Every finding on record at Ohioans Home Healthcare, Inc

Substantial Allegation Survey Substantial Allegation 107369 Ohioans Home Healthcare is in substantial compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies in regard to the allegations contained in the substantial allegation #OH00107369 completed on 07/25/24. An entrance conference was conducted on 07/18/24 at 4:50 PM with the Administrator. An exit conference was conducted on 07/25/23 at 2:30 PM with administrative staff.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on medical record review, staff interview, and policy review, the facility failed to complete skilled nursing (SN) visits as scheduled and wound measurements as ordered. This affected Patient #4 with the potential to affect all patients cared for by this agency. The medical record for Patient #4 was reviewed on 7/25/24. Patient #4 had a start of care (SOC) date of 10/07/22 with a diagnosis of paraplegia and pressure ulcer sacral region. The plan of care reviewed was for 03/30/24 to 05/28/24 and 05/29/24 to 06/09/24. Skilled nursing (SN) was ordered for three times per week to complete dressing changes to the sacral area. Orders stated to cleanse the wound with soap and water, rinse well, dry and apply 50-50 triad/Vaseline mixture to surrounding wound. Orders on the plan of care further stated for the SN to obtain wound measurements weekly. The re-certification visit on 03/29/24 documented a wound measurement to the left ischium/buttocks area of 3.8 centimeters (cm) by 5 cm, and .9 cm depth. No measurements were completed or documented for the weeks of 04/21/24 to 04/26/24, 5/05/2 to 05/11/24, 5/12/24 to 05/18/24, 5/26/24 to 06/01/24 and 6/02/24/ to 06/08/24. A request was made to Staff A for a policy related to completing wound measurements. Staff A stated this agency does not have a policy and just goes by the plan of care (POC) which states to complete weekly. Skilled visits were completed three times per week as scheduled except for missed visits (MV) documented on 04/15/24 and 04/29/24 due to this patient being at the wound clinic. Missed visits were in the medical record for 05/06/24, 05/17/24, 05/22/24, 05/28/24 and 06/03/24. A request was made to Staff A for a policy related to the missed visits. Staff A provided a policy titled, "Missed Visits." This policy states if a visit is missed for any reason, the clinician should attempt to reschedule it for the same week so that the physician ordered frequency is maintained and would not be considered a missed visit. If a visit is missed and cannot be rescheduled the clinician/office will notify the physician of the missed visit. This notification will include the date, time, physician name, method of notification and the staff reporting the information. No documentation was found of an attempt to reschedule the visits and no documentation was found in the medical record the physician was notified. Staff A provided missed visits slips for 05/22/24, 05/28/24 and 06/03/24 with a fax date of 06/27/24 to the physician for the missed visits. Staff A stated there is no requirement or timeframe stating when the physician should be notified. Staff A further stated no physician was notified for the missed visit which occurred on 05/17/24 and no documentation was found in the medical record an attempt was made to reschedule. The findings of not notifying the physician of a missed visit per policy was verified with Staff A on 07/25/24 at 1:30 PM. Staff A further verified wound measurements were not completed weekly as ordered on the POC.

