Every finding on record at Quality Home Health, LLC

Recertification survey completed. Standard Level deficiencies cited. Abbreviations: # = number AM = morning SN = Skilled Nurse SOC = Start of care RN = Registered Nurse NP = Nurse Practitioner PM = afternoon/evening ROM = Range of Motion Pt./ Pts. = Patient/Patients HHA = Home Health Aide PT = Physical Therapist/Therapy OT = Occupational Therapist/Therapy

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interview, it was determined the Agency failed to ensure a RN performed the initial assessment within 48 hours of the Physician referral for Home Health Care services. This was found in 6 of 7 (Pts. # 2, 3, 4, 1, 5 and 7) clinical records reviewed 4. Pt. #1 was admitted to Home Health Services on 8/5/23 with a primary diagnosis of Unspecified Hyperlipidemia. The clinical record was reviewed on 12/5/23, and contained a referral dated 7/11/23 to initiate service. The referral was faxed from the Physician's office to the Agency on 7/28/23 to initiate service. The SOC comprehensive assessment completed by the RN was dated 8/5/23. The SOC visit was conducted 8 days after receipt of the referral. As of 12/5/23, the record lacked documentation service was initiated within 48 hours of the referral. 5. Pt. #5 was admitted to Home Health Services on 10/2/23 with a primary diagnosis of Chronic Obstructive Pulmonary Disease. The clinical record was reviewed on 12/5/23, and contained the SOC comprehensive assessment completed by the RN and dated 10/2/23. As of 12/5/23, the record lacked a referral to initiate Home Health Services on 10/2/23. 6. Pt. #7 was admitted to Home Health Services on 3/31/23 with a primary diagnosis of Urinary Tract Infection. The clinical record was reviewed on 12/5/23, and contained a referral dated 3/28/28 to initiate service. The referral was faxed from an inpatient facility to the Agency on 3/28/23. The SOC comprehensive assessment completed by the RN was dated 3/31/23. The SOC visit was conducted 3 days after receipt of the referral. As of 12/5/23, the record lacked documentation service was initiated within 48 hours of the referral. 7. During an interview with the Administrator and the Director of Nursing on 12/6/23 from 10:00 AM to 12:10 PM, the Director of Nursing confirmed the above findings. Findings include: 1. Pt. #2 was admitted to Home Health Services on 11/16/23 with the principal diagnosis of Polyosteoarthritis. The clinical record was reviewed on 12/4/23. The Face-to Face form signed by the Physician on 11/7/23 and faxed to Home Health Agency on 11/13/23 required: "SN to monitor and assess vitals, and medications regimens and to educate the Pt. about disease process, medication and diet.” The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from an inpatient facility. As of 12/07/23, the record lacked documentation the Agency initiated service within the required time frame. 2. Pt. #3 was admitted to Home Health Services on 11/30/23 with the principal diagnosis of Bilateral Primary Osteoarthritis. The clinical record was reviewed on 12/5/23. The Face-to-Face order was signed by the Nurse Practitioner and faxed to HHA on 11/15/23 for “SN to assess the disease process, symptom management, medication knowledge and compliance.” PT, Pt. needs gait training, range of motion exercises. Evaluate and treat.” The record lacked a Physician order SOC date or documentation the Pt. was discharged from an inpatient facility. As of 12/7/23, the record lacked documentation the Agency initiated service within the required time frame. 3. Pt. #4 was admitted to Home Health Services on 8/14/23 with the principal diagnosis of Fusion of Spine, Cervical. The clinical record was reviewed on 12/4/23. Pt. was discharged from Skilled Nursing facility on 8/9/23 with home health services for “PT, OT, and RN.” The record lacked a Physician ordered SOC date as of 12/7/23. The record lacked documentation the Agency initiated service within the required time frame.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical record review, Agency policy review and staff interview, it was determined the Agency failed to ensure the RN provided accurate written instructions to the Home Health Aide. This was found in 1 of 1 (Pt. #6) clinical record reviewed with Home Health Aide services. Findings include: 1. Pt.#6 was admitted to Home Health Services on 9/2/23 with a primary diagnosis of Disruption of External Operation (Surgical) Wound, Not Elsewhere Classified, Subsequent Encounter. The clinical record was reviewed on 12/5/23, and contained the Home Health Aide visit notes that included documentation the Home Health Aide performed the following tasks: 9/4/23 - "Assist bed bath, Comb/brush hair, Brush teeth, Medication remind, commode, toilet, and prepare lunch." 9/7/23 - "Brush teeth, Commode, Assist with feeding." 9/11/23 - "Sponge bath, Commode, Assist with feeding." 9/14/23 - "Commode, Prepare lunch." The Home Health Aide Care Plan completed by the RN and dated 9/2/23, lacked instructions for the Home Health Aide to perform the above tasks. The Home Health Aide Care Plan dated 9/2/23, required the Home Health Aide to assess the patient's blood pressure, 2 times a week for 8 weeks. The Care Plan included a section for the RN to enter a blood pressure parameter, requiring the Home Health Aide to notify the RN if the patient's blood pressure was outside the stated parameter. This section was left blank, no blood pressure parameter was entered on the Care Plan. 2. The Agency policy titled, “Home Health Aide (HHA) was reviewed and included: “…Duties…2. Task to be performed by an HHA must be assigned by and performed under the supervision of an RN who will be responsible for the for the patient care provided by the HHA. 3. During an interview with the Administrator, and the Director of Nursing on 12/5/23 at 10:40 AM, the Director of Nursing confirmed the above tasks were needed for the Pt., and that the RN failed to provide accurate written instructions to the Home Health Aide.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on clinical record review, Agency policy review and staff interview, it was determined the Agency failed to ensure the Home Health Aide followed the Home Health Aide Care Plan. This was found in 1 of 1 (Pt. #6) clinical record reviewed with Home Health Aide services. Findings include: 1. Pt. #6 was admitted to Home Health Services on 9/2/23 with a primary diagnosis of Disruption of External Operation (Surgical) Wound, Not Elsewhere Classified, Subsequent Encounter. The clinical record was reviewed on 12/5/23 and contained the Home Health Aide Care Plan, completed by the RN and dated 9/2/23, requiring the Home Health Aide to provide these services 2 times a week for 8 weeks: “Clean patient’s bedroom, Clean patient’s bathroom, Make bed / change linens, Assist with ROM Active/Passive exercises, Light housekeeping, Maintain clean environment, Check blood pressure." The Home Health Aide progress notes below included documentation the Home Health Aide failed to complete these tasks: 9/4/23 – ROM exercises and Check blood pressure. 9/7/23 – ROM exercises, Clean patient areas, Change bed linens, Make patient bed, and Check blood pressure. 9/11/23 – Check blood pressure. 9/14/23 – ROM exercises and Check blood pressure. 2. The Agency policy titled, “Home Health Aide (HHA) was reviewed and included: “…Duties 1. Provides personal care and related services in the home, under the direction, instruction and supervision of the staff nurse and the Agency Supervisor…” 3. During an interview with the Administrator and the Director of Nursing on 12/6/23 at 10:40 AM, the Director of Nursing confirmed the Home Health Aide failed to follow the instructions written on the Home Health Aide Care Plan.