Every finding on record at Omni Home Health District 4

During the home health survey conducted from 2/22/2021 to 2/24/202, Emergency Preparedness was reviewed. St Vincent's Home Health is in compliance with Emergency Preparedness per Code for Federal Regulations (CFR)42, Part 484.22, Condition of Participation for Home Health Agencies.

A recertification survey was completed on 2/22/2021 to 2/24/2021 at St Vincent's Home Health. The facility was in compliance with Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies .

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 record review and staff interview, the agency failed to initiate telehealth monitoring as ordered in the Plan of Care for 1 of 17 sampled patients (Patient #13). The findings include: Record review for Patient #13 revealed a 62-year old female with Start of Care (SOC) date 1/28/21. The diagnoses included myocardial infarction, heart failure, diabetes, chronic kidney disease, chronic pulmonary obstructive disease, and stasis ulcers to bilateral lower legs. The Plan of Care (POC) included Skilled Nurse (SN) 1 wk 1, 3 wk 2, 1 wk 6; Physical Therapy (PT) 2 wk 4; and Occupational Therapy (OT) 1 wk 5. Review of the physician orders for home health included Telehealth monitoring, PT, and MSN visits to include medication reconciliation, diet/fluid adherence, daily weight monitoring, and report new/worsening symptoms of rapid weight gain primary care physician/ cardiologist. Ensure patient understands medication regimen. Review of the Plan of Care, dated 1/28/21, included the following: SN to evaluate and develop a plan of care in coordination with the physician. Use telehealth (Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation of vital signs, weights and oxygen saturation levels) to provide services as necessary and appropriate according patient condition. SN to provide instructions related to heart failure, measures to prevent heart failure, measures to manage heart failure and possible complications. Call physician for weight gain of 2-5 pounds overnight or 5 pounds in one week. Review of the records found no documentation that telehealth services, including devices required, had been initiated in the home. Patient required daily weights to assess and immediately treat excess weight gain to prevent additional hospitalizations. Because the SN only visited two times a week, it was imperative that daily weights were done by the patient in the home and sent electronically to the monitoring center to alert the physician of changes. Review of the Start of Care assessment performed by the SN on 1/28/21 revealed a weight of 334 pounds. The SN documented weights on 2/4 and 2/5/21 at 334 pounds. SN visits on 2/8, 2/10, and 2/15 revealed the weight was recorded as 346 pounds (12 pound increase). There was no documentation the physician had been notified of the weight gain. An interview was conducted on 2/24/21 at 11:35 am with the Executive Director (ED). She was asked where were the daily weights recorded, and she said they would be in the home folder. She was asked if the nurse entered the weights in the record, and she said if there was an alert set up at the SOC. She was asked if telehealth services were in place in the home, she said the patient probably refused it. When asked where was the refusal documented, she could not find any documentation. After review of the records, the ED stated there was a new nurse that started the case and it was not set up. She was asked if there was documentation that the physician was notified regarding 12-pound weight gain on 2/8/21. She said there was no documentation the physician was notified or that the SN questioned the weight and re-weighed with significant weight gain.