Every finding on record at Sunrise Home Health & Supplies of Bradenton

Complaint investigation 2022018279 was conducted from 1/30/23 to 1/31/23 at Sunrise Home Health & Supplies of Bradenton. Sunrise Home Health & Supplies of Bradenton was not in compliance with Code of Federal Regulations ( CFR) Part 484.22, Condition of Participation for Home Health Agencies. The Condition of Participation for Care Planning Coordination, and Quality of Care at CFR 484.60, G0570, was out of compliance.

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: Sunrise Home Health and Supplies of Bradenton was not in compliance with the Condition of Participation for Care planning, Coordination of Services and Quality of care. Based on patient record review; staff, patient, and provider interviews; and review of policies and procedures the home health agency failed to demonstrate that they could meet the patients' medical, nursing, rehabilitative, and social needs in his or her place of residence and failed to provide a basic operational oversight of the patients' care. The home health agency failed to provide the home health services written in the individualized plan of care for four of four patients reviewed ( # 1, # 2, # 3 and # 5). (Refer to G572) Failed to develop a Plan of Care which included the frequency and duration of visits to be made by the Home Health Aide (HHA) for 3 (Patient #1 ,Patient #3, Patient # 5) of 4 patients' records sampled.(Refer to G574), Failed to review and revise the plan of care for two of four patients reviewed ( Patient # 1, Patient # 2 and Failed to alert the physician of changes in the plan of care for three of four patients reviewed ( #Patient 1, Patient # 2, Patient # 3.) (Refer to G590)

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on patient record review, patient and family interview, staff interview patient record review, and policy review, it was determined the home health agency failed to provide the home health services written in the individualized plan of care for four of four patients reviewed ( # 1, # 2, # 3 and # 5). Findings Included: Review of the record for Patient # 2 revealed that she was admitted to home care services on 8/18/21 with diagnoses that included hypertensive heart disease with heart failure' unspecified fracture of upper end of right humerous, sequela; unspecified displaced fracture of surgical neck of right humerus,sequela; unspecified displaced fracture of surgical neck of right humerus,sequela; displaced fx of greater tuberosity of right humerous, sequela; type 2 diabetes mellitus without complications and history of falling Review of the Home Health Certification and Plan of Care for Patient # 2 revealed a start of care date of 8/18/21 with a certification period of 12/16/21 through 2/13/22 . Orders for discipline and treatment included Skilled Nurse frequency 1x a week for one week , 2 times a week for 8 weeks;; and Home Health Aide frequency 1 time a week for 8 weeks effective 9/13/21. The plan of care stated " home health aide to provide assistance with personal care and ADLS as indicated by limitations on functional and physicals status Review of the Home Health Certification and Plan of Care for Patient 2 for certification period 2/14/22 through 4/14/22 revealed Skilled Nurse frequency of two times a week for 9 weeks , a Physical Therapy frequency of " re evaluate and treat" and a Home Health Aide frequency of 1 time a week for nine weeks. Review of the home health visit documentation in the electronic patient record revealed that home health aide visits were not completed on 12/21/21, 1/4/22 , 1/11/22 and 3/4/22. The documentation revealed that the home health aide visits for 12/21/21 1/4/22 and 1/11/22 were scheduled for Staff B, a home health aide. An interview was conducted with the Administrator/ Director of Nursing on 1/30/23 at 2: 00 p.m. She stated regarding the lack of home health aide visits, "We had one quit on us and we didn’t know about it, we got complaints from patients that she hadn’t been to see them in a while, that’s when we found out she quit. It was during the time we had Patient # 2 as a patient. An interview was conducted with the Administrator and Director of Nursing, on 1/3123 at 12: 46 p.m. she stated Staff B only worked a week and she forgot to take her off the visit scheduled for Patient # 2. She stated the home health visit for 3/4/22 was scheduled to be done by an LPN and she confirmed there was no documentation that the visit was completed. There was no documentation found in the