Every finding on record at Union First Care Inc

Substantial Allegation Survey Substantial Allegation 103742 and 103664 The following deficiencies are based upon substantial allegation 103742 completed on 02/01/24. No deficiencies were cited related to allegation(s) contained in substantial allegation 103664 also completed on 02/01/24. Union First Care Inc 369218, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a comprehensive assessment was completed the last five days of every 60 days for one of three patients reviewed (Patient #2). This could affect all patients receiving services from the agency. The current active patient census was 76. Findings: Review of Patient #2's medical record revealed a 05/02/23 admission date with diagnoses including chronic pain syndrome, paraplegia, seizures, multiple sclerosis and essential hypertension. Her functional limitations included amputation and endurance. She was up as tolerated and transferred to bed and chair. She was oriented with a fair prognosis. The physician ordered plan of care for the certification period dated 05/02/23 to 06/30/23 revealed orders for home health aide services five times a week for seven hours a day. A 07/26/23 Communication Note revealed the home health aide called the squad for Patient #2 and she was taken to the emergency room and hospitalized. Further review revealed the only physician ordered plan of care in the patient's record was the plan of care for the certification period dated 05/02/23 through 06/30/23. There was no evidence a comprehensive assessment was completed the last five days of the 60-day period. Interview on 01/31/24 at 9:55 A.M. with Staff A revealed the nurse told him she thought she completed a comprehensive assessment before Patient #2 went to the hospital but they did not have one for her record.

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 record review and interview, the agency failed to ensure each patient received home health services as written in the individualized plan of care for one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The active census was 76. Findings include: Review of Patient #1's medical record revealed a 07/20/23 start of care date. Diagnoses included quadriplegia and neuromuscular dysfunction of the bladder. Review of the physician ordered plan of care for the certification period dated 11/17/23 to 01/15/24 revealed orders for home health aide services 16 hours a week for 60 days to assist with personal care, light housekeeping, laundry, meals, errands, and appointments. No skilled nurse needs were identified at this time. A 11/07/23 text at 2:42 P.M. from Staff D revealed she was ill and was missing a visit for Patient #1. There was no evidence the physician was notified services were not provided as ordered. Interview on 01/30/24 at 4:14 P.M. with Staff A verified there was no evidence the physician was notified of the missed visit. This deficiency represents non-compliance investigated under Substantial Allegation 103742.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to notify the physician of a change in the patient's condition for one of three patients reviewed (Patient #2). This could affect all patient's receiving services from the agency. The active patient census was 76. Findings include: Review of Patient #2's medical record revealed a 05/02/23 admission date with diagnoses including chronic pain syndrome, paraplegia, seizures, multiple sclerosis and essential hypertension. Her functional limitations included amputation and endurance. She was up as tolerated and transferred to bed and chair. She was oriented with a fair prognosis. The physician ordered plan of care for the certification period dated 05/02/23 to 06/30/23 revealed orders for home health aide services five times a week for seven hours a day. A 07/26/23 Communication Note revealed the home health aide called the squad for Patient #2 and she was taken to the emergency room. The nurse was notified. There was no documentation as to the condition that precipitated the emergency room visit. Review of a 09/18/23 third party oversight entity request for documentation revealed a request for documentation from 07/23/23 to 08/04/23 regarding the hospitalization and death of the patient. A typewritten document dated 09/23/23 indicated the home health aide notified on 07/26/23 that she called the squad and the patient was taken to the emergency room. She stayed with her until she was admitted and then she left. On 08/07/23 the agency heard from the case manager through a phone call the patient passed away on 08/04/23. Further review revealed there was no documentation related to what symptoms the patient was displaying prior to her transport to the emergency room. There was no evidence to support the physician was notified of the patient's changing condition/hospitalization. Interview on 01/29/24 at 6:31 P.M. with Staff A verified there was no evidence the physician was notified when the patient was transported to the emergency room and hospitalized.

