Every finding on record at Omnicare Home Healthcare Agency, LLC

Emergency Preparedness Survey At the time of the Emergency Preparedness survey completed on 12/22/22, Omnicare Home Healthcare Agency is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies

Partially Extended Recertification Survey An entrance conference was conducted with the Director of Nursing at 12:20 PM on 12/19/22, and an exit conference was completed with the Director of Nursing by phone on 12/22/22 at 2:00 PM. The following deficiencies are based on the partially extended recertification survey completed 12/22/22. Omnicare Home Healthcare Agency 368375, is not in compliance with the requirements found at 42 CFR Part 484 Subpart B, C for Home Health Agencies.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on a record review, review of OASIS transmissions, and staff interview, the facility failed to transmit OASIS data within 30 days of completing an assessment for Patient #1. The agency census was one. . Interview with Staff A stated during the entrance conference revealed the registered nurses (RNs) gather the OASIS data and this information is transmitted from the office by Staff A. Staff A stated since this agency does not have many patients they send the OASIS information in under a different agency's name which operates out of this same office. The medical record for Patient # 1, who was this agency's only patient at this time, was reviewed on 12/20/22. Patient # 1 had a start of care of 08/31/21 with a diagnosis of acute kidney failure and Type 2 diabetes with neuropathy. The certification periods reviewed were for 10/12/22-12/10/22 and 12/11/22-2/08/22. A re-certification OASIS was completed on 12/09/22 with orders for skilled nursing two times per day to provide glucose monitoring, assessments and give insulin. A request was made to Staff A for OASIS submissions for Patient #1. Interview on on 12/21/22 at 5:00 PM Staff A stated they looked for submissions in both agency reports and this client does not show any submissions at all. The findings of not submitting OASIS information as required was verified with Staff A.

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, policy review and staff interview, the agency failed to notify the physician and provider of missed visits and failed to ensure patients received the home health services as written in the plan of care for three of 10 medical records reviewed (Patient #2, #4, and #5). This could affect all patients receiving services from the agency. The agency census was one. 1. The medical record for Patient #2 was reviewed on 12/20/22. Patient #2 had a start of care (SOC) of 04/28/22 with a primary diagnosis of a left ankle fracture. The certification period reviewed was for 04/28/22-06/26/22. The plan of care (POC) listed home health aide (HHA) visits two times per day Monday thru Friday. The first HHA visit was completed on 05/12/22. A missed visit note on 05/13/22 at 10:00 AM was in the medical record but no reason was listed for the missed visit and the physician and case manager were not notified. Interview on 12/20/22 at 4:30 PM Staff A revealed a note was found in scheduling indicating the agency was waiting on insurance authorization but no documentation was found the physician or case manager were notified. A missed visit on 06/21/22 indicated the aide quit and Patient #2 requested to be discharged from this agency. Review of the agency policy titled "Variance/Incident/Reporting" revealed under significant changes: the provider shall be notified and case manager within one business day if the provider does not furnish an authorized service as authorized by the case manager. The findings of not notifying the physician or case manager of the two week delay in care was verified during an interview with Staff A on 12/21/22 at 4:30 PM. 2. The medical record for Patient #4 was reviewed on 12/21/22. Patient #4 had a start of care date of 06/06/19 with a primary diagnosis of transient cerebral ischemic attacks. The certification period reviewed was for 06/06/19-08/04/19 with skilled nurse ordered one time per week for assessments and medication set-up. Skilled visits were completed as scheduled with a missed visit (MV) note on 07/08/19 by the RN stating cancelled but listed no reason. This MV note revealed the case manager was not notified. No other visits were completed for this certification period which ended 08/04/19. No documentation of what happened to Patient #4 a discharge assessment was found in the medical record. Interview on 12/21/22 at 3:00 PM Staff A verified the medical record lacked evidence of MV notes for the remainder of the certification period or information regarding discharging Patient #4 from this agency. 3. The medical record for Patient #5 was reviewed on 12/21/22. Patient #5 had a SOC date of 05/01/18 with a primary diagnosis of spinal stenosis. The certification period reviewed was for 05/01/18-06/29/18 with HHA services ordered two times per week seven hours in the morning and two hours in the evening. Skilled nursing notes on 05/04/18 revealed this client was informed the aide he requested could not take the case but has agreed to allow another aide to care for them. This note further stated the aide would start on Sunday 05/06/2018 with the next shift scheduled on Saturday 05/12/2018. Missed visits were in the medical record for 05/06/18, 05/13/18 and 05/20/18. The medical record lacked evidence of any visits completed by a HHA for Patient #5. A note on 05/21/18 stated when the aide arrived for care Patient #5 stated they were no longer with this company and did not need services. Interview on 12/21/22 at 1:30 PM Staff A verified no other missed visits were found further stating they had no idea why aide services were not provided as ordered. The findings of not completing HHA visits as ordered on the plan of care was verified with Staff A on 12/21/22 at 5:00 PM.

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 agency failed to list the home health aide frequency and duration of services on the plan of care for one of ten records reviewed (Patient #6). This has the potential to affect all patients cared for by this agency. The facility census was one. The medical record for Patient #6 was reviewed on 12/21/22. Patient #6 was admitted on 01/12/21 with a primary diagnosis of high blood pressure and osteoarthritis. The certification period reviewed was for 01/12/21-03/12/21. The plan of care (POC) had orders for skilled nurse visits one time per week and home health aide (HHA) to provide assistance with personal care. No frequency or duration was found on the POC for aide services. Skilled nurse visits were completed on 01/12/21 and 10/20/21 with no aide visits completed. A note from the case manager on 01/25/21 stated another agency was taking over care for Patient #6 and a discharge OASIS was completed. Interview on 12/21/22 at 5:00 PM Staff A stated no documentation was found in the medical record regarding aide visits or service frequency to be provided. Staff A provided an aide care plan for Patient #6 which instructed the HHA on what activities to complete each visit as well as weekly. Staff A verified the findings of not having a frequency or duration on the plan of care for HHA services.