patient record of the reason for the missed visits and no documentation that the physician was notified of the missed visits. Review of the record for Patient # 5 revealed he was admitted to the home health agency on 1/6/23 and an Oasis Transfer to hospital as completed on 1/17/23. Record review revealed that A Face to Face encounter was completed by the physician on 1/5/23 which indicated that Patient $ 5 required the following medically necessary services : Skilled Nursing, Physical Therapy, Occupational Therapy and Home Health Aide. Record review indicated that the patient resumed care with the agency effective 1 /23/23 per physician's telephone order " Okay to resume care status post hospital stay. Patient still needs SN ( Skilled Nursing), PT ( Physical Therapy), OT ( Occupational Therapy) and HHA ( Home Health Aide). Review of Patient # 5's electronic record revealed that the Oasis Start of Care, conducted on 1/9/23 by a Registered Nurse , had not been completed with signature and submitted as of the end date of the survey on 1/31/23. An Oasis Resumption of Care had not been completed with signature and submitted by the Registered Nurse as of the end date of the survey, 1/31/23 . There was a Physical Therapy Plan of Care with Full Evaluation completed 1/10/23 and an Occupational Therapy Plan Of Care completed 1/14/23. There was no Home Health Certification and Plan of Care for Patient # 5 that included Skilled Nursing or Home Health Aide Services for the start of care of 1/6/23 or the resumption of care of 1/23/23. Review of the electronic record for Patient # 5 revealed that he received home health aide visits on 1/11/23 and 1/13/23 with no plan of care for home health aide services , There were no skilled nursing visits documented Patient #1 On 1/30/23 at 1:00pm there was no answer at Patient #1’s home phone. A voice mail was left on the answering machine. At 3:10 pm the patient’s wife called back. She said the patient had been receiving HHA services as well as PT and OT. She handed the phone to a woman she said was a friend of the family. This friend said “they were supposed to continue to get a HHA, but she did not show. They were told they had no orders. They never got a discharge visit from a nurse.” The friend did not give specific dates. On 1/31/23 at 12:45pm Telephone Interview was conducted with the nurse at the doctor’s office. When asked if the doctor was notified of missed visits in December and HHA being discontinued; the nurse answered while looking the record. She said that they did not have any notifications of any kind with Sunrise Home Health in December 2022 or January 2023 regarding Patient #1. They did have the Patient down on their record as a patient and currently being seen by Sunrise Home Health. Patient #3 A Record review for Patient #3 indicated SOC (Start of Care) 1/12/23. Further review of the Medical record revealed a Home Health Certification and Plan of Care (2567) for the certification period 1/12/23-3/12/23. Signed by the physician 1/17/23. There was a note under Nursing stating “Home Health Aide to provide assistance with personal care and ADLs as indicated by limitations on physical and status impeding self-care.” There were no frequencies noted on the 2567 for HHA (Home Health Aide). There was a Home Health Aide Care Plan signed by the DON on 1/12/23 with a frequency of 1w3 (1time a week times 3 weeks) Further review revealed a fax cover sheet to the physician, dated 1/30/23, with 2 Physician Order sheets both electronically signed by the DON the day of the survey 1/30/23. They were not signed by the physician. The first stated “Frequency change: HHA: 1w3 Effective from 01/12/2023 Late Order; HHA 1w3” The second Physician order sheet stated, “Change in frequency for HHA effective week of 1/30/23 2w6.” Attached to these 2 change order sheets was a fax cover sheet to the physician dated 1/30/23 Stating “Please sign and fax back ASAP – (fax number)” Review of the Master Calendar for SOC 01/12/2023 for Episode 01/12/2023-03/12/2023 revealed 1 HHA visit (1/13) for week 1; 1 visit (1/17) for week 2: 2 visits (1/24 & 27) for week 3; 2 visits scheduled for week 4, week 5 and week 6. The calendar had typed frequencies for SN, PT, OT and ST. There were no frequencies. for the HHA. Handwritten in the Sunday column was 1x3 on week 1 and 2x6 on week 4. The same HHA was scheduled for all the HHA visits per the Master Calendar. The record revealed a HHA Care Plan signed by the DON dated 1/12/23 which indicated only a frequency/duration of 1w3.

