Every finding on record at Pediatric Services of America

Unannounced visits concluded on 10/28/2024 at Aveanna Healthcare for the purpose of a complaint investigation. Standard-level deficiencies were identified.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record reviews, review of agency documentation, interviews with agency personnel, and review of agency policies, for one of three patients (Patient #1) who received Home Health Aide services, the agency failed to follow the physician approved plan of care and failed to follow the agency Aide Assignment and Duties (Care Plan) policy. The findings included: a. Patient #1 had a start of care date of 09/23/2022 with diagnoses that included cerebral palsy, hemiplegia, falls, legal blindness, anxiety and bipolar disorder. The physician’s orders for the certification period of 09/12/2024 to 11/10/2024 included Nurse’s Aide (NA) services twenty-hours per week for unskilled care. Additionally, the Patient would receive skilled nursing visits every sixty-days for a comprehensive assessment for the re-certification of services and monthly supervisions of the care provided by the NA. Review of Patient #1's care plan dated 09/12/2024 identified the NA would perform the following tasks, assisting the Patient with personal hygiene/grooming, oral care, incontinence care, showering, dressing, light housekeeping and laundry. Review of NA #1’s monthly supervisions dated 07/12/2024, 08/08/2024 and 09/06/2024 performed by a Registered Nurse (RN) identified Patient #1 was satisfied with the care provided by NA #1. The 09/06/2024 supervision, identified NA #1 grocery shopped for the Patient, but the care plan was not evaluated and updated to reflect the need for grocery shopping. i. Interview and review of Patient #1’s clinical record and the agency’s investigation document dated 10/14/2024 at 10:15 AM, on 10/21/2024 with Administrator #1 and the Supervisor of Clinical Services (SCS) #1, identified Nurse’s Aide (NA) #1 had provided care for the Patient from March 2023 until October 2024. Patient #1 had requested NA #1 grocery shop for him/her as needed and gave NA #1 permission to use the Patient’s electronic benefits transfer (EBT) card (a card provided by the government for supplemental nutritional assistance that functions as a pre-paid debit card and used to purchase eligible food items). On 10/14/2024, Patient #1 alleged NA #1 utilized the EBT card for personal use, as the Patient indicated NA #1 was returning from the grocery store with less food items then in 2023. Patient #1 further indicated not reviewing the grocery store receipts and would throw the receipts away. SCS #1 identified grocery shopping for the Patient was not a task on the Patient’s care plans, therefore, NA #1 failed to follow the Patient’s care plan as ordered and the agency failed to evaluate and update the Patient’s care plan to reflect his/her needs. Review of the agency’s Aide Assignment and Duties (Care Plan) policy identified an individual care plan would be developed by the appropriate personnel to ensure that care and services were appropriate to the patient’s specific needs/problems. A written patient care instructions for the Aide must be prepared by the Registered Nurse who was responsible for the supervision of the Home Health Aide. The care plan would be evaluated and updated on an ongoing basis to reflect the patient’s needs. Home Health Aides must document to the tasks assigned on the written aide care plan. A Home Health Aide must provide services that are ordered by a physician, included on the care plan and consistent with Home Health Aide training. Subsequent to the surveyor’s inquiry, the Administrator identified NA #1 was placed on leave the week of 10/21/2024 pending the outcome of the agency’s investigation.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on clinical record reviews, review of agency documentation, interviews with agency personnel, and review of agency policies, for one of three patients (Patient #1) who received Home Health Aide services, the agency failed to follow the physician approved plan of care, and failed to follow the agency's Aide Assignment and Duties (Care Plan) policy. The findings included: a. Patient #1 had a start of care date of 09/23/2022 with diagnoses that included cerebral palsy, hemiplegia, falls, legal blindness, anxiety and bipolar disorder. The physician’s orders for the certification period of 09/12/2024 to 11/10/2024 included Nurse’s Aide (NA) services twenty-hours per week for unskilled care. Additionally, the Patient would receive skilled nursing visits every sixty-days for a comprehensive assessment for the re-certification of services and monthly supervisions of the care provided by the NA. Review of Patient #1's care plan dated 09/12/2024 identified the NA would perform the following tasks, assisting the Patient with personal hygiene/grooming, oral care, incontinence care, showering, dressing, light housekeeping and laundry. Review of NA #1’s monthly supervisions dated 07/12/2024, 08/08/2024 and 09/06/2024 performed by a Registered Nurse (RN) identified Patient #1 was satisfied with the care provided by NA #1. The 09/06/2024 supervision, identified NA #1 grocery shopped for the Patient but the care plan was not evaluated and updated to reflect the need for grocery shopping. i. Interview and review of Patient #1’s clinical record and the agency’s investigation dated 10/14/2024 at 10:15 AM on 10/21/2024 with Administrator #1 and Supervisor of Clinical Services (SCS) #1, identified Nurse’s Aide (NA) #1 had provided care for the Patient from March 2023 until October 2024. Patient #1 had requested NA #1 grocery shop for him/her as needed and gave NA #1 permission to use the Patient’s electronic benefits transfer (EBT) card (a card provided by the government for supplemental nutritional assistance that functions as a pre-paid debit card and used to purchase eligible food items). On 10/14/2024, Patient #1 alleged NA #1 utilized the EBT card for personal use, as the Patient indicated NA #1 was returning from the grocery store with less food items then in 2023. Patient #1 further indicated not reviewing the grocery store receipts and would throw the receipts away. SCS #1 identified grocery shopping for the Patient was not a task on the Patient’s care plans, therefore, NA #1 failed to follow the Patient’s care plan as ordered and the agency failed to evaluate and update the Patient’s care plan to reflect his/her needs. Review of the agency’s Aide Assignment and Duties (Care Plan) policy identified an individual care plan would be developed by the appropriate personnel to ensure that care and services were appropriate to the patient’s specific needs/problems. A written patient care instructions for the Aide must be prepared by the Registered Nurse who was responsible for the supervision of the Home Health Aide. The care plan would be evaluated and updated on an ongoing basis to reflect the patient’s needs. Home Health Aides must document to the tasks assigned on the written aide care plan. A Home Health Aide must provide services that are ordered by a physician, included on the care plan and consistent with Home Health Aide training. Subsequent to the surveyor’s inquiry, the Administrator identified NA #1 was placed on leave the week of 10/21/2024 pending the outcome of the agency’s investigation.