Hhs Homecare, 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 interview and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to ensure a care plan was created for the Certified Home Health Aide (CHHA) when providing services to one of eight sampled patients (Patient 8). This deficient practice resulted in the HHA providing care without adhering to a care plan. A review of Patient 8’s “Home Health Certification and Plan of Care”, for certification period 10/23/2023 to 12/21/2023, indicated a start of care on 8/24/2023, with diagnoses including hypertensive heart disease (high blood pressure). A review of Patient 8’s “Communication”, dated 10/25/2023”, indicated the CHHA was to visit the patient once a week for 9 weeks. During an interview on 11/9/2023, at 11:37 a.m., the Director of Nursing (DON) stated there was no care plan for the CHHA. The DON stated she was not sure of who was responsible in creating a care plan. The DON stated a care plan was important for the CHHA, so she knows what the patient needs are. A record review of the HHA’s undated policy and procedure titled, “Home Health Aide Plan of Care”, indicated, “Policy: Each patient receiving home health aide services will have an individualized plan developed by an appropriate professional and utilized to direct the care performed by the assigned aide.” A review of HHA’s general form titled “Job Description – Home Health Aide (HHA)” revised 3/2018, indicated “A paraprofessional person who is specifically trained, competent and performs assigned functions of personal care to the patient in their residence under the direction, instruction, and supervision of the registered nurse (RN). Qualifications: Must meet Medicare Conditions of Participation for Home Health Aide training program and competency.” A review of facility’s policy and procedure titled “Supervisory Visits” undated, Indicated “CHHA supervisory visits to be conducted every 14 days by a skilled professional and updated in the clinical record.””

“Protection of records CFR(s): 484.110(d) Standard: Protection of records. The clinical record, its contents, and the information contained therein must be safeguarded against loss or unauthorized use. The HHA must be in compliance with the rules regarding protected health information set out at 45 CFR parts 160 and 164. This Standard is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to ensure patient care records were safeguarded against unauthorized used for eight of eight sampled patients (Patient 1, Patient 2, Patient 3, Patient 4, Patient 5, Patient 6, Patient 7, and Patient 8). This deficient practice had the potential to result in patient medical record not secure for unauthorized use. A review of Patient 1’s “Home Health Certification and Plan of Care”, for certification period 10/1/2023 to 11/29/2023, indicated a start of care on 10/1/2023, with diagnoses including type 2 diabetes (too much sugar in the blood). A review of Patient 2’s “Home Health Certification and Plan of Care”, for certification period 10/17/2023 to 12/15/2023, indicated a start of care on 10/17/2023, with diagnoses including essential hypertension (high blood pressure). A review of Patient 3’s “Home Health Certification and Plan of Care”, for certification period 10/8/2023 to 12/6/2023, indicated a start of care on 10/8/2023, with diagnoses including hypertensive heart disease (high blood pressure). A review of Patient 4’s “Home Health Certification and Plan of Care”, for certification period 9/17/2023 to 11/15/2023, indicated a start of care on 9/17/2023, with diagnoses including hypertensive heart disease (high blood pressure). A review of Patient 5’s “Home Health Certification and Plan of Care”, for certification period 9/16/2023 to 11/14/2023, indicated a start of care on 9/16/2023, with diagnoses including Diabetes Mellitus II (high blood sugar). A review of Patient 6’s “Home Health Certification and Plan of Care”, for certification period 9/16/2023 to 11/14/2023, indicated a start of care on 9/16/2023, with diagnoses including other spondylosis (degeneration of the bones and disks in the neck). A review of Patient 7’s “Home Health Certification and Plan of Care”, for certification period 5/19/2023 to 7/17/2023, indicated a start of care on 5/19/2023, with diagnoses including hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). A review of Patient 8’s “Home Health Certification and Plan of Care”, for certification period 10/23/2023 to 12/21/2023, indicated a start of care on 8/24/2023, with diagnoses including hypertensive heart disease (high blood pressure). During an interview on 11/7/2023, at 1:37 p.m., the Director of Nursing (DON) stated there was no nursing notes visit records in the medical records of all the patients because the intake coordinator was behind in filing them. During an interview on 11/8/2023, at 10:00 a.m., Registered Nurse 1 (RN 1) provided nursing notes for Patients 1, Patient 2, Patient 3, and Patient 4. During an interview