Lorian Health

“Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient’s behavior, the behavior of other persons in the patient’s home, or situation; This Element is not met as evidenced by: Based on interview and record review, the agency failed to notify a patient that their behavior could lead to discharge and attempt to resolve the problem prior to discharging for cause for one of two sampled patients (1). As a result, Patient 1 was discharged without the opportunity to improve their behavior and may have gone without needed home health services. Findings: Per the agency’s Home Health Certification and Plan of Care for the certification period of 2/19/24 through 4/18/24, Patient 1 was admitted to the agency on 2/19/24 with diagnoses to include quadriplegia (inability to move the arms and legs). Per the agency’s Visit Note Report, dated 4/2/24, Skilled Nurse (SN) 2 was providing a home visit to Patient 1, and documented, “…Patient started yelling at SN due to blood pressure cuff tightness and hit SN hand…” Per the agency’s Client Occurrence Report, dated 4/2/24, “…SN reported physical and verbal abuse from patient and requested to be removed from the case…patient will have to be discharged due to physical violence against staff…” Per the agency’s Orders, there was an order on 4/4/24 for Patient 1, “…Discharge patient from home health services effective 4/4/24. Patient to be re-directed to another home health agency due to patient physically abusing staff…” On 6/11/24 at 9:25 A.M., a telephone interview was conducted with SN 2. SN 2 stated, while taking Patient 1’s blood pressure during a home visit, Patient 1 hit her hand during the procedure and said that it was too tight. SN 2 stated that she then left the home and notified her supervisor of the incident. On 7/9/24 at 1:25 P.M., a telephone interview was conducted with Clinical Manager (CM) 3. CM 3 stated, she was unable to find documentation of Patient 1 threatening or abusing staff prior to 4/2/24, or any incidents of Patient 1 presenting a serious imminent threat of physical harm to staff. CM 3 further stated, when a patient threatened their staff, such as in Patient 1’s case, it was their practice to discharge the patient without making any attempts to resolve the problem prior to discharging. The agency did not have a policy on discharging for cause.”

“Provide contact info other services CFR(s): 484.50(d)(5)(iii) (iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and This Element is not met as evidenced by: Based on interview and record review, the agency failed to provide a list of other home health agencies to a patient prior to discharging them for cause for one of two sampled patients (1). This failure may have caused Patient 1 to go without needed home health services. Findings: Per the agency’s Home Health Certification and Plan of Care for the certification period of 2/19/24 through 4/18/24, Patient 1 was admitted to the agency on 2/19/24 with diagnoses to include quadriplegia (inability to move the arms and legs). Per the agency’s Orders, there was an order on 4/4/24 for Patient 1, “…Discharge patient from home health services effective 4/4/24. Patient to be re-directed to another home health agency…” On 7/5/24 at 10:25 A.M., a telephone interview was conducted with Clinical Manager (CM) 3. CM 3 stated, the agency did not provide contact information for other home health agencies to Patient 1 at the time of discharge. CM 3 stated they thought it was the responsibility of Patient 1’s doctor to refer them to other home health agencies. The agency did not have a policy on discharging for cause.”