Every finding on record at Too Care Home Health Agency Inc

A recertification survey entrance was conducted on 10/25/2023. Census: Licensed and Certified Home Health: 12

A recertification survey entrance was conducted on 10/25/2023. Census: Licensed and Certified Home Health: 12 Abbreviations/Definitions POC-Plan of Care SOC- Start of Care RN -registered nurse LVN – licensed vocational nurse DON- Director of Nursing SN- Skilled nursing

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review, interviews, and observation, the agency failed to provide the patient and caregiver with written information outlining a visit schedule including frequency of visits by home health staff in 2 (Patients 2 and 3) of 3 patients' home folders reviewed during home visits. This failure potentially placed the patients at risk of missed visits by staff when visits were not scheduled and conflicted with other appointments and the availability of the patients. FINDINGS: Patient 2: Review of the record revealed a POC dated 08/08/2023-10/06/2023 with a SOC date 11/18/2015. The POC listed the primary diagnosis as Idiopathic gout (a condition of the body, with an unknown cause, that produces too much uric acid and leads to inflammation and pain in joints), left ankle and foot. The POC listed orders for SN visits once a week for nine weeks. Review of the record revealed no evidence that a visit schedule had been provided to Patient 2. A review of patient 2 and 3's clinical record revealed the patients reside at the same address. During a home visit with Patient 2 on 10/27/2023 at 2:00 PM, the patient's home folder was reviewed. The surveyor asked Patient 2 if any paperwork from the home folder had been removed or placed elsewhere. Patient 2 said there had not been anything removed that he knew of. The surveyor asked if a written visit schedule to show when the nurse would be visiting was provided to the patient. Patient 2 said the nurse comes every week on Mondays to see him and his wife. The home folder did not include a visit schedule for the patient. Patient 3: Review of the record revealed a POC dated 07/29/2023-09/26/2023 with a SOC date 12/11/2020. The POC listed the primary diagnosis as Hyperlipidemia (blood that has too many fatty deposits in the arteries that increases the risk of blockages in the arteries). The POC listed orders for SN visits once a week for nine. The POC listed orders for SN visits once a week for nine weeks. Review of the record revealed no evidence that a visit schedule had been provided to Patient 3. During a home visit with Patient 3 on 10/27/2023 at 2:30 PM, the patient's home folder was reviewed. The surveyor asked Patient 3 if any paperwork from the home folder had been removed or placed elsewhere. Patient 3 said she did not think anything had been removed. The surveyor asked if a written visit schedule to show when the SN would be visiting was provided to the patient. Patient 3 said the nurse came every Monday to see her and her husband. The home folder did not include a visit schedule for the patient. In an interview with the Administrator on 10/30/2023 at 2:00 PM, the surveyor reviewed the findings and asked why Patient 2 and 3 did not have written visit schedules, provided by the agency, in the home folders. The Administrator said the visit schedules should have been put in the folders. The Administrator stated she would ask LVN A and RN A why it was not in the patients’ folders and make sure it is taken and placed in the patients' home folders.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on record review, interviews and observation, the agency failed to provide the patient and caregiver with written information regarding the patient’s medications in plain language with no medical abbreviations in 2 (Patients 2 and 3) of 3 patients' home folders reviewed during home visits. This failure could place patients at risk of medication errors or adverse reactions. Findings: Patient 2: Review of the record revealed a POC dated 08/08/2023-10/06/2023 with a SOC date 11/18/2015. The POC listed orders for SN visits once a week for nine weeks. The POC included a diagnosis of Type 2 Diabetes Mellitus (adult onset of a condition in which the way the body processes sugars in the blood and in the insulin the body makes). The POC included a list of Patient 2’s medications. A review of the POC included Patient 2 was taking Metformin and Januvia for Type 2 Diabetes Mellitus. A review of the record revealed no evidence that Patient 2 had been given information regarding the medications listed on Patient 2’s POC or listed on the Medication Profile. During a home visit with Patient 2 on 10/27/2023 at 2:00 PM, the patient's home folder was reviewed. The surveyor asked Patient 2 if any paperwork from the home folder had been removed or placed elsewhere. Patient 2 said there had not been anything removed that he knew of. The surveyor asked if the nurse had provided him with a list of his medications and reviewed them with the patient. Patient 2 said the nurse always asked him about his medications and said his family helps him keep up with his medications. The