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 personnel record review, policy review, and interview, the agency failed to ensure home health aides received 12 hours of inservice annually for one of one home health aide reviewed for annual inservices (Staff H). This could affect all patients receiving services from the agency. The active patient census was 76. Findings include: Review of Staff H's personnel file revealed a hire date of 02/23/22. Review of Staff H's inservice documentation revealed three one-hour certificates for 2023. Review of the facility's policy titled, Inservice Education, revised October 2017, revealed direct care personnel must have a minimum of 12 hours of ongoing education during each 12 month period. Interview 01/29/24 at 5:39 P.M. with Staff A revealed he thought each class was worth three hours. He indicated staff were to take a class each quarter. He acknowledged the certificates read the classes were worth one hour each and did not fulfill the 12 hour requirement.

Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This ELEMENT is not met as evidenced by: Based on personnel record review, policy review and interview, the clinical manager failed to ensure the agency employs qualified personnel for one of three personnel records reviewed (Staff D). This could affect all patients receiving services from the agency. The active census was 76. Findings include: Review of personnel records revealed Staff D was hired on 04/22/23. On hire she presented a cardiopulmonary resuscitation (CPR)/First Aide/Automated External Defibrillator (AED) certificate issued on 06/18/21 and with an expiration date of 06/18/23. There was no evidence Staff D had a current CPR/First Aide/AED certificate. Review of the facility's policy titled, Personnel Records, revised October 2017, revealed the personnel records will contain CPR, if required. Interview on 01/29/24 at 5:39 P.M. with Staff A revealed they were setting up a class for any employee with an expired CPR certification. At 6:25 P.M. Staff A included they were going to come up with a tracking system. An email 01/30/24 at 3:26 P.M. from Staff A verified Staff D did not have a current CPR certification until it was discovered her certificate expired. Staff D took a CPR class 01/29/24. He verified the aides were to have current CPR/First Aide certification.

SUBSTANTIAL ALLEGATION SURVEY SUBSTANTIAL ALLEGATION 97012 The following deficiencies are based upon substantial allegation OH00097012 completed03/30/23. Union First Care Inc. is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure staff provided personal care while appropriately dressed. This affected one (Patient #1) of four patients whose medical records were reviewed. Findings include: Review of the medical record for Patient #1 revealed a start of care date of 01/05/23. Patient #1's primary diagnosis was Alzheimer's disease. Review of the plan of care for the certification period of 01/05/23 to 03/05/23 revealed home health aide visits 84 hours per week for 60 days. On 03/29/23 at 1:37 PM, the videos taken by Patient #1's daughter in Patient #1's home showed home health aide Staff C providing care while partially nude. Staff C was wearing no shirt or bra while providing care to Patient #1. During interview on 03/30/23 at 10:39 AM, the Administrator, Staff A viewed the video and confirmed Staff C was a home health aide for the agency. During an interview on 03/30/23 at 1:06 PM, Patient #1's daughter was interviewed by phone. She stated she had taken the video which showed Staff C performing care on Patient #1 while partially nude. Patient #1's daughter said this was unprofessional and that is one of the reasons she switched home health agencies. During interview on 03/30/23 at 2:01 PM, Staff C was interviewed by phone. She verified she did provide care to Patient #1 but stated she never provided care "while naked". During interview on 03/30/23 at 3:02 PM, the Administrator stated Staff C had been terminated, but no investigation had been completed related to Staff C providing care while partially nude and no corrective action had been implemented.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to provide all services outlined in the plan of care. The affected one (Patient #1) of four patients reviewed. Findings include: Review of the medical record for Patient #1 revealed a start of care date of 01/05/23. Patient #1's primary diagnosis was Alzheimer's disease. Review of the plan of care for the certification period of 01/05/23 to 03/05/23. The orders on the plan of care were skilled nursing visits one time every 60 days, and home health aide visits 84 hours per week for 60 days. Review of the home health aide care plan also read 84 hours of aide visits per week. Review of the aide time sheets from 01/29/23 to 02/13/23 revealed Staff B and Staff C provided aide visits to the patient. After 02/13/23, Patient #1 was provided a different home health aide, Staff D. Home health aide services were not provided until the week of 01/08/23, which was only 37 hours. The week of 01/15/23, only 28 hours were provided. The week of 01/22/23, only 28 hours were provided. The week of 01/29/23, only 79 hours were provided. The week of 02/05/23, only 60 hours were provided. The week of 02/12/23, only 60 hours were provided. There was no documentation the physician was notified of the missed visits. During interview on 03/30/23 at 3:02 PM, Staff A, the Administrator confirmed the finding of missed visits and shortage of home health aide hours and the lack of physician notification.