on 11/8/2023, at 10:50 a.m., RN 1 stated nursing visit notes are typed in a PDF (a type of document in a computer) template, using a personal computer. RN 1 stated once notes are typed, they are printed, signed and either given in person at the office or emailed. During an interview on 11/9/2023, at 11:13 a.m., the DON stated nursing visit notes were typed by each nurse using their personal computer. The DON stated the nursing visit notes were saved in the nurses’ personal computer. The DON stated she did not know if the nurses’ personal computers were secure against computer viruses, hacking protection, and were privacy compliant (HIPPA). The DON stated patient records needed to be kept in a closed, locked cabinet because it was important to keep patient records safe, and to keep them in a place were only staff have access to them. The DON stated the email where records were sent are not considered the medical record. The DON stated she did not know if the email was HIPPA compliant. During an interview on 11/9/2023, at 11:21 a.m., the DON stated it was important to have nursing visit notes in the patients’ record so staff are aware of patients’ current condition. A review of facility’s policy and procedure titled “Records” undated, indicated “All active paper records will be filed alphabetically and stored in a secure area with access by approved personnel only. Electronic medical records/paper medical records will be stored in a secure manner that is easily retrievable if records are requested.” A review of facility’s policy and procedure titled “Privacy of PHI” revised November 2022, indicated “will identify risk and safeguard protected health information against loss, destruction, tampering, or unauthorize use. The organization Agency will implement security measures sufficient to reduce risk and vulnerabilities to a reasonable and appropriate level to comply with HIPPA security standards.””

“State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This Element is not met as evidenced by: Based on interview and record review the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to ensure eight of eight sampled patients (Patient 1, Patient 2, Patient 3, Patient 4, Patient 5, Patient 6, Patient 7, and Patient 8) received information regarding the State toll free home health complaint telephone hotline, its contact information, its hours of operation, and its purpose. This deficient practice had the potential to result in a violation of patient’s rights due to not having the information necessary to make a complaint regarding the agency’s care. A review of Patient 1’s “Home Health Certification and Plan of Care”, for certification period 10/1/2023 to 11/29/2023, indicated a start of care on 10/1/2023, with diagnoses including type 2 diabetes (too much sugar in the blood). A review of Patient 2’s “Home Health Certification and Plan of Care”, for certification period 10/17/2023 to 12/15/2023, indicated a start of care on 10/17/2023, with diagnoses including essential hypertension (high blood pressure). A review of Patient 3’s “Home Health Certification and Plan of Care”, for certification period 10/8/2023 to 12/6/2023, indicated a start of care on 10/8/2023, with diagnoses including hypertensive heart disease (high blood pressure). A review of Patient 4’s “Home Health Certification and Plan of Care”, for certification period 9/17/2023 to 11/15/2023, indicated a start of care on 9/17/2023, with diagnoses including hypertensive heart disease (high blood pressure). A review of Patient 5’s “Patient Profile” indicated a start of care date (SOC) of 9/16/2023 with diagnoses including Diabetes Mellitus II (high blood sugar). A review of Patient 6’s “Patient Profile” indicated a start of care date (SOC) of 9/16/2023 with diagnoses including other spondylosis (degeneration of the bones and disks in the neck). A review of Patient 7’s “Patient Profile” indicated a start of care date (SOC) of 5/19/2023 and end of care (EOC) of 6/16/2023 with diagnoses including hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). A review of Patient 8’s “Home Health Certification and Plan of Care”, for certification period 10/23/2023 to 12/21/2023, indicated a start of care on 8/24/2023, with diagnoses including hypertensive heart disease (high blood pressure). A review of HHA’s patients admission folder, indicated “You may also call Department of Public Health – HOTLINE NUMBER 919-785-1214 – 24 HOURS A DAY”. HHA’s form titled “Client Bill of Rights and Responsibilities” indicated “Call the Department of health Hotline at 1-800-792-9770.” During a concurrent interview and record review on 11/9/2023, at 10:45 a.m., the agency’s admission folder (a folder provided to patients describing services, information, and resources) was reviewed with the Director of Nursing (DON). The folder indicated a complaint number. The DON stated the phone number provided in the folder was not the number to call the California Department of Public Health. The