Every finding on record at United Hebrew of New Rochelle Certified Home Health Agency, Inc.

A standard re-certification survey of United Hebrew of New Rochelle Certified Home Health Agency, located at 40 Willow Drive New Rochelle, NY 10803 was initiated on 11/27/2023 and exited on 11/30/2023 to evaluate the Agency’s compliance with Federal Conditions of Participation and State requirements. Deficiency practices were identified within Level I standards in Plan of Care CoP 484.60 ( G574) expanding to a partially extended survey. The Home Health Care Agency reported an active total census of 18 patients at the entrance conference on 11/27/2023. The survey consisted of a review of seven (7) Clinical Records (Patients #1, #2, #3, #4, #5, #6, and #7); two (2) discharge records, three (3) observational home visits, and eight (8) records for Professionals and Paraprofessional personnel (Employees #1, #2, #3, #4, #5, #6, #7, and #8) . The Agency’s Quality Assurance and Performance (QAPI) Program; QAPI Committee meeting minutes for the past twelve (12) months; the complaint log from 11/1/2022 through 11/27/23; the Emergency Preparedness Plan; the Health Commerce System Policy; the Influenza Vaccination Policy; The Covid-19 and Infection Control Policy and the Covid-19 vaccination policy; the Agency Infection Control Program; and other pertinent Policies; the agency's admission packet; the complaint log for 2023. Pre-survey activities consisted of a review on11/21/2023 of the agency's Health Commerce System account, Certification and Survey Provider Enhanced Reports (CASPER) for the period of 09/02/2022 to 8/17/2023., and the Agency's compliance with report submissions for the 2022 statistical report and the Emergency Drill submission for 2022. The Director of Patient Services was interviewed. The findings were reviewed at the exit conference on 11/30/2023. The following deficiencies are identified as a result of the survey: Federal Deficiencies: G - 0434 Participate in Care G - 0512 - Initial Assessment Visit G - 0572 - Plan of Care G - 0574 - Plan of Care Must Include the Following G - 0578 - Conformance with physician orders G - 0590 - Promptly alert relevant physician of changes G - 0798 - Home Health Aide Assignments and Duties State Deficiencies J - 1128 - Governing Authority J - 1276 - Governing Authority J - 1412 - Personnel J - 1432 - Personnel J - 1444 - Personnel J- 1520 - Records and Reports

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on Clinical record reviews and staff interview, the agency failed to ensure that patients are advised of the frequencies of all services to be furnished at the start of care. This was evident for three (3) of seven (7) records reviewed. (Patient #1, #3, and #5). Failure to ensure that patients and/or caregivers are advised of the frequencies of all services to be furnished at the start of care has the potential for negative patient outcomes. The findings are: 2. Patient #3 has a start of care date of 11/9/23. The “ Home Health Certification and Plan of Care dated 11/10/23 documents:” Aide, three times a week for two weeks beginning week of 11/15/23. The form titled:” Patient Plan of Care” lacks documented evidence that the patient was informed about aide services. 3. Patient #5 has a start of care date 11/13/23. The form titled:” Patient Plan of Care” lacks documented evidence that the patient was informed about the frequency and duration of Physical Therapy visits and services. During an interview with the Director of Patient Services on 11/29/23 at 12:00 PM no explanation was provided. 1. Patient #1 has a start of care date of 10/2/23 with diagnoses of Cerebral Vascular Accident with Hemiplegia, Type Two Diabetes Mellitus, and Chronic Pain as documented on the Home Health Care Certification and Plan of Care dated 10/2/23 through 11/30/23. The initial Patient's rights titled "Plan of Care" dated 10/2/23 documenting the services and frequency the Patient is to receive is not signed by the Patient and or the Patient's representative. The record documents the Patient started home health aide services on 10/10/23. The record lacks documented evidence the patient's rights was updated to include the home health aide and frequency of services. During an interview with the Director of Patient Services (DPS) on 11/28/23 at 12:00 PM, the DPS did not provide an explanation for the above.

Standard: Initial assessment visit. CFR(s): 484.55(a) Standard: Initial assessment visit. This STANDARD is not met as evidenced by: Based on record review and staff interview the agency failed to ensure that the initial assessment visit by a Registered Nurse (RN) is held within 48 hours of referral or the physician ordered start of care. This was evident for one (1) of seven (7) clinical records reviewed. (Patient #5). Failure to ensure that the initial assessment visit is held by an RN within 48 hours of referral, or the physician ordered start of care has the potential for negative patient outcomes. The findings are: Patient #5 has a start of care date of 11/13/23 with diagnosis that include Essential Hypertension as documented on the “ Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024. The “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024 documents: "Skilled Nursing to assess and evaluate. Interventions: Skilled Nursing to assess current pain management regimen including relief measures, effectiveness and side effects. Skilled Nursing to teach patient caregiver regarding medications and medications management". The " Resident face Sheet" dated 11/3/23 with an attached email dated 11/3/23 documents:" Attached referral for skilled homecare services, PT/OT/hha/RN (Physical Therapy, Occupational Therapy, Home Health Aide, Registered Nurse). Resident has a discharge date of Friday 11/10/23. Will send additional notes next week". There is no documented evidence of additional referral notes in the clinical record. The "Skilled Nursing Visit Note" dated 11/13/23 documents the RN Start of Care admission visit. There is no documented evidence the initial assessment was held within 24 hours of referral. There is no documented evidence the Physician was notified of the delay in the start of care. On 11/29/23 at 2:30PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings.

