Absolute Home Health Agency, Inc.

“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 Home Health Agency (HHA) staff failed to followed the written plan of care for one of seven sampled patients (Patient 1). LVN 1 (Licensed vocational nurse) failed to conduct a complete and thorough skin assessment during home visits. This deficient practice placed the patient at a potential risk for delayed wound healing, a decline in the condition of the wound, and possible risk for infection on the wound site. On 7/25/2024, at 11 a.m., a complaint validation survey was conducted at the HHA. to investigate allegations regarding poor hygiene care being provided by HHA 1, that resulted in the patient having rashes on her groin and redness on her sacral area. A review of Patient 1’s admission record indicated Patient 1 was admitted to the Home Health agency on 2/3/2023, with diagnosis that included osteoporosis (condition in which bones become weak and brittle). A review of Patient 1’s plan of care (POC) from 6/3/2023 to 8/1/2023, included an order for the skilled nurse (SN) to visit Patient 1 once a week for eight weeks, to assess the skin for breakdown on every visit. One of the skilled nursing interventions included to notify the physician of skin breakdown. On 6/5/2023, the physician order dated 6/5/2023, indicated the HHA visit frequency would be twice a week for eight weeks for activity of daily living assistance and hygiene. A review of Patient 1’s HHA visit dated 6/27/2023, indicated the redness of Patient 1’s sacral area was resolved. However, there was no documented evidence if the HHA staff or the physician were notified regarding the patient’s skin condition. A review of Patient 1’s LVN (Licensed Vocational Nurse) Skilled Nursing Visit dated 6/8/2023, 6/15/2023, and 6/22/2023, indicated Patient 1’s skin was warm to touch but there were no indication if the skin was intact or within normal limits in her narrative notes. During a phone interview with LVN 1 on 7/26/2024, at 2:45 p.m., when asked if Patient 1 had skin rashes, she stated she does not remember if Patient 1 had skin rashes. She further stated that she always documents a complete detail of the patient’s skin condition in the narrative section of the visit notes. During an interview with the DPCS (Director of Patient Care Services) on 7/27/2024, at 1:15 p.m., he stated LVN 1’s skin assessment was incomplete and needed to have more detailed information of Patient 1’s skin condition. A review of the agency’s undated policy and procedure titled “Wound Assessment”, indicated during initial and follow-up nursing visits, any non-intact skin areas shall be assessed and documented and complete measurement of the wound (length, width, depth) shall be documented at least weekly.”

“Written instructions to patient include: CFR(s): 484.60(e) Standard: Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: This Standard is not met as evidenced by: Based on observation, interview, and record review, the Home Health agency (HHA) failed to provide a copy of a recent updated plan of care for two of seven sampled patients (Patient 3 and Patient 5). This deficient practice had the potential to result in the patient and/or the family/caregiver to not know their treatment plan, the services provided by the HHA, and not being an active participant in their care planning process. b. A review of Patient 5’s Patient Profile indicated a Start of Care (SOC) date of 6/26/2024, with a primary diagnosis of hypertensive heart disease with heart failure (heart problems that occur because of high blood pressure that is present over a long time) and secondary diagnosis of chronic systolic congestive heart failure (specific type of heart failure that occurs in one of the heart’s left chamber). A review of Patient 5’s “Home Health Certification and Plan of Care” (a written plan that specifies scope, frequency, duration of services and a program of treatment or care) for the certification period from 6/26/2024 to 8/24/2024 indicated orders for the Skilled Nurse (SN) to visit Patient 5 once a week for nine weeks and Physical Therapy (PT) for evaluation. The orders also included for the SN to assess Patient 5’s compliance with home the exercise program in order to ensure Patient 3 is improving results of physical therapy.” During a joint home visit on 7/26/2024 at 10 am, at Patient 5’s residence with Registered Nurse 1 (RN 1), Patient 5 was observed awake, alert, and oriented to person, place, and time and able to walk in a slow pace and sit on a chair while holding