Every finding on record at Tender Home Care Providers, LLC

EMERGENCY PREPAREDNESS SURVEY The following deficiency is based on the emergency preparedness survey completed on 09/16/21.

Establishment of the Emergency Program (EP) CFR(s): 484.102 The [facility, except for Transplant Programs] must comply with all applicable Federal, State and local emergency preparedness requirements. The [facility] must establish and maintain a [comprehensive] emergency preparedness program that meets the requirements of this section.* The emergency preparedness program must include, but not be limited to, the following elements: *[For hospitals at §482.15:] The hospital must comply with all applicable Federal, State, and local emergency preparedness requirements. The hospital must develop and maintain a comprehensive emergency preparedness program that meets the requirements of this section, utilizing an all-hazards approach. The emergency preparedness program must include, but not be limited to, the following elements: *[For CAHs at §485.625:] The CAH must comply with all applicable Federal, State, and local emergency preparedness requirements. The CAH must develop and maintain a comprehensive emergency preparedness program, utilizing an all-hazards approach. The emergency preparedness program must include, but not be limited to, the following elements: This CONDITION is not met as evidenced by: Based on document review and staff interview, the agency failed to develop and maintain the comprehensive emergency preparedness program per the requirements of 42 CFR Part 484.102 Conditions of Participation for Home Health Agencies. This has the potential to affect all 31 patients. Findings include: Documentation review revealed the agency failed to document a completed agency-based and community-based all hazards risk assessment, to develop an emergency plan and policies based on the all hazards risk assessments, to develop a communication plan, to develop an emergency preparedness training and testing program, to educate all staff on the plan and policies, and to conduct exercises to test the emergency plan at least annually. The findings were verified in an interview with Staff A on 09/14/21 at 3:30 PM.

Partial Extended Recertification Survey An entrance conference was conducted on 09/13/21 at 1:05 PM with administrative personnel, and an exit conference was completed on 09/16/21 at 4:00 PM with administrative personnel. The following deficiencies are based on the Partial Extended Recertification survey completed on 09/16/21. Tender Home Care Providers, LLC 368401, is not in compliance with the requirements found at 42 CFR Part 484 Subpart B, C for Home Health Agencies.

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 medical record review and staff interview, the agency failed to ensure patients received the home health services as written in the plan of care for four of seven medical records reviewed (Patients #2, #4, #5, and #7). The agency census was 31. Findings include: 1. Review of the medical record for Patient #2 revealed a plan of care dated 08/18/21 to 10/16/21 with orders for home health aide services up to 35 hours per week. Review of the medical record revealed 35.5 hours of home health aide services the week of 08/22/21 and 39 hours of home health aide services the week of 09/05/21. The medical record lacked documentation of additional orders or physician notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 09/16/21 at 9:50 AM. 2. Review of the medical record for Patient #4 revealed plans of care dated 06/03/21 to 08/01/21 and 08/02/21 to 09/30/21 with orders for home health aide services up to 70 hours per week. Review of the medical record from 07/11/21 to 09/11/21 revealed documentation of 71 hours and 41 minutes to 76 hours and 53 minutes of home health aide services per week. The medical record lacked documentation of additional orders or physician notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 09/16/21 at 1:24 PM. 3. Review of the medical record for Patient #5 revealed an order dated 07/16/21 for home health aide services up to 46 hours per week. Review of the medical record revealed documentation of 46 hours and 21 minutes to 46 hours and 31 minutes of home health aide services the weeks of 08/01/21, 08/08/21, and 09/05/21. The medical record contained documentation of only 42 hours and six minutes of home health aide services the week of 08/29/21. The medical record lacked documentation of additional orders or physician notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 09/16/21 at 1:30 PM. 4. Review of the medical record for Patient #7 revealed a plan of care dated 12/28/20 to 02/25/21 with an order for occupational therapy to assess and evaluate for treatment. The medical record lacked documentation of any occupational therapy visit. The medical record lacked documentation of physician notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 09/15/21 at 2:43 PM.

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 medical record review and staff interview, the agency failed to ensure the plans of care contained the frequency and duration of visits to be made for three of seven medical records reviewed (Patients #2, #4, and #5). The agency census was 31. Findings include: 1. Review of the medical record for Patient #2 revealed a plan of care dated 08/18/21 to 10/16/21 with orders for home health aide services up to 35 hours per week. The orders lacked the frequency of the home health aide hours to be provided. The medical record contained documentation from 07/11/21 to 9/11/21 of five hours of home health aide services per day either in one five hour shift or two shifts of two and three hours each. The findings were verified in an interview with Staff A on 09/16/21 at 9:50 AM. 2. Review of the medical record for Patient #4 revealed plans of care dated 06/03/21 to 08/0121 and 08/02/21 to 09/30/21 with orders for home health aide services up to 70 hours per week. The orders lacked the frequency of the home health aide hours to be provided. The medical record contained documentation from 07/11/21 to 9/11/21 of two home health aide visits per day of five or more hours each. The findings were verified in an interview with Staff A on 09/16/21 at 1:24 PM. 3. Review of the medical record for Patient #5 revealed an order dated 07/16/21 for home health aide services up to 46 hours per week. The orders lacked the frequency of the home health aide hours to be provided. The medical record contained documentation from 07/11/21 to 9/11/21 of one home health aide visit per day of two hours and 28 minutes to ten hours and 21 minutes each. The findings were verified in an interview with Staff A on 09/16/21 at 1:30 PM.

Non-skilled direct observation every 60 days CFR(s): 484.80(h)(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, the registered nurse must make an on-site visit to the location where the patient is receiving care no less frequently than every 60 days in order to observe and assess each aide while he or she is performing care. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure patients not receiving skilled care received an on-site supervisory visit at least every 60 days while the aide was providing care for one of one non-skilled medical record reviewed (Patient #5). A total of seven medical records were reviewed. The agency census was 31. Findings include: Review of the medical record for Patient #5 revealed an admission date of 06/18/21. The medical record contained orders for home health aide services up to 46 hours per week. The medical record lacked documentation of any supervisory visit. A recertification visit was made by the registered nurse on 08/12/21. The findings were verified in an interview with Staff A on 09/16/21 at 1:30 PM.