Every finding on record at The Jewish Home for the Elderly of Fairfield Count

Unannounced visits concluded at Mozaic Home Care and Hospice on 04/03/2025 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey

Unannounced visits concluded at Mozaic Home Care and Hospice on 04/03/2025 for the purpose of a recertification survey. Standard-level deficiencies were identified.

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 review of the clinical record, review of agency policy and interview with agency personnel for two of ten patients (Patient’s #1 and # 2) in the survey sample, the agency licensed personnel failed to provide the ordered services. The findings include: a. Patient #1 had a start of care date of 3/4/25 and diagnoses that included endometrial cancer, left heel pressure injury, Diabetes Mellitus Type II, Neuroplastic disorder, hypertension. The physician orders dated 3/4/25 through 5/2/25 included nursing services twice a week for health assessment and wound care to left heel unstageable pressure ulcer, apply betadine followed by clean dry dressing once daily and physical therapy services twice a week for mobility and strength, Occupational Therapy once a week for decreased strength and bed mobility, and Medical Social Work evaluation for resources and home supports. Interview and review of the nursing clinical notes dated 3/11/25, 3/13/25, and 3/26/25 with the Administrator and Clinical Manager/CM on 4/3/25 at 1:25pm identified missed visit notes were entered by the nurse identifying the patient was not available for a nursing visit but failed to identify documentation of a physician notification within the missed visit note, and failed to ensure nursing services were provided weekly as ordered. b. Patient #2 had a start of care date of 11/9/24 and diagnoses that included Atrial fibrillation, s/p Atrio Ventricular node ablation, lymphoma, hx. of stroke, hypertension, Lupus and cardiomyopathies. The physician's orders dated 3/9/25 to 5/7/25 included nursing services once weekly for cardiac complications, neuro checks, and medication management and a speech language pathology evaluation for swallowing difficulties and cognitive decline. Interview and review of the nursing clinical note dated 3/28/25 with the Administrator and CM on 4/3/25 at 1:25pm identified a missed visit note was entered in the clinical chart identifying the patient was unavailable for the nursing visit, but failed to identify documentation of a physician notification within the missed visit note and failed to ensure nursing services were provided weekly as ordered. Review of agency policy for Missed Visit directed a missed visit note type is entered to represent a visit that should have occurred but did not and will not. The missed visit entry is designed to account for a physician approved visit frequency that was missed, i.e. you were unable to follow the physician’s orders.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on review of the clinical record, and interview with agency personnel for one of ten patients (Patient #1) in the survey sample, the agency licensed personnel failed to follow the agency procedure for weekly wound measurements. The findings include: Patient #1 had a start of care date of 3/4/25 and diagnoses that included endometrial cancer, left heel pressure injury, Diabetes Mellitus Type II, Neuroplastic disorder, hypertension. The physician orders dated 3/4/25 through 5/2/25 included nursing services twice a week for health assessment and assessment of wound status, signs and symptoms of healing and complications, daily wound care to a left heel unstageable pressure ulcer, apply betadine followed by clean dry dressing once daily, and physical therapy services twice a week for mobility and strength, Occupational Therapy once a week for decreased strength and bed mobility, and Medical Social Work evaluation for resources and home supports. Review of the nursing clinical notes for the week of 3/9/25 through 3/15/25 with the Administrator and CM on 4/3/25 at 1:15pm identified 2 missed nursing visits for 3/11/25 and 3/13/25, and a skilled nursing visit with wound care on 3/12/25 by LPN #1 but failed to identify weekly wound measurements were completed for the week of 3/9/25 through 3/15/25, per the agency procedure and best practice standard. The CM further identified it is the agency expectation that the patient wound/s are measured weekly, close to the same day as previously measured for wound assessment consistency and best practice. Training is completed at hire and during agency in-service trainings. Review of the agency pressure injury and wound assessment protocol identified the steps the agency clinical staff would perform for the assessment of wound healing as it relates to the patient’s care plan, including clinical visit documentation on wound location, type of wound, extent of tissue involvement, type and percentage of tissue in wound base, wound size, including length, width, and depth measurements, wound exudate, odor, peri wound assessment, and patient pain level.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews, review of agency documentation, interviews with agency personnel, for two of ten patient's (Patient’s #1 and # 2) in the survey sample, the agency failed to communicate a missed skilled nursing visit with the patient's physician. a. Patient #1 had a start of care date of 3/4/25 and diagnoses that included endometrial cancer, left heel pressure injury, Diabetes Mellitus Type II, Neuroplastic disorder, hypertension. The physician orders dated 3/4/25 through 5/2/25 included nursing services twice a week for health assessment and wound care to left heel unstageable pressure ulcer, apply betadine followed by clean dry dressing once daily and physical therapy services twice a week for mobility and strength, Occupational Therapy once a week for decreased strength and bed mobility, and Medical Social Work evaluation for resources and home supports. Interview and review of the nursing clinical notes dated 3/11/25, 3/13/25, and 3/26/25 with the Administrator and CM on 4/3/25 at 1:25pm identified missed visit notes were entered by the nurse identifying the patient was not available for the nursing visit but failed to identify documentation of a physician notification within the missed visit note. b. Patient #2 had a start of care date of 11/9/24 and diagnoses that included Atrial fibrillation, s/p Atrio Ventricular node ablation, lymphoma, hx. of stroke, hypertension, Lupus and cardiomyopathies. The physician's orders dated 3/9/25 to 5/7/25 included nursing services once weekly for cardiac complications, neuro checks, and medication management and a speech language pathology evaluation for swallowing difficulties and cognitive decline. Review of the nursing clinical note dated 3/28/25 with the Administrator and CM on 4/3/25 at 1:25pm identified a missed visit note was entered in the clinical chart identifying the patient was unavailable for a nursing visit on 3/28/24 but failed to identify documentation of a physician notification within the missed visit note. Review of agency policy for Missed Visit directed a missed visit note type is entered to represent a visit that should have occurred but did not and will not. The missed visit entry is designed to account for a physician approved visit frequency that was missed, i.e. you were unable to follow the physician’s orders, and the actions of the clinicians that the physician was made aware of the missed visit.

