Every finding on record at Pns Homecare Services, Inc

On 11/16/21 through 11/19/21, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Professional Nursing Services. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

A Medicare recertification survey was conducted by the Michigan Department of Licensing and Regulatory Affairs from 11/16/2021 through 11/19/21 at: Professional Nursing Services 16250 Northland Drive, Suite 200 Southfield, MI 48075 This agency has no branch sites. Records Reviewed: 3 records with home visits; 4 records without home visits, for a total of 7 records reviewed. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the conditions of participation for home health agencies at: 42 CFR Part 484.

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on document review and interview, the agency failed to ensure the comprehensive assessment accurately reflected the patient's current health status for 7 of 7 (MR's #1, 2, 3, 4, 5, 6 and 7) records reviewed, resulting in incomplete clinical information to aid in determining the needs of this patient and for measuring the patient's progress toward goals/outcomes. Findings include: MR#1: The Start of Care (SOC) was dated 11/3/21. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Type 2. During record review on 11/17/21, it was noted that the SOC comprehensive assessment dated 11/3/21, documented under "Primary Diagnosis and Other Diagnoses", all 17 diagnoses have an effective date of 11/3/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. MR#2: The Start of Care (SOC) was dated 10/9/21. The Plan of Care (POC) identified diagnoses of Stage 2 Pressure Ulcer and Diabetes Type 2. During record review on 11/17/21, it was noted that the SOC comprehensive assessment dated 10/9/21, documented under "Primary Diagnosis and Other Diagnoses", all 21 diagnoses have an effective date of 10/9/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. MR#3: The Start of Care (SOC) was dated 9/26/21. The Plan of Care (POC) identified diagnoses of Stage 3 Left Pressure Ulcer and Chronic Kidney Disease (CKD). During record review on 11/17/21, it was noted that the SOC comprehensive assessment dated 9/26/21, documented under "Primary Diagnosis and Other Diagnoses", all 14 diagnoses have an effective date of 9/26/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. MR#4: The Start of Care (SOC) was dated 10/24/21. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and Difficulty Walking. During record review on 11/17/21, it was noted that the SOC comprehensive assessment dated 11/3/21, documented under "Primary Diagnosis and Other Diagnoses", all 11 diagnoses have an effective date of 10/24/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. MR#5: The Start of Care (SOC) was dated 11/9/21. The Plan of Care (POC) identified diagnoses of Venous Insufficiency, Congestive Heart Failure (CHF), and Peripheral Vascular Disease. During record review on 11/18/21, it was noted that the SOC comprehensive assessment dated 11/9/21, documented under "Primary Diagnosis and Other Diagnoses", all 21 diagnoses have an effective date of 11/9/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. MR#6: The Start of Care (SOC) was dated 8/21/21. The Plan of Care (POC) identified diagnoses of Lymphedema, Hypertension and Diabetes Type 2. During record review on 11/18/21, it was noted that the SOC comprehensive assessment dated 8/21/21, documented under "Primary Diagnosis and Other Diagnoses", all 14 diagnoses have an effective date of 9/28/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. MR#7: The Start of Care (SOC) was dated 9/28/21. The Plan of Care (POC) identified diagnoses of Chronic Ulcer Left Calf and Ankle, Venous Insufficiency and Hypertension. During record review on 11/19/21, it was noted that the SOC comprehensive assessment dated 9/28/21, documented under "Primary Diagnosis and Other Diagnoses", all 15 diagnoses have an effective date of 9/28/21. No onset, prior treatments, outcomes, or history of how these diagnoses led to the need for home care were documented. The Adm#1 was questioned on 11/19/21 at 12:45 pm and confirmed the findings stating, "The comprehensive assessment was not completed accurately."