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 reviews and staff interviews, the agency failed to ensure that an individualized plan of care is developed for all patients based on the comprehensive assessment, and the patients' medical diagnoses that specify the patients' needs for home care services. This was evident for one (1) of seven (7) clinical records reviewed. (Patient #5). Failure to ensure that an individualized plan of care is developed for all patients based on the comprehensive assessment and patients' medical diagnosis that specify patients' needs for home care services has the potential for negative patient outcomes. The findings are: Patient #5 has a start of care date of 11/13/23 with diagnosis that include Essential Hypertension as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024. The “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024 documents: "Skilled Nursing to assess and evaluate. Interventions: Skilled Nursing to assess current pain management regimen including relief measures, effectiveness and side effects. Skilled Nursing to teach patient caregiver regarding medications and medications management”. The "Skilled Nursing Visit Note" dated 11/13/23 documents: "Patient referred for home care services post inpatient rehabilitation due to Diverticulitis/ Clostridium Difficile and underwent Laparoscopic Sigmoid Collecting". Physical Therapy initiated to assess and evaluate to address all deficit". The form titled “Patient Plan of Care” dated 11/13/23 signed by the patient documents” Skilled Nursing assess and evaluate. Physical Therapy assess and evaluate”. There is no documented evidence of an order for Physical Therapy in the Plan of Care. There is no documented evidence of diagnoses Diverticulitis and Clostridium Difficile in the Plan of Care. There is no documented evidence of the type of services the patient is to receive in the Plan of Care. There is no documented evidence of the frequency of visits and duration of services in the Plan of Care. There is no documented evidence an individualized plan of care was developed based on the comprehensive assessment and the patient's medical diagnosis that specify the patient's needs for home care services. On 11/30/2023 at 12:30 PM, the Director of Patient Services was interviewed and stated "The process is incomplete. The physical therapy referral was lost, and the Physical Therapist saw the patient yesterday. The system lost the data". On 11/30/23 at 4:30PM, the Director of Patient Services stated:" Patient is receiving only nursing services. There is a lapse between 11/13/23 and 11/27/23". No further explanation was provided.

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 clinical record review and staff interview the agency failed to ensure a complete Plan of Care (POC) was developed to meet the individualized needs of the patient in five (5) of seven (7) records (Patients #1, #2, #3, #4, and #5). Failure to develop a comprehensive POC has the potential for negative patient outcomes. The findings are: 3. Patient #3 has a start of care date of 11/9/2023 with diagnosis of Essential Hypertension as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/9/2023 to 1/7/2023. The “Home Health Certification and Plan of Care” for the Certification Period of 11/9/2023 to 1/7/2023 documents:” Orders/ Treatments, Discipline Orders: Skilled Nursing to assess and evaluate. Physical Therapy twice a week for three weeks beginning the week of 11/14/2023. Medications: Amlodipine 10 mg one tablet oral once a day, Aspirin Enteric Coated 81 mg oral delayed release tablet once a day, and Eliquis 2.5 mg oral tablet once a day”. The Oasis assessment dated 11/9/23 documents:” Patient referred for Home Care services post short inpatient stay with total knee replacement, Tachycardia, Pulmonary Embolism, and Chronic Kidney Disease Stage 4. There is no documented evidence of a list of current diagnoses in the Plan of Care. There is no documented evidence of Blood Pressure Parameters for Physician notification. There is no documented evidence the Pan of Care is complete. 4. Patient #4 has a start of care date of 11/8/2023 with diagnoses to include Type I Diabetes Mellitus with Autonomic Poly Neuropathy, Gastroparesis, Essential Hypertension, and Long-Term Current Use of Insulin as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/8/2023 to 1/6/2023. The “Home Health Certification and Plan of Care” for the Certification Period of 11/8/2023 to 1/6/2023 documents:” Orders/ Treatments, Discipline Orders: Skilled Nursing to assess and evaluate; Physical Therapy twice a week for three weeks beginning the week of 11/13/2023; Medications Humalog Kwik Pen 100 units/ ml injectable solution inject 0 units three times a day before meals. Insulin sliding scale FSBS 150-250 = 5 units, 251-300 = 6 units, 301-350 = 7 units, 351- 400 = 8 units, If greater than 350 or below 70 call Physician; Lantus Solostar Pen 100 units/ml subcutaneous solution inject 6 units subcutaneous 2 times a day, at 8:00AM and 10:00PM, Hydrochlorothiazide 25 mg tablet oral once a day, Nifedipine 30 mg tablet extended oral once a day, and Hydralazine 25 mg tablet, one tablet every 8 hours”. There is no documented evidence of Blood Pressure Parameters for Physician notification. There is no documented evidence of the person responsible to administer the Finger sticks and the Insulin, and the person responsible to notify the Physician in the event of hypo or hyperglycemia. There is no documented evidence the Plan of Care is complete. 5. Patient #5 has a start of care date of 11/13/23 with diagnosis that include Essential Hypertension as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024. The “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024 documents:” Skilled Nursing to assess and evaluate; Interventions: Skilled Nursing to assess current pain management regimen including relief measures, effectiveness and side effects. Skilled Nursing to teach patient caregiver regarding medications and medications management”. The "Skilled Nursing Visit Note" dated 11/13/23 documents: "Patient referred for home care services post inpatient rehabilitation due to Diverticulitis/ Clostridium Difficile and underwent Laparoscopic Sigmoid Collecting". Physical Therapy initiated to assess and evaluate to address all deficit". The form titled “Patient Plan of Care” dated 11/13/23 signed by the patient documents” Skilled Nursing assess and evaluate. Physical Therapy assess and evaluate”. There is no documented evidence of an order for Physical Therapy in the Plan of Care. There is no documented evidence of diagnoses Diverticulitis and Clostridium Difficile in the Plan of Care. There is no documented evidence of the type of services the patient is to receive in the Plan of Care. There is no documented evidence of the frequency of visits and duration of services in the Plan of Care. There is no documented evidence the Plan of Care is complete. On 11/30/2023 at 12:30PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. 