Every finding on record at Option Care Enterprises, Inc

HHA Comprehensive Assessment in Disaster CFR(s): 484.102(b)(1) [(b) Policies and procedures. The HHA must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least every 2 years.] At a minimum, the policies and procedures must address the following:] (1) The plans for the HHA's patients during a natural or man-made disaster. Individual plans for each patient must be included as part of the comprehensive patient assessment, which must be conducted according to the provisions at §484.55. This STANDARD is not met as evidenced by: . A. Based on a review of clinical records, interview during home visits and staff interviews, it was determined the Agency failed to ensure the comprehensive assessment contained an individualized emergency preparedness plan. This was found in 17 of 17 (Pts. #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 13, 14, 15, 16 and 17) clinical records reviewed. Findings include: 1. The following clinical records were reviewed from 1/19/21 at 1:30 PM to 1/20/21 at 4:00 PM. Pt. #1. SOC 01/07/21. Pt. #2. SOC 11/18/20. Pt. #3. SOC 01/07/21. Pt. #4. SOC 01/16/21. Pt. #5. SOC 01/13/21. Pt. #6. SOC 11/17/20. Pt. #7. SOC 12/03/18. Pt. #8. SOC 02/07/20. Pt. #9. SOC 01/03/21. Pt. #10. SOC 11/23/18. Pt. #11. SOC 09/01/20. Pt. #12. SOC 04/10/20. Pt. #13. SOC 01/08/20. Pt. #14. SOC 10/30/20. Pt. #15. SOC 01/17/20. Pt. #16. SOC 03/07/20. Pt. #17. SOC 02/07/20. The records lacked documentation Agency staff had incorporated an individualized emergency preparedness plan into the comprehensive assessments for these Pts. 2. Home visits were conducted on the following Pts. from 1/20/21 at 9:00 AM to 1/21/21 at 11:30 AM: Pt. #1. SOC 01/07/21. Pt. #2. SOC 11/18/20. Pt. #3. SOC 01/07/21. Pt. #4. SOC 01/16/21. Pt. #5. SOC 01/13/21. During the home visits with Pts. #1, 2, 3, 4 and 5, the Pts. and/or caregivers stated they were not aware of an individualized Emergency Preparedness Plan and did not know what to do in the event of an emergency or disaster. 3. During an interview with the Senior Director of Operations, Administrator, Nursing Supervisor #1, Nursing Supervisor #2 and the Area Clinical Director for the Nursing Team on 1/20/21 at 2:30 PM - 4:30 PM, 1/21/21 at 10:00 AM and 1:30 PM; the Administrator and Nursing Supervisor #1 confirmed that the Agency failed to incorporate an individualized emergency preparedness plan into the comprehensive assessment.

Recertification survey completed. Standard level deficiencies cited. A Focused Infection Control Survey (FIC) was conducted on 1/21/21. The Facility was in compliance with the requirements for Infection Control for COVID-19. Abbreviations: Pt./Pts. = Patient/patients POC = Plan of care PsOC = Plans of care SOC = Start of care # = number AM = Morning PM = Afternoon lab = laboratory CBC = Complete Blood Count W/Diff = with differential CMP = Comprehensive Metabolic Panel SN = Skilled Nurse RN = Registered Nurse Mg = Magnesium Phos = Phosphorus

At discharge CFR(s): 484.55(d)(3) At discharge. This ELEMENT is not met as evidenced by: . A. Based on a review of closed clinical records and staff interview, it was determined the Agency failed to ensure the comprehensive assessment was updated at discharge. This was found in 5 of 5 (Pts. # 13, 14, 15,16, and 17) closed clinical records reviewed. Findings include: 1. Pt. #13. SOC 1/8/20. Primary Diagnosis: Cystic Fibrosis with Pulmonary Manifestations. The clinical record was reviewed on 1/20/21 at 2:00 PM. The record contained the SOC comprehensive assessment dated 1/8/20 and provided service from 1/8/21 to 2/5/20. The record contained the Agency's discharge summary dated 2/5/20. As of 1/20/21, the record lacked a discharge comprehensive assessment for Pt. #13. 2. Pt. #14. SOC: 10/30/20. Primary Diagnosis: Malignant Neoplasm of connective and soft tissue of head. The clinical record was reviewed on 1/20/21 at 3:57 PM. The record contained the SOC comprehensive assessment dated 10/30/20 and provided service from 10/30/20 to 12/28/20. The record contained the Agency discharge summary dated 11/6/20. As of 1/20/21, the record lacked a discharge comprehensive assessment for Pt. #14. 3. Pt. #15. SOC 1/17/20. Primary Diagnosis: Acute Appendicitis with Perforation. The clinical record was reviewed on 1/20/21 at 1:30 PM. The record contained the SOC comprehensive assessment dated 1/8/20 and provided service from 1/7/20 to 3/16/20. The record contained the Agency's discharge summary dated 1/30/20. As of 1/20/21, the record lacked a discharge comprehensive assessment for Pt. #15. 4. Pt. #16. SOC 3/7/20. Primary Diagnosis: Pneumonia. The clinical record was reviewed on 1/20/21 at 2:30 PM. The record contained the SOC comprehensive assessment dated 3/7/20 and provided service from 3/7/20 to 5/5/20. The record contained the Agency's discharge summary dated 3/19/20. As of 1/20/21, the record lacked a discharge comprehensive assessment for Pt. #16. 5. Pt. #17. SOC: 2/7/20. Primary Diagnosis: Chron's with Rectal Bleeding. The clinical record was reviewed on 1/20/21 at 3:30 PM. The record contained the SOC comprehensive assessment dated 11/13/20 and provided service from 12/3/20 to 1/31/21. The record contained the Agency's discharge summary dated 12/10/20. As of 1/20/21, the record lacked a discharge comprehensive assessment for Pt. #17. 6. During staff interview with Senior Director of Operations, Administrator, Nursing Supervisor #1, Nursing Supervisor #2 and the Area Clinical Director for Nursing team on 1/20/21 at 2:30 PM - 4:30 PM, 1/21/21 at 10:00 AM, and 1:30 PM; the Administrator, Nursing Supervisor #1 and Nursing Supervisor #2 confirmed the above findings.

