Rc Home Healthcare Inc.

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on observation, interview, and record review, the agency failed to ensure a Registered Nurse (RN) provided a correct written patient care instruction to a Certified Home Health Aide (CHHA) for one of seven sampled patients (Patient 2) when the CHHA’s care plan (a written plan that outlines the specific services and care an individual needs to receive at home) indicated false assessments and incorrectly checked duty items for CHHA 1 to complete during Patient 2’s home visit. This failure resulted in Patient 2 receiving inappropriate care which could negatively impact Patient 2’s quality of life. Findings: A review of Patient 2’s face sheet (a document that gives a summary of patient’s information), indicated a start of care date of July 16, 2024, with a recertification period of July 16, 2024, to September 13, 2024. Patient 2 had diagnoses that included Alzheimer’s disease (a brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks). During a home visit observation on May 20, 2025, at 1:35 PM, with CHHA 1 and Patient 2’s family member, Patient 2 was observed in her room, lying down, awake, confused but aware of herself. CHHA 1 walked up to Patient 2 and extended her hands to guide Patient 2 to the shower. Once Patient 2 finished her shower, CHHA 1 guided Patient 2 out with her extended hands and led Patient 2 to sit down in Patient 2’s dining room chair. During an interview on May 20, 2025, at 2:15 PM, with CHHA 1 and Patient 2’s family member, CHHA 1 confirmed she did not review Patient 2’s plans of care prior to providing Patient 2’s home visit care. CHHA 1 stated she swabbed Patient 2’s mouth because Patient 2 did not like her teeth brushed. CHHA 1 and Patient 2’s family member confirmed Patient 2 did not have dentures. CHHA 1 stated that Patient 2’s family member washes Patient 2’s clothes. CHHA 1 also confirmed that she does not do any light housekeeping. CHHA 1 further stated that she performed range of motion (movement of joint) during Patient 2’s shower by instructing Patient 2 to raise her arm. During a concurrent interview and record review on May 20, 2025, at 2:25 PM, with CHHA 1, Patient 2’s CHHA plans of care, dated May 7, 2025, was reviewed. The CHHA plan of care indicated, clean dentures every visit, light housekeeping, wash clothes every visit, assist with ambulation (walking) with walker every visit, and active range of motion (AROM—when a patient uses the muscles to perform movement at a specific joint) to right and left arm and leg. CHHA 1 verified and confirmed Patient 2’s plan of care. During a concurrent interview and record review on May 21, 2025, at 2:04 PM, with the Administrator/Director of Patient Care Services (Admin/DPCS), Patient 2’s CHHA plan of care, dated May 7, 2025, was reviewed. The CHHA plan of care indicated, clean dentures every visit, light housekeeping, wash clothes every visit, assist with ambulation with walker every visit, and active range of motion to right and left arm and leg. The Admin/DPCS stated that she was also responsible as Patient 2’s RN staff. The Admin/DPCS verified and stated that denture care and washing clothes should not have been on the CHHA care plan. The Admin/DPCS explained her expectation for light housekeeping for CHHA 1 included clean up after Patient 2’s shower and fix the bed. The Admin/DPCS stated, CHHA 1 should have informed her to remove assisting Patient 2 with walker every visit since Patient 2 did not use a walker. The Admin/DPCS confirmed that Patient 2’s CHHA plan of care did not reflect Patient 2’s current assessment and contained inaccurate duty items for CHHA 1 to provide for Patient 2 during home visit. A review of the agency’s policy and procedure titled, “HOME HEALTH AIDE PLAN OF CARE,” undated, indicated, “…POLICY: Each patient receiving home health aide services will have an individualized plan developed and utilized to direct care performed by the assigned aide…. 2. The home health aide plan of care will be individualized to the specific patient and will include at least: A. Type of services/procedures to be provided, such as hands on personal care, the performance of simple procedures as an extension of therapy or nursing services, assistance in ambulation or exercises, and assistance in administering medications ordinarily self administered… D. Functional Limitations… H. Specific procedure(s) to be performed, including amount, frequency, and duration. I. Safety measures, including use of specific equipment. K. Reporting changes in patient’s condition and needs… 4. The home health aide plan of care will be revised at least every 60 days, based upon a professional reassessment of the patient and at any time the patient’s change of condition warrants revision…””

