Every finding on record at United Home Health Services, Inc

Substantial Allegation Survey Substantial Allegation OH00121349 Extended Substantial Allegation Survey Complaint Number OH00121349 The following deficiency is are based upon substantial allegation OH00121349 completed on 04/12/21. United Home Health Services, 367793, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C for Home Health Agency. United Home Health Services 367793 is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the date of the receipt of the deficiency report (2567) for this survey.

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: This is CONDITION is not met as evidenced by the agency's failure to follow physician orders per the plan of care to obtain ordered laboratory (lab) tests. This affected one patient (#1) who did not have laboratory tests for therapuetic blood levels of a blood thinning medication drawn as ordered by the physician. See G710.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated 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 follow physician orders per the plan of care to obtain ordered laboratory (lab) tests to monitor the therapuetic effects of blood thinning medication for one (#1) of three patients reviewed. Findings include: Medical record review revealed Patient #1 was admitted to the agency on 03/05/21. Diagnosis included pulmonary embolism (as a condition in which one or more arteries in the lungs become blocked by a blood clot). Review of the plan of care revealed a start of care date of 03/05/21. Medications included the blood thinning medication warafarin 5 milligrams (mg) daily. The Skilled Nurse (SN) was to assess the protime/international normalized ratio (PT/INR) every two weeks. The goals included the patient's PT/INR status will be stabilized within 60 days. The INR levels assist in determining a therapuetic range of the warafarin. An INR range of 2.0 to 3.0 is generally an effective therapeutic range. Review of the SN note dated 03/25/21 revealed the SN attempted venipuncture twice, but was unsuccessful. The SN documented another SN would return later in the evening 03/25/21. The record was silent for an additional SN visit on 03/25/21. Review of laboratory results dated 03/26/21 revealed the blood specimen was insufficient volume to perform the INR labs. There were no documented attempts to redraw the blood specimen. Review of the SN dated 04/01/21 revealed a venipuncture was completed. Review of lab results dated 04/01/21 revealed the blood specimen sample was insufficient to measure the INR. There were no documented attempts to redraw the blood specimen. Review of a physician order dated 04/02/21 revealed the physician ordered an immediate (STAT) INR to be obtained on 04/02/21. Review of lab results dated 04/02/21 revealed INR results were 1.5. Review of the Skilled Nursing (SN) notes from 03/05/21 through 04/05/21 revealed Patient #1 had not been told to go to an emergency room or elsewhere for lab work. Interview on 04/06/21 at 2:47 PM the Director of Nursing (DON) confirmed the above. The DON indicated when the labs for 03/26/21 came back insufficient, someone should have been sent out immediately the same day to redraw or tell the patient to go elsewhere for the labs. This citation substantiates Substantial Allegation OH 00121349.

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 staff interview, the agency failed to employ staff who were competent in performing venipunctures to obtain laboratory specimens. This nine (B, D, E, F, G, H, I, J, and K) out of ten personnel files reviewed. Findings include: Review of personnel record for Staff K, a Registered Nurse (RN), revealed the nurse had competency for venipuncture dated 02/23/2020. The recorded competency revealed Staff K had some experience with venipuncture and needed review and/or supervision. Review of personnel record for Staff D (RN) revealed the nurse did not have venipuncture listed on an undated evaluation. Review of personnel records for three RNs (Staff B, Staff F, and Staff I) and four Licensed Practical Nurses (LPN) personnel records (Staff E, Staff G, Staff H, and Staff J) revealed no had competencies for venipuncture were present in the files. Interview on 04/06/21 at 2:47 PM the Director of Nursing (DON) confirmed the above. Review of the agency policy titled "Lab Testing," revised 02/13/21, revealed the agency staff performing the test would have adequate specific training and orientation for performing tests. The training would be specific to the laboratory test the staff member would perform.