Every finding on record at Sehaj Home Health, Inc.

The following reflects the findings of the California Department of Public Health during the investigation of a complaint. Complaint number: CA00707721 Representing the Department: HFEN 31403 The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the agency. Three deficiencies were issued for complaint number CA00707721 See tags 436, 442, 454.

Patient rights CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient's rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This CONDITION is not met as evidenced by: Based on interview and record review, for one of three sampled patients (Patient 1), the facility failed to meet the Condition of Participation for Patient Rights when the agency did not provide notification prior to termination of services, terminated services without just cause and did not provide the services as ordered by the doctor. Refer to deficiencies at G436, G442, G454. The cumulative severity and intensity of the deficiencies resulted in the failure of the facility to meet 484.50, Patient Rights.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency did not provide the services as ordered by the doctor for one (Patient 1) of three sampled patients. Patient 1 was to receive skilled nursing services, until no longer needed and her goals had been met. This failure had the potential for unmet healthcare goals and unecessary stress for Patient 1. Based on interview and record review, the home health agency did not provide the services as ordered by the doctor for one of three sampled patients (Patient 1). Patient 1 was to receive skilled nursing services until no longer needed and her goals had been met. This failure resulted in the potential for unmet healthcare goals and unnecessary stress for Patient 1. Findings: Record review on 8/10/2021 of the document "Admission Criteria and Process," (not dated) showed, "Once a patient is admitted to service, the organization will be responsible for providing care and services within its financial and service capabilities, mission, and applicable law and regulations." Record review on 8/10/2021 of the document "Plan of Care," showed Patient 1's Start of Care date was 8/31/2020 with the current certification period 8/31/2020 to 10/29/2020. Diagnoses included lung cancer. Skilled nursing interventions included assisting Patient 1 with draining fluids that accumulated around her lungs through a tube surgically placed into her chest. Licensed nursing staff were to "Asses/Perform/Instruct Patient/Caregiver: oxygen administration at 4-6 Liters per minute via nasal cannula continuously," and to "Assess: respiratory status-COPD exacerbation, pleural effusion." (C0PD: chronic obstructive pulmonary (lung) disease) (pleural effusion: a build up of fluid between the lungs and the chest) Doctor's orders included "Discharge when medical condition stable and patient no longer in need of skilled care." Frequencies for skilled nursing visits included "RN/LVN: 1 x week for 8 weeks starting 9/9/2020 (week 2) Start Date: 9/9/2020 End Date: 10/29/2020. In an interview on 3/26/2021 at 2:46 p.m., Patient 1 stated she had been told by staff without notice the agency wanted to discharge her because the pleurx bottles (bottles needed to collect the lung fluid) were too expensive. Patient 1 stated hearing this was a "Horrible" experience especially since she was so ill with cancer at that time. In a second interview at 11:58 a.m. on 8/11/2021, Patient 1 stated Registered Nurse 2 (RN 2) told her he had been pressured to discharge her by agency staff because she was "High maintenance." Record review of the document "OASIS Discharge," showed Patient 1 had been discharged on 8/10/2020. In an interview on 8/10/2021 at 12:20 p.m., the agency's administrator (ADM) stated that it was the agency's clinicians who decided when a patient was ready for discharge and it had been Registered Nurse 1 (RN 1) who decided Patient 1 had been ready for discharge. The ADM confirmed there was no documentation in the clinical record which showed Patient 1 had met her goals and was ready for discharge. There was no documentation in the record which showed the doctor had been consulted regarding Patient 1's medical status and ability to be discharged. There was no discharge order from the doctor. In an interview at 12:25 p.m. on 8/10/2021, Registered Nurse 2 (RN 2) stated he had been told by agency staff that Patient 1 needed to be discharged. RN 2 stated he did not feel Patient 1 was ready to be discharged since she required continued skilled nursing care such as managing the fluid drained from her lungs. RN 2 stated if Patient 1 were to discharged at that time, she needed to go directly into another home health agency. In an interview on 8/11/2021 at 11:58 a.m., Patient 1 stated the agency staff did not discharge her into the care of another home health agency and that the discharge was "Stressful."