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined the agency failed to ensure the comprehensive assessment included a review of all medications to determine any adverse effects; failed to document the findings of the drug regime review as required in 5 of 7 sampled records reviewed (MR's #1, 2, 3, 4 and 5), resulting in the potential for harmful medication effects for all patients serviced by this Agency. Findings include: MR#1: The Start of Care (SOC) was dated 11/3/21. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Type 2. During record review on 11/17/21, section M2001 of the "Comprehensive Assessment" dated 11/3/21, completed by the Registered Nurse (RN), documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#2: The Start of Care (SOC) was dated 10/9/21. The Plan of Care (POC) identified diagnoses of Stage 2 Pressure Ulcer and Diabetes Type 2. During record review on 11/17/21, section M2001 of the "Comprehensive Assessment" dated 10/9/21, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. MR#3: The Start of Care (SOC) was dated 9/26/21. The Plan of Care (POC) identified diagnoses of Stage 3 Left Pressure Ulcer and Chronic Kidney Disease (CKD). During record review on 11/17/21, it was noted that the “Medication Profile” was blank under the section “Drug Regimen Review”, which lists “Potential drug reactions, significant side effects and significant drug interactions.” The agency failed to complete a medication review. MR#4: The Start of Care (SOC) was dated 10/24/21. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and Difficulty Walking. During record review on 11/17/21, it was noted that the “Medication Profile” was blank under the section “Drug Regimen Review”, which lists “Potential drug reactions, significant side effects and significant drug interactions.” The agency failed to complete a medication review. MR#5: The Start of Care (SOC) was dated 11/9/21. The Plan of Care (POC) identified diagnoses of Venous Insufficiency, Congestive Heart Failure (CHF), and Peripheral Vascular Disease. During record review on 11/18/21, section M2001 of the "Comprehensive Assessment" dated 11/9/21, completed by the RN, documented "Yes – Issues found during review." The comment section regarding “Describe problems found during review” was left blank. The agency failed to document the medication issues that were found during review. The Adm#1 was questioned on 11/19/21 at 12:30 pm and confirmed the findings stating, "Yes, the medication documentation is not correct."

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview, it was determined that the Agency failed to provide care and services in accordance with the plan of care in 4 (MR's # 1, 2, 3 and 6) of 7 records reviewed for provision of services, from a total of 7 records reviewed, resulting in the potential for decline in physical functioning and unmet care needs. Findings include: MR#1: The Start of Care (SOC) was dated 11/3/21. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Type 2. During record review on 11/17/21, it was noted the Skilled Nurse (SN) documented "Missed Visit" on 11/9/21 and 11/12/21. The agency failed to attempt to reschedule the missed visits to meet the ordered POC. MR#2: The Start of Care (SOC) was dated 10/9/21. The Plan of Care (POC) identified diagnoses of Stage 2 Pressure Ulcer and Diabetes Type 2. During record review on 11/17/21, it was noted the SN documented "Missed Visit" on 10/12/21 and 10/14/21. Additionally, Physical Therapy (PT) documented "Missed Visit" on 10/21/21 and 10/22/21. The agency failed to attempt to reschedule the missed visits to meet the ordered POC. MR#3: The Start of Care (SOC) was dated 9/26/21. The Plan of Care (POC) identified diagnoses of Stage 3 Left Pressure Ulcer and Chronic Kidney Disease (CKD). During record review on 11/17/21, it was noted the SN documented "Missed Visit" on 11/13/21. Additionally, PT documented "Missed Visit" on 10/28/21. The agency failed to attempt to reschedule the missed visits to meet the ordered POC. MR#6: The Start of Care (SOC) was dated 8/21/21. The Plan of Care (POC) identified diagnoses of Lymphedema, Hypertension and Diabetes Type 2. During record review on 11/18/21, it was noted the SN documented "Missed Visit" on 9/9/21, 9/16/21 and 10/14/21. The agency failed to attempt to reschedule the missed visits to meet the ordered POC. The Adm#1 was questioned on 11/19/21 at 12:35 pm and confirmed the findings stating, "Yes, the visit frequency was not met."

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure a discharge summary was complete, that provided the patient's current health status at the time of discharge, progress toward goals, and forwarded to the physician within 5 days of discharge in 2 (MR# 6 and 7), of 2 closed records, from a total of 7 records reviewed, resulting in the potential for unidentified continuing health care concerns and unmet care needs. Findings include: MR#6: The Start of Care (SOC) was dated 8/21/21. The Plan of Care (POC) identified diagnoses of Lymphedema, Hypertension and Diabetes Type 2. The Registered Nurse (RN) completed a discharge OASIS (outcome and assessment information set) on 10/19/21. During record review on 11/18/21, it was noted that there was no documented evidence a discharge summary was sent to the physician within 5 business days of the patient's discharge. MR#7: The Start of Care (SOC) was dated 9/28/21. The Plan of Care (POC) identified diagnoses of Chronic Ulcer Left Calf and Ankle, Venous Insufficiency and Hypertension. The RN completed a discharge OASIS on 11/8/21. During record review on 11/19/21, it was noted that there was no documented evidence a discharge summary was sent to the physician within 5 business days of the patient's discharge. The Adm#1 was questioned on 11/19/21 at 12:45 pm and confirmed the findings stating, "I cannot say for sure if they were sent out within the 5 business days window."