Substantial Allegation Survey Substantial Allegation 62761 and 71755 The following deficiencies are based upon substantial allegation 71755 completed on 10/31/22. Union First Care is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies. No deficiencies were issued in regard to allegations contained in substantial allegation 62761.

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 and staff interview, the agency failed to provide home health aide services according to the plan of care. This affected one (Patient #1) of four sampled patients. The census was 28. Findings include: Review of the medical record for Patient #1 revealed a start of care dated 06/17/22 with a primary diagnosis of chronic respiratory failure. Review of the physician ordered plan of care for the certification period 06/17/22 to 08/15/22 and certification period starting again on 09/01/22 revealed the patient was to receive skilled nursing once every 60 days, and home health aide visits 25 hours per week. Review of the patient's home health aide time sheets revealed 22.5 hours the week of 06/19/22. The patient was hospitalized from 07/28/22 to 08/31/22. No time sheets were found or provided for the weeks of 09/04/22, 09/11/22, 09/18/22, 09/25/22, and 10/02/22. During interview on 10/03/22 at 2:15 PM, Staff A confirmed not all the home health aide hours were provided as ordered. Staff A confirmed no missed visit notes or home health aide time sheets were found for the weeks noted above.

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 02/16/21, Union First Care Inc is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Extended Recertification Survey COVID-19 Focused Infection Control Survey An entrance conference was conducted with the CEO/Administrator on 02/08/21, and an exit conference was completed with the CEO/Administrator on 02/16/21. The following deficiency is based on the extended recertification survey completed 02/16/21. Union First Care Inc 369218, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agencies. At the time of the COVID 19 Focused Infection Control Survey completed on 02/16/21, Union First Care Inc is in compliance with the requirements at 42 CFR Part 484.70 related to Infection Control. Union First Care Inc is precluded from providing its own home health aide training and competency testing or competency evaluation program for a period of two years from the date of exit of this survey.

Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient's medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This CONDITION is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure services were provided as written on the plan of care (G572). The cumulative effect of these systemic practices resulted in the agency's inability to ensure the patients' care needs would be met.