1. Patient #1 has a start of care date of 10/2/23 with diagnoses of Cerebral Vascular Accident with Hemiplegia, Type Two Diabetes Mellitus, and Chronic Pain as documented on the Home Health Care Certification and Plan of Care dated 10/2/23 through 11/30/23. The Home Health Care Certification and Plan of Care (POC) dated 10/2/23 through 11/30/23 documents: Skilled Nursing (SN) to assess and evaluate; Physical Therapy (PT) to assess and evaluate then 1 x 1 week, 2 x week x 3 weeks; Occupational Therapy (OT) assess than 3 x weeks two weeks then 2 x week x 4 weeks; medications include Glimepiride and Jardiance (antidiabetic medications), Chlorthalidone and Enalapril (antihypertensives), Acetaminophen 325 mg two tablets every 8 hours as needed for pain. The record documents the Patient received a home health aide five (5) days a week for four (4) hours a day. The POC lacks documented evidence of revision to include aide services and aide tasks. There is no documented evidence of Blood Pressure Parameters and pain parameters for Physician notification. The POC does not document whether the Patient is testing their blood glucose. There is no documented evidence the Pan of Care is complete. 2. Patient #2 has a start of care date of 8/23/23 with diagnosis of Essential Hypertension as documented on the Home Health Care Certification and Plan of Care dated 8/23/23 through 10/21/23. The Home Health Care Certification and Plan of Care dated 8/23/23 through 10/21/23 documents a diagnosis of Essential Hypertension; SN to assess and evaluate; PT assess then 1 x1 x 1 week then 2 x2 weeks; medications include Cefuroxime (antibiotic), Cranberry tablets, Tamsulosin Urinary Retention (Benign Prostatic Hyperplasia), and Gabapentin (nerve pain). The SN assessment dated 8/23/23 documents the Patient has diagnoses of Arthritis and Chronic Pain; "blood pressure 97/57, vital signs outside the acceptable range for this patient (95/60 to 140/90)". The hospital discharge summary dated 8/22/23 documents the Patient has diagnoses to include Benign Prostatic Hyperplasia (BPH) and Urinary Tract Infection (UTI). The PT visits dated 8/28/23, 8/30/23, 9/5/23, 9/8/23, 9/11/23 and 9/14/23 document the Patient has pain to the knees and the Patient is using OTC (over the counter pain) pain medications. The notes do not document the name of the OTC medications, dosage, and frequency. The POC does not document the diagnoses of Arthritis, Chronic Pain, BPH and UTI and the OTC pain medication. The POC does not document parameters for blood pressure and pain for physician notification. There is no documented evidence the Pan of Care is complete. During an interview with the Director of Patient Services (DPS) on 11/28/23 at 12:00 PM, the DPS did not provide an explanation for the above.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on clinical records review and staff interviews, the agency failed to ensure that pertinent patient services and treatments are performed in conformance to the Physician's Order. This was evident in four (4) of seven (7) records reviewed. (Patients #1, #2, #3, and #5) Failure to ensure that pertinent patient services and treatments are performed has the potential for negative patient outcomes. The findings are: 3. Patient #3 has a start of care date of 11/9/23 with diagnoses that includes Essential Hypertension as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/9/2023 to 1/7/2023. The “Home Health Certification and Plan of Care” for the Certification Period of 11/9/2023 to 1/7/2023 documents: "Orders/ Treatments, Discipline Orders: Skilled Nursing to assess and evaluate. Physical Therapy twice a week for three weeks beginning the week of 11/14/2023. Medications: Acetaminophen 500 mg oral 2 caps (capsules), Amlodipine 10 mg one tablet oral once a day, Aspirin Enteric Coated 81 mg oral delayed release tablet once a day, Eliquis 2.5 mg oral tablet once a day, Alopurinol 100 mg tab oral (PO) once a day, Atorvastatin 10 mg tab PO once a day (QD),Glucosamine 500 mg PO QD, Labetalol 300 mg tab PO QD, Pantoprazole 40 mg oral delayed release one tab PO QD, Senna 8.6 mg PO QD at bedtime, Tamsulosin 0.4 mg PO caps once a day, Vit B12 1000 mcg oral one tab PO QD. Aide, three times a week for two weeks beginning week of 11/15/23". On 11/29/23 at 11:00AM, during an observational home visit, the surveyor observed two sets of medications in the home: blister packs and medication bottles. The patient stated:" I am taking what's in the bottles". The patient states that he is not sure which set of medications to take. The surveyor reviewed the following medication bottles: Atorvastatin 40 mg daily filled date 9/21/23, Lisinopril 10 mg Twice a day (BID) filled date 4/28/23, Allopurinol 300 mg daily filled date 8/29/23, Amlodipine 5 mg daily filled date 7/19/23, Hydrochlorothiazide 25 mg daily filled date 7/6/2023Phentermine 15 mg caps daily filled date 10/2/23, Diazepam 5 mg daily every 8-12 hours pain and spasm, Calcitriol 0.25 meq filled date 9/1/23". There is no documented evidence of medication reconciliation by the nurse or the Physical Therapist. There is no documented evidence of Aide Plan of Care in the home. On 11/28/23 at 12:00PM and 11/30/23 at 3:30PM, the surveyor requested the aide plan of care and aide activity sheets from 11/15/23 to 11/30/23. The documentation was not received. There is no documented evidence the aide services were provided in accordance with the Plan of Care. 4. Patient #5 has a start of care date of 11/13/23 with diagnosis that include Essential Hypertension as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024. The “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024 documents: "Skilled Nursing to assess and evaluate. Interventions: Skilled Nursing to assess current pain management regimen including relief measures, effectiveness and side effects. Skilled Nursing to teach patient caregiver regarding medications and medications management”. The form titled “Patient Plan of Care” dated 11/13/23 signed by the patient documents” Skilled Nursing assess and evaluate. Physical Therapy assess and evaluate”. There is no documented evidence of an order for Physical Therapy in the Plan of Care. There is no documented evidence of the type of services the patient is to receive in the Plan of Care. There is no documented evidence of the frequency and duration of physical therapy services. On 11/30/23 at 12:30PM, the Director of Patient Services was interviewed and stated:" The Physical Therapy referral was lost, and the Physical Therapist saw the patient yesterday. The system has lost the data". No further explanation was provided. 