual under investigation to protect the patient until authorities can intervene..." The policy lacked information of where and when abuse allegations were to be reported to the designated appointed State Agency.

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 interview and document review the agency failed to inform the physician of services that were not provided for 1 of 3 patients (P2) reviewed for patient rights. Findings include: P2's diagnoses included colostomy repair, post traumatic stress disorder, bipolar disorder and age related osteoporosis obtained from the plan of care for certification period 2/11/21, through 4/11/21. The physical therapy (PT) plan of care for the same period identified P2 received PT 3 times weekly for 4 weeks to perform balance training to decrease the risk of injury, to assist with exercises to get strength back and patient to ambulate 150 feet on even surfaces without assistive device. Review of P2's clinical record, revealed P2 did not not receive physical therapy services from 3/15/21, through 3/22/21. In addition, the medical record lacked documentation that P2's physician was notified of the missed visits. On 3/22/21, at 11:14 a.m. the human resource/medical records manager reviewed P2 medical record and stated P1 had not received therapy the previous week because the physical therapist had been out since 3/15/21, following an allegation of sexual assault against him. She further stated the agency did not have another physical therapist on staff and she had communicated with the operations manager who indicated she was working on getting the patients to a contract agency to continue with therapy since the agency did not have a therapist. On 3/22/21, at 12:23 p.m. human resource/medical records manager stated the operation manager had told her she had missed notifying P2's physician for the missed visits due to the agency not being able to provide physical therapy services. She then stated the operations manager was in the process of referring P2 to another agency. On 3/23/21, at 10:19 a.m. during a telephone interview, the quality assurance/clinical coordinator RN stated the physician should have been notified when the missed visits happened as the agency was not able to furnish the services per the plan of care developed for the patient and signed by the physician. The agency undated Standard HH5-5B and HH5-9A policies directed patient care was to follow a written plan of care established and reviewed periodically by a doctor of medicine, osteopathy, or podiatry medicine.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on interview and document review, the home health agency (HHA) failed to ensure treatment and services were provided as ordered by the physician and as indicated in the plan of care for 1 of 3 patients (P1) reviewed reviewed for patient rights. Findings include: P1's diagnoses included Parkinson's disease, aphasia, slurred speech, post traumatic stress disorder and mild cognitive impairment obtained from the plan of care for certification period 3/5/21, through 5/3/21. The physical therapy (PT) plan of care for the same period identified P1 received PT 3 times weekly for 3 weeks then 2 times weekly for three weeks with primary focus on bilateral upper and lower extremities to increase client's ability to perform recliner to/from Commode independently. During a review of a Sheriff's County Office report dated 3/12/21, on a allegation of sexual assault the reported indicated the agency physical therapist (PT) who had been to P1's home had massaged her legs and her lower back and during the massage, the PT had moved his hands all the way up to P1's legs to the point of where the pull up underwear was. On 3/22/21, at 12:57 p.m. during a telephone interview, the agency physical therapist stated during a physical therapy evaluation visit on 3/12/21, he had done a manual therapy called myofascial release therapy (Is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore motion) on P1 to arms, both upper extremities to the shoulders, both legs from the knees to the feet. PT stated people called it massage but was not massage because it was to help release muscles that were stacked together which caused pain. The PT stated he thought he had the myofascial release therapy in the plan of care. PT was informed it was not in the plan of care then he stated "it's too bad because physical therapy is not just about walking." PT also stated this was the second time he had completed this myofascial release therapy on P1 with the other date being 3/3/21, and a family member was present during the visit. The PT acknowledged he did not document the visit. On 3/23/21, at 10:19 a.m. during a telephone interview, the quality assurance/clinical coordinator RN stated all the staff were supposed to follow the plan of care which has been derived from evaluation. She also stated if any patient contact was done it should be documented. She reviewed the physical therapy plan of care and verified the plan of care did not have orders for the PT to do myofascial release. In addition, she stated if the professional staff did any revision to the plan of care they were supposed to send the revision to the physician to be signed. P1 nor P1's family was interviewed per patients request. The Physical Therapist job description signed by PT on 2/9/21, directed him to provide therapy services as outlined in the plan of care, PT was to chart/document all the services that were rendered to the patient and PT was to follow established policies and procedures of the Nightingale Home Healthcare. The agency undated Therapy Services Patient Assessment and Plan of care directed the physician was to be notified in a timely and appropriate manner of any changes in the patients clinical status and/or needs or requests that suggest to modify the plan of care.