Every finding on record at Northwest Healthcare Alliance, Inc.

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 Part 484 conducted this health and safety survey. Examination number: 2022-196 Dates Onsite: 03/28/22, 03/29/22, 03/30/22, 03/31/22 This survey was conducted by: Surveyor #1 Surveyor #5 Surveyor #3 participated in the survey as an orientee DOH staff found the facility in substantial compliance with all Conditions of Participation except those standard-level deficiencies listed below. DOH recommends recertification based on an acceptable plan of correction.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on document review, record reviews, and interview, the agency failed to ensure that the plan of care was followed as ordered by the physician for 4 of 17 patients (Patient #101, #110, #113, #117). Failure to follow the plan of care, as ordered by the physician, could place the patient at risk of worsening symptoms of existing diagnoses. Findings included: 1. Document review of agency’s policy titled, “Plan of Care (POC),” (Policy #2.1.007, date revised 12/01/21) showed that the appropriate plan of care is developed and revised timely and that physician’s orders are followed for each patient’s plan of care. 2. Record review of patient records for Patients #101, #110, #113, and #117 showed: a. Patient #101 was admitted on 03/10/22 with Age-related osteoporosis, Essential hypertension, and History of falling–not a complete list. The physician ordered Skilled Nursing (SN), Home Health Aide, and Physical Therapy (PT) services. On 03/11/22, the physician ordered PT services for 1 time per week for 1 week, then 2 times per week for 4 weeks, and then 1 time per week for 4 weeks. The week of 03/13/22, received 1 of the 2 PT visits. The record had no documentation to explain the missed PT visit, and no evidence the physician received notification of the missed visit. b. Patient #110 was admitted on 01/21/22 with Cellulitis of right lower limb, Infection/inflammation reaction due to internal right knee prosthesis, Paroxysmal atrial fibrillation – not a complete list. The physician ordered SN, PT, Occupational Therapy (OT), and Social Work Services (MSW) services. On 01/23/22, the physician ordered PT services for 1 time per week for 7 weeks and then 1 time per week every 2 weeks for 2 weeks. The week of 03/06/22, the patient received no PT visits. The record had no documentation to explain the missed PT visits, and no evidence the physician received notification of the missed visits. c. Patient #113 was admitted on 04/30/21 with Dementia with lewy bodies, Pressure Ulcer of left heel, stage 2, and Type 2 diabetes mellitus with diabetic neuropathy – not a complete list. The physician ordered SN and PT services. On 08/29/21, the physician ordered SN services for the patient 3 times per week for 1 week, then 2 times per week for 1 week, then 3 times per week for 1 week, then 2 times per week for 1 week, then 3 times per week for 1 week, then 2 times per week for 1 week, then 3 times per week for 1 week, then 2 times per week for 1 week, and then 1 time per week for 1 week. The week of 09/05/21, the patient received 1 of 2 SN visits. The record had no documentation to explain the missed SN visit, and no evidence the physician received notification of the missed visit. d. Patient #117 was admitted on 01/06/21 with Atherosclerosis of native arteries of right leg with ulceration of calf, Venous insufficiency (chronic), Non-pressure chronic ulcer of right calf, pressure ulcer of left heel, unstageable, and Pressure ulcer of right heel, stage 2 – not a complete list. The patient was hospitalized on 01/16/21, discharged home, and resumed services with the agency on 01/24/21. The physician ordered SN and PT services. On 01/24/21, the physician ordered SN services 1 time per week for 1 week, then 2 times per week for 2 weeks, and then 1 time per week for 3 weeks. The week of 01/31/21, the patient received 2 of the 4 SN visits. On 02/07/21, the physician ordered SN services 3 times per week for 4 weeks. The week of 02/07/21, the patient received 1 of the 3 SN visits and the weeks of 02/21/21 and 02/28/21, the patient received 1 of 3 SN visits. The record had no documentation to explain the missed SN visits, and no evidence the physician received notification of the missed visits. On 01/24/21, the physician ordered PT services for 1 time per week for 1 week, then 4 times per week for 1 week, and then 2 times per week for 4 weeks. The week of 01/31/21, the patient received 2 of 4 PT visits. The weeks of 02/07/21, 02/14/21, 02/21/21, and 02/28/21, the patient received 1 of 2 PT visits. The record had no documentation to explain the missed PT visits, and no evidence the physician received notification of the missed visits. 3. On 03/30/22 at 2:00 PM, Surveyor #1 interviewed the agency’s Executive Director (Staff #111) about the lack of documentation of the missed visits. Staff #111 acknowledged the findings and stated that they were unable to find any explanation for the missed visits.