Every finding on record at Richlands Home Care, Inc

An unannounced Medicare/Medicaid home health recertification survey was conducted at the above noted agency 07/05/2022 to 07/07/2022 by one (1) Medical Facilities Inspector from the Virginia Department of Health Office of Licensure and Certification. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found not to be in compliance with 42 CFR 484.102 the Conditions of Participation: Emergency Preparedness for Home Health Agencies.

EP Training Program CFR(s): 484.102(d)(1) §403.748(d)(1), §416.54(d)(1), §418.113(d)(1), §441.184(d)(1), §460.84(d)(1), §482.15(d)(1), §483.73(d)(1), §483.475(d)(1), §484.102(d)(1), §485.68(d)(1), §485.625(d)(1), §485.727(d)(1), §485.920(d)(1), §486.360(d)(1), §491.12(d)(1). *[For RNCHIs at §403.748, ASCs at §416.54, Hospitals at §482.15, ICF/IIDs at §483.475, HHAs at §484.102, "Organizations" under §485.727, OPOs at §486.360, RHC/FQHCs at §491.12:] (1) Training program. The [facility] must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the [facility] must conduct training on the updated policies and procedures. *[For Hospices at §418.113(d):] (1) Training. The hospice must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing hospice employees, and individuals providing services under arrangement, consistent with their expected roles. (ii) Demonstrate staff knowledge of emergency procedures. (iii) Provide emergency preparedness training at least every 2 years. (iv) Periodically review and rehearse its emergency preparedness plan with hospice employees (including nonemployee staff), with special emphasis placed on carrying out the procedures necessary to protect patients and others. (v) Maintain documentation of all emergency preparedness training. (vi) If the emergency preparedness policies and procedures are significantly updated, the hospice must conduct training on the updated policies and procedures. *[For PRTFs at §441.184(d):] (1) Training program. The PRTF must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) After initial training, provide emergency preparedness training every 2 years. (iii) Demonstrate staff knowledge of emergency procedures. (iv) Maintain documentation of all emergency preparedness training. (v) If the emergency preparedness policies and procedures are significantly updated, the PRTF must conduct training on the updated policies and procedures. *[For PACE at §460.84(d):] (1) The PACE organization must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing on-site services under arrangement, contractors, participants, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Demonstrate staff knowledge of emergency procedures, including informing participants of what to do, where to go, and whom to contact in case of an emergency. (iv) Maintain documentation of all training. (v) If the emergency preparedness policies and procedures are significantly updated, the PACE must conduct training on the updated policies and procedures. *[For LTC Facilities at §483.73(d):] (1) Training Program. The LTC facility must do all of the following: (i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role. (ii) Provide emergency preparedness training at least annually. (iii) Maintain documentation of all emergency preparedness training. (iv) Demonstrate staff knowledge of emergency procedures. *[For CORFs at §485.68(d):](1) Training. The CORF must do all of the following: (i) Provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. All new personnel must be oriented and assigned specific responsibilities regarding the CORF's emergency plan within 2 weeks of their first workday. The training program must include instruction in the location and use of alarm systems and signals and firefighting equipment. (v) If the emergency preparedness policies and procedures are significantly updated, the CORF must conduct training on the updated policies and procedures. *[For CAHs at §485.625(d):] (1) Training program. The CAH must do all of the following: (i) Initial training in emergency preparedness policies and procedures, including prompt reporting and extinguishing of fires, protection, and where necessary, evacuation of patients, personnel, and guests, fire prevention, and cooperation with firefighting and disaster authorities, to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles. (ii) Provide emergency preparedness training at least every 2 years. (iii) Maintain documentation of the training. (iv) Demonstrate staff knowledge of emergency procedures. (v) If the emergency preparedness policies and procedures are significantly updated, the CAH must conduct training on the updated policies and procedures. *[For CMHCs at §485.920(d):] (1) Training. The CMHC must provide initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles, and maintain documentation of the training. The CMHC must demonstrate staff knowledge of emergency procedures. Thereafter, the CMHC must provide emergency preparedness training at least every 2 years. This STANDARD is not met as evidenced by: Based on document review and staff interview it was determined the agency’s emergency preparedness plan failed to contain documentation initial and biennial emergency preparedness training was provided to all new and existing staff and individuals providing services under arrangement consistent with their expected role and failed to include documentation of demonstration/testing of staff’s knowledge of the agency’s emergency preparedness plan. Findings: The agency's emergency preparedness plan was reviewed in the agency on 07/07/2022. The agency's emergency preparedness plan failed to include documentation of initial and biennial staff training and demonstration/testing of staff's knowledge. The Administrator/Director of Nursing acknowledged the agency failed to provide emergency preparedness training and testing to all new and existing staff and anyone one working under arrangement. The lack of the above noted training and testing information was reviewed with the Administrator/Director of Nursing prior to and during the exit conference conducted in the agency on 07/07/2022.

