Every finding on record at Nuvantage Healthcare Corporation

Substantial Allegation Survey Substantial Allegation Number OH31951 The following deficiencies are based upon substantial allegation31951 completed on 10/13/21. International Quality Healthcare Corporation, , is not in compliance with the requirements of 42 CFR Part 484, Subpart B, C, Home Health Agencies.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the home health agency failed to ensure the plan of care of one patient ordered a frequency and duration of home health aide visits to be made. This affected Patient #3. Findings include: Review of the medical record of Patient #3 revealed the patient was admitted for non-skilled services of the agency on 03/20/20. An email composed by a case manager to the home health agency, dated 03/24/20, stated the following: “Below is the info for the member that needs 47 hours of care per week, with the following hours: Monday through Friday 7am to 11am, 2pm to 5pm; Saturday and Sunday 8am to 11am, 2pm-5pm.” A total of two certification periods were reviewed including 07/13/21 to 09/10/21 and 09/11/21 to 08/22/21. Diagnoses included paraplegia and type 2 diabetes mellitus. Both plans of care ordered for the patient to receive services provided by a home health aide of “up to 47 hours per week.” The home health aide was ordered to provide assistance with personal care and activities of daily living as indicated by limitations on functional and physical status. Staff A was interviewed on 10/13/21 at 04:00 PM. It was confirmed that a plan of care must specify a frequency and duration of services to be provided and aide services “up to 47 hours” is neither a duration nor a frequency.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on medical record review, staff interview, and review of facility protocol, the home health agency failed to ensure aides provided services according to the plan of care related to scheduled hours. This affected Patient #3. Findings include: Review of the medical record of Patient #3 revealed the patient was admitted for non-skilled services of the agency on 03/20/20. An email composed by a case manager to the home health agency, dated 03/24/20, stated the following: “Below is the info for the member that needs 47 hours of care per week, with the following hours: Monday through Friday 7am to 11am, 2pm to 5pm; Saturday and Sunday 8am to 11am, 2pm-5pm.” A total of two certification periods were reviewed including 07/13/21 to 09/10/21 and 09/11/21 to 08/22/21. Diagnoses included paraplegia and type 2 diabetes mellitus. Both plans of care ordered for the patient to receive services provided by a home health aide of “up to 47 hours per week.” The home health aide was ordered to provide assistance with personal care and activities of daily living as indicated by limitations on functional and physical status. Staff A was interviewed on 10/13/21 at 03:20 PM and asked to provide the Electronic Visit Verification (EVV) summary sheet for the period of 09/04/21 through 09/19/21. The EVV summary for requested period revealed the number of hours listed for Sunday, 09/05/21 was 5 hours, and Saturday, 09/11/21 was 5 hours. Staff A was again interviewed on 10/13/21 at 04:00 PM. It was confirmed that the plan of care was not followed as there were two days, 09/05/21 and 09/11/21, where the medical record lacked documentation the aide provided services for the entire number of hours scheduled.