Every finding on record at Nurturing Home Healthcare Agency Inc

A recertification survey was conducted on 11/05/2024. The census was 58 (LCHHS) and 82(LHHS). No deficient practice was cited. Abbreviations: LCHHS – Licensed and Certified Home Health Services LHHS – Licensed Home Health Services

A recertification survey was conducted on 11/05/2024. The census was 58 (LCHHS) and 82(LHHS). Abbreviations: LCHHS – Licensed and Certified Home Health Services LHHS – Licensed Home Health Services DON -Director of Nursing OT – Occupational Therapy

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on observation, record reviews, and interviews, the administrator failed to be responsible for all day-to-day operations of the agency. In that, the administrator failed to ensure that 1 of 3 (#2) active client visited during the survey process received Occupational Therapy services as ordered by the referring physician. This failure could further worsen client’s functional abilities and could lead to poor health outcome for client and family. Findings include: Review of patient #2’s referral orders dated 06/30/2023 revealed that patient’s physician ordered Home Health with Skilled Nursing, Physical Therapy and Occupational Therapy to evaluate and treat. Review of patient #2’s plan of care for episode 07/03/2023 to 08/31/2023 showed patient received only skilled Nursing and Physical Therapy services, but no Occupational services during the entire certification period. Further review of patient’s plan of care revealed that patient was 71 year old female living with family and was unable to perform self-care or make her own meals and was totally dependent on caregiver for all activities of daily living. Observation during home visit on 11/06/2024 at 11:33a.m., Surveyor met patient sitting on an oversized armchair in the living room. The patient’s spouse did everything for patient even though patient was awake, alert, oriented to person, place, and time. The patient was not able to perform her activities of daily living without assistance from the spouse. The patient was not able to prepare her own meals or perform selfcare like take a bath or dress up by herself without the assistance of her spouse. During interview with agency’s Administrator/Director of Nursing on 11/07/2024 at 11:17a.m., the administrator/Director of Nursing was asked why Occupational Therapy (OT) services was not provided to Patient #2 during the 07/03/2023 – 08/31/2023 episode. The administrator told survey that patient #2 may have refused OT services, but the administrator was unable to show documentation of patient’s refusal of the service sating that the admission nurse may have forgotten to document it. Surveyor was also not able to speak with the admission nurse because he was no longer an employee of the agency. The administrator/DON was asked who was responsible for reviewing referral orders to ensure patients receive the services ordered by physicians. The administrator stated, “That would be the case managers. The Clinical Supervisor also reviews the referral orders and me. I usually review all the referral orders that we receive, but I don’t know how we all manager to miss this one.” Surveyor requested to speak with case manager who was responsible for reviewing referral orders for patient #2 to ensure patient received the services ordered by their physicians. The Administrator informed surveyor that the case manager was no longer working at the agency. During interview with patient #2 on 11/07/2024 at 2:03p.m., the patient stated that the admission Nurse did not discuss anything about Occupational therapy services with her during the admission visit and the patient did not know that insurance company had eventually authorized the OT services after the initial denial of her request for the service. Patient further stated that she would not have refused Occupational services if she knew the insurance company had authorized the service for her.