Every finding on record at Toledo Home Health Services LLC

Substantial Allegation Survey Substantial Allegation Number 94502 An entrance conference was conducted with the Office Manager on 1/03/23 at 11:15 AM, an exit conference was conducted with the same Office Manager by phone on 1/06/23 at 10:45 AM. No deficiencies were cited related to the allegation contained in Substantial Allegation Number 94502 completed on 01/06/23; however, the facility was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiency was cited. Toledo Home Health Services, 369134, is not in compliance with the requirements found at 42CFR 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, policy review and staff interview, the facility failed to notify the physician when aide visits were not completed as ordered on the plan of care (POC). This affected two patients (Patient #1 and Patient #2) with the potential to affect all patients cared for by this agency. The agency census was 41. 1. The medical record for Patient # 1 was reviewed on 01/03/23. Patient #1 had a start of care (SOC) of 09/08/22 with a primary diagnosis of hypertension (high blood pressure). The certification period reviewed was for 09/08/22-11/06/22 with orders on the POC for aide services 20 hours per week. No aide services were provided from the SOC of 09/08/22 until 09/16/22. Twenty hours of aide services were provided for the week of 09/18/22 with the last visit completed on 09/23/22. Review of the Missed Visit form listed dates of 09/12/22, 09/13/33, 09/14/22 and 09/15/22. This form stated the aide was not available and the Case Manager (CM) was notified but not the physician. The discharge summary for Patient #1, dated 10/03/22, listed this patient went to a different agency. Interview with Staff A revealed the aide was not available and the CM notified. Review of the facility policy titled "Plan of Care-CMS #485 and Physician Orders" lists under #12 if a physician refers a patient under a POC that cannot be completed until an evaluation visit, the physician is consulted to approved additions or modifications to the original plan. A interview was completed with Staff A on 01/03/22 at 5:40 PM. Staff A stated they believed the CM notified the physician regarding the missed visits. 2. The medical record for Patient #2 was reviewed on 01/03/23. Patient #2 had a SOC of 08/31/22 with a primary diagnosis of pre-excitement syndrome. The certification period reviewed was for 10/30/22-12/28/22 with orders received on the POC for home health aide (HHA) 16 hours per week. A missed visit note was in the medical record for 11/24/22 with the CM notified. A note on 12/05/22 stated the CM was notified regarding this clients services being placed on hold due to no HHA available. This missed visit note did not state the physician was notified regarding the change for the POC. The findings of not notifying they physician that care could not be provided as ordered on the POC and according to the facility policy was verified with Staff A on 01/06/22 at 10:30 AM.