Every finding on record at Waterford at Fairway Village LLC

MEDICARE HOME HEALTH RECERTIFICATION SURVEY The Washington State Department of Health (DOH) in accordance with Medicare Conditions of Participation set forth in 42 CFR 484, conducted this health and safety survey. Onsite dates: 12/12/22 - 12/15/22 Examination number: X2022-1066 The survey was conducted by: Surveyor #3 DOH staff found the agency in substantial compliance with all Conditions of Participation except those standard-level deficiencies listed below. DOH recommends recertification based on an acceptable plan of correction.

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 document review, record review, and interview, the agency failed to timely provide secondary services as ordered by the physician for 3 of 10 patients (Patient #303, #308 and #310). Failure to provide timely services, as ordered by the physician, could place the patient at risk of worsening symptoms of existing diagnoses. Findings included: 1. Document review of agency’s undated policy titled, “Outcome and Assessment Information Set," showed that the comprehensive assessment will be completed no later than five calendar days after the Start of Care (SOC). 2. Record review for 3 of 10 patient records showed: a. Patient #303 had a start of care of 12/02/22. The patient was admitted for primary diagnoses of COVID-19, pneumonia, and chronic respiratory failure—not a complete list. The referral orders dated 11/28/22 included a Skilled Nursing (SN) assessment, a Physical Therapy (PT) evaluation, an Occupational Therapy (OT) evaluation and Home Health Aides (HHA). The OT evaluation did not occur until 12/14/22. The HHA services had not been initiated at the time of the survey exit. There was no documentation as to why the OT evaluation and HHA services did not occur timely, and no documentation that the physician was notified of the delayed OT evaluation. On 12/15/22 at 10:00 AM, the Surveyor conducted a home visit for Patient #303 with the Physical Therapist (Staff #306). During the visit, the spouse of Patient #303 stated that they were still waiting for the Home Health Aide to start providing services and that the spouse felt unsafe helping Patient #303 in the shower due to weakness and unsteadiness. The spouse stated that the agency had not communicated when the Home Health Aide services would begin and that they are "waiting for a call." b. Patient #308 had a start of care of 09/01/22. The patient was admitted for primary diagnoses of Hypertension, contusion to right shoulder and right knee, history of falls—not a complete list. The referral orders dated 08/29/22 included a Physical Therapy (PT) evaluation and an Occupational Therapy (OT) evaluation. The OT evaluation did not occur until 09/08/22. There was no documentation as to why the OT evaluation did not occur timely, and no documentation that the physician was notified of the delayed OT evaluation. c. Patient #310 had a start of care of 06/03/22. The patient was admitted for primary diagnoses of Congestive Heart Failure, urinary tract infection, unsteadiness on feet—not a complete list. The referral orders dated 06/03/22 included a Physical Therapy (PT) evaluation and an Occupational Therapy (OT) evaluation. The OT evaluation did not occur until 06/09/22. There was no documentation as to why the OT evaluation did not occur timely, and no documentation that the physician was notified of the delayed OT evaluation. 3. On 12/15/22 at 1:15 PM, the Surveyor interviewed the agency's Home Health Clinical Director (Staff #301) about the failure to complete OT evaluations within 5 days as required for the patient's comprehensive assessment. Staff #301 stated that the agency currently only has 1 Occupational Therapist who works 1 day per week. Due to the scheduling, it is difficult for the agency to complete the OT evaluations within the 5 days. Staff #301 also acknowledged that the agency is not documenting notification to the physician of the agency's inability to complete the evaluations within the required timeframe.

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 that the patient plan of care contained all required elements for 1 of 10 patients (Patient #306). Failure to ensure the patient plan of care is complete with all required elements may place patients at risk of receiving inappropriate care. Findings included: 1. Document review of the agency's policy and procedure titled, "Private Pay Patient Services for More Than One-Time Visits" dated 07/10/21, showed that private pay patients will have a plan of care that will include the following: current diagnosis, nutritional needs, medications if the medications are being monitored, cognitive or functional limitations, educational needs, indication of a signed advanced directive or POLST (Surveyor only listed the elements required in the policy that were pertinent to this finding.) 2. Record review for Patient #306 showed a start of care date of 09/27/22. The record showed that Patient #306 is a private pay patient. Patient #306 is receiving weekly skilled nursing services for medication set up. The plan of care showed no evidence of the following: all pertinent diagnoses, mental, psychosocial, and cognitive status, advanced directives, functional limitations, activities permitted, nutritional requirements, all medications and treatments, safety measures to protect against injury and patient/caregiver education and training to facilitate timely discharge. 3. On 12/14/22 at 1:00 PM, the Surveyor interviewed the Home Health Clinical Director (Staff #301) about the missing plan of care elements. Staff #301 stated that the agency was not aware that all patients regardless of payor source are required to have the same elements in the plan of care. Staff #301 stated that the agency currently has at least 4 private pay patients, and that the agency is using the same plan of care document for all private pay patients which does not include all of the required elements.