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 and staff interview, the agency failed to ensure services were provided as written on the plan of care for seven of seven patients reviewed (Patient #1, #2, #3 #4, #5, #6, and #7). This could affect all patients receiving services from the agency. The census was 22. Findings include: 1. Review of the medical record for Patient #1 was completed on 02/11/21. Review of the physician ordered plan of care for the certification periods dated 10/26/2020 to 12/24/2020 and 12/25/2020 to 02/22/21 revealed a start of care date of 10/26/2020 and a primary diagnosis of quadriplegia. The plan of care included orders for skilled nursing visits seven days per week, three hours on Monday, Wednesday, and Friday for bowel program days and two hours on non-bowel program days, and home health aide visits five hours per day, seven days per week. Review of skilled nursing visit notes revealed the only visit notes found in the record or provided were 10/28/2020, 11/01/2020, 11/15/2020, 11/20/2020, 11/21/2020, 11/22/2020, 11/23/2020, 12/01/2020, 12/02/2020, 12/03/2020, 12/04/2020, 12/05/2020, 12/06/2020, 12/08/2020, and 12/09/2020. A transfer summary was completed on 12/10/2020, and a resumption of care Outcome Assessment and Information Set (OASIS) was completed on 01/05/21. The only skilled nursing visits found after the resumption of care were 01/07/21, 01/14/21, 01/28/21, and 02/07/21. No home health aide visit notes were found in the record or provided. No missed visit notes or physician notification was identified. 2. Review of the medical record for Patient #2 was completed on 02/11/21. The physician ordered plan of care for the certification period dated 12/23/20 to 02/20/21 revealed a start of care date of 12/23/2020 and a primary diagnosis of chronic idiopathic constipation. The plan of care included skilled nursing visits twice per day, seven days per week, and home health aide visits six hours per day, seven days per week. Review of the skilled nursing visit notes revealed the only visit notes found in the record or provided were 01/31/21, 02/01/21, 02/02/21, 02/03/21, 02/04/21, 02/05/21, and 02/06/21. No home health aide visit notes were found or provided. No missed visit notes or physician notification was identified. 3. Review of the medical record for Patient #3 was completed on 02/11/21. The physician ordered plan of care for the certification period dated 01/15/21 to 03/15/21 revealed a start of care date of 01/15/21 and a primary diagnosis of quadriplegia. The plan of care included skilled nursing visits three hours per day, seven days per week. Review of the skilled nursing visit notes revealed documentation that services were provided daily for three and a half hours, not three hours. There was no documentation services were provided on 01/16/21, 01/17/21, 01/23/21, 01/24/21, or 01/30/21. There was no documentation of missed visits or physician notification. An interview with Staff A on 02/11/21 at 10:00 AM revealed Patient #3 received skilled nursing visits Monday through Friday and the patient's mother provided care on the weekends. 4. Review of the medical record for Patient #4 was completed on 02/11/21. The physician ordered start of care for the certification period dated 12/30/2020 to 02/27/21 revealed a start of care date of 10/31/2020 and a primary diagnosis of bipolar disorder. The plan of care included skilled nursing visits twice per day, seven days per week, and home health aide visits four hours per day, seven days per week. The patient had a resumption of care OASIS completed on 01/12/21. The only skilled nursing visit notes found in the record or provided after the resumption of care was 01/13/21 and 01/14/21. No home health aide visits notes were found in the record or provided. No missed visit notes or physician notification was identified. 5. Review of the medical record for Patient #5 was completed on 02/11/21. The physician ordered plan of care for the certification period dated 02/05/21 to 04/05/21 revealed a start of care date of 12/07/2020 and a primary diagnosis of generalized anxiety disorder. The plan of care included skilled nursing visits one time every 60 days, and home health aide visits 42 hours per week. No home health aide visit notes were found in the record or provided. No missed visit notes or physician notification was identified. 6. Review of the medical record for Patient #6 was completed on 02/11/21. The physician ordered plan of care for the certification period dated 01/10/21 to 03/10/21 revealed a start of care date of 11/11/2020 and a primary diagnosis of adrenogenital disorder. The plan of care included skilled nursing visits one hour per day, seven days per week, and home health aide visits four hours per day, seven days per week. The visit to conduct the recertification OASIS completed on 01/06/21 was the only visit found in the record. There were no other skilled nursing visit or home health aide visit notes in the record or provided. No missed visit notes or physician notification was identified. 7. Review of the medical record for Patient #7 was completed on 02/11/21. The physician ordered plan of care for the certification period dated 01/08/21 to 03/08/21 revealed a start of care date of 01/08/21 and a primary diagnosis of chronic respiratory failure. The plan of care included skilled nursing visits 16 hours per week on Saturdays and Sundays. Review of the skilled nursing visit notes revealed the only notes found in the record or provided were 01/09/21 for one hour and 01/10/21 for 8 hours. No missed visit notes or physician notification was identified. These findings were confirmed with Staff A in an interview on 02/10/21 at 10:45 AM and 02/11/21 at 11:00 AM.

Non-skilled direct observation every 60 days CFR(s): 484.80(h)(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, the registered nurse must make an on-site visit to the location where the patient is receiving care no less frequently than every 60 days in order to observe and assess each aide while he or she is performing care. This ELEMENT is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure that if home health aide services were provided to a patient who was not receiving skilled care, the registered nurse must make an on-site visit to the location where the patient was receiving care no less frequently than every 60 days in order to observe and assess each aide while he or she is performing care for one of one records reviewed for a patient receiving home health aide services only (Patient #5). A total of seven patient records were reviewed. The census was 22. Findings include: 1. Review of the medical record for Patient #5 was completed on 02/11/21. The physician ordered plan of care for the certification period dated 02/05/21 to 04/05/21 revealed a start of care date of 12/07/2020 and a primary diagnosis of generalized anxiety disorder. The plan of care included skilled nursing visits one time every 60 days, and home health aide visits 42 hours per week. There was no evidence a home health aide supervisory visit was conducted while the aide was present and providing services at the time of the recertification assessment. This finding was confirmed in an interview with Staff A on 02/11/21 at 11:30 AM.