Every finding on record at Unique Home Health Care Agency, LLC

On 12/5/23 through 12/8/23, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Unique Home Health Care Agency, LLC. This was a standard survey. The requirements for participation in Medicare at 42 CFR 484.102 Emergency Preparedness were not reviewed.

The following standard level deficiencies were identified during a Medicare authorized Recertification survey conducted by the Michigan Department of Licensing and Regulatory Affairs on 12/5/23 through 12/8/23 at: Unique Home Health Care Agency, LLC 32985 Hamilton Ct., Ste 100B Farmington Hills, MI 48334 Records reviewed: 3 records with home visits, 2 discharged records, and 2 active records without home visits. At the conclusion of the survey, this Agency was found to be non-compliant, at a standard level, with the Conditions of Participation at subpart 42 CFR 484 for Home Health Agencies.

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure the Initial Comprehensive Assessment accurately reflected the patient's condition at the time of admission and documented the events that lead to the need for home care for 6 (P#'s 1, 2, 3, 4, 5, 6) patients admitted to this agency, from a total of 7 sampled records reviewed, resulting in the potential for unidentified health concerns and unmet care needs. Findings include: P-4: The patient's start of care (SOC) was 10/27/23 with diagnoses that included Surgical Wound, Cancer and Atrial fibrillation. On 12/6/23 at 1:00 p.m., during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 10/27/23, which was the date care began. There was no clearly documented history or rational that lead to the need for home care referral. P-5: The patient's SOC was 9/24/23 with diagnoses that included Hypertension, Osteoarthritis of knees and hips and abnormal gait. On 12/6/23 at 2:00 p.m., during the record review, it was noted that the Initial Comprehensive Assessment listed 6 diagnoses which included repeated falls, generalized weakness, Osteoarthritis and Hypertension with an onset date of 9/24/23, the date care began. There was no documented history of the events that lead to the need for home care referral. P-6: The patient's SOC was 10/22/23 with diagnoses that included Non-Pressure Chronic Ulcers Bilateral Calves, Peripheral Vascular disease and Hypertension. During the record review on 12/7/23 at 8:55 a.m., it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset as the date of admission to this agency. The patient was transferred to an inpatient facility on 10/27/23 and resumed care with this agency on 11/1/23. The Resumption of Care Assessment listed all diagnoses for the date the patient resumed services. The Agency failed to document a clear clinical picture for the above-mentioned patients at the time of admission. These findings were reviewed with and acknowledged by the Administrator during an interview on 12/7/23 at 1:30 p.m. P-1: The patient's start of care (SOC) was 10/27/23, with diagnoses that included venous insufficiency, non-pressure chronic ulcer, and diabetes mellitus. On 12/5/23, during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 8/27/23. There were no documented diagnoses history, onset, or previous treatments in the SOC assessment. Under each body system section of the SOC assessment, there was a lack of information documented to ascertain home care needs. P-2: The patient's start of care (SOC) was 9/15/23, with diagnoses that included venous insufficiency, non-pressure chronic ulcer, and diabetes mellitus. On 12/6/23, during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 9/15/23. There were no documented diagnoses history, onset, or previous treatments in the SOC assessment. Under each body system section of the SOC assessment, there was a lack of information documented to ascertain home care needs. P-3: The patient's start of care (SOC) was 1/13/23, with diagnoses that included neuromuscular dysfunction of bladder, urogenital implant, and hypertension. On 12/7/23, during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 1/13/23. There were no documented diagnoses history, onset, or previous treatments in the SOC assessment. Under each body system section of the SOC assessment, there was a lack of information documented to ascertain home care needs. During an interview on 12/8/23 at 1:00 p.m., the administrator (Adm #1) acknowledged the above findings. P-1: The patient's start of care (SOC) was 10/27/23, with diagnoses that included venous insufficiency, non-pressure chronic ulcer, and diabetes mellitus. On 12/5/23, during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 8/27/23. There were no documented diagnoses history, onset, or previous treatments in the SOC assessment. Under each body system section of the SOC assessment, there was a lack of information documented to ascertain home care needs. P-2: The patient's start of care (SOC) was 9/15/23, with diagnoses that included venous insufficiency, non-pressure chronic ulcer, and diabetes mellitus. On 12/6/23, during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 9/15/23. There were no documented diagnoses history, onset, or previous treatments in the SOC assessment. Under each body system section of the SOC assessment, there was a lack of information documented to ascertain home care needs. P-3: The patient's start of care (SOC) was 1/13/23, with diagnoses that included neuromuscular dysfunction of bladder, urogenital implant, and hypertension. On 12/7/23, during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 1/13/23. There were no documented diagnoses history, onset, or previous treatments in the SOC assessment. Under each body system section of the SOC assessment, there was a lack of information documented to ascertain home care needs. During an interview on 12/8/23 at 1:00 p.m., the administrator (Adm #1) acknowledged the above findings. P-4: The patient's start of care (SOC) was 10/27/23 with diagnoses that included Surgical Wound, Cancer and Atrial fibrillation. On 12/6/23 at 1:00 p.m., during the clinical record review, it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset date of 10/27/23, which was the date care began. There was no clearly documented history or rational that lead to the need for home care referral. P-5: The patient's SOC was 9/24/23 with diagnoses that included Hypertension, Osteoarthritis of knees and hips and abnormal gait. On 12/6/23 at 2:00 p.m., during the record review, it was noted that the Initial Comprehensive Assessment listed 6 diagnoses which included repeated falls, generalized weakness, Osteoarthritis and Hypertension with an onset date of 9/24/23, the date care began. There was no documented history of the events that lead to the need for home care referral. P-6: The patient's SOC was 10/22/23 with diagnoses that included Non-Pressure Chronic Ulcers Bilateral Calves, Peripheral Vascular disease and Hypertension. During the record review on 12/7/23 at 8:55 a.m., it was noted that the Initial Comprehensive Assessment listed all diagnoses with an onset as the date of admission to this agency. The patient was transferred to an inpatient facility on 10/27/23 and resumed care with this agency on 11/1/23. The Resumption of Care Assessment listed all diagnoses for the date the patient resumed services. The Agency failed to document a clear clinical picture for the above-mentioned patients at the time of admission. These findings were reviewed with and acknowledged by the Administrator during an interview on 12/7/23 at 1:30 p.m.

