Every finding on record at Universal Medical Staffing Agency

Substantial Allegation Survey Substantial Allegation 71391 The following deficiency is based upon substantial allegation 71391 completed on 08/18/22.

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 the physician's ordered plan of care (485) and failed to notify the physician of signs of a urinary tract infection. This affected one (Patient #1) of three patients reviewed. Medical record review revealed the Patient #1 was admitted to the agency on 04/06/22. Diagnoses included hypertension, pressure ulcer of the left heel and hemiplegia affecting the right side. The physician’s ordered plan of care for the certification period of 06/05/22 to 08/03/22 revealed Patient #1 was to have a Skilled Nursing (SN) visits one to two times per week. The SN goals listed on the 485 included the SN was to assess/evaluate: skin, medication compliance and safety. The patient had pressure ulcers on the leftheel and the buttocks noted on the 485. Review of the SN note dated 06/10/22 and 06/11/22 revealed under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN documented there were no signs or symptoms of infection noted by the SN. There was no documentation of where the wounds were located and no measurements of the wounds at the time of the SN visit. Review of the SN note dated 06/17/22 revealed under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN documented there were no signs or symptoms of infection noted by the SN. There was documentation Patient #1 had a pressure ulcer to his buttocks but not of how the large the wound was at the time of the SN visit. Review of the SN note dated 07/01/22 revealed under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN documented there were no signs or symptoms of infection noted by the SN. There was no documentation of the location of the wounds of the size of the wounds at the time of the SN visit. The SN noted Patient #1 had an indwelling Foley catheter to the left thigh, with foul urine draining due to not drinking enough fluids. Review of the SN note dated 07/02/22 revealed under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN documented there were no signs or symptoms of infection noted by the SN. There was no documentation of the location of the wounds of the size of the wounds at the time of the SN visit. Review of the SN note dated 07/08/22 revealed the SN documented under the genitourinary assessment section patient #1 had cloudy urine with a foul odor. There was no documentation the physician was notified of the abnormal finding. Under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN documented there were no signs or symptoms of infection noted by the SN. There was no documentation of the location of the wounds of the size of the wounds at the time of the SN visit. Review of the SN note dated 07/09/22 revealed the SN documented under the genitourinary assessment section patient #1 had foul urine odor. and a Foley bag. There was no documentation the physician was notified of the abnormal finding. Under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section wound care the SN did not document. There was no documentation of any wounds. Review of the SN note dated 07/14/22 revealed the SN documented under the genitourinary assessment section patient #1 had foul smelling dark in color urine odor and a Foley bag. There was no documentation the physician was notified of the abnormal finding. Under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN did not document. There was no documentation of any wounds. Review of the SN note dated 07/15/22 under the section wound care revealed the SN did not document. Review of the SN note dated 07/22/22 revealed under the skin assessment the SN documented Patient #1’s skin was pink, warm, fair, and dry/itchy rash. Under the section for wound care the SN did not document. Interview on 08/18/22 at 11:41 AM Registered Nurse (RN) J agreed there was no description of Patient #1's wound in most of the SN notes, and this should have been included as part of the skin assessment. The SN should have reported foul urine odor on 07/01/22, 07/08/22, 07/09/22 and 07/14/22 as this was a sign of a potential infection. RN J did note the agency was not providing wound care but was giving education/instruction to caregivers and was to assess the skin on each visit. This deficiency substantiates Substantial Allegation 71391.

Substantial Allegation Survey Substantial Allegation 70829 An entrance conference was conducted on 07/13/22 at 9:30 AM with administrative personnel, and an exit conference was completed on 07/13/22 at 3:00 PM with administrative personnel. The following deficiency is based upon substantial allegation 70829 completed on 07/13/22. Universal Medical Staffing & Home Healthcare 369025, is not in compliance with the requirements at 42 CFR Part 484 Subpart B, C for Home Health Agencies.

