Every finding on record at Nurturing Home Care, Inc

A Medicare complaint investigation was conducted by the Michigan Department of Licensing and Regulatory Affairs on 1/18/24 at: Elara Caring 30400 Telegraph Road suite 334 Bingham Farms, MI 48025 3 clinical records were reviewed for this survey. Allegation 1: It was alleged the agency failed to start rehab services as scheduled. Allegation 2: It was alleged the agency failed to provide weekly nursing services as ordered. At the conclusion of the investigation, it was determined that the allegations are substantiated with a citation.

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 record review and interview, the agency failed to ensure that skilled nursing services were provided at the frequency ordered by the physician in the plan of care and failed to ensure occupational therapy and physical therapy services were provided as ordered in the plan of care for 1 of 3 (P-1) records reviewed, resulting in the potential for physical decline and negative patient outcomes. Findings include: P-2: Review of the record on 1/18/24, showed the 9/25/23 Plan of Care (POC) documented ordering occupational therapy (OT) services with a visit frequency of 1WK1, effective 10/08/2023. The patient was admitted to the hospital on 10/4/23 and returned home on 10/09/2023. A resumption of care was initiated by the agency on 10/10/23, with an order for OT to start the week of 10/15/2023. An order dated 10/20/23 requested the initial visit be moved to 10/27/23, the reason given was per “patient request.” The initial OT evaluation was completed by the occupational therapist (OT-1) on 10/27/2023 with an ordered visit frequency of 1 visit per week for 5 weeks. The second OT visit was on 11/3/2023 was completed as ordered. A missed visit note was entered in the record on 11/14/23 for a missed visit on 11/10/23, and another missed visit note was entered in the record on 11/19/23, for a missed visit on 11/16/23. There was no documented evidence in the record that OT attempted to reschedule missed visits. There were no reasons documented for the missed visits. The agency failed to follow the POC ordered visit frequency. P-4: This 87-year-old patient was admitted to home health care on 12/7/23 with diagnoses of chronic obstructive pulmonary disease, peripheral vascular disease, and hypertensive heart disease with heart failure. Review of the record on 1/18/24, showed the plan of care (POC) documented skilled nursing (SN) with a visit frequency of 1WK1, 2WK2, and 1WK6. SN had documented visits on 12/7, 12/12, 12/20, 12/26, 1/5, 1/12, and 1/17. SN had a missed visit during week two, beginning 12/10, and a missed visit during week 3, beginning 12/17, with no documented reason in the record. The agency failed to follow the POC ordered visit frequency. Also for this record; PT had a documented visit attempt on 12/9/23. The patient declined that visit. No further visits were documented in the record. OT had an initial visit ordered on the plan of care (POC) the week of 12/10/23. The OT never made a visit. No OT visits were documented in the record. During a review of the complaint log on 1/18/24, it was discovered that a submission by the complainant had been received by the agency on 1/8/24. The complaint reported that the PT and OT had never made visits. Under the Intervention/Resolution Comments section of the complaint, there were two comments as follows; PT eval is sitting unassigned on 12/12/23, and OT eval is sitting unassigned on 12/29/23. During an interview on 1/18/24 at 4:15 p.m., the administrator (ADM-1) said the agency was having trouble getting orders from the doctor for PT services to be provided after the initial visit and the OT never went out due to the order not being entered into the agency’s system. The agency failed to ensure that PT and OT services were started as ordered. During the same interview on 1/18/24 at 4:15 p.m., the administrator acknowledged the above findings.