Every finding on record at Town and Country Home Health Care

A survey with CMS Appendix Z Emergency Preparedness Requirements, was conducted on 9/12/23 through 9/13/23, during a recertification survey. The agency is NOT in compliance with the Appendix Z Emergency Preparedness Requirements.

EP Program Patient Population CFR(s): 484.102(a)(3) §403.748(a)(3), §416.54(a)(3), §418.113(a)(3), §441.184(a)(3), §460.84(a)(3), §482.15(a)(3), §483.73(a)(3), §483.475(a)(3), §484.102(a)(3), §485.68(a)(3), §485.542(a)(3), §485.625(a)(3), §485.727(a)(3), §485.920(a)(3), §491.12(a)(3), §494.62(a)(3). [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years. The plan must do the following:] (3) Address [patient/client] population, including, but not limited to, persons at-risk; the type of services the [facility] has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.** *[For LTC facilities at §483.73(a):] Emergency Plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do all of the following: (3) Address resident population, including, but not limited to, persons at-risk; the type of services the LTC facility has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans. *NOTE: ["Persons at risk" does not apply to: ASC, hospice, PACE, HHA, CORF, CMCH, RHC/FQHC, or ESRD facilities.] This STANDARD is not met as evidenced by: Based on interview and document review, the facility failed to address the home health care patient population, including, but not limited to: persons requiring additional assistance and those with limited mobility; the type of services the facility had the ability to provide in an emergency; and continuity of operations in their emergency preparedness (EP) plan. This had the potential to affect the two patients that received home care services from the agency. The facility's Emergency Preparedness (EP) plan, undated, lacked a description of the home care patient population. When interviewed on 9/13/23, at 1:35 p.m. the administrator verified the EP plan did not address the home care patient population. The administrator indicated the previous home care director had combined the home health care (HHC) and assisted living (AL) policies before she left and had assumed she made sure the policies covered both provider types.

Local, State, Tribal Collaboration Process CFR(s): 484.102(a)(4) §403.748(a)(4), §416.54(a)(4), §418.113(a)(4), §441.184(a)(4), §460.84(a)(4), §482.15(a)(4), §483.73(a)(4), §483.475(a)(4), §484.102(a)(4), §485.68(a)(4), §485.542(a)(4), §485.625(a)(4), §485.727(a)(5), §485.920(a)(4), §486.360(a)(4), §491.12(a)(4), §494.62(a)(4) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years [annually for LTC facilities]. The plan must do the following:] (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation. * * [For ESRD facilities only at §494.62(a)(4)]: (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation. The dialysis facility must contact the local emergency preparedness agency at least annually to confirm that the agency is aware of the dialysis facility's needs in the event of an emergency. This STANDARD is not met as evidenced by: Based on interview and document review, the facility failed to implement a process for cooperation and collaboration with local, tribal, regional, state, and federal emergency preparedness (EP) officials' efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the facility's efforts to contact such officials and, when applicable, of its participation in collaborative and cooperative planning efforts in their emergency plan. This had the potential to affect the two patients receiving home care services. The facility's Emergency Preparedness (EP) plan, undated, lacked a written plan that included collaboration with tribal agencies. When interviewed on 9/13/23, at 1:35 p.m. the administrator stated she was unaware of the need to collaborate with additional state and local officials, including tribal agencies, to create an integrated response in the event of an emergency.

On 9/12/23 to 9/13/23 a recertification survey was conducted. This resulted in a partial extended survey at Town and Country Home Health Care. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. Unduplicated census: 1 Total home visits conducted: 0 Number of records reviewed: 4 Hours of Operation: 8:00 a.m. to 4:30 p.m. No branch offices.

Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient's condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This ELEMENT is not met as evidenced by: Based on interview and document review, the agency failed to complete comprehensive assessments for skilled patients every 60 days, beginning with the start of care (SOC) date for 2 of 2 skilled private pay patients (P1, P2) reviewed for home care services. P1's plan of care (POC) for the certification period 5/23/23 to 8/20/23 indicated start of care (SOC) was 12/15/17, and included diagnoses acute respiratory failure with hypoxia, hypertension and history of falling. The POC indicated P1 received skilled nurse visits (SNV) once every other week and two SNV per month as needed for change in condition, blood draw and medication management. POC also indicated home health aide (HHA) once weekly and once per week as needed to assist with shower assistance and linen change. Record review indicated comprehensive assessments had been completed every 90 days for P1 on 11/24/22, 2/20/23 and 5/18/23. P2's POC for the certification period 8/25/23 to 11/23/23 indicated SOC was 10/24/22, and diagnoses included type two diabetes, chronic kidney disease and congestive heart failure with hypertension. The POC indicated SNV once every 90 days and six SNV as needed for diabetic management and education, fall prevention and safety guidance. Record review indicated comprehensive assessments had been completed every 90 days for P2 on 2/15/23, 5/18/23 and 8/25/23. When interviewed on 9/12/23, at 4:15 p.m. the director of nursing (DON) indicated comprehensive assessments and plan of treatments were completed every 90 days for private pay patients. Review of the agency policy, 6.01 Assessments, Reviews and Monitoring revised 9/22, indicated ongoing assessments to be completed as needed and cannot exceed 90 calendar days since last assessment.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on interview and document review, the agency failed to ensure supervisory visits of home health aides (HHAs) were completed every 14 days as required for 1 of 2 patients (P1) reviewed who had skilled nurse visits (SNV) and HHA services for longer than 14 days. P1's plan of care (POC) for the certification period 5/23/23 to 8/20/23 indicated start of care (SOC) was 12/15/17, and included diagnoses acute respiratory failure with hypoxia, hypertension and history of falling. The POC indicated P1 received skilled nurse visits (SNV) once every other week and two SNV per month as needed for change in condition, blood draw and medication management. POC also indicated home health aide (HHA) once weekly and once per week as needed to assist with shower assistance and linen change. Review of P1's record indicated supervisory visits were completed on 11/17/22 and 2/20/23. Supervisory visits were not performed every 14 days as required. When interviewed 9/12/23, at 9:30 a.m., the DON stated supervisory visits were completed at 30 days, 60 days and 90 days after admission. She further indicated if the patient had Medicare as a payer source, the supervisory visits were completed every 30 days and as needed. Review of the agency's policy/procedure titled Supervision of Unlicensed Personnel, revised 2/8/16, indicated supervisory visits will be conducted every 14 days for patients who are skilled. The policy further indicated supervisory visits will be conducted every 60 days for patients who are not skilled.