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 may choose to include. This ELEMENT is not met as evidenced by: . A. Based on a review of clinical records and staff interviews, it was determined the Agency failed to ensure the PsOC included medications, accurate and/or complete. This was found in 17 of 17 (Pts. #1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 13, 14, 15, 16 and 17) clinical records reviewed. Findings include: 1. The clinical records indicated below were reviewed from 11/19/21 at 1:30 PM to 11/20/21 at 4:00 PM, and contained the following PsOC which lacked the patient's medications: Pt. #1. SOC 01/07/21. POC certification period 01/07/21 to 03/07/21. Pt. #2. SOC 11/18/20. POC certification period 11/18/20 to 01/16/21. Pt. #3. SOC 01/17/21. POC certification period 01/17/21 to 03/17/21. Pt. #4. SOC 01/16/21. POC certification period 01/16/21 to 03/16/21. Pt. #5. SOC 01/13/21. POC certification period 01/13/21 to 03/13/21. Pt. #6. SOC 11/17/20. POC certification period 11/17/20 to 01/15/21. Pt. #7. SOC 12/03/18. POC certification period 09/23/20 to 11/21/20. Pt. #8. SOC 02/07/20. POC certification period 10/04/20 to 12/02/20 and POC effective 12/03/20. Pt. #9. SOC 01/03/21. POC certification period 01/03/21 to 03/03/21. Pt. #10. SOC 11/23/18. POC certification period 01/11/21 to 03/11/2. Pt. #11. SOC 09/01/20. POC certification period 10/31/20 to 12/29/20 and POC effective 12/30/20. Pt. #12. SOC 04/10/20. POC certification period 12/06/20 to 02/03/21. Pt. #13. SOC 01/08/20. POC certification period 01/08/20 to 03/07/20. Pt. #14. SOC 10/30/20. POC certification period 10/30/20 to 12/28/20. Pt. #15. SOC 01/17/20. POC certification period 01/17/20 to 03/16/20. Pt. #16. SOC 03/07/20. POC certification period 03/07/20 to 05/05/20. Pt. #17. SOC 02/07/20. POC certification period 12/03/20 to 01/31/21. 2. Pt. #7. SOC 12/3/18. Primary Diagnosis: Post-Surgical Malabsorption. The clinical record was reviewed on 1/19/21 at 2:30 PM. The record contained the SOC comprehensive assessment completed by the RN contained the date of "12/03/18". The POC for the certification period of 9/23/20 to 11/21/20 and POC effective 11/23/20 included the SOC date as "11/06/2018". The PsOC effective 9/23/20 and 11/23/20 were inaccurate. 3. Pt. #11. SOC 9/1/20. Primary Diagnosis: Unspecified Cystic Fibrosis. The clinical record was reviewed on 1/20/20 at 9:45 AM. The record contained the POC with the certification period of 10/31/20 to 12/29/20 requiring: "...SN to obtain lab specimen(s) as ordered (specify labs & lab frequency): CBC w/Diff, CMP..." The lab specimen order lacked the lab frequency. 4. Pt. #2. SOC 11/18/20. Primary Diagnosis: Malignant Neoplasm of Bone and Articular Cartilage. The clinical record was reviewed on 1/20/21 at 9:30 AM. The record included POC for the certification periods of 11/18/20 to 1/16/21. The POC effective 11/18/20 included: "SN to obtain lab specimen(s) (specify lab/lab frequency) CBC D, CMP, Mg, Phos". The POC lacked documentation on frequency. 5. During staff interview with Senior Director of Operations, Administrator, Nursing Supervisor #1, Nursing Supervisor #2 and the Area Clinical Director for Nursing team on 1/20/21 at 2:30 PM - 4:30 PM, 1/21/21 at 10:00 AM, and 1:30 PM; the Administrator, Nursing Supervisor #1 and Nursing Supervisor #2 confirmed the above findings.