Every finding on record at Raamis Community Home Healthcare, Inc

Substantial Allegation Survey Substantial Allegation OH00122385 No deficiencies were cited related to allegation contained in substantial allegation OH00122385 completed on 06/09/21; however, the facility was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiencies are cited. Raamis Community Home Health Care Inc, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Within 48 hours of the patient's return CFR(s): 484.55(d)(2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This ELEMENT is not met as evidenced by: Based medical record review and staff interview, the agency failed to ensure the comprehensive assessment was updated within 48 hours of the patient's return home from a hospital admission for one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. Findings include: The medical record review for the Patient #1 was completed on 06/09/21. The medical record review revealed a plan of care for the certification period beginning 02/20/21 that stated the patient was diagnosed with heart failure, type two diabetes mellitus, hypertension, and peripheral vascular disease. The plan of care revealed the patient was to receive skilled nursing visits twice a week. The medical record review revealed a transfer Outcome and Assessment Information Set (OASIS) dated 04/17/21 that stated the patient was admitted to the hospital through the emergency department for other reasons. On 06/09/21 at 9:15 AM in an interview, Staff D said she was in the patient's home on 04/17/21. She said she was there when the ambulance came to take the patient to hospital. The medical record review revealed the patient was released from the hospital on 04/27/21. The medical record review did not reveal where a resumption of care OASIS was completed upon the patient's return home. On 06/09/21 at 9:15 AM in an interview, Staff A confirmed a resumption of care OASIS was not completed when the patient returned from the hospital.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on staff interview and record review, the agency failed to ensure the physician was updated of a change in the patient's condition for one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. Findings include: The medical record review for the Patient #1 was completed on 06/09/21. The medical record review revealed a plan of care for the certification period beginning 02/20/21 that stated the patient was diagnosed with heart failure, type two diabetes mellitus, hypertension, and peripheral vascular disease. The review revealed the patient was on one diuretic. The plan of care revealed the patient was to receive skilled nursing visits twice a week. The medical record review revealed a skilled nurse visit was provided by Staff D on 04/15/21. The review did not reveal any skin impairment, but did reveal swelling in both lower legs. There was no evidence of communication with the physician for any reason. On 06/09/21 at 9:15 AM in an interview, Staff D said on 04/15/21 she noticed the patient's legs were swollen, red, and weeping, but intact. She stated that was a new finding for the patient. She stated she did not call the physician about it. Further review of the patient's record revealed the patient was in the hospital from 04/17/21 through 04/27/21. Review of an incident report for 05/05/21 revealed Staff D called an ambulance against the patient's wishes. The review revealed the ambulance was called because of an inability to get wound orders from the hospital was putting the patient at risk. The review also revealed concerns about multiple pets and sanitation while the surgical wound clears. The review did not reveal any description of said surgical wound. The report was signed by Staff D on 04/29/21. On 06/09/21 at 2:30 PM in an interview, Staff A stated the date of the incident in the report, 05/05/21, was correct, and the date by the signature was incorrect. Further medical record review revealed a skilled nurse visit was provided on 05/05/21. The review did not reveal any discussion with the patient's physician concerning the lack of wound care orders and sanitation concerns. The note stated, "Patient is waiting for squad to take her back to hospital. I (sic) stay until they arrive." On 06/09/21 at 9:15 AM in an interview, Staff D stated she did not remember providing any home visits to the patient after the hospital discharge of 04/27/21. She was therefore unable to elaborate on the documentation of the 05/05/21 visit.

Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure the nurse prepared clinical notes for one of three patient's reviewed (Patient #1). The could affect all patients receiving services from the agency. Findings include: The medical record review for Patient #1 was completed on 06/09/21. The medical record review revealed a plan of care for the certification period beginning 02/20/21 that stated she was diagnosed with heart failure, type two diabetes mellitus, hypertension, and peripheral vascular disease. The review revealed the patient was on one diuretic. The plan of care revealed the patient was to receive skilled nursing visits twice a week.. The medical record review revealed a skilled nurse visit was provided by Staff D on 04/15/21. The review did not reveal any skin impairment, but did reveal swelling in both lower legs. On 06/09/21 at 9:15 AM in an interview, Staff D said that on 04/15/21 she noticed the patient's legs were swollen, red, and weeping, but intact. She stated that was a new finding for the patient. There was no documentation in the patient's record regarding the patient's legs being red or weeping. On 06/09/21 at 9:15 AM in an interview, Staff D said she was in the patient's home on 04/17/21. She said she was there when the ambulance came to take the patient to hospital. She said emergency medical services was called because the patient was in a lot of pain. She said she did not create a skilled nurse visit note or otherwise document her presence in the home on 04/17/21. Review of an incident report for 05/05/21 revealed Staff D called an ambulance against the patient's wishes. The review revealed the ambulance was called because of an inability to get wound orders from the hospital was putting the patient at risk. The review also revealed concerns about multiple pets and sanitation while the surgical wound clears. The report was signed by Staff D on 04/29/21. On 06/09/21 at 2:30 PM in an interview, Staff A stated the date of the incident in the report, 05/05/21, was correct, and the date by the signature, 04/29/21, was incorrect. The medical record review revealed a skilled nurse visit was provided on 05/05/21. The review did not reveal any description of a surgical wound, number and type of pets, and/or what specific sanitation concerns there were. The review did reveal the patient complained of leg pain. The note stated, "Patient is waiting for squad to take her back to hospital. I (sic) stay until they arrive." On 06/09/21 at 9:15 AM in an interview, Staff D stated she did not remember providing any home visits to the patient after the hospital discharge of 04/27/21. She was therefore unable to elaborate on the documentation of the 05/05/21 visit.