DON stated it was important for the patients to have the correct number so they are aware of where they can call to file a complaint, as this was their right. The DON stated the information also needed to include the 24-hour availability of the state complaint number. During a concurrent interview and record review on 11/9/2023 at 10:45 a.m. with the Administrator/Director of Nurses (ADM/DON) of HHA’s patients admission folder, ADM/DON stated 919-785-1214 was the Departments complaint number and called it. ADM./DON stated, “This is (ACHC) number, not the Department of Health.” ADM/DON stated the Departments complaint number was listed on the HHAs form titled “Client Bill of Rights and Responsibilities.” ADM/DON stated the form did not state the number was toll free, it did not have their working hours, or that the numbers’ purpose was to place complaints. ADM/DON stated it was important for the patients to have the Departments complaint number because it was their right. ADM/DON stated patients needed to have the freedom and knowledge to call and place a complaint. A review of facility’s policy and procedure titled “Admission Criteria and Process” undated, indicated “If eligibility criteria are met, the patient and family/caregiver will be provided with an organization brochure and various educational materials providing sufficient information on: Complaint/grievance process. A review of facility’s policy and procedure titled “Patient Bill of Rights and Responsibilities” revised 3/2019, indicated “Patients have the right: to be advise of the telephone number and hours of operation of the State’s Home Health Agency hotline, that receives complaints or questions about local home health agencies.””

“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 observation, interview, and record review, the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to review, update, and document all the medications and treatments, for three of eight sampled patients (Patient 1, Patient 5, and Patient 6). This deficient practice placed the patients at risk of medication side effect, drug interaction, and harm. 1. A review of Patient 1’s “Home Health Certification and Plan of Care”, for certification period 10/1/2023 to 11/29/2023, indicated a start of care on 10/1/2023, with diagnoses including type 2 diabetes (too much sugar in the blood). During an observation of the home visit on 11/8/2023, at 10:30 a.m., with Registered Nurse 1 (RN 1), RN 1 reviewed the medications of Patient 1 taking at home. The following medications were not updated in Patient 1’s “Drug Regimen Review”: Ibuprofen (pain medication) 600 mg (mg-milligrams, unit of measurement) 1 tablet twice daily. Naproxen (muscle relaxant, pain) 550 mg 1 tablet twice daily. During an interview on 11/9/2023 at 12:17 p.m., the Director of Nursing (DON) stated the nurse was supposed to review the medications of Patient 1 on every visit, to make sure to check for changes, discontinuation, and/or reviews. 2. A review of Patient 5’s “Patient Profile” indicated a start of care date (SOC) of 9/16/2023 with diagnoses including Diabetes Mellitus II (high blood sugar). During a concurrent interview, observation, and record review on 11/8/2023 at 10:35 a.m. with RN 2 of Patient 5’s medication list and medication bottles, RN 2 stated medication bottle labels were different than Patient 5’s medication list. Medication list: Simvastatin (medication to treat high cholesterol) 40 mg 1 tablet orally daily. Atenolol (medication to treat high blood pressure) 50mg 1 tablet orally daily. Escitalopram (medication to treat depression) 10mg 1 tablet orally daily. Medication bottle label: Simvastatin 40 mg 1 tablet orally at bedtime Atenolol 50mg 1 tablet orally two times per day Escitalopram 10mg 1 tablet orally at bedtime 3. A review of Patient 6’s “Patient Profile” indicated a start of care date (SOC) of 9/16/2023 with diagnoses including other spondylosis (degeneration of the bones and disks in the neck). During a concurrent interview, observation, and record review on 11/8/2023 at 11:05 a.m. with RN 2 of Patient 6’s medication list and medication bottles, RN2 stated the HHA needs to “check these better”. Medication list: Lorazepam (a medication that treats anxiety [an intense, excessive, and persistent worry and fear about everyday situations])). 0.5mg 1 tablet orally every bedtime Medication bottle label: Lorazepam 0.5mg 1 tablet orally daily During an interview on 11/8/2023 at 11:20 a.m. with RN 2, RN 2 stated medication reconciliation must be completed at every visit. RN 2 stated medication bottle labels should match the patient’s medication list. RN 2 stated she did not realize the medication labels and the medication list do not match. A review of facility’s policy and procedure titled “Medication Reconciliation” revised 3/2018, indicated “The agency will reconcile patients’ medication at time of admission and on an ongoing basis 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.”

