Every finding on record at Wellcare Home Health, Inc

Substantial Allegation Survey Substantial Allegation 102457 No deficiencies were cited related to allegations contained in substantial allegation 102457 completed on 12/12/23; however, the agency was found not to be in compliance with all requirements for Home Health Agency participation and the following deficiency is cited. Wellcare Home Health, Inc 367786, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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 the individualized plan of care included the duration of visits to be made for three of three patients reviewed for home health aide services (Patient #1, #2, and #3). This could affect all patients receiving services from the agency. The patient census was 52. Findings include: 1. Review of Patient #1's physician ordered plan of care for the certification period dated 07/06/23 through 09/03/23 revealed orders for home health aide (HHA) services three times a week for 60 days to assist with personal care, and ADL’s. The plan of care did not specify the number of hours (duration) the HHA was to provide weekly. Review of the physician ordered plan of care for the certification period dated 09/04/23 through 11/02/23 revealed orders for HHA services five times a week to assist with personal care, and ADL’s. The plan of care did not specify the number of hours (duration) the HHA was to provide weekly. Interview with the Administrator on 12/12/23 at 10:00 AM revealed that Patient #1 was to receive 20 hours of HHA services and it had been this way since 04/13/22. 2. Review of Patient #2's physician ordered plan of care for the certification period dated 11/03/23 through 01/01/23 revealed orders for HHA services two times a week for 60 days. The plan of care did not specify the number of hours (duration) the HHA was to provide weekly. 3. Review of Patient #3's physician ordered plan of care for the certification period dated 10/15/23 through 12/13/23 revealed orders for HHA services seven times a week. The plan of care did not specify the number of hours (duration) the HHA was to provide weekly.

Substantial Allegation Survey Substantial Allegation 31887 The following deficiency is based upon substantial allegation 31887 completed on 09/23/21. Wellcare Home Health Inc. is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C, Home Health Agencies.

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 home health agency failed to ensure the plan of care of one patient ordered a frequency and duration of home health aide visits to be made. This affected one (Patient #1) of three patients reviewed. Findings include: Review of the medical record for Patient #1 revealed the patient was admitted for non-skilled services of the agency on 03/28/15. A total of three certification periods were reviewed including 04/25/21 to 06/23/21, 06/24/21 to 08/22/21, and 08/23/21 to 10/21/21. Diagnoses included hypertension, atrial fibrillation, and major depressive disorder. A total of 13 medications, including were listed on the plan of care. All three plans of care ordered for the patient to receive services provided by a home health aide of “up to 14 hours per week.” The home health aide was ordered to provide assistance with personal care and activities of daily living as indicated by limitations on functional and physical status. Staff A was interviewed on 09/23/21 at 02:30 PM. It was confirmed that a plan of care must specify a frequency and duration of services to be provided. It was further confirmed that aide services “up to” 14 hours is neither a duration nor a frequency as required.