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 interview and record review the facility failed to develop a Plan of Care which included the frequency and duration of visits to be made by the Home Health Aide (HHA) for 3 (Patient #1 ,Patient #3, Patient # 5) of 4 patients' records sampled. Review of the record for Patient # 5 revealed he was admitted to the home health agency on 1/6/23 and an Oasis Transfer to hospital as completed on 1/17/23. Record review revealed that A Face to Face encounter was completed by the physician on 1/5/23 which indicated that Patient $ 5 required the following medically necessary services : Skilled Nursing, Physical Therapy, Occupational Therapy and Home Health Aide. Record review indicated that the patient resumed care with the agency effective 1 /23/23 per physician's telephone order " Okay to resume care status post hospital stay. Patient still needs SN ( Skilled Nursing), PT ( Physical Therapy), OT ( Occupational Therapy) and HHA ( Home Health Aide). Review of Patient # 5's electronic record revealed that the Oasis Start of Care, conducted on 1/9/23 by a Registered Nurse , had not been completed with signature and submitted as of the end date of the survey on 1/31/23. An Oasis Resumption of Care had not been completed with signature and submitted by the Registered Nurse as of the end date of the survey, 1/31/23 . There was a Physical Therapy Plan of Care with Full Evaluation completed 1/10/23 and an Occupational Therapy Plan Of Care completed 1/14/23. There was no Home Health Certification and Plan of Care for Patient # 5 that included r Home Health Aide Services for the start of care of 1/6/23 or the resumption of care of 1/23/23. Review of the electronic record for Patient # 5 revealed that he received home health aide visits on 1/11/23 and 1/13/23 with no plan of care for home health aide services , There were no skilled nursing visits documented Patient #1 Per record review conducted on 1/31/23 for Patient #1 the Home Health Certification and Plan of Care for SOC 7/23/2022 Certification Period: 11/20/2022-01/18/2022 revealed: Under the section Orders for Discipline and Treatment was a Frequency for the Physical Therapist (PT) which indicated 3w3, 2w,3 1w1 effective 11/20/22. There were no frequencies, orders, or goals for the Occupational Therapy/Certified Occupational therapy Assistant (OT/COTA) or the Home Health Aide (HHA). The physician signature and Signature date sections were blank. The Master Calendar, which showed the scheduled personnel, for the Episode 11/20/2022-12/28/2022; Recert (recertification) date 11/19/2022, showed only a PT frequency. There were no listed frequencies for OT/COTA or HHA. The calendar revealed visits for the stated PT frequency for the PTA but there were also visits noted on the calendar for the COTA of 3w2 (11/22, 11/23, 11/25, 11/29, 12/01, 12/02); 2w3 (12/06, 12/08, 12/13, 12/15, 12/20, 12/22) and for the HHA of 2w2 (11/22, 11/25, 11/29 and 12/2). There was a Physician Order sheet, dated 12/15/22, which stated, “3 missed visits 12/8/22; 12/13/22: 12/15/22 patient has private care, no longer needs HHA as of 12/3/22.” This was Electronically signed by the Director of Nursing (DON) and dated 12/15/2022. There was no physician signature. Patient #3 Review of the Medical record for Patient #3 revealed a Home Health Certification and Plan of Care (2567) for the certification period 1/12/23-3/12/23. Signed by the physician 1/17/23. There was a note under Nursing which stated “Home Health Aide to provide assistance with personal care and ADLs as indicated by limitations on physical and status impeding self-care.” There were no frequencies noted on the 2567 for the HHA (Home Health Aide). There was a Home Health Aide Care Plan signed by the DON on 1/12/23 with a frequency of 1w3 (1time a week times 3 weeks). The Master Calendar, which shows the personnel scheduled visits for the patient, did not have any frequencies listed in the Frequencies section. But did show the HHA as being scheduled for 01/13, 01/17, 01/24, o1/27, 01/31, 02/03, 02/07,02/10 02/14 and 02/17. Further review revealed a fax cover sheet to the physician, dated 1/30/23, with 2 Physician Order sheets both electronically signed by the DON the day of the survey 1/30/23. They were not signed by the physician. The first stated “Frequency change: HHA: 1w3 Effective from 01/12/2023 Late Order; HHA 1w3” The second Physician order sheet stated, “Change in frequency for HHA effective week of 1/30/23 2w6.” In a telephone interview, on 1/30/23 at 12:40 pm, the patient's daughter-in-law answered and the Patient’s son was also there. They both said that Patient #3 was unable to talk on the phone but was there. The patient said the PT was visiting at this time and was in the room. They stated they were satisfied with the service and were supposed to get HHA 2Xweek and PT 3Xweek. "The HHA came last Friday the 27th and was very good."