1. Patient #1 has a start of care date of 10/2/23 with diagnoses of Cerebral Vascular Accident with Hemiplegia, Type Two Diabetes Mellitus, and Chronic Pain as documented on the Home Health Care Certification and Plan of Care dated 10/2/23 through 11/30/23. The Home Health Care Certification and Plan of Care (POC) dated 10/2/23 through 11/30/23 documents: Skilled Nursing (SN) to assess and evaluate; Physical Therapy (PT) to assess and evaluate then 1 x 1 week, 2 x week x 3 weeks; Occupational Therapy (OT) assess than 3 x weeks two weeks then 2 x week x 4 weeks; medications include Acetaminophen 325 mg two tablets every 8 hours as needed for pain. The SN assessment dated 10/2/23 documents: generalized pain, pain interferes with activity and movement. The assessment does not include a comprehensive assessment to include the amount and frequency the Acetaminophen is being used. The PT notes between 10/3/23 through 11/16/23 lack documented evidence of a complete pain assessments to include the amount and frequency the Acetaminophen is being used. The OT made an assessment on 10/6/23 documents the Patient has Arthritis. The assessment lacks documented evidence of a complete pain assessment to include location, rating and the amount and frequency the Acetaminophen is being used. 2. Patient #2 has a start of care date of 8/23/23 with diagnosis of Essential Hypertension as documented on the Home Health Care Certification and Plan of Care dated 8/23/23 through 10/21/23. The Home Health Care Certification and Plan of Care dated 8/23/23 through 10/21/23 with diagnosis of Essential Hypertension; SN to assess and evaluate; PT assess then 1 x1 x 1 week then 2 x 2 weeks; medications include Cefuroxime (antibiotic), Cranberry tablets, Tamsulosin Urinary Retention (Benign Prostatic Hyperplasia), Gabapentin (nerve pain). The nursing assessment dated 8/23/23 documents the Patient has chronic pain. The assessment does not document the location of the pain, the rating and the effectiveness of the pain medication. The PT visits dated 8/28/23, 8/30/23, 9/5/23, 9/8/23, 9/11/23 and 9/14/23 document the Patient has pain to the knees and the Patient is using OTC (over the counter) pain medications. The note does not specify the name of the OTC medication and the frequency the patient is using it. During an interview with the Director of Patient Services (DPS) on 11/28/23 at 12:00 PM, the DPS did not provide an explanation for the above.

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 clinical record review and staff interview the clinical records lack documented evidence that changes that would alter the Plan of Care (POC) are promptly communicated to the physician. This was evident in three (3) of seven (7) records reviewed. (Patients #2, #4 and #5). Failure to consult with the physician when changes occur in the patient's condition has the potential for negative patient outcomes. The findings are: 2. Patient #4 has a start of care date of 11/8/2023 with diagnoses that include Type I Diabetes Mellitus with Autonomic Poly Neuropathy, Gastroparesis, Essential Hypertension, Long Term Current Use of Insulin as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/8/2023 to 1/6/2023. The “Home Health Certification and Plan of Care” for the Certification Period of 11/8/2023 to 1/6/2023 documents:” Orders/ Treatments, Discipline Orders: Skilled Nursing to assess and evaluate. Physical Therapy twice a week for three weeks beginning the week of 11/13/2023". On 11/28/23 at 11 AM, during an observational home visit, the patient reports a internal gastric pump was inserted for his gastroparesis. There is no documented evidence of how to use the pump and to notify the physician in case of pump malfunction. The patient complains of a fungus on his buttocks that is getting worse. The patient stated:" Last week it was unbearable to sit". The " Physical Therapy Visit Note" documented the following visits: 11/13/23, 11/19/23, 11/21/23, and 11/27/23. The therapist present during the home visit stated:" In terms of your medications, it's out of my range. I am here for your balance and other stuff. I will pass on your complaints". There is no documented evidence the patient's complaint of the fungus was reported to the nurse in previous visits. There is no documented evidence the fungus episode was reported to the physician. On 11/29/23 at 2:45 PM, the Director of Patient Services was interviewed and did not provide an explanation for the findings. 3. Patient #5 has a start of care date of 11/13/23 with diagnosis that include Essential Hypertension as documented on the “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024. The “Home Health Certification and Plan of Care” for the Certification Period of 11/13/2023 to 1/11/2024 documents:” Skilled Nursing to assess and evaluate. Interventions: Skilled Nursing to assess current pain management regimen including relief measures, effectiveness and side effects. Skilled Nursing to teach patient caregiver regarding medications and medications management”. The form titled “Patient Plan of Care” dated 11/13/23 signed by the patient documents” Skilled Nursing assess and evaluate. Physical Therapy assess and evaluate”. From 11/13/23 to 11/28/23, there is no documented evidence of a Physical Therapy evaluation or visits. There is no documented evidence the Physician was informed of the missed visits of Physical Therapy. There is no documented evidence the Physician was notify of the lapse in services for 16 days. On 11/30/23 at 4:30PM, the Director of Patient Services was interviewed and stated:” The process is incomplete. The Physical Therapy referral was lost. The system has lost the data. There was no order for Physical Therapy until 11/27/23. There is a lapse between 11/13/to 11/28/23. The focus was for rehab. Patient is receiving only nursing services". No further explanation was provided. 