Rx Staffing and Home Care

“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) failed to ensure the individualized plan of care (POC) was signed by a physician within 30 days of the patient’s start of care for two of 17 sampled patients (Patients 9 and Patient 16). These failures had the potential to result in the agency providing patient care that was not approved by the physician. A review of Patient 16’s “Home Health certification and Plan of care [POC]”, indicated, Patient 16’s Start of Care (SOC) was 1/27/2024 for certification period of 1/27/2024 through 3/26/2024. The POC indicated he had multiple diagnoses that included uncontrolled blood sugar. Patient 16’s POC had no physician’s signature. During a concurrent interview and record review on 3/12/2024 at 3:25 p.m., the Case Manager (CM) verified Patient 16’s POC had no physician’s signature. The CM stated, “The State requires POC to be signed by the physician within 30 days”. A review of the agency’s policy titled, “PHYSICIAN PLAN OF CARE ORDERS” initiated, 5/1/2019, indicated, “…1. The plan of care shall be developed…and signed and dated by the physician within 30 working days…” A review of Patient 9’s clinical record indicated a Plan of Care (POC) for the certification period of 1/31/2024 through 3/30/2024 and a Start of Care (SOC) dated 1/31/2024. Patient 9’s diagnoses included chronic pain syndrome. Further review of Patient 9’s POC indicated, the POC was signed by the physician on 3/4/2024, 33 days later. In a concurrent interview and record review on 3/14/2024 at 11:36 a.m., the Case Manager (CM) confirmed Patient 9’s POC was signed by the physician over 30 days. The CM stated her expectation was for the POC to be signed by the physician within 30 days.”

“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) failed to ensure the medication profile was reviewed for 1 of 7 sampled patients (Patient 7) who received home visits. This failure had the potential for Patient 7 to receive medications with the wrong dose which could cause adverse effects and potential omission of medications. Findings: A review of the clinical record indicated Patient 7 had a Plan of Care (POC) for the certification period of 2/18/2024 through 4/17/2024 and the Start of Care (SOC) dated 2/18/2024. Patient 7’s diagnoses included unspecified atrial fibrillation (irregular heartbeat which can lead to stroke without proper treatment), type 2 diabetes mellitus (too much sugar in the blood), and Parkinson’s disease (progressive disorder that affects movement). Further review of Patient 7’s POC indicated Patient 7 was forgetful and she was living in a Board and Care (B & C) with 24/7 caregivers. During an observation of the home visit for Patient 7 on 3/13/2024 starting at 10 a.m., the Licensed Nurse (LN) provided a list of medications to Patient 7’s caregiver. The LN informed Patient 7’s caregiver to call the LN if the caregiver had questions pertaining to Patient 7’s medications. The LN did not review the list of medications with Patient 7’s caregiver. In an interview on 3/13/2024 at 10:46 a.m., the caregiver stated she started as Patient 7’s caregiver on Saturday (3/9/2024). In an interview on 3/13/2024 at 10:58 a.m., the LN confirmed she provided a list of Patient 7’s medication to the caregiver. The LN stated there was no change with Patient 7’s medications. The LN further confirmed the caregiver for Patient 7 today was a different caregiver from the one she had when LN visited last week. An interview was conducted with the Case Manager (CM) on 3/13/2024 at 4:30 p.m. The CM stated her expectation was for the LN to review Patient 7’s medications and provide education to the caregiver every home visit especially if the caregiver was new. A review of the agency’s policy and procedure (P & P) dated 5/1/2019 and titled, “MEDICATION ADMINISTRATION” indicated, “…The nurse will routinely monitor all medications to determine their action, special precautions, patient’s response, side effects, allergies, and contraindications.” In a concurrent interview and P & P review on 3/13/2024 at 4:55 p.m., the CM defined “routinely” as conducted every home visit.”