Seaport Scripps Home Health

“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 interview and record review, the agency failed to complete home visits per the plan of care for two of 17 sampled patients (6, 8). As a result, Patient 6 and Patient 8 did not receive the care and services ordered by their physicians. Findings: 1. Per the agency’s “Home Health Certification and Plan of Care,” for the certification period from 3/8/25 through 4/29/25, Patient 6 was admitted to the agency on 3/8/25 with diagnoses to include cerebral infarction (a lack of blood supply to the brain). Per the agency’s Orders, there was an order on 3/30/25 for Patient 6 to have the Certified Home Health Aide (CHHA) visit one time per week for three weeks. On 5/30/25 at 9:13 A.M., an interview and record review were conducted with the Director of Patient Care Services (DPCS). The DPCS stated, the CHHA visit was not completed for Patient 6 on the week of 3/30/25. The DPCS further stated, there should have been documentation to explain why the visit was missed. 2. Per the agency’s “Home Health Certification and Plan of Care,” (POC) for the certification period from 2/9/25 through 4/4/25, Patient 8 was admitted to the agency on 2/9/25 with diagnoses to include osteomyelitis (bone infection). Per the POC, there was an order for Patient 8 to have Skilled Nurse (SN) visits three times per week starting on the week of 3/16/25. On 5/30/25 at 9:13 A.M., an interview and record review were conducted with the Director of Patient Care Services (DPCS). The DPCS stated, there were only two SN visits for Patient 8 on the week of 3/16/25. The DPCS further stated, there should have been documentation to explain why the third visit for the week was not completed. Per the agency’s policy titled, “Missed Visits,” revised April 2018, “If a visit is missed and not rescheduled the clinician will…Document in the patient’s clinical record…Reason for the missed visit””

“Nursing services supervised by RN CFR(s): 484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k). This Element is not met as evidenced by: Based on interview and record review, the agency failed to supervise Licensed Vocational Nurses (LVN) every 30 days for two of 17 sampled patients (5, 15). As a result, the agency could not ensure that LVNs provided appropriate patient care. Findings: 1. Per the agency’s “Home Health Certification and Plan of Care,” for the certification period from 4/20/25 through 6/18/25, Patient 5 was admitted to the agency on 6/30/23. On 5/30/25 at 9:13 A.M., an interview and record review were conducted with the Director of Patient Care Services (DPCS), and the Quality Assurance Manager (QAM). The QAM stated, that the last two times that a Registered Nurse (RN) supervisory visit was completed for Patient 5’s LVN, were on 2/18/25 and 4/18/25. The DPCS stated, an RN supervisory visit should have been conducted on the LVN at least every 30 days. Per the agency’s policy titled, “Responsibilities/Supervision of Clinical Services,” revised April 2018, “Licensed Practical/vocational nurses will be supervised by a registered nurse making a visit to the home with or without the lpn/lvn every thirty (30) days” 2. Per the agency’s “Home Health Certification and Plan of Care,” for the certification period from 4/14/25 through 6/12/25 Patient 15 was admitted on 6/8/24 to the agency with a diagnosis of Encounter for fitting and adjustment of Urinary Device. During a record review of Patient 15’s visit calendar, the document indicated that Patient 15 was seen twice by a Licensed Vocational Nurse (LVN) between April 13, 2025, and May 13, 2025. Additionally, Patient 15 had two scheduled LVN visits scheduled between May 14, 2025, and May 31, 2025. There were no Registered Nurse visits completed or scheduled during the same time frames. On 5/30/25 at 9:20 A.M., an interview and record review were conducted with the Director of Patient Care Services (DPCS), and the Quality Assurance Manager (QAM). The QAM stated during the last 30 days Patient 15 had no supervisory visits. An RN supervisory visit should have been conducted on the LVN at least every 30 days. Per the agency’s policy titled, “Responsibilities/Supervision of Clinical Services,” revised April 2018, “Licensed Practical/vocational nurses will be supervised by a registered nurse making a visit to the home with or without the LPN/LVN every thirty (30) days””