Every finding on record at Pediatric Services of America, LLC

Based on the findings of an unannounced, onsite Medicare recertification survey conducted on November 2 through November 4, 2022, Aveanna Healthcare was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced, onsite Medicare recertification survey conducted November 2 through November 4, 2022, Aveanna Healthcare was found not to be in compliance with the following requirement of 42 CFR, Part 484, Subparts B &; C, Conditions of Participation: Home Health Agencies.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on the review of agency policies/procedures and clinical records, and based on interview with the area clinical manager and the operations manager, the agency failed to ensure ventilator (mechanical device which assists with breathing) settings were maintained as per physician orders for two (2) of two (2) clients (patients) who were ventilator dependent. (Clients #3 and #5) Findings include: On November 4, 2022 at approximately 2:45 PM, review of the agency policy titled "Care Plan" revealed the following: Overview…An individualized plan of care will be developed…to ensure that care and services are appropriate to the patient’s specific needs/problems. On November 4, 2022 at approximately 2:47 PM, review of the agency policy titled "Physician Orders" revealed the following: Overview...Care and services will be provided in accordance with physician's (or other authorized practitioner's) orders, as required by law and regulations. On November 4, 2022 at approximately 2:37 PM, review of the agency policy titled "Mechanical Ventilation” revealed the following: Overview…The goal of mechanical ventilation is to provide respiratory support for patients who need assistance to maintain adequate gas exchange…Policy…5. Physician orders for patient ventilator settings…are within acceptable ranges for safe management in the home environment… Client #3: On November 3, 2022 at approximately 11:19 AM, review of the clinical record revealed the patient is 43 years old, the start of care date was 01/18/2016, diagnoses include dependence on ventilator and that skilled nursing (SN) is to maintain the following ventilator settings as documented on the interim physician order dated 10/24/2022 and “Plan of Care” for the recertification period of 11/01/2022 through 12/30/2022: - PEEP (positive end-expiratory pressure-the positive pressure provided when a breath is exhaled) setting at 3 during daytime and sleep hours; and -Humidity setting at 31 degrees Celsius during sleep hours. Review of SN ventilator flow sheet documentation revealed the PEEP setting was zero (0) and that a sleep-time humidity setting was not documented by the licensed practical nurse (LPN-Employee #6) during the overnight SN shifts provided on 10/25/2022, 10/26/2022 and 10/27/2022. Client #4: Between November 3, 2022 at approximately 1:01 PM and November 4, 2022 at approximately 7:00 AM, review of the clinical record revealed the patient is 17 years old, the start of care date was 03/22/2017, diagnoses include dependence on ventilator and that skilled nursing (SN) is to maintain the following ventilator settings as documented on the “Plan of Care” for the recertification period of 09/06/2022 through 11/04/2022: -Humidity setting range 30-32 degrees Celsius from 10:00 AM to 10:00 PM; and -Humidity setting range 36-38 degrees Celsius from 10:00 PM to 10:00 AM. Review of SN ventilator flow sheet documentation revealed that the humidity setting range was maintained as follows: -09/08/2022 between 5:30 AM and 9:00 AM: 30.9 to 31 degrees Celsius; -09/09/2022 between 11:00 AM and 12:00 PM: 37 degrees Celsius; -09/30/2022 at 11:00 AM: 37 degrees Celsius; and -10/10/2022 at 11:00 AM: 37 degrees Celsius. There was no documentation on the SN ventilator flow sheet which provided evidence that the LPN (Employee #7) maintained the ventilator humidity settings per the physician orders included on the “Plan of Care” on the above referenced dates/times. During interview conducted on November 4, 2022 at approximately 3:05 PM, the area clinical director and the operations manager confirmed that the above referenced ventilator settings were not maintained as per physician orders for the above identified patients.