“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 Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to perform supervisory visits for their License Vocational Nurses (LVN) services for eight of eight sampled patients (Patient 1, Patient 2, Patient 3, Patient 4, Patient 5, Patient 6, Patient 7, and Patient 8). This failure had the potential to result in patients receiving care from an unqualified staff. A review of Patient 1’s “Home Health Certification and Plan of Care”, for certification period 10/1/2023 to 11/29/2023, indicated a start of care on 10/1/2023, with diagnoses including type 2 diabetes (too much sugar in the blood). The record also indicated the skilled nurse (SN) was visiting Patient 1, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 2’s “Home Health Certification and Plan of Care”, for certification period 10/17/2023 to 12/15/2023, indicated a start of care on 10/17/2023, with diagnoses including essential hypertension (high blood pressure). The record indicated the SN was visiting Patient 2, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 3’s “Home Health Certification and Plan of Care”, for certification period 10/8/2023 to 12/6/2023, indicated a start of care on 10/8/2023, with diagnoses including hypertensive heart disease (high blood pressure). The record indicated the SN was visiting Patient 3, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 4’s “Home Health Certification and Plan of Care”, for certification period 9/17/2023 to 11/15/2023, indicated a start of care on 9/17/2023, with diagnoses including hypertensive heart disease (high blood pressure). The record indicated the SN was visiting Patient 4, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 5’s “Home Health Certification and Plan of Care”, for certification period 9/16/2023 to 11/14/2023, indicated a start of care on 9/16/2023, with diagnoses including Diabetes Meletus II (high blood sugar). The record indicated the SN was visiting Patient 5, once a week for the first week, then twice a week for the next two weeks, then once a week for six weeks. A review of Patient 6’s “Home Health Certification and Plan of Care”, for certification period 9/16/2023 to 11/14/2023, indicated a start of care on 9/16/2023, with diagnoses including other spondylosis (degeneration of the bones and disks in the neck). The record indicated the SN was visiting Patient 6, once a week for the first week, then twice a week for the next two weeks, then once a week for six weeks. A review of Patient 7’s “Home Health Certification and Plan of Care”, for certification period 5/19/2023 to 7/17/2023, indicated a start of care on 5/19/2023, with diagnoses including hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). The record indicated the SN was visiting Patient 7, once a week for the first week, then twice a week for the next two weeks, then once a week for six weeks. A review of Patient 8’s “Home Health Certification and Plan of Care”, for certification period 10/23/2023 to 12/21/2023, indicated a start of care on 8/24/2023, with diagnoses including hypertensive heart disease (high blood pressure). The record indicated the SN was visiting Patient 8, twice a week for the first two weeks, then once a week for seven weeks. During an interview on 11/9/2023, at 11:32 a.m., the Director of Nursing (DON) stated licensed vocational nurses were supposed to be supervised every 30 to 60 days. The DON stated, “I don’t think we have any documents to show supervisory visits”. The DON stated supervisory visits were important to make sure the licensed nurse was doing their job correctly. A review of facility’s policy and procedure titled “Responsibilities/Supervision of Clinical Services” undated, indicated “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 unless state regulation requires more frequently. Supervisory visits will be documented, dated, and signed by the supervising professional and included in the clinical record.””