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure a review of all the medications the patients were taking was conducted for two of seven sampled patients (Patients 1 and 2) when: 1. For Patient 1: the Medication Profile (MP-a current list of all medications prescribed for a specific patient), indicated tetracyte (an antibiotic which kills bacteria) was to be applied as a spray when the contracted wound care company’s information sheet indicated the tetracyte was to be applied as drops to Patient 1’s wound. This failure had the potential to cause a less precise measurement of medication when a small, specific volume was required. 2. For Patient 2: the MP indicated the wrong dose for two medications (tamsulosin-a medication that makes urination easier and ibuprofen-a pain medication) and one medication (atorvastatin- a medication to lower cholesterol and triglyceride levels in the blood) was not indicated on the MP. This failure had the potential to cause ineffective drug therapy, significant side effects and noncompliance with drug therapy for Patient 2. Findings: 1. A review of Patient 1’s care plan (contains information about a patient’s diagnosis, the goals of treatment, and specific nursing orders), undated, indicated, a start of care date of April 1, 2022, with a recertification period of May 15, 2025, to July 13, 2025. Patient 1 had diagnoses that included stage III, pressure sore to the left hip (an open wound with full-thickness skin loss due to prolonged pressure). During a home visit observation on May 20, 2025, from 11:15 AM to 12:26 PM, with a Licensed Vocational Nurse (LVN 1), LVN 1 was observed performing Patient 1’s wound care. LVN 1 administered a few drops from a bottle marked “tetracyte” to Patient 1’s wound. During an interview with LVN 1 on May 20, 2025, at 12:08 PM, LVN 1 stated she did not have Patient 1’s wound care physician’s orders to review but followed the information sheet left at Patient 1’s house by a contracted wound care company. A review of a contracted wound care company’s information sheet titled “[name of contracted wound care company] Plan of Care,” undated, indicated a picture of a bottle of tetracyte drops and “Step 2, If applicable: Apply Tetracyte.” A review of Patient 1’s physician’s order, dated March 20, 2025, indicated, “tetracyte spray apply to affected site with every dressing change.” During an interview on May 22, 2025, 10:17 AM, with the Director of Patient Care Servies Designee (DPCSD), the DPCSD stated she had written Patient 1’s tetracyte verbal order and made a mistake. The DPCSD stated the order should have indicated tetracyte drops, not tetracyte spray and because of this error Patient 1’s MP was inaccurate. 2. A review of Patient 3’s care plan, undated, indicated, a start of care date of April 9, 2024, with a recertification period of April 4, 2025, to June 2, 2025. Patient 6 had diagnoses that included open wound to left lower leg, hyperlipidemia (abnormally high level of fats in your blood), and benign prostatic hyperplasia (BPH-A non-cancerous condition where the prostate gland is larger than normal). During a home visit observation on May 21, 2025, at 1:30 PM, with the Administrator/Director of Patient Care Services (Admin/DPCS) and in the presence of Patient 3’s family member, an observation of Patient 3’s actual medication bottles available in the home were compared with Patient 3’s most current MP showed: a. A bottle indicated a fill date of April 7, 2025, for tamsulosin, 0 (zero).4 (four) mg (milligrams-a unit of measurement), take one capsule by mouth at bedtime. The MP indicated tamsulosin, 0.4 mg, take two capsules by mouth at bedtime. b. A bottled indicated ibuprofen 100 mg in 5 (five) ml (milliliters-a unit of measurement). The MP indicated ibuprofen 100mg, give 5ml by mouth every six-eight hour, as needed for pain. c. A bottle indicated a fill date of April 7, 2025, for atorvastatin 20 mg, take one tablet by mouth once a day and the atorvastatin was not listed on the MP. During a follow-up interview on May 21, 2025, at 12:30 PM, with the Admin/DPCS, the Admin/DPCS acknowledged that atorvastatin was not indicated on the MP. The Admin/DPCS stated the tamsulosin should have been updated with the new physician’s order. The Admin/DPCS stated that medications should be checked at every nurse visit and nurses should have caught this and changed the medication orders. Patient 3’s family member stated that atorvastatin and tamsulosin were changed during Patient 3’s Primary Care Physician (PCP) visit. During an interview on May 21, 2025, at 1:49 PM, with