Every finding on record at Nova Home Health Care, Inc

An emergency preparedness survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 8/19/24 through 8/22/24 at: Nova Home Health Care 3345 W. Auburn Rd. suite 204 Rochester Hills, MI 48309 For this survey 2 home visits (only 2 visits were available) with record reviews, 3 active records without a home visit and 2 discharged records were reviewed. At the conclusion of the survey the agency was found to be out of compliance with the conditions of participation for emergency preparedness at: 42 CFR Part 484.22

Development of EP Policies and Procedures CFR(s): 484.102(b) §403.748(b), §416.54(b), §418.113(b), §441.184(b), §460.84(b), §482.15(b), §483.73(b), §483.475(b), §484.102(b), §485.68(b), §485.542(b), §485.625(b), §485.727(b), §485.920(b), §486.360(b), §491.12(b), §494.62(b). (b) Policies and procedures. [Facilities] must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. *[For LTC facilities at §483.73(b):] Policies and procedures. The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. *Additional Requirements for PACE and ESRD Facilities: *[For PACE at §460.84(b):] Policies and procedures. The PACE organization must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must address management of medical and nonmedical emergencies, including, but not limited to: Fire; equipment, power, or water failure; care-related emergencies; and natural disasters likely to threaten the health or safety of the participants, staff, or the public. The policies and procedures must be reviewed and updated at least every 2 years. *[For ESRD Facilities at §494.62(b):] Policies and procedures. The dialysis facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years. These emergencies include, but are not limited to, fire, equipment or power failures, care-related emergencies, water supply interruption, and natural disasters likely to occur in the facility's geographic area. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to review or update Emergency Preparedness policies and procedures for the emergency plan. The policies and procedures must be reviewed and updated at least annually. This deficient practice could affect the health and safety of all agency patients in the event of natural, man-made, or facility-based emergency. Findings include: During review of the agencies emergency preparedness program on 8/22/24, there was no documented evidence emergency preparedness policies and procedures were reviewed and updated for 2023. During an interview on 8/22/24 at 1:30 p.m., the administrator (Staff-1), acknowledged the findings.

EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.542(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, REHs at §485.542, OPO, "Organizations" under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE's emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI's emergency plan, as needed. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to conduct exercises to annually test the emergency plan or provide documentation of an actual event that would qualify as a test of the emergency plan; and failed to analyze the clinic's response to and maintain documentation of all drills, tabletop exercises, emergency events and revise the emergency plan as needed. This deficient practice could affect the health and safety of all clinic patients in the event of a facility emergency or disaster. Findings include: On 8/22/24, the clinic's emergency preparedness documentation was reviewed. Record review indicated there was no documentation of a full-scale exercise, a table-top exercise, or an actual event that would qualify as a test of the emergency plan in 2023. The administrator (Staff-1) acknowledged the above findings during a meeting on 8/22/24 at 1:30 p.m.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 8/19/24 through 8/22/24 at: Nova Home Health Care 3345 W. Auburn Rd. suite 204 Rochester Hills, MI 48309 For this survey 2 home visits (only 2 visits were available) with record reviews, 3 active records without a home visit and 2 discharged records were reviewed. At the conclusion of the survey the agency was found to be out of compliance with the conditions of participation for home health agencies at: 42 CFR Part 484.

