Every finding on record at Presbyterian Homes Home Care

On 9/25/23 through 9/27/23, a survey for compliance with CMS Appendix Z Emergency Preparedness Requirements, was conducted during a recertification survey. The facility is in full compliance with the Appendix Z Emergency Preparedness Requirements.

On 9/25/23 through 9/27/23, a recertification survey was conducted. This resulted in a partial extended survey at Presbyterian Homes Home Care. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. Unduplicated census previous 12 months: 1,592 Total home visits conducted: 7 Parent Location: 2845 Hamline Ave N, Roseville, MN 55113 All previous branches were verified to be closed. Hours of operation: 8:00 a.m. through 4:30 p.m. Total number of records reviewed: 17 In addition to the recertification, the following complaints were reviewed. As a result: No deficiency was issued for complaint: 95189 (H70875810C) and 61850 (H7087024C). Deficiencies were issued for complaint. 71822 (H70875811C).

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on interview and document review, the home health agency (HHA) failed to discharge a patient with just cause for 1 of 1 patient (P15) reviewed for agency-initiated discharge. Findings include: P15’s Home Health Certification and Plan of Care (POC) dated 7/9/22 through 9/6/22, identified P15 had diagnoses of epilepsy and major depressive disorder. P15 received skilled nurse (SN) visits once every two weeks to assess, evaluate and intervene on conditions to minimize complications. Additionally, every two weeks the SN would review and reconcile medications as needed and fill the pill organizer with current medications. P15’s goals included to receive medications as prescribed and verbalize understanding of medication compliance and measures to manage depression. P15 planned to discharge to care of family once goals were met. P15’s initial start of care date was 1/21/20. P15’s discharge letter from the HHA dated 7/15/22, identified effective 7/31/22, P15 would be discharged from services. P15’s county case worker would be notified and would assist to find a new HHA effective 8/1/22. The letter lacked rationale for the discharge. P15’s physician order dated 7/29/22, identified to discharge client without visit due to transfer to another HHA effective 8/7/22. The letter lacked rationale for the discharge. P15’s Client Coordination Note Report (CCNR)’s from 5/1/22 through 8/1/22, lacked rationale related to discharge. P15’s CCNR dated 8/3/22 identified during a SN visit he was “very worried” about the transition to another company, and licensed practical nurse (LPN)-A advised P15 to call the number on the discharge letter if he had questions. Attempts on 9/26/23, to contact P15 by phone were not successful. On 9/26/23 at 2:07 p.m. P15’s county case manager (CCM) stated she was not informed of P15’s discharge from the agency and when she called to ask, the agency stated it was due to lack of staffing. On 9/27/23 at 9:22 a.m. the administrator stated there was not enough staffing to meet P15’s needs and that’s why he was discharged. The administrator agreed there was no documentation of the rationale for discharge or care coordination in P15’s record. The agency’s undated discharge policy identified clients would be discharged if there was not a safe plan at home, the client chose to not return home, or if the certification expired while the client was in an inpatient facility. Additionally, if the agency terminated a service plan, and the client continued to need home care services, the agency would provide the client with a written notice of termination with the reason for termination, a list of known licensed home care providers in the clients immediate geographic area, and a discharge summary would be completed, kept in the client record and provided to the new agency and primary medical team.

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 interview and record review the facility failed to ensure supervisory visits for home health aide (HHA) services occurred every 14 days for 1 of 1 patients (P10) who received HHA services and skilled nursing services. Findings include: P10's plan of care (POC) dated 7/30/23- 9/27/23, indicated P10 was oriented, but forgetful. P10 had diagnoses of bilateral hearing loss, kidney disease, and chronic anticoagulant use. P10 required skilled nurse (SN) services every 2 weeks and HHA services twice a week. P10's HHA visit notes dated 7/30/23-9/27/23, indicated P10 had received HHA services twice a week. P10's SN visit notes dated 7/30/23-9/27/23, indicated a supervisory HHA visit occurred once on 9/27/23. P10's medical record lacked evidence that additional supervisory HHA visits had occurred. On 9/27/23 at 3:25 p.m., the clinical administrator verified R10's supervisory visits had not occurred every 14 days and only occurred with P10's recertification assessment. The clinical administrator stated she was unaware of the need for supervisory visits every 14 days with patients who also have SN services. A facility policy titled Home Health Aide Supervisory Visits undated, directed the agency to supervise HHA employees according to federal and state regulations. Furthermore, the policy directed supervision of HHA employees must be completed by a registered nurse every 14 days for Medicare/skilled care clients.