Asian Network Pacific Home Care, 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 did not provide services as outlined in the plan of care for one of three sampled patients (Patient 5) when Patient 5 did not receive education and training on seizure (a sudden burst of abnormal electrical activity in the brain that can cause shaking or jerking of the body) precautions and edema (swelling that happens when too much fluid builds up in the body’s tissue) management as required by the established plan of care. This failure had the potential to place Patient 5 at risk for unmanaged seizure activity and inadequate understanding of edema management, which could result in delayed recognition of complications and delayed access to necessary medical interventions. During a review of Patient 5’s “Home Health Certification and Plan of Care” for certification period 2/16/25 – 4/16/25, the plan of care indicated, Patient 5’s start of care was 2/16/25, with diagnoses that included a pneumonitis (inflammation of lung tissues) due to inhalation of food and vomit and unspecified convulsion [a type of seizure (abnormal electrical activity in the brain) uncontrollable shaking or jerking of the muscles], and hemiplegia (paralysis that affects one side of the body) following other nontraumatic intracranial hemorrhage (bleeding in the brain that is not caused by injury) affecting left dominant side. The plan of care indicated interventions to address Patient 5’s seizure disorder and edema that included education for Patient 5 and caregivers on seizure precautions and measures to detect and relieve edema. During a review of Patient’s clinical document, titled, “OASIS-E1 Start of Care” (SOC), dated 2/16/25, the “SOC” record indicated Patient 5 was recently hospitalized due to subdural hematoma (bleeding in the brain) and seizures. The “SOC” record also indicated Patient 5 had a 2+ pitting edema (moderate swelling which means when a gentle pressure is applied to the swollen area, it leaves a small dent that takes a few seconds to go away) on bilateral feet. During a record review of Patient 5’s “Skilled Nursing Visit” (SNV) records, dated 2/28/25 and 3/7/25, the “SNV” records indicated Patient 5 experienced an additional episode of 2+ pitting edema on bilateral feet. The “SNV” records did not include any interventions, such as measures to relieve the edema or education provided to Patient 5 and/or caregiver regarding edema management. During a record review of Patient 5’s “Skilled Nursing Visit” (SNV) records, dated 2/28/25 and 3/7/25, the “SNV” records indicated Patient 5 had another episode of 2+ pitting edema on bilateral feet. The “SNV” records did not show any interventions including education and management on how to relieve Patient 5’s edema when the Registered Nurse (RN) 1 and RN 2 noted the 2+ pitting edema during 2/28/25 and 3/7/25 visits. During a record review of Patient 5’s “SN“ records dated, dated 2/19/25, 2/21/25, 2/25/25, 2/28/25, 3/4/25, 3/7/25, 3/11/25, 3/14/25, 3/18/25/, and 3/25/25, the “SNV” records did not show any education or trainings provided to Patient 5 and/or Patient’s 5 caregiver regarding seizure precautions all throughout the documented episodes. During an interview on 9/10/25 at 2:10 p.m. with the Director of Clinical Services (DCS), the DCS stated RN 1 and RN 2 should have educated Patient 5 and/or Patient 5’s caregiver on seizure precautions and edema management especially if they were included in the plan of care. The DCS stated seizure precautions education should have included minimizing injury during an episode, calling 911, timing of the seizure episode, and protecting Patient 5 in the event of an active seizure. The DCS stated not providing education created a risk that Patient 5’s caregivers would not know how to respond appropriately if the patient experienced a seizure. The DCS further stated edema management including interventions and instructions should also have been provided to Patient 5 and the caregiver when RN 1 and RN 2 noted the edema on the day of their visit. During a record review of the agency’s policy and procedure (P&P), titled, “Care Planning”, revised in May 2024, the P&P indicated, “To plan and provide individualized care and/or services appropriate to the goals and needs of patient’s services by the agency...The care plan is developed in collaboration with home health team to cover all pertinent diagnosis…The plan of care includes at least the following information…Interventions to address the identified patient’s needs...Interventions, including teaching and training guidelines, are appropriate to the scope of practice of the individual developing and/or updating the plan of care…””

“Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This Element is not met as evidenced by: Based on interview and record review the home health agency did not provide services as outlined in the plan of care for one of three sampled patients (Patient 5) when Patient 5 did not receive education and training on seizure (a sudden burst of abnormal electrical activity in the brain that can cause shaking or jerking of the body) precautions and edema (swelling that happens when too much fluid builds up in the body’s tissue) management as required by the established plan of care. This failure had the potential to place Patient 5 at risk for unmanaged seizure activity and inadequate understanding of edema management, which could result in delayed recognition of complications and delayed access to necessary medical interventions. During a review of Patient 5’s “Home Health Certification and Plan of Care” for certification period 2/16/25 – 4/16/25, the plan of care indicated, Patient 5’s start of care was 2/16/25, with diagnoses that included a pneumonitis (inflammation of lung tissues) due to inhalation of food and vomit and unspecified convulsion [a type of seizure (abnormal electrical activity in the brain) uncontrollable shaking or jerking of the muscles], and hemiplegia (paralysis that affects one side of the body) following other nontraumatic intracranial hemorrhage (bleeding in the brain that is not caused by injury) affecting left dominant side. The plan of care indicated interventions to address Patient 5’s seizure disorder and edema that included education for Patient 5 and caregivers on seizure precautions and measures to detect and relieve edema. During a review of Patient’s clinical document, titled, “OASIS-E1 Start of Care” (SOC), dated 2/16/25, the “SOC” record indicated Patient 5 was recently hospitalized due to subdural hematoma (bleeding in the brain) and seizures. The “SOC” record also indicated Patient 5 had a 2+ pitting edema (moderate swelling which means when a gentle pressure is applied to the swollen area, it leaves a small dent that takes a few seconds to go away) on bilateral feet. During a record review of Patient 5’s “Skilled Nursing Visit” (SNV) records, dated 2/28/25 and 3/7/25, the “SNV” records indicated Patient 5 experienced an additional episode of 2+ pitting edema on bilateral feet. The “SNV” records did not include any interventions, such as measures to relieve the edema or education provided to Patient 5 and/or caregiver regarding edema management. During a record review of Patient 5’s “Skilled Nursing Visit” (SNV) records, dated 2/28/25 and 3/7/25, the “SNV” records indicated Patient 5 had another episode of 2+ pitting edema on bilateral feet. The “SNV” records did not show any interventions including education and management on how to relieve Patient 5’s edema when the Registered Nurse (RN) 1 and RN 2 noted the 2+ pitting edema during 2/28/25 and 3/7/25 visits. During a record review of Patient 5’s “SN“ records dated, dated 2/19/25, 2/21/25, 2/25/25, 2/28/25, 3/4/25, 3/7/25, 3/11/25, 3/14/25, 3/18/25/, and 3/25/25, the “SNV” records did not show any education or trainings provided to Patient 5 and/or Patient’s 5 caregiver regarding seizure precautions all throughout the documented episodes. During an interview on 9/10/25 at 2:10 p.m. with the Director of Clinical Services (DCS), the DCS stated RN 1 and RN 2 should have educated Patient 5 and/or Patient 5’s caregiver on seizure precautions and edema management especially if they were included in the plan of care. The DCS stated seizure precautions education should have included minimizing injury during an episode, calling 911, timing of the seizure episode, and protecting Patient 5 in the event of an active seizure. The DCS stated not providing education created a risk that Patient 5’s caregivers would not know how to respond appropriately if the patient experienced a seizure. The DCS further stated edema management including interventions and instructions should also have been provided to Patient 5 and the caregiver when RN 1 and RN 2 noted the edema on the day of their visit. During a record review of the agency’s policy and procedure (P&P), titled, “Care Planning”, revised in May 2024, the P&P indicated, “To plan and provide individualized care and/or services appropriate to the goals and needs of patient’s services by the agency...The care plan is developed in collaboration with home health team to cover all pertinent diagnosis…The plan of care includes at least the following information…Interventions to address the identified patient’s needs...Interventions, including teaching and training guidelines, are appropriate to the scope of practice of the individual developing and/or updating the plan of care…” During a record review of the agency’s P&P, titled, “Assessment”, revised in January 2024, the P&P indicated, “Data obtained during assessment visits is used to determine patient’s needs for care and/or services and to develop a plan of care…The patient and family/caregiver should be evaluated for knowledge and instructed about the patient’s condition/disease process, proposed care, potential benefits and effects of the care and/or services to be provided…”