Every finding on record at Reliant Home Health Agency, Inc.

Based on the findings of an onsite unannounced home health agency Medicare recertification survey conducted August 24, 2021, August 25, 2021, and August 31, 2021, Reliant Home Health Agency, Inc. was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an unannounced onsite home health agency Medicare recertification survey conducted August 24, 2021, August 25, 2021, and August 31, 2021, Reliant Home Health Agency, Inc. was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient's immediate needs, but no later than 5 calendar days after the start of care. This ELEMENT is not met as evidenced by: Based on review of agency policies, clinical records (CR), and interview with the Director of Nursing, the agency failed to ensure the registered nurse (RN) completed a timely comprehensive assessment within five (5) days of start of care for five (5) of seven (7) CR reviewed. (CR #2, 3, 4, 6, and 7). Findings included: Review of agency policy titled "Client Plan Of Care" on August 25, 2021, at approximately 11:00 A.M. stated, "The nurse or appropriate therapist will complete an initial assessment of the client in the client's home..." A review of clinical records conducted on August 24, 2021, from approximately 12:00 P.M. to 3:30 P.M. and August 25, 2021, from approximately 2:00 P.M. to 4:00 P.M. revealed the following: CR #2, start of care March 28, 2021, contained an initial comprehensive assessment dated March 20 2021, for the certification period March 28, 2021, through May 25, 2021. CR #3, start of care June 14, 2020, contained an initial comprehensive assessment that was not dated. CR #4, start of care July 24, 2020, contained no documentation of an initial comprehensive assessment. CR #6, start of care November 21, 2020, contained an initial comprehensive assessment dated November 27, 2020. CR #7, start of care October 1, 2020, contained an initial comprehensive assessment dated September 2, 2020. An interview with the Director of Nursing on August 31, 2021, at 4:00 P.M. confirmed the above findings.

Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This ELEMENT is not met as evidenced by: Based on review of agency policies, clinical records (CR), and interview with the Director of Nursing, the agency failed to ensure the registered nurse (RN) completed a timely comprehensive assessment within the last five (5) days of the certification period for six (6) of seven (7) CR reviewed. (CR #1, 2, 3, 4, 6, and 7). Findings included: Review of agency policy titled "Reassessment/Periodic Review of Plan of Treatment" on August 25, 2021, at approximately 11:00 A.M. stated, "Purpose: Patient reassessment is an ongoing process throughout the patient's contact with the agency. Reassessment is used to evaluate the patient's current problems and needs to adjust the care being provided when appropriate.... Each patient is to be reviewed: At least every 60 days..." A review of clinical records conducted on August 24, 2021, from approximately 12:00 P.M. to 3:30 P.M. and August 25, 2021, from approximately 2:00 P.M. to 4:00 P.M. revealed the following: CR #1, start of care June 18, 2020, contained no documentation of a comprehensive assessment completed within the last five (5) days of the certification period, August 17, 2020, through October 15, 2020. CR #2, start of care March 28, 2021, contained no documentation of a comprehensive assessment completed within the last five (5) days of the following certification periods, May 26, 2021, through July 25, 2021, and July 26, 2021, through September 23, 2021. CR #3, start of care June 14, 2020, contained no documentation of a comprehensive assessment completed within the last five (5) days of the following certification periods, August 13, 2020, through October 11, 2020; October 12, 2020, through December 10, 2020; December 11, 2020, through February 8, 2021; February 9, 2021, through April 19, 2021; April 20, 2021, through June 18, 2021; and June 19, 2021, through August 18, 2021; and August 18, 2021, through October 16, 2021. CR #4, start of care July 24, 2020, contained no documentation a comprehensive assessment completed within the last five (5) days of the following certification periods, September 20, 2020, through November 20, 2020; November 21, 2020, through January 19, 2021; January 20, 2021, through March 20, 2021; March 21, 2021, through May 19, 2021; May 20, 2021, through July 18, 2021; and July 19, 2021, through September 16, 2021. CR #6, start of care November 21, 2020, contained no documentation of a comprehensive assessment completed within the last five (5) days of the following certification periods, January 20, 2021, through March 20, 2021; March 21, 2021, through May 19, 2021; May 20, 2021, through July 18, 2021; and July 19, 2021, through September 16, 2021. CR #7, start of care October 1, 2020, contained no documentation of a comprehensive assessment completed within the last five (5) days of the following certification periods, November 30, 2020, through January 28, 2021; January 29, 2021 through March 29, 2021; March 30, 2021, through May 29, 2021; May 30, 2021, through July 27, 2021; and July 28, 2021, through September 25, 2021. An interview with the Director of Nursing on August 31, 2021, at 4:00 P.M. confirmed the above findings.