Every finding on record at Physicians Choice Home Health Care Inc

A Recertification survey was conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Department of Health and Human Services. The survey conducted from 09/18/2023 to 09/20/2023 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CFR 484.102.

A Recertification survey was conducted by Healthcare Management Solutions, LLC on behalf of the Nevada Department of Health and Human Services. The survey conducted from 09/18/2023 to 09/20/2023 resulted in a finding of substantial compliance respective to the applicable Condition of Participation (CoP) under 42 CFR 484, Subparts A through C with the following standard-level deficiencies listed below.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on document review, policy review, and interview, the home health agency failed to maintain ongoing surveillance, analysis, and investigation of infection data as a component of its infection control program. This failure had the potential to affect the health and safety of all patients who received home health services and agency staff. Findings include: Review of a document presented as the agency's "Infection Control Tracking," revealed it included the patients name, status e.g., discharged, transferred, admitted, cause of infection e.g., urinary tract infection, cellulitis, respiratory infection, and antibiotic. During an interview on 09/19/2023 at 12:00 PM, the Administrator confirmed the document was printed on 09/19/2023 and that the information was derived from forms the nurse or therapist enters into the electronic medical record (EMR) system when the patient was started on an antibiotic or had symptoms indicating an infection was present. The Administrator confirmed the agency had not been reviewing the data on a regular basis or completing an investigation or analysis of the infection surveillance data. Review of an agency policy titled, "Infection Control Surveillance System," dated March 2018, revealed, "The Agency will implement an infection control surveillance system for patients and staff. The definition of infections is based on the most common infections prevalent to Agency's services that are high volume, frequent infectious complications and have a high potential for prevention by staff and/or have an increased risk for negative patient outcomes … At least quarterly, the Director of Clinical Services and infection control and QAPI [quality assessment performance improvement] Committees will review and assess the infection control logs … Problems and/or undesirable trends in infections will be identified."

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review, policy review, and interview, the home health agency failed to ensure two of two patients (Patient (P)12 and P14) who were receiving HHA (Home Health Aide)/CNA (Certified Nurse Aide) (Aide) services had supervisory visits documented at least every 14 days. Failure for the Registered Nurse (RN), Physical Therapist (PT), or Occupational Therapist (OT) to complete Aide supervisory visits had the potential to affect the services provided and safety of patient care. Findings include: Review of P12's "Plan of Care (POC)" in the electronic medical record (EMR) revealed a Start of Care Date (SOC) of 08/15/2023. Services included "Aide once a week, OT once a week, and PT once a week. An RN had completed a visit one time for the SOC assessment. Review of the PT and OT visit notes in the EMR showed a section marked "Therapy/Aide Supervision" which was blank on all documented visits. Review of P14's "POC" in the EMR revealed a SOC of 08/15/2023. Services included "Aide once a week, OT two times a week, and PT two times a week. An RN had completed a visit one time for the SOC assessment. Review of the PT and OT visit notes in the EMR showed a section marked "Therapy/Aide Supervision" which was blank on all documented visits. During an interview on 09/20/2023 at 3:00 PM, the Administrator reviewed the EMR for P12 and P14 and confirmed supervisory visits had not been documented since the SOC for both patients. Review of an agency policy titled, "Home Health Aide Supervision" dated February 2021, revealed, "All home health aide supervisory visits will be made at least every 14 days … If Home Health Aide services are provided to a patient who is receiving skilled nursing, physical, or occupational therapy or speech-language pathology services, a registered nurse or other appropriated skilled professional who is familiar with the patient, the patient's plan of care and written patient care instructions must make an onsite visit to the patient's home no less frequently than every 14 days."