Review and revision of the plan of care CFR(s): 484.60(c) Standard: Review and revision of the plan of care. This STANDARD is not met as evidenced by: Based on patient record review, staff interview and review of facility policy and procedure, it was determined the home health agency failed to review and revise the plan of care for two of four patients reviewed (Patients # 1, #2). Review of the record for Patient # 2 revealed that she was admitted to home care services on 8/18/21 with diagnoses that included hypertensive heart disease with heart failure' unspecified fracture of upper end of right humerous, sequela; unspecified displaced fracture of surgical neck of right humerus,sequela; unspecified displaced fracture of surgical neck of right humerus,sequela; displaced fx of greater tuberosity of right humerous, sequela; type 2 diabetes mellitus without complications and history of falling Review of the Home Health Certification and Plan of Care for Patient # 2 revealed a start of care date of 8/18/21 with a certification period of 12/16/21 through 2/13/22 . Orders for discipline and treatment included Home Health Aide frequency 1 time a week for 8 weeks effective 9/13/21. The plan of care stated " home health aide to provide assistance with personal care and ADLS as indicated by limitations on functional and physicals status Review of the Home Health Certification and Plan of Care for Patient 2 for certification period 2/14/22 through 4/14/22 revealed Skilled Nurse frequency of two times a week for 9 weeks , a Physical Therapy frequency of " re evaluate and treat" and a Home Health Aide frequency of 1 time a week for nine weeks. Review of the home health visit documentation in the electronic patient record revealed that home health aide visits were not completed on 12/21/21, 1/4/22 , 1/11/22 and 3/4/22. The documentation revealed that the home health aide visits for 12/21/21 1/4/22 and 1/11/22 were scheduled for Staff B, a home health aide. An interview was conducted with the Administrator/ Director of Nursing on 1/30/23 at 2: 00 p.m. She stated regarding the lack of home health aide visits, "We had one quit on us and we didn’t know about it, we got complaints from patients that she hadn’t been to see them in a while, that’s when we found out she quit. It was during the time we had Patient # 2 as a patient. An interview was conducted with the Administrator and Director of Nursing, on 1/3123 at 12: 46 p.m. she stated Staff B only worked a week and she forgot to take her off the visit scheduled for Patient # 2. She stated the home health visit for 3/4/22 was scheduled to be done by an LPN and she confirmed there was no documentation that the visit was completed. There was no documentation found in the patient record of the reason for the missed visits , no documentation that the physician was notified of the missed visits and no documentation that the plan of care was revised to reflect that home health aide visits could not be completed. Review of a policy entitled Care Delivery and Treatment Conformance with Physician Orders, (implemented 1/2009 and revised 1/13/2009) revealed : Purpose : to accept document and follow orders in compliance with CMS Home Health, Florida applicable laws and regulations, and CHAP standards. Policy : Agency staff must follow the physician's treatment orders that contained in the plan of care. If the orders cannot be followed and must be altered in some way, the patient's physician must be notified and must approve of the change. If the agency staff provides fewer visits that the physician has ordered, it has altered the plan of care and the physician must be notified. The agency will maintain documentation in the clinical record indicating the reason for the missed visit and that the physician was notified of the visit. Orders, including verbal orders , are accepted, signed , and dated by authorized personnel. Verbal orders must be authenticated and dated by the physician in accordance with CHAP standard which is as soon as possible but no later than 30 days of issuing the order, . Any revision to the plan of care ( verbal orders) due to a change in patient health status must be communicated to the patient, representative ( if any), caregiver, and all physicians issuing order for the HHA plan of care. Procedure : The plan of care consists of the initial orders ( aka 485) and subsequent documented verbal orders. The