Substantial Allegation Survey Substantial Allegation OH00124122 An entrance conference was conducted with the Administrator at 11:00 AM on 08/09/21, and an exit conference was completed with the Administrator at 5:00 PM on 08/10/21. Ohioans Home Healthcare, Inc 368247, is in substantial compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies in regard to the allegations contained in substantial allegation OH00124122 completed on 08/10/21.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the agency failed to promptly alert the relevant physician to any changes in the patient's condition or needs that suggest the plan of care should be altered for one of five patients reviewed (Patient #3). This had a potential to affect all patients receiving services from the agency. The patient census was 2309. Findings include: The medical record review for Patient #3 revealed the patient started with the agency on 06/14/21. The plan of care included orders for skilled nursing visits one time a week for one week starting 06/14/21 and then once a week for eight weeks starting 06/20/21. The nurse was to Assess/Perform/Instruct the patient/patient caregiver on ostomy care and instruct the patient/patient caregiver on care of ostomy equipment and supplies. Review of the start of care assessment completed on 06/14/21 revealed the patient's ostomy bag was intact, noted liquid dark brown stool. The patient reported she just had to change her ostomy bag because it did not stay on for more than three days. It had come off in as little as a few hours also. The patient had no ring barrier for under her ostomy bag. The patient had no adhesive wipe remover or adhesive wipes. The patient's abdominal area was reddened from the liquid stool leaking on her skin. A skilled nursing visit on 06/23/21 written by Staff C revealed the patient's ileostomy bag was leaking fecal material onto her clothing and it was reported by the patient that she had changed clothing twice already that day. The nurse reviewed foods to eat to help with thickening her stool. There was no documentation that Staff C assisted with the leaking ostomy bag during the visit. Further, it appeared that Staff C only advised that she would be calling the physician's office to get the order faxed to the medical supply company for them to send her supplies before the patient ran out. There was no documentation Staff C was going to report the condition of the patient's ostomy bag or the condition of the patient to the physician. A nursing visit note dated 06/27/21, revealed Staff C arrived and found the patient with stool on herself. The patient smelled bad with body odor and fecal smell. The patient also reported she had no more flanges that fit the bags she had left. Staff C asked the patient when she bathed last and the patient stated a week ago. The patient was educated to keep her skin cleansed as the natural salt could cause further skin irritation. The patient's abdomen was red and irritated all around the stoma, approximately 10 centimeters around. When assisting the patient to bathroom to clean up, Staff C found the bathroom in disarray with mounds of trash with stool on them and the toilet covered in stool. The nurse applied a new ostomy bag. There was no documentation that the nurse reported the patient's condition to the physician. Medical record review revealed an additional visit for the week on 07/16/21. Staff C found the patient with reddened and irritated skin around the ostomy site, but the area had improved slightly. The patient was observed to be unclean with stool found under her finger nails. The patient was again educated on how she needed to change her ostomy bag and to wash her skin better to help increase her healing. The patient reported she had changed her bag yesterday. Staff C instructed the patient to call when she needed the bag changed so that the nurses could help her with the changes. There was no documentation that Staff C notified the physician of the patient's condition or the condition of the patient's skin around the ostomy site. A nursing visit note dated 07/22/21 revealed Staff C again found the patient with a leaking ostomy bag and her skin still remained reddened and irritated. The patient was found to have stool still under her nails. Staff C did educate the need for better hygiene to reduce skin irritation. The nurse offered to change the ostomy bag and have her wash her abdomen with soap and water but the patient declined as she only had one ostomy bag left. Staff C encouraged the patient to get a wash rag and wipe her abdomen off to prevent further skin irritation, but the patient did not get up like she said she would do. The nurse spoke with the doctor's office earlier in the week and the doctor reported the patient had always been the "woe is me" type and it got worse when her mother passed away. Staff C asked the patient about her depression which she reported had got better. Staff C again offered to change the ostomy bag, but the patient only had one left and new ones would not arrive until tomorrow or the next day. There was no documentation of communication with the physician about the reddened and irritated skin surrounding the ostomy site or the condition of the patient. The nursing visit note for 07/29/21 revealed that the patient had changed the ostomy bag one hour before the nurse arrived. The patient had not called and asked for assitance as requested. The skin around the ostomy site was much redder than the previous week. The patient had stool under her fingernails and the apartment smelled of stool. Staff C's nursing note revealed no documentation the physician was made aware of the increased redness around the ostomy site or the condition of the patient and her apartment. The nursing visit note for 08/04/21 revealed the nurse, Staff H, found the patient sitting with stool covered clothing and the ostomy bag not attached to the appliance ring. Stool was coming out onto the reddened and irritated skin around the site. Staff H assisted the patient with changing and cleaning the site and changing into clean clothing. Staff H applied medication to the surrounding skin to reduce the contact of stool to the skin. Staff H contacted the physician and discussed the adverse effects of the use of a new medication, but there was no documentation Staff H discussed with the physician the patient's irritated and reddened skin or the patient's inability to perform adequate self care. Interview with Staff A on 08/09/21 at 4:35 PM revealed the Director of Nursing (DON) advised Staff A that the nurses were in fact advocating for the patient and that the physician was aware of the issues, but had not given any new orders. Staff A did state the nurses were failing to document the communication. Interview with Staff C on 08/10/21 at 12:50 PM revealed she did not document all the times she had called the doctor and received no response. This deficiency substantiates Substantial Allegation OH00124122.