Unannounced visit was concluded at Friedman Home Care and Chaifez Family Hospice on 3/30/2022 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visit was concluded at Friedman Home Care and Chaifez Family Hospice on 3/30/2022 for the purpose of recertification, state re-licensure and COVID 19 staff vaccination survey. Standard-level deficiencies were identified. The agency was in compliance with staff vaccination regulatory requirements at the time of the survey.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on clinical record review, personnel interviews, and review of the agency policy for two of four patients (Patient#1 and #9) who required home health aide services, the agency failed to ensure the supervision of licensed practical nurses (LPN) and home health aides (HHA) were conducted and documented. The findings include. Patient #9 had a start of care date of 2/22/2022 and a diagnosis that included spinal stenosis lumbar region without neurogenic claudication, progressive supranuclear opthalmoplegia, chronic pain, hypertension, orthostatic hypotension and asthma. The physicians orders for the certification period of 2/22/22 through 4/22/2022 included nursing services 1 time per week to assess and evaluate pain, medication, and safety and a Home Health Aide (HHA) 2 times per week for hygiene and safety. Interview and review of patient #9's clinical record from 2/22/2022 through 3/30/2022 with the supervisor of clinical services (SCS) on 3/30/2022 at 11:00am identified 1 visit made by the Licensed Practical Nurse (LPN) and failed to identify a Registered Nurse (RN) assigned to monitor and evaluate the LPN's performance in the provision of services, provision of treatments, patient education and data collection regarding the patient's status and health needs. Additionally, the SCS identified 7 visits made by a HHA and failed to identify a RN assigned to monitor and evaluate the HHA competencies. The SCS identified the agency does not have a policy on supervision of LPN's or HHA's when upon policy request. Supervisor of Clinical Services- Liza Mitchell Client #9 -Catherine Lynam Patient#1 had a start care date of 1/5/22 and diagnoses that included diabetes mellitus type II, unstageable pressure ulcer to the left heel and heart disease. The physician's orders for the certification period of 1/5/2022 through 3/5/2022 included nursing services twice a week for six weeks for wound care, vital signs and general assessments, and a supervision of home health aides every 14 days, and home health aide services twice a week for eight weeks for assistance with the activities of daily living. Review of Registered Nurse/RN#1 note dated 1/10/22 identified a documented supervision of a home health aide. Review of RN#1 note dated 1/17/22 identified a documented supervision of a licensed practical nurse. a. Interview and review of Patient#1's clinical record with the Supervisor of Clinical Services on 3/30/22 at 2:00 pm identified only one documented supervision of a home , but failed to identify home health aides supervision every 14 days in accordance with the agency policy; b. Interview and review of Patient#1's clinical record with the Supervision of Clinical Services on 3/30/22 at 2:10 pm identified only one documented supervision of a licensed practical nurse, but failed to identify licensed practical nurses every 30 days in accordance with the agency policy. The agency policy directed to document supervisory visits at least every two weeks for clients receiving aide services and every thirty (30) days for clients receiving LPN services.

Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This ELEMENT is not met as evidenced by: Based on clinical record review and interview with the agency personnel for one of one (Pt#1) in a survey sample, the agency failed to monitor and verify documentation for completeness, accuracy and timely submission, and further failed to develop an agency policy for monitoring, of clinical documentation. The findings include: Patient#1 had a start of care date of 1/5/22 and diagnoses that included diabetes mellitus type II, unstageable pressure ulcer to the left heel and obstructive pulmonary disease. The physician's orders for the certification period of 1/5/2022 through 3/5/2022 included nursing services twice a week for six weeks for wound care and general assessments, and home health aide services twice a week for eight weeks for assistance with the activities of daily living. a. Review of Licensed Practical Nurse/LPN#1 note dated 1/15/22 identified that LPN#1 completed the visit on 1/15/22 and completed the visit note on 1/21/22 (6 days later). b. Review of LPN#1 note dated 1/18/22 identified that LPN#1 completed the visit on 1/18/22 and completed the visit note on 1/24/22 (6 days later). c. Review of LPN#1 note dated 1/25/22 identified that LPN#1 completed the visit on 1/25/22 and completed the visit note on 1/30/22 (5 days later). d. Review of LPN#1 note dated 2/1/22 identified that LPN#1 completed the visit on 2/1/22 and completed the visit note on 2/16/22 (15 days later). e. Review of LPN#1 note dated 2/8/22 identified that LPN#1 completed the visit on 2/8/22 and completed the visit note on 2/22/22 (14 days later). f. Review of LPN#2 note dated 2/12/22 identified that LPN#2 completed the visit on 2/12/22 and completed the visit note on 3/2/22 (18 days later). g. Review of LPN#1 note dated 2/22/22 identified that LPN#1 completed the visit on 2/22/22 and completed the visit note on 3/1/22 ( 7 days later). h. Review of LPN#2 note dated 3/4/22 identified that LPN#2 completed the visit on 3/20/22 and completed the visit note on 3/20/22 (16 days later). Interview and review of nurses notes with the SCS on 3/30/22 at 2:15 identified that the agency personnel were expected to completed a visit note 24 to 48 hours after the visit, and failed to identify that the nurses followed the agency practice in regard to a timeliness of the note completion. In addition, the SCS indicated that the agency did not have a policy regarding a timeliness of a skilled visit note completion.