Every finding on record at Senior Home Care, Inc.

During the recertification survey from 3/14/22 to 3/17/22, the home health agencies emergency preparedness plan was reviewed. Kindred at Home was in compliance with 42 CFR 484, requirements for home health agencies.

A recertification survey was conducted from 3/14/22 to 3/17/22 Kindred at Home was not in compliance with 42 CFR 484, requirements for home health agencies.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on interview and record review, the home health agency (HHA) failed to provide evidence that showed an initial assessment visit to determine the immediate care and support needs of the patient was conducted within 48 hours of the referral for 2 of 17 sampled patients (#5 and #16). 2. Patient #16 was admitted to the agency on 11/10/21 with diagnoses that included stage 2 pressure ulcer of sacral region, type 2 diabetes, glaucoma and history of falling. Review of patient’s #16 medical record revealed the HHA received a referral order from the physician on 11/5/21 that read, “Eval and Treat Unsteady gait wheelchair dependant and wound care.” Review of the “Client Coordination Note Report” did not reveal any communication with the physician regarding the delay in care from 11/5/21 to 11/10/21. On 3/15/22 at 2:45 PM, the Executive Branch Director (EBD) explained when a referral came to the office, it was reviewed by the clinical manager (CM) to ensure it was valid. The EBD indicated the CM verified there was an appropriate physician's order for homecare services, then the scheduler added a visit and assign to a clinician to perform within 24-48 hours. The EBD stated the scheduler also made a welcome call. The EBD noted the clinician received the visit in their tablet and was responsible for calling the patient to set up the day and time of the initial visit. The EBD conveyed in the event a visit could not be made by the agency staff, the CM called the physician and explained why the SOC was not done. The EBD reported most times a delayed SOC was due to the patient requesting the visit for a later day. The EBD indicated the call to the physician was documented in a “Client Notes Report” in the patient’s medical record and the note included an approval for a new SOC date was obtained by the MD. The EBD confirmed notification to the physician regarding the delay in care was not documented for patient #16. The EBD indicated since it was not documented, it was not done, and she confirmed a new order was not obtained with a new start of care (SOC). Review of the agency policy and procedure titled, “Initial and Comprehensive Assessments” revised on 01/2022 read, “The office will conduct an initial assessment visit to the patient: Within 48 hours of the referral for services; or within 48 hours of the patient’s discharge from the hospital; or on the date the PCP specifies care is to start.” The policy further read, “If the office receives a referral and cannot make the first visit within 48 hours of the referral or patient discharge from a hospital, the office will contact the Provider with knowledge of the patent’s current condition (PCP or referring entity) for direction and to obtain a specific start of care date or refer the patient to another provider for services.” 1. Review of "Kindred at Home health Referral "form reflected patient #5's referral was received by the home health agency on 12/212021. Patient #5's referral included orders for Skilled Nursing for disease management and teaching. Physical Therapy for home exercise program (HEP) and strengthening. Occupational therapy for activities of daily living (ADL) supervision. Patient #5" s Plan of Care noted the Start of Care date of 12/25/2021. The Start of Care date is the initial visit to the patient's home. The Registered Nurse (RN) Outcome Assessment Information Set (OASIS) Admission dated 12/25/2021 reflected the focus of care was "Congested Heart Failure exacerbation post-care." Additional diagnoses included chronic pain, fall history, unspecified atrial fibrillation, acute and chronic respiratory failure with hypoxia, anxiety, and depression. This assessment also showed that patient #5 was at risk for rehospitalization. On 3/17/22 at 1:10 PM, the Administrator stated that an RN did not visit patient #5 within 48 hours per the company's policy. She said she was unsure why an RN did not complete the admission timely.