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 record review and interview, the agency failed to ensure the comprehensive assessment included an accurate review of all medications to determine potential adverse effects or duplicate drug therapy in 3 of 7 (P-3, 4, 5) records reviewed, resulting in the potential for harmful medication effects for all patients serviced by this agency. Findings include: P-3: The start of care (SOC) was dated 8/2/24, with a diagnosis of polyarthritis. During record review on 8/20/24, it was noted that the comprehensive assessment stated (under M2001 Drug Regimen Review), “Yes, issues found during review.” The record failed to include a medication interaction or duplicate drug therapy report, or any documentation related to the issues found during review. P-4: The start of care (SOC) was dated 7/18/24, with diagnoses of spondylosis, back pain, and weakness. During record review on 8/20/24, it was noted that the comprehensive assessment stated (under M2001 Drug Regimen Review), “Yes, issues found during review.” The record failed to include a medication interaction or duplicate drug therapy report, or any documentation related to the issues found during review. P-5: The start of care (SOC) was dated 5/11/24, with diagnoses of sequelae post CVA, weakness, and falls. During record review on 8/21/24, it was noted that the comprehensive assessment stated (under M2001 Drug Regimen Review), “Yes, issues found during review.” The record failed to include a medication interaction or duplicate drug therapy report, or any documentation related to the issues found during review. During an interview on 8/22/24 at 1:30 p.m., the administrator (Staff-1) acknowledged the above findings.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to document submission of the discharge summaries to the physician in 2 of 2 discharge records (P-1, 2), from a total of 7 records reviewed, resulting in the potential for unidentified continuing health care concerns and unmet care needs. Findings include: P-1: The start of care (SOC) was dated 4/18/24, with diagnoses that included pain, and osteoarthritis. During record review on 8/19/24, it was discovered that there was no documentation in the record that a discharge summary was sent to the physician. The patient was discharged on 6/1/24. P-2: The SOC was dated 2/22/24, with diagnoses that included Parkinson's, decreased balance and unsteady. During record review on 8/19/24, it was discovered that there was no documentation in the record that a discharge summary was sent to the physician. The patient was discharged on 4/13/24. During an interview on 8/22/24 at 1:30 p.m., the administrator (Staff-1) acknowledged the above findings.

On 8/10/21 through 8/12/21, the Michigan Department of Licensing and Regulatory Affairs conducted a Recertification Survey at Nova Home Health Care in Rochester Hills. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 8/10/2021 through 8/12/21 at: Nova Home Health Care, Inc. 3345 W. Auburn Road, Suite 204 Rochester Hills, MI 48309 At the time of the survey, the agency did not operate any branch offices or subunits. Clinical records reviewed for this survey included 3 records with home visits; and 4 records; without home visits which included 3 discharge records and 1 active record for a total of 7 records reviewed. At the conclusion of the survey, the agency was found to be out of compliance with standard level deficiencies for the conditions of participation for home health agencies at: 42 CFR Part 484.

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:

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 record review and interview, it was determined the agency failed to ensure a Registered Nurse or Physical Therapist performed an initial assessment of the patient within 48 hours of the referral date, facility discharge date or on the physician's ordered start of care date in 1 of 7 records reviewed out of a total sample of 7 records (MR #6). Findings include: MR #6: The physician's referral order for home physical therapy services was dated 6-30-21 with a faxed stamp date of 6-30-21. The initial assessment of the patient was dated 7-13-21, 13 days after the agency received the referral. There was no documentation to explain why the start of care assessment was delayed. There was no evidence of a physician's ordered to delay the initial assessment until 7-13-21. During an interview on 8-12-21 at 3:00 PM, ADM-1 confirmed the above findings and stated "I don't know what happened in this case they should have been out within 48 hours or have documentation as to why they're not and then there should be a physician's order for the new start of care date."