“Required items in clinical record CFR(s): 484.110(a)(1) The patient’s current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This Element is not met as evidenced by: Based on interview and record review the Home Health Agency (HHA, an organization that delivers skilled nursing and other therapeutics service to a patient at home) failed to ensure the patients’ medical records accurately included all nursing visiting records for eight of eight sampled patients (Patient 1, Patient 2, Patient 3, Patient 4, Patient 5, Patient 6, Patient 7, and Patient 8). This deficient practice resulted in patients’ medical records were incomplete that could place the patients at risk for delayed and lack of care coordination and services. A review of Patient 1’s “Home Health Certification and Plan of Care”, for certification period 10/1/2023 to 11/29/2023, indicated a start of care on 10/1/2023, with diagnoses including type 2 diabetes (too much sugar in the blood). The Home Health Certification and Plan of Care indicated the skilled nurse (SN) was visiting Patient 1, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 2’s “Home Health Certification and Plan of Care”, for certification period 10/17/2023 to 12/15/2023, indicated a start of care on 10/17/2023, with diagnoses including essential hypertension (high blood pressure). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 2, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 3’s “Home Health Certification and Plan of Care”, for certification period 10/8/2023 to 12/6/2023, indicated a start of care on 10/8/2023, with diagnoses including hypertensive heart disease (high blood pressure). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 3, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 4’s “Home Health Certification and Plan of Care”, for certification period 9/17/2023 to 11/15/2023, indicated a start of care on 9/17/2023, with diagnoses including hypertensive heart disease (high blood pressure). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 4, twice a week for the first two weeks, then once a week for seven weeks. A review of Patient 5’s “Home Health Certification and Plan of Care”, for certification period 9/16/2023 to 11/14/2023, indicated a start of care on 9/16/2023, with diagnoses including Diabetes Mellitus II (high blood sugar). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 5, once a week for the first week, then twice a week for the next two weeks, then once a week for six weeks. A review of Patient 6’s “Home Health Certification and Plan of Care”, for certification period 9/16/2023 to 11/14/2023, indicated a start of care on 9/16/2023, with diagnoses including other spondylosis (degeneration of the bones and disks in the neck). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 6, once a week for the first week, then twice a week for the next two weeks, then once a week for six weeks. A review of Patient 7’s “Home Health Certification and Plan of Care”, for certification period 5/19/2023 to 7/17/2023, indicated a start of care on 5/19/2023, with diagnoses including hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 7, once a week for the first week, then twice a week for the next two weeks, then once a week for six weeks. A review of Patient 8’s “Home Health Certification and Plan of Care”, for certification period 10/23/2023 to 12/21/2023, indicated a start of care on 8/24/2023, with diagnoses including hypertensive heart disease (high blood pressure). The Home Health Certification and Plan of Care indicated the SN was visiting Patient 8, twice a week for the first two weeks, then once a week for seven weeks. During an interview on 11/7/2023, at 1:37 p.m., the Director of Nursing (DON) stated there were no nursing notes visit records in the medical records of all the patients because the intake coordinator was behind in filing them. The DON stated the nurses emailed their notes to the intake coordinator and was responsible in printing and filing them. The DON stated she did not know the timeline of when the notes were supposed to be in the chart. The HHA failed to ensure nursing visit notes were included in the patient medical records for Patient 1, Patient 2, Patient 3, Patient 4, Patient 5, Patient 6, Patient 7, and Patient 8. A review of facility’s policy and procedure titled “Contents of Clinical Record/Documentation” undated, indicated “The Following information will be available in the clinical record for patients receiving skilled care: Signed and dated progress notes for each discipline rendering services. Clinical notes shall be signed and incorporated into the patients’ health record at least every seven working day.” A review of facility’s policy and procedure titled “Records” undated, indicated “Electronic medical records/paper medical records will be stored in a secure manner that is easily retrievable if records are requested.””