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 patients received the home health services as written in the plan of care for three of three medical records reviewed (Patient #1, #2, and #3). The agency census was 34. Findings include: 1. Review of the medical record for Patient #1 revealed plans of care dated 04/13/22 to 06/11/22 and 06/12/22 to 08/10/22 with orders for home health aide services six hours per day, seven days per week. The medical record lacked documentation of home health aide services on 05/17/22, 05/20/22, 05/21/22, 05/22/22, 05/23/22, 05/24/22, 05/25/22, 05/26/22, 05/29/22, 06/01/22, 06/10/22, 06/12/22, 06/17/22, 06/20/22, 06/25/22, 06/30/22, 07/03/22, 07/04/22, and 07/10/22. The medical record contained documentation home health aide services were provided each day ranging from six hours and eight minutes to 22 hours and 48 minutes on 05/15/22, 05/16/22, 05/18/22, 05/19/22, 05/31/22, 06/02/22, 06/03/22, 06/04/22, 06/05/22, 06/07/22, 06/08/22, 06/13/22, 06/15/22, 06/16/22, 06/18/22, 06/21/22, 06/22/22, 06/23/22, 06/26/22, 06/27/22, 06/28/22, 07/01/22, 07/02/22, 07/05/22, 07/06/22, 07/07/22, 07/09/22, 07/11/22, and 07/12/22. The medical record contained documentation home health aide services each day ranging from two hours to five hours and 32 minutes on 05/30/22, 06/06/22, 06/09/22, 06/11/22, 06/14/22, 06/19/22, 06/24/22, 06/29/22, and 07/08/22. On 05/27/22, the medical record contained documentation of home health aide services provided for 26 hours and 23 minutes. On 05/28/22, the medical record contained documentation of 49 hours and 19 minutes of home health aide services. The clock in time was 12:45 PM on 05/28/22 and the clock out time was 2:04 PM on 05/30/22. The dates with home health aide hours were provided in one to four visits per day. The medical record lacked documentation of any additional physician orders or notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 07/13/22 at 12:14 PM. 2. Review of the medical record for Patient #2 revealed a plan of care dated 06/04/22 to 08/02/22 with orders for home health aide services three hours a day Monday through Thursday and two hours per day on Friday. The medical record contained documentation of home health aide services for three hours and 21 minutes on Monday 06/06/22, two hours and 49 minutes on Wednesday 06/08/22, five hours and 19 minutes on Tuesday 06/28/22, four hours and 43 minutes on Wednesday 06/29/22, an hour and 48 minutes on Friday 07/02/22, and three hours and 30 minutes on Thursday 07/07/22. The medical record lacked documentation of any additional physician orders or notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 07/13/22 at 2:45 PM. 3. Review of the medical record for Patient #3 revealed a plan of care dated 04/27/22 to 06/25/22 with orders for skilled nursing twice a week and home health aide services five hours per day, four days per week. The medical record contained one skilled nursing visit and one missed visit note for skilled nursing the week of 06/12/22, however, the missed visit note documented the physician was not notified of the missed visit. The medical record contained documentation of home health aide services for four hours and 11 minutes on 06/13/22 and four hours and 16 minutes on 06/14/22. The medical record contained documentation of home health aide services ranging from five hours and seven minutes to eight hours and 26 minutes on 06/15/22, 06/20/22, 06/21/22, 06/22/22, and 06/23/22. The medical record contained a missed visit for the home health aide on 06/16/22 which noted the case manager was notified by email but the physician was not notified. A plan of care dated 06/26/22 to 08/24/22 included orders for home health aide services eight hours per day, Monday through Friday. The medical record contained documentation of home health aide services for five hours and 26 minutes on Tuesday 06/28/22, seven hours and 44 minutes on Thursday 06/30/22, five hours and 33 minutes on Monday 07/04/22, four hours on Tuesday 07/05/22, seven hours and 13 minutes on Wednesday 07/06/22, and eight hours and 15 minutes on Thursday 07/07/22. The medical record lacked documentation of any additional physician orders or notification that services were not provided as ordered. The findings were verified in an interview with Staff A on 07/13/22 at 2:45 PM.

Emergency Preparedness Survey At the time of the emergency preparedness survey completed on 03/15/21, Universal Medical Staffing & Home Healthcare is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Partial Extended Recertification Survey COVID 19 Focused Infection Control Survey An entrance conference was conducted on 03/10/21 at 10:45 A.M. with administrative staff and an exit conference was conducted on 03/15/21 at 3:30 P.M. with administrative staff. Universal Medical Staffing & Home Healthcare is not in compliance with the requirements of 42 CFR Part 484, Subpart B, C for Home Health Agencies. At the time of the Partial Extended Recertification Survey, a COVID 19 Focused Infection Control Survey was also completed with no deficiencies.

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 medical record review and staff interview, the agency failed to ensure the individualized plan of care included a duration of visits for four of four patients reviewed who were receiving home health aide services (Patient #1, #2, #3, and #5). The sample size was seven patients. The agency census was 40. Findings include: 1. On 03/10/21 at 1:30 P.M., review of the physician ordered plan of care for Patient #1 revealed an order was written for Home Health Aide services as six visits "up-to" 28 hours a week. 2 On 03/11/21 at 12:54 P.M., review of the physician ordered plan of care for Patient #2 revealed an order was written for Home Health Aide services to be completed daily "up-to" 56 hours every week for nine weeks. 3. On 03/11/21 at 1:15 P.M., review of the physician ordered plan of care for Patient #3 revealed Home Health Aide orders were written for five visits every week "up-to" 30 hours every week. On 03/11/21 at 1:21 P.M., interview with Staff A confirmed the orders written on the physician orderd plan of care for Patient #1, #2, and #3 did not provide information concerning a specific duration of visits. 4. On 03/11/21 at 1:50 P.M., review of the physician ordered plan of care for Patient #5 revealed an order was written for Home Health Aide services two visits daily "up-to" 35 hours. An additional interview with Staff A at that time confirmed the findings.