the Admin/DPCS and Patient 3’s family member, Patient 3’s family member stated she gave 15 ml (1500 mg) of ibuprofen and not 5 ml (500 mg) of ibuprofen. A review of the agency’s policies and procedure titled, “Medication Profile,” undated, indicated, “…Purpose: To define the use of the medication profile in evaluating a patient’s medication regimen…. Procedure…3. A drug regimen review will be performed at the time of admission, when updates to the comprehensive assessments are performed, …4. During subsequent home visits, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver, as well as other clinicians, understand the medication regimen. This includes, but will not be limited to: A. Using the medication profile, in conjunction with other pertinent data, to evaluate the use of the drugs in the home setting. B. Using the medication profile to teach the purpose of medication, dosages, routes, administration times, side effects, and contraindications. C. Using the medication profile as a communication tool for other clinicians involved in care…””

“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 observation, interview, and record review, the agency failed to ensure a Certified Home Health Aide (CHHA) provided all the services listed on the “Home Health Aide Care Plan [a written plan that outlines the specific services and care an individual needs to receive at home],” for one of seven sampled patients (Patient 2). This failure had the potential for Patient 2 not to receive the necessary services increasing the risk that the patient’s needs will not be met. Findings: A review of Patient 2’s face sheet (a document that gives a summary of patient’s information), indicated a start of care date of July 16, 2024, with a recertification period of July 16, 2024, to September 13, 2024. Patient 2 had diagnoses that included Alzheimer’s disease (a brain disorder that slowly destroys memory and thinking skills, and eventually, the ability to carry out the simplest tasks). During a home visit observation on May 20, 2025, at 1:35 PM, with CHHA 1 and Patient 2’s family member, Patient 2 was observed in her room, lying down, awake, confused but aware of herself. CHHA 1 walked up to Patient 2 and extended her hands to guide Patient 2 to the shower. Once Patient 2 finished her shower, CHHA 1 guided Patient 2 out with her extended hands and led Patient 2 to sit down in Patient 2’s dining room chair. During an interview on May 20, 2025, at 2:15 PM, with CHHA 1 and Patient 2’s family member, CHHA 1 confirmed she did not review Patient 2’s plans of care prior to providing Patient 2’s home visit care. CHHA 1 stated she swabbed Patient 2’s mouth because Patient 2 did not like her teeth brushed. CHHA 1 and Patient 2’s family member confirmed Patient 2 did not have dentures. CHHA 1 stated that Patient 2’s family member washes Patient 2’s clothes. CHHA 1 also confirmed that she does not do any light housekeeping. CHHA 1 further stated that she performed range of motion (movement of joint) during Patient 2’s shower by instructing Patient 2 to raise her arm. During a concurrent interview and record review on May 20, 2025, at 2:25 PM, with CHHA 1, Patient 2’s CHHA plans of care, dated May 7, 2025, was reviewed. The CHHA plan of care indicated, clean dentures every visit, light housekeeping, wash clothes every visit, assist with ambulation (walking) with walker every visit, and active range of motion (AROM—when a patient uses the muscles to perform movement at a specific joint) to right and left arm and leg. CHHA 1 verified Patient 2’s plan of care and confirmed that she did not follow Patient 2’s CHHA plan of care. During a concurrent interview and record review on May 21, 2025, at 2:04 PM, with the Administrator/Director of Patient Care Services (Admin/DPCS), Patient 2’s CHHA plan of care, dated May 7, 2025, was reviewed. The CHHA plan of care indicated, clean dentures every visit, light housekeeping, wash clothes every visit, assist with ambulation with walker every visit, and active range of motion to right and left arm and leg. The Admin/DPCS stated that she was also responsible as Patient 2’s RN staff. The Admin/DPCS explained her expectation for light housekeeping for CHHA 1 included clean up after Patient 2’s shower and fix the bed. The ADMIN/DPCS further stated her expectation for CHHA 1 is to check the CHHA plan of care prior to providing care and if there are any changes with the CHHA plan of care, then CHHA 1 should inform the ADMIN/DPCS. A review of the agency’s policy and procedure titled, “HOME HEALTH AIDE PLAN OF CARE,” undated, indicated, “…POLICY: Each patient receiving home health aide services will have an individualized plan