1. Patient #2 has a start of care date of 8/23/23 with diagnosis of Essential Hypertension as documented on the Home Health Care Certification and Plan of Care dated 8/23/23 through 10/21/23. The Home Health Care Certification and Plan of Care dated 8/23/23 through 10/21/23 documents diagnosis of Essential Hypertension; SN to assess and evaluate; PT assess then 1 x1 x 1 week then 2 x 2 weeks; medications include Cefuroxime (antibiotic), Cranberry tablets, Tamsulosin Urinary Retention (Benign Prostatic Hyperplasia), Gabapentin (nerve pain). The nursing assessment dated 8/23/23 documents: the Patient's "blood pressure is 97/57, vital signs outside the acceptable range for this patient (95/60 to 140/90)". There is no documented evidence the physician was notified of the blood pressure reading. During an interview with the Director of Patient Services (DPS) on 11/28/23 at 12:00 PM, the DPS did not provide an explanation for the above.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record reviews and staff interviews, the agency failed to ensure that Home Health Aides (hha) are assigned to patients by the Registered Nurse (RN) with written patient care, instructions, and that nursing maintains overall responsibility for the written patient care instructions. This was for evident for two (2) of two (2) patients receiving home health aides. (Patient #1 and #3). Failure to ensure that Home Health Aides (hha) are assigned to all patients by the Registered Nurse (RN) with written patient care, instructions, and that nursing maintains overall responsibility for the written patient care instructions has the potential for negative patient outcomes. The findings are: 2. Patient #3 has a start of care date of 11/9/23. The “Home Health Certification and Plan of Care dated 11/10/23 documents:” Aide, three times a week for two weeks beginning week of 11/15/23. There is no documented evidence of an aide plan of care in the clinical record. On 11/28 23 at 12:00PM and 11/30/23 at 3:30PM, the surveyor requested the aide plan of care and aide activity sheets from 11/15/23 to 11/30/23. This information was not received. On 11/29/23 at 11:00AM, during an observational home visit, an aide was present in the home. There is no documented evidence of an aide plan of care in the home. The aide stated no one has observed him providing care to the patient. He does what the patient tells him to do. On 11/29/23 at 2:30 PM, the Director of Patient Services was interviewed and did not provide an explanation for findings, 1. Patient #1 has a start of care date of 10/2/23 with diagnoses of Cerebral Vascular Accident with Hemiplegia, Type Two Diabetes Mellitus, and Chronic Pain as documented on the Home Health Care Certification and Plan of Care dated 10/2/23 through 11/30/23. The Home Health Care Certification and Plan of Care (POC) dated 10/2/23 through 11/30/23 documents: Skilled Nursing (SN) to assess and evaluate; diet is NAS (no added salt) NCS (no concentrated sweets. The Aide Plan of Care dated 10/10/23 documents the aide is to assist with shower, hair, shaving, dressing, skin care, perineal care, remind medications, Home Exercise Program, (HEP), meal preparation and assist with feeding, and light housekeeping. The Aide Plan of Care does not document the special diet. The aide Plan of Care does not document the frequencies for each task. During an interview with the Director of Patient Services (DPS) on 11/29/23 at 12:30 PM, the DPS did not provide an explanation.

A standard re-certification survey for United Hebrew of New Rochelle Home Health Agency located at 40 Willow Drive, New Rochelle, NY 10805 was initiated on 1/11/2021 and exited 1/14/2021. Deficient practices were identified within high priority standards in Plan of Care resulting in a partial extended survey. Eight (8) clinical records were reviewed and are identified as Patients #1, #2, #3, #4, #5, #6, #7, and #8. Three (3) Home Visits (HV) were conducted with Patients #4, #5 and #6. Six (6) personnel records were reviewed and are identified as Employees #1, #2, #3, #4, #5, and #6. Policies and procedures for Emergency Preparedness Plan, Health Commerce System, Infection Control and Influenza Vaccination policy were reviewed. The Internet Quality Improvement and Evaluation System (iQIES) Reports were reviewed for the period of 10/1/2019 - 9/30/2020. The agency's Complaint log was reviewed for the years 2019 and 2020. Administrative and clinical staff were interviewed. The agency's Quality Improvement meeting (QI) minutes were reviewed for 2019 and 2020. The following deficiencies are cited: G-0536- A Review of All Current Medications G-0574- Plan Of Care Must Include The Following G-0578- Conformance With Physcian Orders G-0590- Promptly Alert Relevant Physcian of Changes G-0684- Infection Control G-0710- Provide Services In The Plan Of Care G-0798- Home Health Aide Assigments and Duties J-1128; 1172; and 1276- Governing Authority J-1424; and 1426- Personnel W-0612- Responsibilities Of Home Care Svcs Entities

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record reviews and staff interview the agency failed to review all medications the Patient is currently using in order to identify any potential adverse effects and drug interaction. This was evident for two (2) of eight (8) patient care records reviewed. (patients # 5 and #6). Failure to review all medications the patient is currently using in order to identify any potential adverse effects and drug interaction may have negative patient outcomes. The findings are: 1. Patient # 5 has a start date of 12/23/20 with diagnosis that include Unspecified dislocated right amioclavicle, Unspecified head injury, Osteoarthritis, History of malignant neoplasm of lymhoid hematopoetic as documented on the "Home Health Care Certification and Plan Of Care" for the certification period of 12/23/20 to 2/20/21. The "Home Health Care Certification and Plan Of Care" documents: "Medication: Amlodipine Besylate 5mg oral tablet one tablet orally ( PO) once a day ( daily), Centrum Adults Therapeutic Multiple Vitamins with Minerals one tablet PO daily, Duloxetine 40 mg delayed release one tablet PO daily, Irbesartan 300 mg one tablet PO daily, MagneBind RX Calcium, Folic Acid and Magnesium one tablet PO daily, Meloxicam 15 mg one tablet 3 to 4 times a day PO, Nexium 20 mg one tablet PO daily, Triferex 150 Forte vitamin B complex with C folic acid and iron one capsule PO twice a day, Vit D3 2000 intl units one capsule daily". On 1/12/21 during a home visit a review of the patient's medications identified a bottle of Meloxicam with a filled date of 12/18/19 labeled as Meloxicam 15 mg one tablet daily. The Patient stated she takes the medication three times a week: Monday, Wednesday and Friday. A review of the patient's medications identified a bottle labeled as Amlodipine 5mg with a filled date of 8/28/20 documents Amlodipine 5 mg one tablet twice a day. The the "Skilled Nurse Visit" note documents the following nursing visits on 12/29/20 and 1/5/2021. There is no documented evidence of a change of order for Amlodipine and Meloxicam on the Plan Of Care. On 1/13/21 at 1:30 PM, the Administrator was interviewed and did not provide an explanation for the above findings. 