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency did not provide sufficient notification for termination of nursing services for one of three sampled patients (Patient 1). Patient 1 was notified on 10/8/2020 that services would be discontinued that same day. This failure resulted in unnecessary stress for Patient 1. Findings: Record review on 8/10/2021 of the document "Plan of Care," showed Patient 1's Start of Care date was 8/31/2020 with the current certification period 8/31/2020 to 10/29/2020. Diagnoses included lung cancer. Skilled nursing interventions included assisting Patient 1 with draining fluids that accumulated around her lungs through a tube surgically placed into her chest. Licensed nursing staff were to "Asses/Perform/Instruct Patient/Caregiver: oxygen administration at 4-6 Liters per minute via nasal cannula continuously," and to "Assess: respiratory status-COPD exacerbation, pleural effusion." (C0PD: chronic obstructive pulmonary (lung) disease) (pleural effusion: a build up of fluid between the lungs and the chest) In an interview on 8/11/2021 at 11:58 a.m., Patient 1 stated Registered Nurse 2 (RN 2) visited her two times during her certification period. RN 2 had made a visit at the start of her care and returned a second time on 10/8/2020 to discharge her. Patient 1 stated she had not been notified of her discharge prior to that day and it had "Upset" her since she was so ill at the time. In an interview on 8/19/2021 at 11:14 a.m., the agency's Director of Nursing (DON) stated Patient 1 had not received written notification prior to her discharge. Record review of the document "OASIS Discharge," (discharge patient assessment) showed the discharge date was 10/8/2020. Record review of the document "Notice of Medicare Non-Coverage" showed "The effective date coverage of your current home health services will end 10/8/2020." Patient 1's signature at the bottom of the page was dated the same day, 10/8/2020.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency discharged a patient without just cause for one of three sampled patients (Patient 1). Patient 1 was discharged without staff consulting the physician or reviewing the status of her healthcare goals as outlined in the plan of care. This failure resulted in unnecessary stress for Patient 1 and the potential for unmet healthcare needs. Findings: Record review on 8/17/2021 of the agency's discharge policy (not titled or dated) showed "Patients will be transferred, referred or discharged for any of the following reasons: ...The treatment goals are attained or are no longer attainable." Record review on 8/10/2021 of the document "Plan of Care," showed Patient 1's Start of Care date was 8/31/2020 with the current certification period 8/31/2020 to 10/29/2020. Diagnoses included lung cancer. Skilled nursing interventions included assisting Patient 1 with draining fluids that accumulated around her lungs through a tube surgically placed into her chest. Licensed nursing staff were to "Asses/Perform/Instruct Patient/Caregiver: oxygen administration at 4-6 Liters per minute via nasal cannula continuously," and to "Assess: respiratory status-COPD exacerbation, pleural effusion." (C0PD: chronic obstructive pulmonary (lung) disease) (pleural effusion: a build up of fluid between the lungs and the chest) Record review on 8/16/2021 of the document "Hospitalist Discharge Summary," showed Patient 1 had been admitted to the hospital Emergency Department on 8/23/2020 and discharged from the hospital on 8/30/2020. The section "Brief Narrative of Hospital Course," showed Patient 1 had been admitted with acute (sudden) respiratory failure due to, "Exudative pleural effusion due to underlying lung carcinoma (Lung cancer) status post thoracenteseis (drainage of fluid from the lungs) with removal of 1300 cc of dark straw exudative fluid." Post procedure, Patient 1 was able to "breathe better" and her oxygen need decreased from 6 Liters to 1. Patient 1 was then admitted to the home health agency on 8/31/2020, 1 day post discharge from the hospital. Review of the document "Physician Orders" dated 8/31/2020, showed skilled nursing was to manage an intravenous (line to administer medications directly into the veins), disease management for COPD, shortness of breath and congestive heart failure. License staff were to manage the drainage from patient 1's lungs and to "Drain only 500ml or less 3x a week ..." Review of the documents "Skilled Nurse Visit Note" showed the following licensed skilled nursing visit notes: 9/2/2020: "amount of (lung) fluid drained today is 160 ml ..." Patient was on 2 Liters of oxygen 9/4/2020: " ...350 ml from chest draining done yesterday." Patient on 2 Liters of oxygen. 9/11/2020: showed Patient 1 had 400 ml drained on 9/8/2020. 9/18/2020: " ...On 2LPM continuous oxygen, chest pain 8/10" (pain scale: 1/10 being the lowest and 10/10 the highest) 9/25/2020: " ...chest pain 8/10 ...draining was last "Tuesday, amount of fluid collected was 350 ml ...." 10/2/2020: " ...chest pain 8/10." 10/8/2020: Patient 1 discharged There was no documentation in the clinical record which showed licensed staff discussed Patient 1's chest pain, fluid drainage or general progress towards her goals with the physician. There was no doctor's order for Patient 1's discharge. In an interview on 8/11/2021 at 11:58 a.m., Patient 1 stated, agency staff had told her without warning that she was being discharged which made her "Very upset." She stated she was in the middle of cancer treatment and had "Almost died," last August when she had copious amounts of fluid drained from her lungs at the hospital. In an interview at 12:15 p.m. on 8/10/2021, the agency's Intake Coordinator (IC) stated there was no discharge order from the doctor in the clinical record. In an interview on 8/10/2021 at 12:20 p.m., the agency's administrator (ADM) stated that it was the agency's clinicians who decided when a patient was ready for discharge and Registered Nurse 1 (RN 1) had decided Patient 1 had been ready. The ADM confirmed there was no documentation in the clinical record which showed Patient 1 had met her goals and was ready for discharge. There was no documentation in the record which showed the doctor had been consulted regarding Patient 1's medical status and ability to be discharged. There was no discharge order from the doctor. In an interview at 12:25 p.m. on 8/10/2021, Registered Nurse 2 (RN 2) stated he had been told by agency staff that Patient 1 needed to be discharged. RN 1 stated he did not feel Patient 1 was ready to be discharged since she continued to require skilled nursing services such as managing her lung drainage and oxygen levels. RN 1 stated following her discharge on 10/8/2020, Patient 1 should have been immediately readmitted to another home health agency so her nursing needs could have been met. In an interview at 8:42 a.m. on 8/11/2021, Patient 1's physician (MD 1) stated typically she would get information from the agency which showed they believed the patient had met their goals and could be discharged. MD 1 stated she had not received any documentation from the agency in regards to Patient 1's discharge. In an interview at 11:58 a.m., Patient 1 stated the agency staff did not discharge her into the care of another home health agency. Patient 1 stated the discharge was, "Stressful." In a second interview at 4:49 p.m. on 8/16/2021, Patient 1 stated she experienced a lot of "Emotional stress" when she had been dropped so suddenly by the home health agency since she was so ill with cancer at the time.