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to conduct a patient-specific, comprehensive assessment that accurately reflected the patient's current health status based on a past medical history that included dates of onset, exacerbations, treatments and outcomes, history of events leading to current home care needs and the referral date in 4 of 7 records reviewed (MR#s 1, 2, 3, 4), resulting in incomplete clinical information to aid in determining the needs of the patient and determining progress towards goals. Findings included: MR#1: The Start of Care (SOC) was dated 6/15/21. The Plan of Care (POC) for the certification period 6/15/21 to 8/13/21 identified diagnoses of Spinal Stenosis of Thoracolumbar region, muscle weakness, lack of coordination, difficulty in walking, Type 2 diabetes (DM2) and Hypertensive Heart Disease (HTN). The patient was receiving Physical Therapy (PT) and Occupational Therapy (OT) services. Upon review of the Start of Care Comprehensive Assessment it was noted under "Past Medical History" the following diagnoses had check marks: "Coronary Artery Disease, Hypertension, prostate cancer, diabetes, pacemaker, and thoracic and lumbar spinal stenosis. There was no history of how long the patient had any of the above diseases/conditions, no dates of onset documented, or when and how the diseases occurred. There was no history of the status of the above diseases including treatments for past medical problems and outcomes of those treatments. There was no documented evidence of an assessment of the events that led to the home care referral, no date for the referral, and no assessment of the patient's specific current home care needs. MR#2: The SOC was dated 3/12/21. The POC identified diagnoses of Parkinson's Disease, Spondylosis, Hypertension (HTN), Chronic Kidney Disease Stage 3 (CKD3), Chronic Obstructive Pulmonary Disease (COPD) and history of falling. Upon review of the Start of Care Comprehensive Assessment it was noted under "Past Medical History" the following diagnoses had check marks: "Osteoarthritis of the Lumbar Spine, History of Falls, Anxiety, Chronic Kidney Disease, Anemia, Thyroid Problems, COPD, Parkinson's Disease, sciatica, Scoliosis." There was no history of how long the patient had any of the above diseases/conditions or when and how the events occurred. There was no history of the status of the above diseases including dates of onset, treatments for past medical problems and outcomes of those treatments. There was no documented evidence of an assessment of the events that led to the home care referral, no date of the referral, and no assessment of the patient's specific current home care needs. MR#3: The SOC was dated 12/20/21. The POC for the certification period 12/21/20 to 2/18/20 identified diagnoses of Hypertensive Heart Disease with Heart Failure( HF), Diabetes type 2 (DM2) muscle weakness, lack of coordination, difficulty walking. The patient was receiving Skilled Nursing (SN), Physical Therapy (PT), and Medical Social Work (MSW)Services Upon review of the Start of Care Comprehensive Assessment it was noted under "Past Medical History," the following diagnoses had check marks, but no dates of onset: "Coronary Artery Disease, Hypertension, and Diabetes. Upon review of the Start of Care Comprehensive Assessment it was noted under "Past Medical History" the following diagnoses had check marks: "Osteoarthritis of the Lumbar Spine, History of Falls, Anxiety, Chronic Kidney Disease, Anemia, Thyroid Problems, COPD, Parkinson's Disease, sciatica, Scoliosis." There was no history of how long the patient had any of the above diseases/conditions or when and how the events occurred. There was no history of the status of the above diseases including dates of onset, treatments for past medical problems and outcomes of those treatments. There was no documented evidence of an assessment of the events that led to the home care referral, no date of the referral, and no assessment of the patient's specific current home care needs related to these diseases. MR#4: The SOC was dated 7/28/21. The POC for the certification period 7/28/21 to 9/25/21 identified diagnoses of Spondylosis with radiculopathy of lumbosacral region, Lack of coordination, Low back pain, Hypertension, difficulty in walking. The patient was receiving Physical Therapy (PT) services. Upon review of the Start of Care Comprehensive Assessment it was noted under "Past Medical History," the following diagnoses had check marks, but no dates of onset: "Hypertension, Osteoarthritis, Gait Problems, and Parkinson's Disease. There was no history of how long the patient had any of the above diseases/conditions or when and how the events occurred. There was no history of the status of the above diseases including dates of onset, treatments for past medical problems and outcomes of those treaments. There was no documented evidence of an assessment of the events that led to the home care referral, no date of the referral, and no assessment of the patient's specific current home care needs related to these diseases. These findings were reviewed and acknowledged by the Administrator (Adm#1) during an interview on 8/12/21 at 2:30 p.m.