onto the table for assistance. During a concurrent interview and record review on 7/26/2024 at 10:30 am with RN 1 at Patient 5’s home, Patient 5’s Health Agency (HHA) folder was reviewed. Patient 5’s HHA folder revealed it was missing a copy of Patient 5’s Plan Of Care (POC). RN 1 stated he has been working with the HHA for five years and the plan of care was not included in Patient 3’s folder only the medication list. During an interview on 7/26/2024 at 10:35 am with Patient 5, when Patient 5 was asked if she was provided with a POC from the HHA or had seen it in her HHA folder, Patient 5 stated she did not remember having or seeing a Plan of Care. During an interview on 7/27/2024 at 11:47 am with the Director of Patient Care Services (DPCS), the DPCS stated the agency should print the POC and provide it to the patient and/or the family member and caregiver. The DPCS further stated that providing the patient and/or family member or caregiver with the POC was important because it would provide them with a “blueprint” of what services to expect, when to expect them, and the goals and time frame set for the patient. a. A review of Patient 3’s clinical record indicated a start of care date (SOC) of 6/4/24 with a primary diagnosis of generalized osteoarthritis (a degenerative joint disease, in which the tissues in the joint break down over time and is the most common type of arthritis, which usually have joint pain and, after rest or inactivity, stiffness for a short period of time). A review of Patient 3’s “Home Health Certification and Plan of Care” (a written plan that specifies scope, frequency, duration of services and a program of treatment or care) for the certification period of 6/4/2024 to 8/2/2024, indicated the physician ordered the skilled nurse (SN) to visit Patient 3 once a week for nine weeks and a Physical Therapy evaluation. The SN’s responsibilities included to assess the patient’s compliance with the home exercise program in order to ensure the patient is improving results of physical therapy. During a joint home visit with Licensed Vocational Nurse 1 (LVN 1) on 7/26/24 at 10 a.m., Patient 3 was observed awake, alert, and oriented. Patient 3 had a home health folder at his residence. During a concurrent review of Patient 3’s home health folder with LVN 1, there was no Plan of Care (POC) inside Patient 3’s home health folder. When Patient 3 was asked if the Home Health Agency provided him with a care plan that specified visit frequency, his diagnoses, the goals set for him, and the interventions to achieve the goals, Patient 3 stated that all the documents he received from the agency were in the folder and stated he does not remember if the Plan of Care documents were included in it. At 10:40 a.m., during an interview with LVN 1, LVN 1 stated that it was the Home Health Agency’s policy to not provide the patients with a copy of the plan of care. LVN 1 stated that it would be a good idea to provide copies of the Plan of Care so the patient could learn about their plan of care such as visit frequency or schedule, goals, interventions, or care instruction. During an interview with the Director of Patient Care Services (DPCS) on 7/27/22024 at 11:47 a.m., the DPCS stated the agency should print the plan of care and provide it to the patient and/or the family member/caregiver. The DPCS stated providing the patient and/or family member/caregiver with the plan of care was important so that they would understand what services to expect, when to expect them, and the goals and time frame set for the patient. A review of the home health agency’s policy, titled “Care Planning Process,” revised January 2005, indicated all clinicians involved in the patient’s care, either directly or indirectly, will contribute to the plan of care, the patient and family/caregiver will participate in decisions regarding the plan of care whenever possible.