An unannounced Medicare/Medicaid home health recertification survey was conducted on at the above noted agency 07/05/2022 to 07/07/2022 by one (1) Medical Facilities Inspector from the Virginia Department of Health, Office of Licensure and Certification. The agency reported 124 unduplicated admissions during the last 12 months. In conjunction with the survey, the following were reviewed: seven (7) clinical records, three (3) personnel files, COVID-19 vaccination requirement, agency admission packet, complaint log, organizational chart, and CLIA (Certified Laboratory Improvement Amendments) waiver. Three (3) home visits and multiple staff interviews were conducted. The facility was found not to be in compliance with the Federal requirements of 42 CFR 484, the Medicare/Medicaid Conditions for Certification of Home Health Agencies. Standard level deficiencies were identified and cited in this report.

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 and staff interview it was determined the Registered Nurse (RN) failed to develop an individualized aide care plan for each patient. Specifically, the plan of care/aide care plan failed to include which tasks specifically must be performed and the specific frequency of these tasks for four (4) of seven (7) clinical records in the survey sample. Four (4) of four (4) clinical records in the survey sample of patient's receiving home health aide services failed to contain the required documentation. (Clinical records #1, #5, #6 and #7) Findings: Seven (7) clinical records were reviewed in the agency 07/06/2022 to 07/07/2022 with the following findings: 1. Clinical record #1 was reviewed for the certification period 06/15/2022 to 08/13/2022. According to patient #1's plan of care the patient was to receive home health aide services one (1) time a week for one (1) week then two (2) times a week for eight (8) weeks. Patient's plan of care included a secondary diagnosis of unspecified psychosis. The following tasks were included on patient's aide care plan and were assigned with a frequency of, per request: Partial Bath/Sponge Per Request Shampoo Hair Per Request 2. Clinical record #5 was reviewed for the certification period 06/07/2022 to 08/05/2022. According to patient #5's plan of care the patient was to receive home health aide services two (2) times a week for nine (9) weeks. The patient's plan of care included a secondary diagnosis of Alzheimer's disease with late onset with dementia in other diseases classified elsewhere with behavioral disturbance. The following tasks were included on patient's aide care plan and were assigned with a frequency of, per request: Oral Hygiene/Denture Care Per Patient Request Partial Bath/Sponge Per Request Shampoo Hair Per Request 3. Clinical record #6 was reviewed for the certification period 06/27/2022 to 08/25/2022. According to patient #6's plan of care the patient was to receive home health aide services two (2) times a week for nine (9) weeks. The following tasks were included on patient's aide care plan and were assigned with a frequency of, per request: Partial Bath/Sponge Per Request Shampoo Hair Per Request 4. Clinical record #7 was reviewed for the certification period 05/20/2022 to 07/18/2022. According to patient #7's plan of care the patient was to receive home health aide services two (2) times a week for eight (8) weeks beginning the week of 05/23/2022 The following tasks were included on patient's aide care plan and were assigned with a frequency of, per request: Complete Bath Per Request Partial Bath/Sponge Per Request Shampoo Hair Per Request The Registered Nurse (RN) failed to develop an individualized aide care plan for the above noted patients that included what tasks were specifically to be performed and the specific frequency of these tasks. The RN also failed to document that the patient is cognitively and functionally able to choose and perform each task in which "as requested " was identified. The above noted findings were acknowledged by the Administrator/Director of Nursing during the clinical record reviews and during the exit conference conducted in the agency on 07/07/2022.