developed and utilized to direct care performed by the assigned aide….2. The home health aide plan of care will be individualized to the specific patient and will include at least: A. Type of services/procedures to be provided, such as hands on personal care, the performance of simple procedures as an extension of therapy or nursing services, assistance in ambulation or exercises, and assistance in administering medications ordinarily self administered… D. Functional Limitations… H. Specific procedure(s) to be performed, including amount, frequency, and duration. I. Safety measures, including use of specific equipment. K. Reporting changes in patient’s condition and needs… 4. The home health aide plan of care will be revised at least every 60 days, based upon a professional reassessment of the patient and at any time the patient’s change of condition warrants revision…””

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure the attending physicians were informed of patients’ discharged from the agency for two of seven sampled patients (Patients 6 and 7) when the discharge summary (a written document that details a patient’s medical condition upon leaving a healthcare facility, summarizing their admission details, diagnosis, treatment received, current medications, and any necessary follow-up care) was not sent to the primary care practitioner (PCP) within five business days of the patients’ discharge. This failure had the potential to result in patients’ PCP being unaware of patients’ current health condition which could cause delayed in diagnoses or provided incorrect treatment decisions that may negatively affect patients’ health and safety. Findings: 1. A review of Patient 6’s face sheet (a document that gives a summary of patient’s information), undated, indicated a start of care date of July 13, 2021, with a certification period of July 13, 2021, to September 10, 2021. Patient 6 had diagnoses that included Parkinson’s disease (a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination). A review of Patient 6’s physician’s order, dated February 3, 2025, indicated Patient 6 had expired in the hospital and had been discharged from the agency. During a concurrent interview and record review on May 19, 2025, at 3:14 PM, with the Office Manager (OM), Patient 6’s discharge summary, dated February 3, 2025, was reviewed. The discharge summary was created. The OM verified and confirmed, there was no documented evidence to indicate that the discharge summary was sent to Patient 6’s PCP (105 days after discharged). During an interview on May 19, 2025, at 3:23 PM, with the Director of Patient Care Services Designee (DPCSD), the DPCSD stated Patient 6’s discharge summary had not been sent to the PCP. 2. A review of Patient 7’s face sheet, undated, indicated a start of care date of August 29, 2024, with a certification period of August 29, 2024, to October 27, 2024. Patient 7 had diagnoses that included open wound to left ankle. A review of Patient 7’s physician’s order, dated April 25, 2025, indicated, Patient 7 had been admitted into the hospital and was discharged from the agency. During a concurrent interview and record review on May 19, 2025, at 4:40 PM, with the OM, Patient 7’s discharge summary, dated April 2, 2025, was reviewed. The discharge summary was created. The OM verified and confirmed, there was no documented evidence to indicate the discharge summary was sent to Patient 7’s PCP (47 days after discharged). The OM stated, the policy for discharge process was not followed. A review of the agency’s policy and procedure titled, “TRANSFER, REFERRAL, AND DISCHARGE CRITERIA AND PROCESS,” undated, indicated, “…DOCUMENTATION: Relevant information includes at least: 1. Consistent information which will facilitate patient service coordination will be documented in the clinical record. When a patient is discharged, transferred or referred to another organization, relevant information includes at least: A. Reason for transfer or discharge. B. Physical and psychosocial status at time of transfer or discharge. C. Summary of the care/service provided and progress toward achieving goals. D. Instruction and/or referrals provided to the Patient. E. Existence of any advance directives, if applicable. F. The date of discharge. 2. Information will be documented on the Discharge summary form. 3. A copy will be forwarded to the attending physician within five days. 4. The discharge record is organized according to the agency policy regarding clinical record contents. Documentation is reviewed by the clinical supervisor and/or designee and completed within five days of the discharge at which time it is removed from the active files...””