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on interview and record review, the home health agency (HHA) staff failed to obtain a skin treatment order for the identified sacral area redness for one of seven sampled patients (Patient 1). This deficient practice placed Patient 1’s skin condition at risk of getting worse, if not treated. On 7/25/2024, at 11 a.m., a complaint validation survey was conducted at the HHA. to investigate allegations regarding poor hygiene care provided by HHA 1, that resulted in Patient 1 having rashes on her groin and redness on her sacral area. A review of Patent 1’s admission record indicated the patient was admitted to the Home Health Agency on 2/3/2023, with diagnosis that included osteoporosis (condition in which bones become weak and brittle). A review of Patient 1’s plan of care (POC) from 6/3/2023 to 8/1/2023, included an order for the skilled nurse (SN) to visit once a week for eight weeks, and to assess skin for breakdown on every visit. One of the skilled nursing intervention was to notify the physician for skin breakdown. A physician’s order dated 6/5/2023, indicated HHA frequency visits of twice a week for eight weeks for activity of daily living assistance and hygiene. A review of Patient 1’s HHA visit dated 6/27/2023, indicated Patient 1’s sacral redness was resolved. However, there was no documented evidence that the HHA staff or the physician were notified regarding Patient 1’s skin condition. A review of Patient 1’s LVN (Licensed Vocational Nurse) Skilled Nursing Visit dated 6/8/2023, 6/15/2023, and 6/22/2023, indicated Patient 1’s skin was warm to touch but there were no indication if the skin was intact or within normal limits. During an interview with HHA 1 on 7/26/2024, at 3 p.m., when HHA 1 was asked if Patient 1 had existing rashes on her groin area, HHA 1 stated she does not remember the patient anymore, but if she sees a newly developed skin rash or open wound, she would document her findings in her notes and would notify the DPCS or nurse at the agency about it. A further review of Patient 1’s clinical record indicated there was no documented evidence the HHA obtained a wound treatment order for Patient 1. During an interview with the DPCS (Director of Patient Care Services) on 7/27/2024, at 1 p.m., DPCS stated he could not provide any documented evidence of a physician’s order for sacral redness treatment for Patient 1.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on interview and record review, the Home Health Aide (HHA 1) failed to notify the agency staff regarding identified redness on Patient 1’s sacral area for one out of seven sampled patients (Patient 1). This deficient practice had the potential to cause the patient’s skin condition to worsen. On 7/25/2024, at 11 a.m., a complaint validation survey was conducted at the HHA. The allegation was regarding poor hygiene care provided by HHA 1, that resulted for the patient to have rashes on her groin and redness on her sacral area. A review of Patient 1’s admission record indicated Patient 1 was admitted to the home health agency on 2/3/2023, with diagnosis that included osteoporosis (condition in which bones become weak and brittle). A review of Patient 1’s Plan of Care (POC) from 6/3/2023 to 8/1/2023, included an order for the skilled nurse (SN) to visit of once a week for eight weeks, to assess Patient 1’s skin for breakdown on every visit. One of the skilled nursing intervention included to notify the physician for skin breakdown. There was a physician’s order dated 6/5/2023, for HHA frequency visits of twice a week for eight weeks for activity of daily living assistance and hygiene. A review of Patient 1’s HHA visit dated 6/27/2023, indicated the redness on Patient 1’s sacral area was resolved. However, there was no documented evidence if the HHA staff or the physician were notified regarding the patient’s skin condition. A review of Patient 1’s LVN (Licensed Vocational Nurse) Skilled Nursing Visit dated 6/8/2023, 6/15/2023, and 6/22/2023, indicated Patient 1’s skin was warm to touch but there was no indication if the skin was intact or within normal limits. During an interview with HHA 1 on 7/26/2024, at 3 p.m., when HHA 1 was asked if Patient 1 had existing rashes on her groin area, HHA 1 stated she does not remember the patient anymore, but if she sees a newly developed skin rash or open wound, she would document her findings in her notes and would notify the DPCS or nurse at the agency about it. During an interview with the DPCS (Director of Patient Care Services) on 7/27/2024, at 1 p.m., the DPCS stated HHA 1 should have notified the HHA staff regarding the redness on Patient 1’s sacral area in order to provide treatment, if needed. A further review of Patient 1’s clinical record indicated there was no documented evidence that the HHA staff or the physician were notified regarding Patient 1’s redness on the sacral area in order to provide wound treatment for Patient 1. A review of the agency’s undated policy titled “Change of Condition” indicated the clinician is responsible for any specific treatment and would notify the attending physician or the HHA of significant changes in the patient’s condition.”