Every finding on record at Trendy Care Home Health Services Inc.

A recertification entrance survey was conducted on 04/03/2023. The census was 1 (one). Licensed and Certified patients - 1 Licensed Home Health patients - 0 Personal Assistance Services patients - 0 The agency met Medicare Conditions of Participation for Emergency Preparedness.

A recertification entrance survey was conducted on 04/03/2023. The census was 1 (one). Licensed and Certified patients - 1 Licensed Home Health patients - 0 Personal Assistance Services patients – 0 The agency met Medicare Conditions of Participation with standard level deficiency. Abbreviations: SN – Skilled Nurse NOMNC - Notice of Medicare Non-Coverage CLIA - Clinical Laboratory Improvement Amendments CFR – Code of Federal Regulations TULIP – Texas Unified Licensure Information Portal POC- Plan of Care

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 and interview, the home health agency failed to provide the written skilled nursing visit schedule detailing service visits to one (Patient #1) of one patient in which a home visit was conducted. This failure caused the Patient #1 at risk of being uninformed and unable to identify the staff schedule to provide care and service on the behalf of the agency. Findings include: Reviewed current Plan of Care (POC) for certification period from 03/09/2023 thru 05/07/2023. The orders for discipline and treatment indicate service to include skilled nursing 1W9. A home visit was conducted with Patient#1, on 04/06/23 at 10:50 AM. The agency’s admission home folder was reviewed during the home visit. The home folder did not include the skilled nursing visit schedule. During home visit the surveyor asked Patient #1 was there any papers removed from the agency home folder he stated he did not remove any paper from the folder. The surveyor asked if he is aware when the agency was supposed to provide services. Patient #1 stated he was not sure when the agency was supposed to provide services. He added the nurse usually comes on Thursdays or Fridays. During an interview with the Administrator on 04/06/23 at approximately 1:00 PM, the surveyor asked why the SN visit schedule was not provided to Patient #1. The Administrator stated she did not think giving a visit schedule to the patient was necessary because the patient was aware that the nurse would come once a week. When the surveyor showed the guidelines CFR 484.60(e)(1) to the Administrator said she was not aware of it.

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, interview, and observation the home health agency failed to provide a medication list, to the patient and his caregiver, with the agency’s written information regarding the client's medication regimen. This failure placed Patient #1 at risk of potential adverse effects, including significant side effects, and duplicate drug therapy by not having a medication profile and administration instructions. Findings include: Reviewed current Plan of Care (POC) for certification period from 03/09/2023 thru 05/07/2023 of Start of Care dated 03/09/2023. Revealed Patient #1 has the following diagnosis: “Type 2 diabetes mellitus, Diabetes neuropathy, Cerebral arthrosclerosis, Malignant neoplasm of prostate, Legal blindness…”. The POC includes the list of medication patient was currently taking includes: “31G, 8MM Insulin pen insulin regimen dose devise BID Subcutaneous; Fluoxetine HCL 20 mg I cap 2 tabs QD PO; Gabapentin 600 mg 1 cap BID PO; Cyanocobalamin 1000 MCG 1/2 tab take one-half PO; …”. A home visit was conducted with Patient #1 on 04/06/23 at 10:50 AM. The agency’s admission home folder was reviewed during the home visit. The home folder did not contain Patient #1’s current medication list with medication name, dosage, frequency, schedule, instructions, or if any medications that would be administered by HHA personnel. An interview was conducted with the Administrator on 04/06/23 at approximately 1:10 PM. The surveyor discussed the findings from the review of Patient #1’s home admission packet. The surveyor asked why the medication list was not in the patient’s home folder. The Administrator stated that the patient’s medication list was three pages long because he goes to see his doctors every week and he had changes in medication and dosages after his visits. Administrator stated the patient gets the discharge instructions from his physician after visit which has a medication list. When surveyor showed the guidelines CFR 484.60(e)(1) the Administrator said she was not aware of it.

12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This STANDARD is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure home health aides received at least 12 hours of in-service training to one of one (Home Health Aide A) home health aide in 2020, 2021 and 2022. This failure placed patients at risk of receiving substandard care from an agency employee (Home Health Aide A) who was not properly trained to perform job duties. Findings include: Review of personnel file for Home Health Aide A, included documented titled “Inservice Record for Year”, revealed that Home Health Aide A, was hired on 03/02/2020, only received infection control in-service in March of 2020 for one hour. There was no evidence of another eleven hours of in-service training provided to the home health aide after March 2020, 2021, and 2022. During an interview with the Administrator on 04/06/23, at approximately 1:45 PM, the surveyor asked why the home health aide was not provided in-service training after March of 2020. The Administrator stated because of COVID-19 everything went to a standstill and Home Health Aide A, was hired because it was a Medicare requirement to have a home health aide available. The surveyor asked again the reason for not providing continue education /training in 2020, 2021, 2022 and until now. The Administrator responded that the agency did not have any patients for home health aide service. The Administrator added that to provide training she must pay the home health aide for the time she spends for training. Home Health Aide A was not available for interview. Review of agency policy titled “Agency In-service and Education, HR.12” dated 080116, (page 1 of 6) read in part: “1. The Agency will provide ongoing in-service/continuing education programs which are appropriate to job responsibility and to the maintenance of necessary skills. B. All Home Health Aides are required to have at least twelve (12) hours of in-service based on the individual’s employment anniversary….”