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 record review and interview, it was determined the agency failed to ensure the comprehensive assessment included a review of all medications to determine any adverse effects, and failed to provide documented evidence that the physician was notified of identified drug interactions in 1 (MR #2) of 7 sampled records reviewed, resulting in the potential for harmful medication effects for all 4 patients currently serviced by this Agency. Findings included: MR#2: The SOC was dated 3/12/21. The POC identified diagnoses of Parkinson's Disease, Spondylosis, Hypertension (HTN), Chronic Kidney Disease Stage 3 (CKD3), Chronic Obstructive Pulmonary Disease (COPD) and history of falling. Upon review of the Comprehensive Assessment, it was noted under the category "(M2001): Drug Regimen Review," that the skilled nurse documented "No Issues Found." However, according to a review of the patient's current medications via "Drugs.Com," there is a major interaction between 2 of the patient's current prescribed medications (Tylenol with Codeine#3 and Alprazolam). Drugs,com advises: "The concurrent use of narcotic pain or cough medications together with other medications that also cause nervous system depression can lead to serious side effects including respiratory distress, coma, and even death. This combination should be reported to the physician." These findings were reviewed and acknowledged by the Administrator and Clinical Manager during an interview on 8/12/21 at 2:30 p.m.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, it was determined the Agency failed to ensure the Registered Nurse (RN) prepared complete written instructions for patient safety needs in 1 of 1 record in which home health aide services were provided (MR#2), from a total of 7 records reviewed, resulting in the potential for unsafe, substandard care and unmet care needs. Findings include: MR#2: The Start of Care (SOC) was dated March 12, 2021. The Plan of Care (POC) for the certification period 3-12-2021 to 5-10-2021 identified diagnoses of Parkinson's Disease, Muscle Weakness, Spondylosis of lumbar region, Hypertension (HTN), Chronic Kidney Disease Stage 3 (CKD3), Chronic Obstructive Pulmonary Disease (COPD) and history of falls. The patient was receiving skilled nursing (SN), Home Health aide (HHa) and Physical Therapy (PT) Services. Upon review of the Plan of Care, the patient was assigned the following safety measures; "keep pathways clear, slow position change, support during transfer and ambulation, safety in activities of daily living (ADLs), fall precautions, and use of assistive devices." The patient also had functional limitations for endurance, ambulation, and hearing. The Aide Care Plan failed to include any of the above-mentioned safety precautions to assure the safety of the patient while receiving Home Health aide services. This finding was reviewed and acknowledged by the Administrator and Clinical director during an interview on 8/12/21 at 2:30 p.m.