admitting nurse or therapist , the clinical manager, as applicable, is responsible for case management and supervising that care is provided in accordance with the Plan of Care. Compliance is verified through clinical records review, visits in the patient's home or by telephone calls to the patient/ care giver. Clinical notes must evidence that care, services, treatments and interventions are delivered and documented in details as ordered by the physician following the frequency and duration ordered by the discipline. Scheduling of continuing visits begins within 1 business day after acceptance / admission of the patient and is updated when applicable frequency/duration orders are received. Missed Visits ( Alterations in the plan of care) Staff must report and missed visit to the office on the day of its occurrence if it cannot be rescheduled within the week of if the reason relates to a change in the patient's physical condition. Unless the patient condition warrants otherwise, the visit must be rescheduled appropriately before the end of the week. Notify immediately the clinical manager and the physician(s) of any change in patien'ts condition, or patient refusal that generated a missed visit that could not be rescheduled. Missed visits that cannot be rescheduled are documented with the underlying reason and the physician is notified on that day if possible. Show Original Findings Findings included: Record review for Patient #1 revealed the Home Health Certification and Plan of Care for the Certification Period: 11/20/2022-01/18/2022. Under the section Orders for Discipline and Treatment was a Frequency for the Physical Therapist (PT) which indicated 3w3, 2w,3 1w1 effective 11/20/22. There were no frequencies, orders, or goals for the Occupational Therapy/Certified Occupational therapy Assistant (OT/COTA) or the Home Health Aide (HHA). The physician signature and Signature date sections were blank. The Master Calendar, which showed the scheduled personnel, for the Episode 11/20/2022-12/28/2022; Recertification date 11/19/2022, showed only a PT frequency of 3w2,2w3,1w1. There were no listed frequencies for OT/COTA or HHA. The calendar revealed visits for the stated frequency for the PTA but there were also visits noted on the calendar for the COTA of 3w2 (11/22, 11/23, 11/25, 11/29, 12/01, 12/02); 2w3 (12/06, 12/08, 12/13, 12/15, 12/20, 12/22) and for the HHA of 2w2 (11/22, 11/25, 11/29 and 12/2). A PT D/C .Oasis visit was scheduled for 12/28. The PT Oasis was available, electronically signed and dated by the PT on 12/28/2022. The Home Health Discharge summary, Signed by the PT on 01/01/23 at 8:06 PM, mentioned PT, SN, HHA and OT With Goals met for PT but unmet for Nursing and OT. There was no documentation of Nursing (SN, HHA) or OT discharge summaries. or notification to the physician. There was a Physician Order sheet dated 12/15/22 which stated “3 missed visits 12/8/22; 12/13/22: 12/15/22 patient has private care, no longer needs HHA as of 12/3/22.” This was Electronically signed by the Director of Nursing (DON) and dated 12/15/2022. There was no physician signature.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on patient record review, patient, staff and medical provider interview and review of policy and procedure, it was determined the home health agency failed to alert the physician of changes in the plan of care for three of four patients reviewed (Patients #1, #2, #3). Findings included: Review of the record for Patient # 2 revealed that she was admitted to home care services on 8/18/21 with diagnoses that included hypertensive heart disease with heart failure' unspecified fracture of upper end of right humerous, sequela; unspecified displaced fracture of surgical neck of right humerus,sequela; unspecified displaced fracture of surgical neck of right humerus,sequela; displaced fx of greater tuberosity of right humerous, sequela; type 2 diabetes mellitus without complications and history of falling Review of the Home Health Certification and Plan of Care for Patient # 2 revealed a start of care date of 8/18/21 with a certification period of 12/16/21 through 2/13/22 . Orders for discipline and treatment included Home Health Aide frequency 1 time a week for 8 weeks effective 9/13/21. The plan of care stated " home health aide to provide assistance with personal care and ADLS as indicated by limitations on functional and physicals