2. Patient #6 has a start of care date of 12/ 19/20 with diagnosis that include Encounter for Surgical after the surgery of the Nervous System, Idiopathic Hydrocephalus, Atherosclerotic Heart Disease, Atrial Fibrillation as documented on the "Home Health Care Certification and Plan Of Care" for the certification period of 12/19/20 to 2/16/21. The "Home Health Care Certification and Plan of Care" for the certification period of 12/19/20 to 2/16/21 documents: Medication: Centrum Silver therapeutic multiple vitamins with minerals one tablet orally ( PO) once a day ( daily) , Clonidine Hydrochloride 0.1 mg /12 hr one tablet PO at bedtime, D3 1000 intl units PO one tablet daily, Droxidopa 300 mg one capsule orally three times a day, Fludrocortisone 0.1 mg one tablet daily, Aspirin 81 mg one tablet daily, Potassium chloride 20meq ( milliquivalent) one tablet once a day, Lipitor 20 mg one tablet PO daily, Amiodarone Hydrochloride one tablet PO daily". On 1/12/21, during a home visit, a review of the medications identified a bottle labeled Sodium Chloride 1 gm, one tablet in the morning and two tablets at dinner with a filled date of 6/20/20. There is no documented evidence of an order for Sodium Chloride on the Plan Of Care. The "Skilled Nurse Visit note " documents the following nursing visits: 12/29/20 and 1/5/2021. On 1/13/21 at 1:15 PM, the Administrator was interviewed and did not provide an explanation for the above findings.

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 may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record reviews and interview, the agency failed to develop/revise complete and comprehensive Plans of Care. This was evident for three (3) of eight (8) clinical records reviewed( patients : #3, #4, and #8). Failure to develop complete and comprehensive Plans of Care places patients at risk for not having needs met and negative patient outcomes. The findings are: 1. Patient #3 has a start of care date of 1/18/20 with a discharge date of 1/8/21 with diagnosis of Stage Three Pressure Ulcer to the Right Hip, Hypertension and Insulin Dependant Diabetes Mellitus as documented on the "Home Health Certification and Plan of Care" for Certification Period dated 11/18/20 through 1/16/21 . The "Home Health Certification and Plan of Care" dated 11/18/20 through 1/16/21 documents the Patient is to receive daily Skilled Nursing (SN) visits for wound care and assessment; assess blood sugar monitoring and results and notify physician as indicated; and Lantus Solostar Pen 12 units at bedtime. The Plan of Care lacks documented evidence of the frequency the Patient is to monitor the blood glucose and parameters for physician notification. The nursing visit dated 12/6/20 documents the Patient is monitoring the blood glucose daily. During an interview with the Administrator on 1/14/21 at 11:30 AM, the Administrator stated the plan of care "should have had the parameters and frequency". No further explanation was provided. 2. Patient # 4 has a start of care date of 12/31/2020 with diagnosis that include Orthostatic Hypotension, Embolism and Thrombosis of Renal Vein, Long term ( current) Use of Anticoagulants as documented on the " Home Health Care Certification and Plan of Care" for the certification period of 12/31/20 to 2/28/21. The " Home Health Care Certificationand Plan of Care for the certification documents: Aide three to four times a week beginning during week of 1/4/21 ending 1/30/21". There is no documentented evidence of the hours and duration of Aides Services. On 1/13/21 at 3:00PM, the Adminitrator was interviewed and did not provide an explanation for the above findings. 3. Patient #8 has a start of care date of 9/15/2020 and a discharge date of 10/2/2020; has a Home Health Care Certification and Plan of Care" dated "9/15/2020 to 11/13/2020" with diagnosis of Hypertensive Heart with Heart failure, Chronic Kidney Failure. The "Home Health Care Certification and Plan of Care" dated 9/15/2020 to 11/13/2020 documents "report to physician if blood glucose (BG) via finger stick greater than 180 or less than 70; Aide 3 times a week times 2 weeks; The Plan of Care lacks documented evidence of the frequency the patient is to monitor the blood glucose and the amount/duration of hours the aide visits to provide service. During an interview with the Administrator/Director of Patient Services (DPS) on 1/13/2021 at 2:30 PM. the Administrator /DPS did not provide an explanation.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician orders. This STANDARD is not met as evidenced by: Based on observations, record reviews and interviews, the agency failed to ensure that services are provided in accordance with the Plans of Care (POC). This is evident for four (4) of eight (8) clinical records reviewed. (Patients #1, #2, #3 and #8) Failure to ensure that patient care is provided in accordance with the Plans of Care has the potential for patients to receive poor care and health care needs to go unmet. The findings are: 1. Patient #1 has a start of care date of 1/9/20 with diagnosis of documents Chronic Skin Ulcer, Cellulitis of Left Lower Limb, Hypertension and Dementia as documented on the "Home Health Certification and Plan of Care" for Certification Period dated 10/9/20 through 12/7/20. The "Home Health Certification and Plan of Care" dated 10/9/2020 through 12/7/20 documents: Skilled Nursing (SN) visits two (2) times a week for 14 weeks for assessment and evaluate; Physical Evaluation (PT) to assess and evaluate; Acetaminophen 325 mg two tablets every 4 hours as needed for pain. The SN notes dated between 10/9/20 through 10/23/21 document the Patient's pain is being assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) scale and documents the Patient's pain is rated between a 1 through 5 (4 to 5 is rated moderate pain). The nursing notes for the months of October, November and December 