Every finding on record at Providence Health & Services-Oregon

The unannounced investigation of Complaint #OR30998 was completed on 11/4/2021. The agency was surveyed for compliance with the Federal Conditions of Participation for Home Health, Part 484. An entrance conference was held with the Executive Director on 10/14/2021 at 2:00 PM. The purpose of the investigation and the investigation needs were explained. An opportunity was provided for questions, answers, and comments. At the time of the investigation, it was determined that the agency was not in compliance with the applicable Conditions of Participation. Standard level deficiency was cited. Definitions and abbreviations: CFR - Code of Federal Regulations OR - Oregon OT - Occupational therapy

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 staff interview, it was determined the home health agency failed to ensure occupational therapy (OT) services were provided according to agency's policy. Findings: Record review of a document titled “Plan of Care” revealed that Patient 1’s start of care was 7/6/2021. The document indicated an order date of 7/6/2021 for occupational therapy. Review of the same document also revealed the first OT visit date of 7/14/2021, which was eight days after the order date. Review of the agency policy titled “Admission Process HH 207-2," revealed “The secondary service (any discipline beyond the admitting discipline) contact to the patient will be made within 72 hours. The physician will be informed by phone call or written communication if the initial visit any discipline is changed.” During an interview with Employee #1 and #2 on 11/3/2021 at 4:30 PM, Employee #1 confirmed the first OT visit was on 7/14/2021. Employee #1 and #2 stated there is no mention of why the OT visit was delayed until 7/14/2021. No further documentation was received. .