Every finding on record at Optima Home Health Services, LLC

Extended Substantial Allegation Survey Substantial Allegation 99300 An entrance conference was conducted on 08/03/23 at 9:30 A.M. with administrative staff, and an exit conference was conducted on 08/07/23 at 2:45 P.M. with the administrative staff. The following deficiencies are based upon extended substantial allegation 99300 completed on 08/07/23. Optima Home Health Services, LLC 368346, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies. Optima Home Health Services, LLC is precluded from providing its own home health aide training and competency testing or competency evaluation for a period of two years from the date of the receipt of the deficiency report (2567) for this survey.

Comprehensive Assessment of Patients CFR(s): 484.55 Condition of participation: Comprehensive assessment of patients. Each patient must receive, and an HHA must provide, a patient-specific, comprehensive assessment. For Medicare beneficiaries, the HHA must verify the patient's eligibility for the Medicare home health benefit including homebound status, both at the time of the initial assessment visit and at the time of the comprehensive assessment. This CONDITION is not met as evidenced by: Based on record review, and interview, the agency failed to ensure the comprehensive assessment was updated and revised as frequently as the patient’s condition warrants due to a major decline or improvement in the patient’s health status, but not less frequently than within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests (G548). The cumulative effect of this systemic practice resulted in the agency's inability to ensure that the patients' nursing needs would be met.

Within 48 hours of the patient's return CFR(s): 484.55(d)(2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This ELEMENT is not met as evidenced by: Based on record review, and interview, the agency failed to ensure the comprehensive assessment was updated and revised as frequently as the patient’s condition warrants due to a major decline or improvement in the patient’s health status, but not less frequently than within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests for one of three patients reviewed (Patient #1). This had the potential to affect all patients receiving services from this agency. The census was 80. Findings include: On 08/03/23 at 11:23 A.M., Patient #1's medical record was reviewed. The patient was originally admitted to the agency on 03/24/18 and had diagnoses including unspecified intellectual disabilities, schizoaffective disorder (bipolar type), essential hypertension, Type 2 diabetes mellitus with diabetic neuropathy, morbid obesity, and long term use of oral hypoglycemic drugs. An interview with Staff A and Staff C at the time of the record review revealed the patient was placed in respite care for the month of March and did not receive care from the agency in March of 2023. Further review of the patient's record revealed a physician order was written on 03/02/23 for the patient's orders to be placed on hold until he returned from respite care. Review of Patient #1's medical record revealed the patient returned home to receive home health agency care on 04/03/23. Review of a nurse's note revealed the patient was seen by Licensed Practical Nurse (LPN) Staff G on 04/05/23. A review of the nurse's note dated 04/05/23 revealed the patient reported he had been admitted to the hospital because he had attempted suicide by attempting to drown himself in the bath tub while at respite care. He stated he was transferred to a behavioral health hospital where he was admitted, and multiple medication changes were made, and the new orders were sent to the home health agency. On 08/07/23 at 9:20 A.M. an interview with Staff F and Staff C revealed the agency reviewed this case over the weekend and both confirmed the agency failed to do an appropriate Resumption of Care (ROC) after the patient returned home from the behavioral health hospital on 04/03/23. On 08/07/23 at 12:48 P.M. an interview with Staff G revealed he/she received a call from Staff C requesting that he/she go see the patient on 04/05/23. Staff C reported to Staff G that the patient had already had a ROC visit, but Staff C wanted Staff G to check on the patient. Further interview revealed Staff G reported this may have been a miscommunication between Staff C and Staff G. Further interview revealed Staff G did not notify a recertification registered nurse to complete a ROC assessment because he/she was told by Staff C that the ROC had already been completed. This deficiency represents noncompliance investigated under Substantial Allegation 99300.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on record review, and interview, the agency failed to integrate orders from all physicians to assure the coordination of all services (G604). The cumulative effect of this systemic practice resulted in the agency's inability to ensure that the patients received care as ordered.

Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This ELEMENT is not met as evidenced by: Based on record review, and interview, the agency failed to integrate orders from all physicians to assure the coordination of all services for one of three patients reviewed (Patient #1). This had the potential to affect all patients receiving home health services from this agency. The census was 80. Findings include: On 08/03/23 at 11:23 A.M., Patient #1's medical record was reviewed. The patient was originally admitted to the agency on 03/24/18 and had diagnoses including unspecified intellectual disabilities, schizoaffective disorder (bipolar type), essential hypertension, Type 2 diabetes mellitus with diabetic neuropathy, morbid obesity, and long term use of oral hypoglycemic drugs. An interview with Staff A and Staff C at the time of the record review revealed the patient was placed in respite care for the month of March and did not receive care from the agency in March of 2023. Further review of the patient's record revealed a physician order was written on 03/02/23 for the patient's orders to be placed on hold until he returned from respite care. Review of Patient #1's medical record revealed the patient returned home to receive home health agency care on 04/03/23. Review of a nurse's note revealed the patient was seen by Licensed Practical Nurse (LPN) Staff G on 04/05/23. A review of the nurse's note dated 04/05/23 revealed the patient reported he had been admitted to the hospital because he had attempted suicide by attempting to drown himself in the bathtub while at respite care. He stated he was transferred to a behavioral health hospital where he was admitted, and multiple medication changes were made, and the new orders were sent to the home health agency. Further interview with the Staff C and Staff A revealed the agency did receive orders from the behavioral health hospital when Patient #1 returned on 04/03/23 from the respite and subsequent behavioral health hospital admission that was over 24 hours long, but Staff G was sent to visit the patient with the orders written prior to the patient being sent for respite. After Staff C and Staff A stated the agency did receive orders from the behavioral health hospital, a discharge order was found by Staff C in the medical record. Review of the discharge note revealed new discharge medication orders were written by the behavioral health hospital that included mental health medications that the patient did not receive after his discharge from the behavioral health hospital. An interview with the Staff C confirmed the new discharge orders were missed because the agency did not do a Resumption of Care (ROC) comprehensive assessment. On 08/03/23 at 1:44 P.M. a telephone interview with Registered Nurse Staff D revealed the agency used a protected telephone "app" that should list all medication orders that were changed while any patient was admitted into an outside hospital, but the Patient #1's medications were not listed in the "app." Further interview confirmed the patient should have received the medications that were changed while he was in the hospital, and if he did not get the medications the agency should be held responsible. On 08/07/23 at 9:20 A.M. an interview with Staff F and Staff C revealed the patient was seen by a physician on 04/20/23, and new orders were written. Staff F confirmed that because the agency failed to do the ROC, the new medications ordered after the behavioral health hospital stay were not provided between 04/03/23 and 04/20/23. On 08/07/23 at 10:30 A.M. review of the medications orders written by the physician on 04/20/23 revealed new orders were written on 04/20/23 that included Amlodipine 10 milligram (mg) for hypertension (HTN), Coreg 25 mg for HTN/cardiac issues, Chlorthalidone 25mg for HTN, Divalproex Sodium 500 mg for the manic phase of bipolar disorder, Metformin 500 mg for Diabetes, Minoxidil 2.5 mg for HTN, Singulair 10 mg tablets for allergies, Paliperidone 9 mg for schizophrenia, Potassium Chloride 10 milliequivalents (mEq) for HTN, and Prazosin 2 mg for HTN. Abilify (antipsychotic), Losartan (for HTN), and Zoloft (antidepressant/antianxiety medication) that was ordered by the behavioral health hospital on 04/03/23 were not listed as medications before or after the physician visit on 04/20/23. On 08/07/23 at 12:48 P.M. an interview with Staff G revealed he/she received a call from Staff C requesting that he/she go see the patient on 04/05/23. Staff C reported to Staff G that the patient had already had a ROC visit, but Staff C wanted Staff G to check on the patient. Further interview revealed Staff G reported this may have been a miscommunication between Staff C and Staff G. Further interview revealed Patient #1 reported to Staff G that he had dropped all new prescriptions to a pharmacy, and the pharmacy informed him they would deliver the medications to him later that evening. Staff G stated he/she did not notify a recertification registered nurse to complete a ROC assessment because he/she was told by Staff C that the ROC had already been completed. This deficiency represents noncompliance investigated under Substantial Allegation 99300.