2020 lack documented evidence of the frequency of the Acetaminophen is being taken. The PT notes between 10/14/20 through 11/12/20 lack documented evidence of Patient's pain being assessed at the time of the visit. The agency's policy titled Pain and Management with a revision date of 6/2019 documents: pain is assessed collaboratively by appropriate personnel; the clinician will ascertain from patient/caregiver what the patient is taking at present to alleviate any pain noted. This will include the name of the pain medication, dosage, the frequency of how often the pain medication is given, the last dosage taken and the response to the medications; staff are responsible to document pain assessment and management procedure(s) in the patient's clinical record, including: pain location and level, use of pharmacological measures to reduce the pain, response to treatment provided; if the patient is non-verbal the agency will use the Baker-Wong FACES pain rating scale. The agency's policy titled Rehabilitation Services with a revision date of 6/10/19 documents: Physical Therapy services will be provided following a comprehensive assessment ...; services provided may include, but are not limited to ... reducing pain. During an interview with the Administrator on 1/14/21 11:30 AM, The Administrator did not provide an explanation for the above. 2. Patient #2 has a start of care date 7/17/20 of with diagnosis documents Cellulitis of the Right Lower Limb and Chronic Peripheral Venous Insufficiency as documented on the "Home Health Certification and Plan of Care" for Certification Period dated 11/14/20 through 1/12/21. The "Home Health Certification and Plan of Care" dated 11/14/20 through 1/12/21 documents SN visits one time a week for four weeks for changes in health status; assess circulation of extremities; goals- Patient can demonstrate techniques to manage circulation and edema; outcomes- Patient's edema will be controlled and swelling resolved. The SN notes dated between 11/19/20 through 1/11/21 lack documented evidence of the Patient's edema. The SN note dated 12/30/20 documents the nurse instructed the Patient to weight himself every day. The SN note dated 1/7/21 lacks documented evidence as to whether the Patient was weighing himself daily and the results. During an interview with the Administrator on 1/14/21 11:30 AM, The Administrator did not provide an explanation for the above. 3. Patient #3 has a start of care date of 1/18/20 with diagnosis of Stage Three Pressure Ulcer to the Right Hip, Hypertension, Severe Protein-Calorie Malnutrition, Insulin Dependant Diabetes Mellitus and Alzheimer's Disease with Dementia as documented on the "Home Health Certification and Plan of Care" for Certification Period dated 11/18/21 through 1/16/21. The "Home Health Certification and Plan of Care" dated 11/18/20 through 1/16/21 documents the Patient is to receive daily SN visits for assess and evaluate and for wound care; assess blood sugar monitoring and results; The SN notes For the month of December 2020 document the Patient's blood sugar levels were monitor on one day, 12/14/20; there is 4. Patient #8 has a Start of Care Date of 9/15/2020 and Discharge date of 10/2/2020 with the following diagnosis " Hypertensive Heart with Heart failure, Chronic Kidney Failure" documented on the Home Health Care Certification and Plan of Care for Certification Period 9/15/20 to 11/13/2020. The "Home Health Care Certification and Plan of Care" dated 9/15/2020 to 11/13/2020 documents "report to physician if blood glucose (BG) via finger stick greater than 180 or less than 70; Aide 3 times a week times 2 weeks; The skilled nursing visit notes lack documented evidence of blood glucose monitoring. There is no documented evidence of blood glucose log. During an interview with the Administrator/Director of Patient Services on 1/13/2021 at 2:30 PM did not provide an explanation for the above.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(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 reviews and stadd interviews, the agency failed to promptly notify the physician of changes in patients' status which may require alteration in the Plans Of Care. This was evident for two (2) of eight (8) patient records reviewed. ( Patients # 4 and #6 ). Failure to promptly notify the physician of changes in patients' status, has the potential for negative patient outcomes. The findings are: 1. Patient # 4 has a start of care date of 12/31/2020 with diagnosis that include Orthostatic Hypotension, Embolism and Thrombosis of Renal Vein, Long term ( current) Use of Anticoagulants as documented on the " Home Health Care Certification and Plan of Care" for the certification period of 12/31/20 to 2/28/21. The " Home Health Care Certificationand Plan of Care for the certification period of 12/31/20 to 2/28/21documents: " Skilled Nursing; 1week for 3 weeks 1 as neeeded ( PRN) for changes in health status, beginning during the wwek of 1/4/21 ending on 1/23/21, Physical Therapy to assess and evaluate 1/4/21 through 1/9/21, Physical Therapy; 1 x week for 1 week, 2 x week for 3 weeks, beginning during week of 1/7/21 ending on 1/30/21, Additional Services: notfy Physician for Systolic Blood Pressure ( B/P) >140mm or 99 mm or 100 bpm or 24 or 101.0 F or 140mm or 99 mm or 100 bpm or 24 or 101.0 F or < 95.0 start date 12/21/20". The Physical Therapy note documents on 12/24/20: " Patient seen for follow-up routine, wife present during visit. Patient with increased tBlood Pressure ( B/P). B/P today initial reading 145/70, subsequent reading 160/70 or 80 standing or after activity. Patient will notify MD today. reviewed standing therapeutic exercises that has been given to patient prior to surgery, worked on Whomberg progression for standing balance, feet wide, tandem, eyes open and eyes closed. Provided techniques for improved balance during these exercises". On 1/4/21 the " Physical Therapy visit note" document " Vital Signs B/P 160/90 at rest left arm standing" On 1/6/21 the " Physical Therapy visit note" document :" Vital Signs " B/P 160/ 80". There is no documented evidence the physician was notified of the patient elevated Blood Pressure or communication of the patient elevated Blood Pressure with the Registered Nurse ( RN). On 12/29 20 the " Skilled Nursing visit note document: " Vital Signs Blood Pressure : 162/72." There is no documented evidence the physician was notified of the patient's elevated Blood Pressure. On 1/13/21 at 11:00 AM, the Administrator was interviewed and did not provide an explanation for the above findings.