Patient's needs CFR(s): 484.55(c)(4) The patient's medical, nursing, rehabilitative, social, and discharge planning needs; This ELEMENT is not met as evidenced by: Based on record review and interview, it was determined that the Agency failed to ensure the patient's Activity of Daily Living needs were adequately met in the patient's home for 1 (P-6) patient who required assistance with grooming, from a total of 7 sampled records review, resulting in the potential for poor hygiene, loss of self-esteem and unmet care needs. Findings include: P-6: The patient's start of care was 10/22/23 with diagnoses that included Non-Pressure Chronic Ulcer Bilateral Calves, Peripheral Vascular Disease, Stroke and Hypertension. The plan of care ordered Skilled Nursing to address wound care. On 12/7/23 at 8:55 a.m., during the clinical record review, it was noted that the Initial Comprehensive Assessment dated 10/22/23 documented, Availability of Assistance: occasional/short-term, impaired mobility, severe shortness of breath, high risk of falls." The Skilled Nursing visit note dated 11/4/23 documented "Patient lives alone. Can't do dressing change himself." A Skilled Nursing visit note dated 11/7/23 documented, "Lives alone. No family support. Severe Shortness of Breath." Upon further review of the record, there was no documented evidence that a Home Health Aide was offered or provided to assist with grooming. These findings were reviewed with and acknowledged by the Administrator during an interview on 12/7/23 at 1:15 p.m.

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 record review and interview, the Agency failed to ensure the plan of care included all the required elements to meet the individualized needs for 4 (P#'s 2, 3, 4, 5) patients, from a total of 7 sampled records reviewed, resulting in the potential for lack of required care and treatment. Findings include: P-4: The patient's start of care (SOC) was 10/27/23 with diagnoses that included Surgical wound left Parietal Scalp, Cancer and Atrial Fibrillation. During the record review on 12/6/23 at 1:00 p.m., it was noted that the plan of care (POC) listed all diagnoses with an onset date of 10/27/23, which was the date of admission. The POC was vague in nature, such as, "instruct patient and caregiver on signs of infection..., interventions to address underlying risk factors..." Additionally, the POC was void of any goals. These findings were reviewed with and acknowledged by the Administrator during an interview on 12/7/23 at 12:45 p.m. P-5: The patient's SOC was 9/24/23 with diagnoses that included Hypertension, Osteoarthritis of knees and hips and Abnormal gait. During the record review on 12/6/23 at 2:00 p.m., it was noted that the POC listed all diagnoses with an onset date of 9/24/23. The POC was incomplete and vague with blank areas such, as “Disease process management_____ (blank space), Energy conservation techniques, Measures to detect and alleviate fluid retention… The interventions did not include measures to achieve the specified tasks. Additionally, the goals were not measurable such as, “be free of pain by..., maintain healthy weight…” These findings were reviewed with and acknowledged by the Administrator during an interview on 12/7/23 at 1:03 p.m. P-2: The patient's SOC was 9/15/23, with diagnoses that included venous insufficiency, non-pressure chronic ulcer, and hypertension. During the record review on 12/7/23, it was noted that the goals on the plan of care (POC) were not measurable, such as, “Patient will recognize side effects of medications, and diarrhea will be under control.” There was no evidence of how these goals could be objectively measured to ascertain progress toward goals. P-3: The patient's start of care (SOC) was 1/13/23, with diagnoses that included neuromuscular dysfunction of bladder, urogenital implant, and hypertension. On 12/7/23, during the clinical record review, it was noted that the goals on the POC were not measurable, such as, “Patient will demonstrate energy conservation techniques by...., patient will demonstrate increased endurance by....” There was no evidence of how these goals could be objectively measured to ascertain progress toward goals. These findings were reviewed with and acknowledged by the Administrator (Adm#1) during an interview on 12/8/23 at 1:00 p.m.

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 ensure the Physician was promptly notified of a significant change in condition for 1 (P-6) of 1 patient who experienced increased wound drainage, from a total of 7 sampled records reviewed, resulting in the potential for development of or untreated infection and unmet care needs. Findings include: P-6: The patient's start of care was 10/22/23 with diagnoses that included Non-Pressure Chronic Ulcer Bilateral Calves, Peripheral Vascular Disease, Stroke and Hypertension. The plan of care ordered Skilled Nursing to address wound care. On 12/7/23 at 8:55 a.m., during the clinical record review, it was noted that the Skilled Nursing visit notes dated 11/19/23 and 11/26/23 both documented, "Wound discharge increased." Upon further review, there was no documented evidence that the Physician had been notified of the patient's change in condition. These findings were reviewed with and acknowledged by the Administrator during an interview on 12/7/23 at 1:15 p.m.