Goals in the patient's plans of care CFR(s): 484.110(a)(3) Goals in the patient's plans of care and the patient's progress toward achieving them; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the plan of care included patient specific objectively measurable goals and outcomes in 4 of a total of 7 sampled records reviewed (MR#s: 1, 2, 3, 4), resulting in difficulty determining the patient's progress toward the achievement of goals. Findings included: MR#1: The Start of Care (SOC) was dated 6/15/21. The Plan of Care (POC) for the certification period 6/15/21 to 8/13/21 identified diagnoses of Spinal Stenosis of Thoracolumbar region, muscle weakness, lack of coordination, difficulty in walking, Type 2 diabetes (DM2) and Hypertensive Heart Disease (HTN). Upon review, it was noted the goals on the POC were not objectively measurable. Examples include: "Patient/Caregiver will demonstrate understanding of individual emergency preparedness plan in 2 weeks; Increase participation in Self-care activities, with ADLs & IADLs within 6 weeks; Independent with performing HEP {home exercise program} and follow fall safety precautions within 6 weeks." MR#2: The SOC was dated 3/12/21. The POC identified diagnoses of Parkinson's Disease, Spondylosis, Hypertension (HTN), Chronic Kidney Disease Stage 3 (CKD3), Chronic Obstructive Pulmonary Disease (COPD) and history of falling. Upon review, it was noted the Goals on the Plan of Care were not objectively measurable. Examples include: "The patient/caregiver will verbalize understanding of individualized emergency plan by 3/12/2021; The patient will verbalize understanding of proper use of pain medication by 3/20/21, Patient's mobility will be improved with assistance of physical therapist." MR#3: The SOC was dated 12/20/21. The POC for the certification period 12/21/20 to 2/18/20 identified diagnoses of Hypertensive Heart Disease with Heart Failure (HF), Diabetes type 2 (DM2) muscle weakness, lack of coordination, difficulty walking. Upon review of the goals on the POC, it was determined the goals were not objectively measurable. Examples included: "The Patient/Caregiver will verbalize understanding of individualized emergency plan by 12/21/2020; Patient/Caregiver to demonstrate knowledge and competency in all aspects of diabetic management to include disease process, foot assessments, signs and symptoms of hypo/hyperglycemia, glucometer use and preparation and administration of diabetic medications ordered by physician by 1/9/21; Patient will maintain heart healthy and diabetic diet compliance during the episode; Patient's mobility will be improved with assistance of physical therapist." MR#4: The SOC was dated 7/28/21. The POC for the certification period 7/28/21 to 9/25/21 identified diagnoses of Spondylosis with radiculopathy of lumbosacral region, Lack of coordination, Low back pain, Hypertension, difficulty in walking. A review of the POC identified that the goals were not objectively measurable to determine the patient's progress towards goals. Examples include: "Patient/Caregiver will demonstrate understanding of individual emergency preparedness plan in 2 weeks; Patient will verbalize understanding of proper use of pain medication by 8/7/21; Prevent Hospitalization." These findings were reviewed and acknowledged by the Administrator during an interview on 8/12/21 at 2:00 p.m.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a discharge summary was sent to the physician within 5 business days of the patient's discharge for 3 of 3 (MR#s 2, 3 and 4) records reviewed in which the patient was discharged from the agency, resulting in the physician not having knowledge of the patient's health status at the time of discharge and a summary of the care received which has the potential to negatively affect these patients. Findings included: MR#2: The SOC was dated 3/12/21. The POC identified diagnoses of Parkinson's Disease, Spondylosis, Hypertension (HTN), Chronic Kidney Disease Stage 3 (CKD3), Chronic Obstructive Pulmonary Disease (COPD) and history of falling. The patient was receiving Skilled Nursing (SN) and Physical Therapy (PT) services. Upon reviewing the record, it was noted the patient was discharged on 4/8/21 by registered nurse (RN#6). RN#6 documented under the category of "Care Coordination" on the discharge summary dated 4/8/21, "Physician notified of discharge summary availability," however there was no indications the Discharge Summary had been sent to the physician within the required 5 days. MR#3: The SOC was dated 12/20/21. The POC for the certification period 12/21/20 to 2/18/20 identified diagnoses of Hypertensive Heart Disease with Heart Failure( HF), Diabetes type 2 (DM2) muscle weakness, lack of coordination, difficulty walking. The patient was discharged from the agency on 1/4/21 with goals met. The SN documented under the category of "Care Coordination" on the discharge summary dated 1/4/21, "Physician notified of discharge summary availability," however there was no indications the Discharge Summary had been sent to the physician within the required 5 days. MR#4: The SOC was dated 4/21/21. The POC for the certification period 4/21/21 to 6/19/21 identified diagnoses of Spondylosis, Low Back Pain, muscle weakness, lack of coordination, and Hypertension (HTN). The patient was receiving Physical Therapy Services (PT). The PT evaluation on the Discharge Summary was based on the prior PT visit dated 5/20/21 due to the patient requesting to be discharged from PT services and the Agency with a missed visit. The Physical Therapist PT#3 documented on the Discharge Summary, dated 5/27/21, "Patient was discharged per request with all goals met. Physician notified of discharge prior to discharge date, per agency policy and timeline; physician notified of discharge summary availability. However, there was no indications the Discharge Summary had been sent to the physician within the required 5 days. These findings were reviewed and acknowledged with the Administrator (ADM#1) on 8/12/21 at 2:30 p.m. ADM#1 stated, "I was not aware that we were required to send the Discharge Summary to the physician within 5 days."