status Review of the Home Health Certification and Plan of Care for Patient 2 for certification period 2/14/22 through 4/14/22 revealed Skilled Nurse frequency of two times a week for 9 weeks , a Physical Therapy frequency of " re evaluate and treat" and a Home Health Aide frequency of 1 time a week for nine weeks. Review of the home health visit documentation in the electronic patient record revealed that home health aide visits were not completed on 12/21/21, 1/4/22 , 1/11/22 and 3/4/22. The documentation revealed that the home health aide visits for 12/21/21 1/4/22 and 1/11/22 were scheduled for Staff B, a home health aide. An interview was conducted with the Administrator/ Director of Nursing on 1/30/23 at 2: 00 p.m. She stated regarding the lack of home health aide visits, "We had one quit on us and we didn’t know about it, we got complaints from patients that she hadn’t been to see them in a while, that’s when we found out she quit. It was during the time we had Patient # 2 as a patient. An interview was conducted with the Administrator and Director of Nursing, on 1/3123 at 12: 46 p.m. she stated Staff B only worked a week and she forgot to take her off the visit scheduled for Patient # 2. She stated the home health visit for 3/4/22 was scheduled to be done by an LPN and she confirmed there was no documentation that the visit was completed. There was no documentation found in the patient record of the reason for the missed visits and no documentation that the physician was notified of the missed visits Findings included: Record review for Patient #1 revealed the Home Health Certification and Plan of Care for the Certification Period: 11/20/2022-01/18/2022. Under the section Orders for Discipline and Treatment was a Frequency for the Physical Therapist (PT) which indicated 3w3, 2w,3 1w1 effective 11/20/22. There were no frequencies, orders, or goals for the Occupational Therapy/Certified Occupational therapy Assistant (OT/COTA) or the Home Health Aide (HHA). The physician signature and Signature date sections were blank. The Master Calendar, which showed the scheduled personnel, for the Episode 11/20/2022-12/28/2022; Recertification date 11/19/2022, showed only a PT frequency of 3w2,2w3,1w1. There were no listed frequencies for OT/COTA or HHA. The calendar revealed visits for the stated frequency for the PTA but there were also visits noted on the calendar for the COTA of 3w2 (11/22, 11/23, 11/25, 11/29, 12/01, 12/02); 2w3 (12/06, 12/08, 12/13, 12/15, 12/20, 12/22) and for the HHA of 2w2 (11/22, 11/25, 11/29 and 12/2). A PT D/C .Oasis visit was scheduled for 12/28. The PT Oasis was available, electronically signed and dated by the PT on 12/28/2022. The Home Health Discharge summary, Signed by the PT on 01/01/23 at 8:06 PM, mentioned PT, SN, HHA and OT With Goals met for PT but unmet for Nursing and OT. There was no documentation of Nursing (SN, HHA) or OT discharge summaries. or notification to the physician. There was a Physician Order sheet dated 12/15/22 which stated “3 missed visits 12/8/22; 12/13/22: 12/15/22 patient has private care, no longer needs HHA as of 12/3/22.” This was Electronically signed by the Director of Nursing (DON) and dated 12/15/2022. There was no physician signature. On 1/31/23 at 12:45pm Telephone Interview was conducted with the nurse at Doctor’s office of record for Patient #1. When asked if the doctor was notified of missed visits in December and HHA being discontinued; she answered, looking in the record, that they did not have any notifications of any kind with Sunrise Home Health in December 2022 or January 2023. They did have Patient #1 down on their record as a patient and currently being seen by Sunrise Home Health. Review of Patient #3's Medical record revealed a Home Health Certification and Plan of Care (2567) for the certification period 1/12/23-3/12/23. Signed by the physician 1/17/23. There was a note under Nursing stating “Home Health Aide to provide assistance with personal care and ADLs as indicated by limitations on physical and status impeding self-care.” There were no frequencies noted on the 2567 for HHA (Home Health Aide). There was a Home Health Aide Care Plan signed by the DON on 1/12/23 with a frequency of 1w3 (1time a week times 3 weeks) Further review revealed a fax cover sheet to the physician, dated 1/30/23, with 2 Physician Order sheets both electronically signed by the DON the day of