Every finding on record at Traditional Home Health and Hospice, LLC

Based on the findings of an unannounced, onsite Medicare recertification survey conducted February 1, 2, 3, 4 and 7, 2022, Traditional Home Health Care was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies-Emergency Preparedness.

Based on the findings of an unannounced, onsite Medicare recertification survey conducted on February 1, 2, 3, 4 and 7, 2022, Traditional Home Health Care was found not to be in compliance with the following requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies. The Medicare recertification survey was conducted for the Dunmore parent office on February 1, 2, 4 and 7, 2022, for the Dunmore and East Stroudsburg branch office on February 2, 2022 and for the Berwick branch office on February 3, 2022.

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 review of agency policies/procedures and clinical records, and based on interview with the co-owner/director of nursing (DON) and the assistant director of nursing (ADON), the agency failed to ensure that the "Home Heath Care Certification and Plan of Care" included physician orders for social work (SW) services for two (2) of two (2) active patients for whom a "Medical Social Worker Visit Note" was generated. (Patients #6 and #19) Findings include: On February 7, 2022 at approximately 3:01 PM, review of the agency policy titled "25. Psychosocial Services" revealed the following: These services are provided according to the interdisciplinary team plan of care. On February 7, 2022 at approximately 3:05 PM, review of the agency policy titled "40. Physician's Orders/Plan of Care" revealed the following: The plan of care must specify the care and services needed to meet the patient-specific needs... Patient #6: On February 4, 2022 at approximately 9:04 AM, review of the clinical record revealed the start of care date was 01/26/2022, the primary diagnosis is pressure ulcer of the left buttocks stage 2 (open or history of open wound) and that skilled nursing (SN), home health aide (HHA), physical therapy (PT) and occupational therapy (OT) services are to be provided as documented on the "Home Health Care Certification and Plan of Care" for the initial certification period of 01/26/2022 through 03/26/2022. Review of start of care SN assessment documentation dated 01/26/2022 revealed the patient's spouse was documented as being overwhelmed. Review of "Medical Social Worker Visit Note" documentation dated 01/27/2022 revealed that at the request of the nursing supervisor, the SW contacted the patient's spouse by telephone to evaluate the spouse's ability to cope with the patient's care. There was no documentation in the clinical record which provided evidence that the "Home Health Care Certification and Plan of Care" for the initial certification period of 01/26/2022 through 03/26/2022 included physician orders for SW services. Patient #19: On February 7, 2022 at approximately 10:20 AM, review of the clinical record revealed the start of care date was 01/25/2022, the primary diagnosis is encounter for aftercare following surgery of the circulatory system and that SN, HHA, and PT services are to be provided as documented on the "Home Health Care Certification and Plan of Care" for the initial certification period of 01/25/2022 through 03/25/2022. Review of start of care SN assessment documentation dated 01/25/2022 revealed the request for SW services was a priority. Review of "Medical Social Worker Visit Note" documentation dated 01/27/2022 revealed the SW completed a telephone consult. There was no documentation in the clinical record which provided evidence that the "Home Health Care Certification and Plan of Care" for the initial certification period of 01/2/2022 through 03/25/2022 included physician orders for SW services. During interview conducted on February 7, 2022 at approximately 3:20 PM, the DON and ADON confirmed physician orders for SW services/consult were not included on the initial "Home Health Care Certification and Plan of Care" for the above identified patients.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures and clinical records, and based on interview with the co-owner/director of nursing (DON) and the assistant director of nursing (ADON), the agency failed to ensure the "Home Health Care Certification and Plan of Care" included physician orders for gastrostomy (feeding tube) maintenance/care and tracheostomy (surgically created airway in the front of the neck)/ventilator (machine that provides assistance with breathing) maintenance/care for one (1) of three (3) active patients for whom a GT or tracheostomy was present. (Patient #14) Findings include: On February 7, 2022 at approximately 3:05 PM, review of the agency policy titled "40. Physician's Orders/Plan of Care" revealed the following: Drugs, services and treatments are administered only as ordered by a physician... Patient #14: On February 7, 2022 between the approximate times of 7:30 AM, and 1:50 PM, review of the clinical record revealed the start of care date was 11/15/2019, the primary diagnosis is other disorder of the lungs, that other diagnoses included encounter for attention to tracheostomy, dependence on ventilator and gastrostomy status and that SN services are to be provided as documented on the "Home Health Care Certification and Plan of Care" for the recertification period of 01/03/2022 through 03/03/2022. Review of January 2022 medication/treatment administration record and/or "Nursing Progress Note" documentation revealed the following was assessed or provided by SN staff: -GT: Size 14 French and flush with10 ml of water; -Tracheostomy suction procedure: Use an 8 French catheter to a depth no greater than 9.5 centimeters; -Ventilator Settings: PIP (peak inspiratory pressure-highest pressure) of 20 and sensitivity of 3 (determines how much effort the patient/client needs to exert before inhaling); and -HME (heat and moisture exchanger which reduces mucus production/cough by humidifying the air which is breathed through the tracheostomy). There was no documentation in the clinical record which provided evidence that the "Home Health Care Certification and Plan of Care" for the recertification period of 01/03/2022 through 03/03/2022 included physician orders for the GT size and flushes, tracheostomy suctioning, the above referenced ventilator settings nor for use of the HME. During interview conducted on February 7, 2022 at approximately 3:20 PM, the DON and ADON confirmed physician orders for the above referenced GT size/flushes, tracheostomy suction procedure, ventilator setting and for use of the HME were not included on the "Home Health Care Certification and Plan of Care" for the above identified patient.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of agency policies/procedures and clinical records, and based on interview with the co-owner/director of nursing (DON) and the assistant director of nursing (ADON), the agency failed to ensure licensed practical nursing (LPN) staff assessed the ETCO2 (amount of carbon dioxide in exhaled air) for one (1) of two (2) active patients for whom a tracheostomy (surgically created airway in the front of the neck) was present. (Patient #2) Findings include: On February 7, 2022 at approximately 3:04 PM, review of the agency policy titled 7. Home Health Comprehensive Assessment... revealed the following: Patient assessment data are collected through a combination of methods including...observation and measurement... Patient #2: Between February 1, 2022 at approximately 1:40 PM and February 3, 2022 at approximately 1:24 PM, review of the clinical record revealed the start of care date was 01/19/2022, the primary diagnosis is cervical (neck) spina bifida (disorder which occurs when the spine and spinal cord do not properly develop), that other (secondary) diagnoses included encounter for attention to tracheostomy and dependence on ventilator (machine that provides assistance with breathing) and that skilled nursing (SN) was to assess the ETCO2 every 8 hours and as needed as documented on the "Home Health Care Certification and Plan of Care" for the initial certification period of 01/19/2022 through 03/19/2022. Review of the "Nursing Progress Note", nursing "Addendum" and medication administration/treatment record forms revealed there was no documentation which provided evidence the LPN (employee #2) assessed the ETCO2 during the 7:00 AM to 3:00 PM shift on 01/19/2022 nor during the 7:00 AM to 2:10 PM shift on 01/20/2022 and there was no documentation which provided evidence the LPN (employee #11) assessed the ETCO2 during the 11:00 PM to 7:00 AM shift on 01/22/2022. During interview conducted on February 7, 2022 at approximately 3:20 PM, the DON and ADON confirmed there was no documentation which provided evidence that the above identified LPN's assessed the ETCO2 for patient #2 on the above referenced dates.