Every finding on record at Warm Hearth at Home Inc

An unannounced Home Health Medicare Complaint Survey (# 104648) was conducted at the above noted agency on February 13, 2024 to February 14, 2024 by one (1) Medical Facilities Inspector from the Office of Licensure and Certification, Virginia Department of Health. In conjunction with the survey, the clinical records of four (4) patients with aide services, the agency's complaint log, nine (9) personnel files, an admission packet, and employee policy and procedures were reviewed. Multiple staff and patient interviews were also conducted. The agency was found not to be in compliance with the federal requirements of 42 CFR 484, Medicare Conditions of Participation of Home Health Agencies.

Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This ELEMENT is not met as evidenced by: Based on staff interviews, select agency document review, and patient interviews, it was determined the agency staff failed to report a patient's complaint to the HHA (Home Health Agency). Specifically, an employee of the agency encountered a patient's complaint regarding an aide who asked for money and was not reported promptly to the agency for one (1) of four (4) patients in the survey sample (Client Record: #2). The findings: Based on staff interviews, select agency document review, and patient interviews, it was determined an agency staff member failed to report a patient's complaint to the HHA (Home Health Agency). Specifically, an employee of the agency encountered a patient's complaint regarding an aide who asked for money and was not reported promptly to the agency for one (1) of four (4) patients in the survey sample (Client Record: #2). The findings: The clinical record for Patient #2 was reviewed for the period of 7/28/2023 to 8/29/2023 with a voluntary discharge date of 8/29/2023 due to an upcoming trip. The agency provided an email dated 8/14/2023 from Patient #2 that requested suspension of services as of 8/30/2023 due to trip with departure on 8/30/2023 and return 9/22/2023. On 2/23/2024 at 12 pm the MFI (Medical Facilities Inspector) interviewed the president of the agency (Staff Member #8). The MFI asked Staff Member #8 if Patient #2 made a complaint to the agency. Staff Member #2 stated, "yes Patient #2 (name redacted) met me in the office because she had concerns over long term insurance policy that we did not submit statements to get reimbursed. However, I showed him/her all the statements to the insurance company. Patient #2 also had concerns about the administrator (Staff Member #5) and assistant administrator (Staff Member #9) who are no longer employed by us". Staff Member #8 explained Patient #2 admitted to grabbing Staff Member #9's arm out in the agency parking lot and regretted doing this. Staff Member #8 then provided a document dated 9/26/2023. This document described Patient #2 came to meet staff member #8 at the office to discuss outstanding bills and long-term insurance filing. Patient #2 expressed the desire for the agency to fire Staff Members #5 and #9 because they were "bad girls". Another concern was no consistency with the PCA schedule. The bills were then reviewed and verified they were submitted to the long-term insurance. Staff member #8 explained to the patient that he/she had an outstanding balance that was due but patient #2 did not feel this should be paid due to the lack of response from the office staff (Staff Member #5 & #9). Patient #2 also requested additional services but Staff Member #8 informed the agency may not be able to provide due to staff. The interview with Staff Member #8 and the above-mentioned document dated 9/26/2023 did not contain information of a PCA asking for money or the PCA's husband entering the patient's home. On 2/13/2024 at 12:15 the MFI requested to speak to the PCA (Staff Member #2) who alleged asked Patient #2 for money. The president stated, “(name redacted) does not work here anymore”. On 2/13/2024 at 1:25 pm the MFI interviewed PCA (Personal Care Aide) Staff Member #7, who had provided care for Patient #2 on the dates of 7/31/2023; 8/01/2023 and 8/03/2023. The MFI asked Staff Member #7 if there was mention of an PCA who requested money for Patient #2. Staff member #7 stated, "yes he/she did tell me one of the PCA's asked for money but swore me to secrecy. He/she told me that one of PCA's and the husband was going to work at the house inside and out. I did not report it to the agency because he/she told me not to and I figured he/she had hired them and that was between them. I was never told that the husband came into Patient #2's (name redacted) bedroom. I never knew if they came or not because I had quit the agency around the end of July 2023 or the first week of August 2023". The interview contained statements of the patient divulging a PCA had asked for money but no mention of the PCA's husband entering the home. On 2/13/2024 at 3:11 pm the MFI called Patient #2 and asked about the complaint lodged. Patient #2 explained, the police was not called because he/she did not want to get involved with the police. Patient #2 further stated, "the PCA (name redacted) did bring the husband into my bedroom, and I did tell him I would hire him for 10 dollars per hour. I decided to pursue this complaint, so this does not happen again. I don't believe the agency did a background check on the PCA (name redacted) because she asked me for money. I did go see the president of the agency and gave the information about this complaint, and he/she was so nice but never did get back with me. I also asked the president to keep it anonymous". The interview contained statements the patient reported a PCA who asked for money and did bring their husband into the patient's bedroom to discuss hourly pay for work. The interview also provided a statement for the president to keep the complaint anonymous. Select Agency Policy Review: A copy of the agency's reporting requirement policy was provided on 2/13/2024 at 5:00 pm to the MFI. The policy was titled, "Abuse Prohibition Policy" a select portion read as follows: "Training 1. All employees will receive orientation and in-services to include f. requirements to report without fear of reprisal, how to report, and to whom to report. If abuse is suspected, it should be immediately reported to the charge supervisor, who will in turn report immediately to the DON (Director of Nursing), who will meet with the Administrator and risk management team to discuss allegations". A copy of Staff Member's #7 training on the reporting requirements was provided on 2/13/2024 at 5:10 pm to the MFI. The training dated 5/15/2023 was signed by Staff Member #7 and titled "Acknowledgement of Mandated Reporter Status" a select portion read as follows: "This means that I am required to report or cause a report made to Virginia Adult Protective Services either by calls APS Hotline or the appropriate local department of social services whenever I have reason to suspect that an adult age 60 or over or an incapacitated adult age 18 and over and who is known to me in my professional or official capacity may be abused, neglected, or exploited. I understand that I must follow the reporting protocol, if any, of my employer, but my employer may not prohibit me form reporting directly to APS." According to the personnel file for Staff Member #7, was trained appropriately for reporting possible abuse/exploitation. The above noted findings regarding the agency's staff failed to report a complaint to the agency and/or APS was acknowledged by the president and administrator during the exit conference of 2/14/2024.

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on review of clinical records and staff interview, it was determined the agency staff failed to follow the plan of care as ordered for one (1) out of four (4) clinical records in the survey sample (Clinical Record #: 2). The findings: Four (4) clinical records were reviewed in the agency on February 13, 2024 - February 14, 2024, with Staff Member #1 as an electronic health record navigator with the following findings: The clinical record for Patient #2 was reviewed for the period of 7/28/2023 to 8/29/2023. The plan of care for the above noted timeframe contained a frequency for an aide Monday through Friday from 10 am to 2 pm. The clinical record for this time frame contained documentation of four (4) aide missed visits on 8/16/2023; 8/17/2023; 8/21/2023 and 8/24/2023. During the clinical record review on 2/13/2024 at 1:20 pm, Staff Member #1 verified the patient was not notified for the four missed visits noted above. The clinical record failed to contain documentation that the patient was notified in advance of the visits not being provided in accordance with the patient's plan of care. The above noted findings regarding the failure of agency's staff conformance with patient's plan of care were reviewed with Staff Member #1 during the clinical record review, and again at the exit conference on 2/14/2024.