the survey 1/30/23. They were not signed by the physician. The first stated “Frequency change: HHA: 1w3 Effective from 01/12/2023 Late Order; HHA 1w3” The second Physician order sheet stated, “Change in frequency for HHA effective week of 1/30/23 2w6.” Attached to these 2 change order sheets was a fax cover sheet to the physician dated 1/30/23 Stating “Please sign and fax back ASAP – (fax number)” Review of the Master Calendar for SOC 01/12/2023 for Episode 01/12/2023-03/12/2023 revealed 1 HHA visit (1/13) for week 1; 1 visit (1/17) for week 2: 2 visits (1/24 & 27) for week 3; 2 visits scheduled for week 4, week 5 and week 6. The calendar had typed frequencies for SN, PT, OT and ST. There were no frequencies. for the HHA. Handwritten in the Sunday column was 1x3 on week 1 and 2x6 on week 4. The same HHA was scheduled for all the HHA visits per the Master Calendar. The record revealed a HHA Care Plan signed by the DON dated 1/12/23 which indicated a frequency/duration of 1w3.

Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide's performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This STANDARD is not met as evidenced by: Based on personnel record review and interview with the Administrator/ Director of Nursing, it was determined that two of two staff (Staff A , Staff B) who were hired by the agency as home health aides did not have the required competency evaluation prior to providing home aide aide services to clients Findings Included: Review of the personnel record for Staff A, a home health aide hired 11/1/22, revealed that no competency evaluation was on file. An interview was conducted with the Administrator/ Director of Nursing, on 1/31/23 at 12:46 p.m. She stated there was no competency evaluation for Staff A as she, ( Administrator/DON) did not do one. On 1/31/22 at 1: 24 p.m. ., the owner of the home health agency stated the Administrator/DON had not done a competency evaluation on Staff A yet. Review of the record for Patient # 1 revealed that Staff A provided home health aide services to this patient on four occasions in November and December 2022 : 11/22/22, 11/25/22, 11/29/22 and 12/2/22. Review of the record for for Patient # 3 revealed that Staff A provided home health aide services on 5 occasions in January 2023: 1/13/23, 1/17/23 , 1/24/23, 1/27/23 and 1/31/23. Review of a list of personnel, provided by the Administrator/ Director of Nursing, on 1/30/23, revealed an entry for Staff B as a Home Health Aide/Nurse Aide with a hire date of 727/21. Review of the list of personnel revealed " Status Active" revealed 82 employees and contractors listed with 22 names highlighted. An interview with the Administrator/Director of Nursing, on 1/31/23 at 12: 46 p.m. revealed "Highlighted names are the ones working, the rest are not working and need to be removed." She stated Staff B only worked a week and she forgot to take her off the visit schedule for Patient # 2 and take her off the personnel List. She stated she has no personnel record for Staff B which would include a competency evaluation. Review of the electronic patient chart documentation for Patient # 2 revealed that Staff B provided signed and completed home health aide services documents for Patient # 2 on 9/7/21 and 10/29/21. Review of a policy, entitled Human Resource Management Competency Evaluation of Staff. 1/2009, revision 1/13/2018, revealed : Purpose : To ensure that standards of care are followed by skilled personnel and that home health aides furnish care in a safe and effective manager. Policy : Personnel providing patient care or services must demonstrate competency in the performance of their assigned duties. Competency assessments are documented with date, name of personnel, topic, method of competency validation, and record of satisfactory performance. The home health aide competency evaluation is performed through direct observation or examination (written or oral) by a registered nurse or by individuals under the supervision of the registered nurse, prior to the independent assumption of duties or, when there is a complaint about the care, and annually as part of a supervisory visit. . A Home Health Aide may provide services on behalf of the agency only after that individual has successfully completed a competency evaluation performed by a Registered Nurse of all tasks that the Home Health Adie & CNA is expected to perform as described in this policy.