Every finding on record at Registered Nurses Care Ltd

Substantial Allegation Survey Substantial Allegation 99331 The following deficiency is based on substantial allegation 99331 completed on 09/26/23. Registered Nurses Care LTD 368071, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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, patient and staff interviews, and policy review, the agency failed to ensure patients received home health services as ordered in the written place of care for one of three patients reviewed (Patient #1). This could affect all patients receiving services from this agency. The census was 74. Findings include: Review of Patient #1's medical record revealed orders for Home Health Aide (HHA) services 35 hours every week for the certification period dated 06/03/23 to 08/01/23. Review of the HHA times sheets for this time period revealed the following: Patient #1 received 23.5 hours of HHA services between 06/04/23 and 06/10/23, 28.5 hours of HHA services between 06/11/23 and 06/17/23, 20 hours of HHA services between 06/18/23 and 06/24/23, 21 hours of HHA services between 06/25/23 and 07/01/23, 24.5 hours of HHA services between 07/02/23 and 07/08/23, 24.25 hours of HHA services between 07/09/23 and 07/15/23, 18 hours of HHA services between 07/16/23 and 07/22/23, 20 hours of HHA services between 07/23/23 and 07/29/29, and 20.75 hours between 07/30/23-08/05/23. There was no documentation the physician was notified that services were not provided as ordered. On 09/20/23 at 3:00 P.M. an interview with Patient #1 revealed he manipulated times and the HHA (Staff B) did try to adjust times but stated he, the patient, could be a bit difficult at times "and I ask him to leave pretty much when I am ready for him to leave". The patient also stated that he did not likely allow his aide to get the full 35 hours because he was unpredictable. Further interview revealed he did not want the HHA to get into trouble because the HHA was trying to work with him to provide appropriate HHA care, and they had "worked it out like this for a long time". On 09/20/23 at 3:06 P.M. an interview with Staff B revealed Patient #1 did not get the full 35 hours because the patient "hints" for him to leave, and he came and went at the patient requested. Further interview revealed the patient refused the HHA services sometimes and asked Staff B to leave at other times. Further interview revealed Staff B did not know he was doing anything wrong because he felt the pay cut was "on me", and the agency only charged for the hours provided. On 09/20/23 at 3:20 P.M. an interview with Staff A revealed the agency felt it was acceptable to keep the HHA orders at 35 hours a week (as written) as long as they did not go over the 35 hours, because the agency only billed for the hours provided and reported they were no longer permitted to write “up-to” orders. Review of the undated policy titled, Patient Visit - Scheduling, revealed the Registered Nurse (RN) or licensed therapist formulates a visit schedule based on the patient's clinical status, needs and wishes at the time of the admission assessment and physician orders. Further policy review revealed the frequency and type of visits are communicated to the clinical supervisor who documents the information on a master/team schedule form and assigns appropriate personnel to provide care and/or services. Further review revealed everyone providing care and/or services to the patient should contact the clinical supervisor at least weekly to confirm that visits have been conducted as scheduled, and the clinical supervisor should be contacted in a timely manner whenever changes need to be made to the type, frequency, dates and/or times of patient visits. Further review revealed that personnel failing to adhere to the visits reporting requirements may be subject to disciplinary action. This deficiency represents non-compliance investigated under Substantial Allegation 99331.