Every finding on record at Solstice Home Health, LLC

An abbreviated survey was conducted from 1/17/2023 through 1/24/2023 in the area of nursing services. The complaint was substantiated and deficiencies were cited.

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, it was determined the home health agency (HHA) failed to provide evidence that they were in compliance with the condition of participation for Patient Rights. Findings include: The HHA failed to ensure that patients received all services outlined in their plan of care. (Refer to G-436)

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, it was determined the home health agency (HHA) did not ensure that patients received all services outlined in their plan of care (POC). Specifically, a patient did not receive aide visits visits as outlined in their POC's for 1 of 6 sampled patients. (Resident identifier: 5) Findings include: Patient 5 was admitted to the agency on 11/18/2022 with diagnoses which included arrhythmia, depression, chronic kidney disease and diabetes. A review of patient 5's medical record was completed on 1/24/2023. A review of the Outcome and Assessment Information Set (OASIS) completed by registered nurse (RN) 1 on 11/18/2022, patient 5 was alert and oriented to person. place and time but was forgetful. Patient 5 was assessed as needing assisting of one person in grooming, dressing (upper and lower body), bathing, toileting, and transfers. Patient 5 was wheelchair bound. Patient 5's POC, for the certification period of 11/18/2022 through 1/16/2023, had orders for a home health aide three times a week beginning 11/21/2022. No aide visits were completed 11/21/2022 to 11/30/2022. The administrator (ADM) documented the following on a Missed Visit Form dated 11/21/2022, "Our aide, [name redacted] called and stated she tested positive for Covid this morning. I instructed her to take care of herself and we would reassign her visits until she is no longer showing symptoms and tests negative. I called [the name of the assisted living facility) and let them know they would need to have their staff provide personal cares this week since our team member is out with Covid and they expressed understanding." On 11/23/2022, the administer again documented, "Facility providing care this week d/t aide having Covid." On 11/28/2022, the ADM documented, called to report the [the name of the assisting living facility]: Our aide is still showing significant symptoms so will not be seeing pts again this week. I offered to send another aide and the nurse stated they can continue to provide the personal cares there at the facility." A telephone interview was conducted with the director of nursing (DON) on 1/23/2023 at 11:39 PM. The DON stated that she was told by the director of operations for the agency that "...we didn't have staff to do that (home health aide) visits and that the assisted living facility would have to do them." The DON further stated that another staff member was not assigned to complete the aide visits. A telephone interview was conducted with the assisted living coordinator (ALC) on 1/23/2023 at 12:12 PM. The ALC stated that patient 5's home health agency was providing showers for patient 5 three times a week. The ALC stated, "We don't do showers." The ALC was unbale to provide evidence that patient 5 had showers completed by either the home health aide or a staff member at the assisted living facility.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on interview and record review, it was determined the home health agency (HHA) failed to provide care planning, coordination of services, and quality of care as required. Findings include: The HHA failed to ensure that each paint's plan of care was updated as indicated. (Refer to Tag G592)

Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient's updated comprehensive assessment, and contain information concerning the patient's progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and medical record review, it was determined the agency did not coordinate care delivery to meet the patient's need. Specifically for 1 of 6 sampled patients, the agency did not coordinate care between caregivers after a patient developed a pressure sore. Further more the patient's plan of care (POC) was not updated to include the development of skin breakdown. (Patient identifier: 5). Findings include: Patient 5 was admitted to the agency on 11/18/2022 with diagnoses which included arrhythmia, depression, chronic kidney disease and diabetes. A review of patient 5's medical record was completed on 1/24/2023. A review of the Outcome and Assessment Information Set (OASIS) assessment, completed by registered nurse (RN) 1 on 11/18/2022, that patient 5 was alert and oriented to person. place and time but was forgetful. RN 1 documented a Braden Scale (used to predict pressure sore risk) of 17. A score of 17 meant the patient was as at risk for skin breakdown. It was documented that patient 5 had a diabetic ulcer to the right heel. Patient 5 did not have skin breakdown on the coccyx documented. Patient 5 was assessed as having a urinary catheter and was continent of bowel. Patient 5 was further assessed as needing assisting of one person in grooming, dressing (upper and lower body), bathing, toileting, and transfers. Patient 5 was wheelchair bound. Patient 5's plan POC for the certification period of 11/18/2022 through 1/16/2023, had no orders for treatment for a pressure sore on the coccyx or right buttock areas. RN 1 documented patient 5's skin was assessed for skin breakdown on bony prominences on 11/28/2022. There was no documented evidence that patient 5 had any skin breakdown on the buttocks or coccyx areas. On 11/29/2023, physical therapist (PT) 1 documented, "Pt (patient) denies pain on this visit but reports some soreness at R (right) buttocks/Upper thigh area..." PT 1 further documented, "...During standing transfer, PT noted skin impairment at R buttock/upper thigh area; notified RN of this finding and trained/educated pt on off loading techniques and W/C (wheelchair) cushion on positioning to reduce pressure in this area PT further discussed appropriate positioning of catheter tube and pt and facility staff to ensure proper drainage." PT 1 documented care coordination with RN 1 related to skin impairment and the catheter tubing positioning. There was no documentation that patient 5's skin breakdown was assessed by a registered nurse on 11/29/2022 or 11/30/2022. Furthermore there was no documentation that patient 5's physician was notified of the skin breakdown. A telephone interview was conducted with PT 1 on 1/23/2023 at 11:13 AM. PT 1 stated that on 11/29/2022, he noticed patient 5's catheter tubing was coming out of the waistband of her pants instead of being placed down the leg. PT 1 further stated that in the process of getting the catheter in the proper place, he saw a stage 2 pressure ulcer about the size of a quarter in width. PT 1 stated that he placed a call to RN 1 after his visit was complete. A telephone interview was conducted with RN 1 on 1/23/2023 at 11:24 AM. RN 1 stated that he was notified of the pressure sore on 11/29/2022 by PT 1. RN 1 stated that he was scheduled to see other patients on 11/29/2022 and 11/30/2022, so he did not assess patient 5's pressure ulcer. RN 1 stated that he was scheduled to visit patient 5 on 12/1/2022 so he planned to assess the pressure ulcer then. RN 1 stated that he did not notify another agency RN, the director of nursing (DON) or the ADM that patient 5 had a pressure ulcer and that he would be unable to assess until 12/1/2022. RN 1 stated he did not notify patient 5's physician of the skin breakdown. A telephone interview was conducted with the DON on 1/23/2023 at 11:39 PM. The DON stated that she had not been notified that patient 5 had skin breakdown. The DON stated that RN 1 should have notified her or the on-call nurse that patient 5 had skin breakdown and needed to be assessed since he was not able to visit the patient until 12/1/2022.