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on review of agency policy, clinical records (CR) and interview with the Director of Nursing, the agency failed to identify the duration and frequency of services to be provided in the plan of treatment for one (1) of seven (7) CR reviewed. (CR #1) Finding include: A review of agency policy titled "Physician's Plan of Care Policy" on August 25, 2021, at approximately 11:00 A.M. states, "Procedure: ... The physician's Plan of Care will include: ... Treatment orders, including type and frequency of service to be provided..." A review of clinical records on August 24, 2021, from approximately 12:00 P.M. to 3:30 P.M. and August 25, 2021, from 2:00 P.M. to 4:00 P.M. revealed the following: CR #1, start of care June 18, 2020, certification period August 17, 2020, to October 15, 2020. Section titled "Orders for Discipline and Treatments" lists services to be provided as "Aide frequency hours per week: Hours to be used at patient's discretion..." An interview with the Director of Nursing on August 31, 2021, at 4:00 P.M. confirmed the above findings.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on review of clinical records (CR), agency policy, and interview with the Director of Nursing, the agency failed to follow its policy regarding signing the plan of care/physician orders for four (4) of seven (7) CR reviewed. (CR# 1, 2, 4, and 6). Findings include: Review of agency policy on August 25, 2021, at approximately 2:00 P.M. revealed policy titled "Physician Orders, Plan of Treatment, Changes" stated, "Physician Signature: ... The director of nursing or an assigned person will contact the physician if the original POT has not been signed and received after 14 days. If not signed POT is received within 30-working day, the patient, and referral source will be notified and services discontinued." A review of the clinical records was conducted on August 24, 2021, between approximately 12:00 P.M. to 3:30 P.M. and August 25, 2021, from approximately 2:00 P.M. and 4:00 P.M. the following: CR #1, start of care June 18, 2020, discharge date September 5, 2020, contained a Home Health Certification and Plan of Care (POC) for certification period reviewd was August 17, 2020, through October 15, 2020, that was not signed by the physician. The CR contained a discharge order dated September 4, 2020, which was not signed by the physician. CR #2, start of care March 28, 2021, contained a POC for certification period July 26, 2021, through September 23, 2021, that was not signed by the physician. CR #4, start of care July 24, 2020, contained a POC for certification period July 19, 2021, through September 16, 2021, that was not signed by the physician. CR #6, start of care November 21, 2020, contained a POC for certification period July 19, 2021, through September 16, 2021, that was not signed by the physician. An interview with the Director of Nursing on August 30, 2021, at approximately 4:00 P.M. confirmed the above findings.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on review of clinical records (CR) and interview with the Director of Nursing, the agency failed to ensure the agency failed to ensure the home health aide (HHA) documented care provided in accordance with the frequency and duration order for four (4) of seven (7) CR reviewed (CR #1, 2, 4, and 6). Findings included: A review of clinical records conducted on August 24, 2021, from approximately 12:00 P.M. to 3:30 P.M. and August 25, 2021, from approximately 2:00 P.M. to 4:00 P.M. revealed the following: CR #1, start of care June 18, 2020, the Home Health Certification and Plan of Care (POC) for the certification August 17, 2020, through October 15, 2020, did not contain duration and frequency of orders to be provided. The HHA documented provision of care ten (10) hours per day, Monday through Friday from August 17, 2020, through September 2, 2020. CR #1 was discharged on September 4, 2020. CR #2, start of care March 28, 2021, certification period July 26, 2021, through September 23, 2021, contained orders for HHA services to be provided 25 hours per week. The HHA documented care provided 24 hours per day from July 24, 2021, through August 24, 2021. CR #4, start of care July 24, 2020, certification period July 19, 2021, through September 16, 2021, contained orders for HHA services to be provided 20 hours per day. The HHA documented care for hours other than ordered as follows: July 23 and 30, 2021 - 18.5 hours, July 27, 28, 29, and 31, 2021, and August 5 and 6, 2021 - 19 hours, August 1, 2021 - 21 hours, and August 2, 2021 - 22 hours. CR #6, start of care November 21, 2020, certification period July 19, 2021, through September 16, 2021, contained orders for HHA services to be provided 42 hours per week. The HHA documented care for hours other than ordered as follows: July 25 through 31, 2021 - 53 hours; August 1 through 7, 2021 - 112 hours; August 8 through 14, 2021 - 110.5 hours; August 15 through 21, 2021 - 109.5 hours. An interview with the Director of Nursing on August 31, 2021, at 4:00 P.M. confirmed the above findings.