Every finding on record at Prohealth Home Care, Inc.

An unannounced federally authorized onsite complaint survey was conducted on 03/17/2025 and 03/31/2025 to 04/01/2025 at ProHealth Home Care in Waukesha, WI in response to complaint #113069. ProHealth Home Care is out of compliance with the Medicare Conditions of Participation for Home Health Agencies, 42 CFR 484. 42 CFR 484.50 Condition of Participation: Patient Rights is NOT MET. Complaint #113069 was substantiated.

Condition of Participation: Patient rights. CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on record review and interview, the agency staff failed to notify/discuss with the patient's physician the planned discharge of 2 of 2 patients discharged for not meeting homebound status (Patient #1 and #3) in a total of 4 records reviewed. Findings Include: Agency staff failed to notify/discuss discharge plans with patient’s attending physician prior to discharge. See Tag G458.

Outcomes/goals have been achieved CFR(s): 484.50(d)(3) The transfer or discharge is appropriate because the physician or allowed practitioner, who is responsible for the home health plan of care and the HHA agree that the measurable outcomes and goals set forth in the plan of care in accordance with §484.60(a)(2)(xiv) have been achieved, and the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the patient no longer needs the HHA's services; This ELEMENT is not met as evidenced by: Based on record review and interview, agency staff failed to notify the patient, patient’s representative, and the physician responsible for the patient’s plan of care when patient no longer needed home care services in 2 of 2 patients discharged for homebound status in a total of 4 records reviewed. (Patient #1 and Patient #3) Findings Include: Review of agency policy titled, “PHHC Discharge. Transfer or Referral” dated 04/17/2024 revealed in part, “Discharges are based on the following criteria: c) The transfer or discharge is appropriate because the authorized prescriber, who is responsible for the plan of care, and the HHA agree that the measurable outcomes and goals set forth in the plan of care have been achieved and the patient no longer needs the HHA’s services." The above policy also revealed, "The patient and/or representative and authorized prescriber are active participants in the discharge, transfer, and/or referral process. A discharge notice will be completed and issued.” Patient #1 was a 74-year-old with a Home Health Agency (HHA) start of care date 03/31/2023. Patient #1's diagnoses included: Pressure Ulcer of the right hip, stage 4 (a deep open wound that extends through the skin, underlying tissue, and potentially exposes muscle tendon, ligament, cartilage, or bone), Multiple Sclerosis, Paraplegia, and Malignant neoplasm of upper lobe of lung, endometrium, and secondary malignant neoplasm of bone with multiple other secondary diagnoses. Review of Patient #1’s medical record revealed Patient #1 was discharged from home care services on 01/17/2025. Reason for discharge on the form titled, “Registered Nurse (RN) OASIS Discharge” revealed under, “Discharge with Not Improved Outcomes, Reason: Change in Patient Circumstances, No Longer Homebound.” There is no documentation within the record that supported either reasons for discharge or that a written notice of pending discharge was given to the patient or ordering Physician prior to discharge. The ordering physician acknowledged Patient #1's discharge via electronic signature on 01/20/2025 (3 days after discharge). Patient # 3 was a 54-year-old with a Home Health Agency (HHA) start of care date 02/26/2025. Patient #3's diagnoses include: Cerebral Infarction and left sided weakness. Patient #3 was discharged due to no longer being homebound, working half days. Review of Patient #3’ s medical record revealed Patient #3 was discharged from home care services on 03/06/2025. Document titled, “Registered Nurse (RN) OASIS Discharge” revealed under, “Homebound Status: Patient is homebound: No”. There is no documentation within the record that supported either reasons for discharge or that a written notice of pending discharge was given to the patient or ordering Physician prior to discharge. Physician electronic signature acknowledging Patient #3's discharge noted on 03/17/2025 (11 days after discharge). During an interview with Administrator B on 03/31/2025 at 03:37 PM Administrator B confirmed the ordering physician acknowledged Patient #1's discharge via electronic signature on 01/20/2025 (3 days after discharge).