home folder did not include a list of the patient’s medications. Patient 3: Review of the record revealed a POC dated 07/29/2023-09/26/2023 with a SOC date 12/11/2020. The POC listed orders for SN visits once a week for nine weeks. The POC listed a diagnosis of Type 2 Diabetes Mellitus. The POC included a list of Patient 3’s medications that included Januvia for Type 2 Diabetes Mellitus. Review of the record revealed no evidence that Patient 3 had been given information regarding the medications listed on Patient 3’s POC. During a home visit with Patient 3 on 10/27/2023 at 2:30 PM, the patient's home folder was reviewed. The surveyor asked Patient 3 if any paperwork from the home folder had been removed or placed elsewhere. Patient 3 said she did not think anything had been removed. The surveyor asked if the nurse had provided a list of Patient 3’s medications and reviewed them with the patient. Patient 3 said the nurse asked about her medications but she is able to keep up with her medications. The home folder did not include a list of Patient 3’s medications. In an interview with the Administrator on 10/30/2023 at 2:00 PM, the surveyor reviewed the findings and asked why Patients 2 and 3 did not have an updated written medication list, provided by the agency, in the patients’ home folders. The Administrator said it should have been in the folder. The Administrator stated she would ask LVN A and RN A why it was not in the patients’ folders and make sure it is taken to the patients' home folders and review with the patients.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review, interview and observation, the agency failed to ensure skilled services followed the written POC for 1 of 2 active patients (Patient 3), whose’ clinical record included a diagnosis of Heart Failure. The skilled nurse, LVN A, failed to check the patient’s weight and document the clinical findings of the weights on 8 consecutive skilled nurse visits. This failure resulted in a lack of weight monitoring to evaluate for weight gain, that would indicate further action may be needed by the patient’s physician to prevent a medical emergency or deterioration in the patient's health care status. Findings Include: Review of Patient 3’s POC with a certification period dated 07/29/23-09/26/23 included a SOC of 11/13/2016. The POC included diagnoses of Type 2 diabetes Mellitus (an adult condition of the body that affects the way the body processes blood sugar) with diabetic polyneuropathy ( a malfunction of the nerves, through out the body, caused by chronic diabetes), Hypertensive heart disease with heart failure, and Unspecified systolic (congestive) and diastolic (congestive) heart failure ( a chronic condition in which the heart does not pump blood as well as it should).. The POC included physician orders for the skilled nurse to weigh the patient weekly and report weight gain greater than 5 pounds in a week to the physician/RN. Review of Patient 3’s clinical record included skilled nurse visit notes signed and dated by LVN A on 08/01/23, 08/10/23, 08/14/23, 08/21/23, 08/28/23, 09/04/23, 09/11/23, and 09/18/23. The skilled nurse visit notes did not include weights for the patient. During a home visit with Patient 3 on 10/27/23 at 2:15 pm, the surveyor asked what the skilled nurse does for the patient during the skilled visit. Patient 3 said the nurse checks her blood pressure, checks her heart, and sometimes does her finger stick, if the patient had not already done the finger stick. The surveyor asked Patient 3 if the nurse checks her weight. Patient 3 said she thought the nurse had, but she was not sure. During an interview with the Administrator on 10/30/23 at 3:00 pm, the surveyor went over the findings and asked why LVN A did not check Patient 3’s weight each visit as ordered. The Administrator reviewed the patient's POC and LVN A's skilled notes. She said LVN A should have documented the weights on the skilled notes. She said she would contact LVN A and ask him about the findings. During the exit conference on 10/31/23 at 3:30 pm, the surveyor asked the Administrator if the DON was coming to the agency for the exit. The Administrator said the DON was not coming. The surveyor asked the Administrator if she knew why LVN A did not check Patient 3’s weights and who's responsibility it was to oversee the care of the patients. The Administrator said LVN A did not document the weight checks and should have so any changes could be reported to the patient’s physician and the DON. The Administrator said she would make sure LVN A and the DON have a meeting to discuss Patient 3's POC. There was no further documentation provided. The surveyor did not have the nurses' phone numbers and was unable to interview LVN A or the DON. The agency’s policy titled "Plan of Care" with a revised date of 07/01/21, read in part, "…The agency will provide optimal care to achieve the goals and outcomes identified in the patient’s plan of care for each patient’s medical, nursing, and rehabilitative needs…. The Clinical manager will ensure the development, implementation, and updates of the individualized plan of care….”