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record reviews and staff interviews, the Governing Authority failed to ensure that the quality improvement developed, implemented, and maintained a COVID-19 Infection Control Policy and Procedure for all healthcare personnel, patients and caregiver. Failure to ensure that the quality improvement develop, implements, and maintains COVID-19 Infection Control Policy and Procedure, has the potential risk for negative patient outcomes. The Finding includes: The COVID-19 Infection Control "Policy & Procedure Manual" with an effective date of 3/26/2020 lack documented evidence of the following regulatory guidance: Daily screening of staff; Maintaining clean equipment and medical and PPE supplies; Transport of usable patient care items; How staff is to obtain needed supplies; Staff returning to work following COVID-19 exposure or infection; Screening patients for COVID-19 symptoms prior to accepting new admissions and referrals; The reuse of PPE and extended use of PPE, including any crisis strategies employed and how these strategies are tracked; and the process for ordering PPE supplies and education provided to staff regarding the reuse and extended use of PPE. There is no documented evidence the Agency has a COVID-19 Infection Control Policy. On 1/13/20 at 1:20 PM, the Administrator/Director of Patient Services was interviewed, and did not provide an explanation for the findings.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on clinical record review and staff interviews the agency failed to ensure that all services ordered by physicians and documented on the Plan of Care were provided to all patients. This was evident for two (2) of eight (8) clinical records reviewed (Patients #4 and #8). Failure to ensure that all services ordered by physicians and documented on the Plan of Care, are provided to all patients, has the potential for negative patient outcomes. The Finding are: 1. Patient # 4 has a start of care date of 12/31/2020 with diagnosis that include Orthostatic Hypotension, Embolism and Thrombosis of Renal Vein, Long term ( current) Use of Anticoagulants as documented on the " Home Health Care Certification and Plan of Care" for the certification period of 12/31/20 to 2/28/21. The " Home Health Care Certification and Plan Of Care" for the certification period of 12/31/20 to 2/28/21 documents: ".Aide three to four times a week beginning during week of 1/4/21 ending 1/30/21". On 1/12/21, during a home visit, the patient/ caregiver stated that no aide services has been provided. On 1/13/21, during an interview with the Administrator, the Administrator stated the patient had refused aide services. A " Skilled Nurse Visit Note document on 1/8/21 : " Caregiver refused scheduled visits. Reports that she canceled HHA services because the aide does not have a copy of her Cvid test result. Caregiver reports that she does not want Skilled Nurse (SN as well because no aide present. Visit not made. MD ( Physician) notified ". A " Home Health Aide Request and Communication Form" documents: "Effective 1/4/21 to 1/30/21, 3 days 3 hours for 4 weeks , Monday, Wednesday and Friday. There is no documented evidence the patient received Aide services on 1/4/21,1/6/21,1/8/21, and 1/11/21. There is no documented evidence the physician was notified of the patient's refusal of services. On 1/13/21 at 1:30 PM, the Administrator was interviewed and did not provide an explanation to the above findings. 2. Patient #8 has a Start of Care Date of 9/15/2020 and Discharge date of 10/2/2020 with the following diagnosis " Hypertensive Heart with Heart failure, Chronic Kidney Failure" documented on the Home Health Care Certification and Plan of Care for Certification Period 9/15/20 to 11/13/2020. The Home Health Care Certification and Plan of Care for Certification Period 9/15/20 to 11/13/2020 documents: "Medication: Eliquis 2.5 mg by mouth once daily; Interventions: aide assist with meal preparation; clean up kitchen after meal preparation" The Home Health Aide Care Plan (APOC) dated 9/15/2020 document the aide to assist with shower 3x weekly; assist with dressing 3x weekly; skin care/apply lotion 3x weekly" The APOC lack documented evidence of the duties the aide is to perform in areas of nutrition; activity and precaution instructions to follow for infection and bleeding. The Aide activity sheets dated 9/21/20, 9/23/20, 9/25/20, 9/28/20, 9/30/20 and 10/2/20 documents the aide perform sponge bath on each visit. There is no documented evidence of the patient receiving the services ordered by the physician as outlined in the Plan of Care There is no documented evidence the APOC was reviewed and discussed with aide. During an interview with the Administrator/Director of Patient Services on 1/13/2021 at 3:00 PM did not provide additional information for the above.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on clinical records review and interviews, the agency failed to ensure all Home Health Aides (HHA) are provided with written patient care instructions for each patient receiving HHA services. This was evident for one (1) of one (1) clinical record reviewed with HHA services. (Patient #8). Failure to ensure all home health aides are provided with written patient care instructions for each patient receiving HHA services has the potential for negative patient outcomes. Findings include: 1. Patient #8 has a Start of Care Date of 9/15/2020 and Discharge date of 10/2/2020 with the following diagnosis " Hypertensive Heart with Heart failure, Chronic Kidney Failure" documented on the Home Health Care Certification and Plan of Care for Certification Period 9/15/20 to 11/13/2020. The Home Health Care Certification and Plan of Care for Certification Period 9/15/20 to 11/13/2020 documents "Medication: Eliquis 2.5 mg by mouth once daily; Interventions: aide assist with meal preparation; clean up kitchen after meal preparation; safety: Standard precautions; bath: shower chair; bath shower" The APOC (Aides Plan of Care) lack documented evidence of the duties the aide is to perform in areas of nutrition; activity; bath with shower chair; and standard precaution instructions. There is no documented evidence that the skilled nurse included bleeding precaution insturctions for the aide to follow as the patient is taking the medication Eliquis. During an interview with the Administrator/Director of Patient Services on 1/13/2021 at 3:30 PM did not provide additional information for the above.