Amaris Home Health Care Agency

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on interview and record review of the Centers for Medicare and Medicaid Services (CMS) Outcome and Assessment Information Set (OASIS) Error Detail report, the agency failed to electronically transmit current and accurate data at least monthly for 67 patients served by the agency. Findings include: 1. Review of the OASIS Error Detail report from 4/1/23 through 3/15/24 revealed 67 assessments were submitted more than 30 days after the “M0090” date, which was the last date information used to completed the comprehensive assessment and determine the OASIS coding was gathered by the assessing clinician. During an interview on 3/20/24 at 1:33 p.m., the agency’s consultant stated the agency previously had contracted with a biller and that biller was supposed to be submitting the OASIS data. She stated the agency reached out to the biller for the validation report but had not been able to get it yet. She further stated the agency owner had “revitalized” the agency’s login to iQIES (Internet Quality Improvement and Evaluation System) and the agency was going to re-submit all OASIS information, just to be sure it was correctly submitted. During an interview on 3/20/24 at 2:21 p.m., the director of nursing (DON) confirmed she and the alternate administrator would be completing all agency OASIS information submission on a weekly basis and would be working closely with the agency’s consultant to ensure they were doing it correctly. During an interview on 3/2024 at 4:15 p.m., the agency’s consultant again confirmed the agency had no evidence as to when OASIS documentation had been submitted, as the third party biller still hadn’t provided the validation report. She further stated the agency was re-submitting all OASIS documentation and therefore confirmed the OASIS submissions were all completed outside the 30 day window required by regulation.”

“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 interviews and record reviews, the agency failed to ensure each patient received home health services in accordance with a written plan of care established and reviewed by a physician for 1 of 4 patient records reviewed (Patient #1) and failed to ensure the agency did not render services prior to the physician’s approval for the services for 1 of 4 patient records reviewed (Patient #4). Findings include: 1. The clinical record for Patient #4 was reviewed on 3/19/24. The plan of care for the certification period dated 3/15/24 to 5/13/24 revealed a start of care date of 1/20/23; diagnoses included paroxysmal atrial fibrillation, chronic obstructive pulmonary disease (COPD), diabetes mellitus, type 2, hypertensive chronic kidney disease, anemia, heart disease, occlusion and stenosis of carotid arteries, hyperlipidemia, gastro-esophageal reflux disease (GERD) and depression. Plan of care orders included skilled nursing (SN) visits zero times for one week, once weekly for eight weeks, zero times for one week and once weekly for one week for medication complications and changes and change of condition; and certified nurse aide (CNA) visits once weekly for one week, once weekly for eight weeks and once weekly for one week. a) The agency failed to ensure the registered nurse (RN) established the plan of care with the physician prior to the provision of services. Clinical record review revealed the director of nursing (DON) completed a recertification comprehensive assessment on 11/14/23, pertaining to the certification period beginning 11/16/23. Review of the assessment revealed Patient #4 received SN services once weekly for nine weeks and three visits as needed (PRN) and CNA services once weekly for one week and twice weekly for eight weeks and the DON received a verbal order from the physician on 11/15/23 for the SN and CNA frequencies. Continued review of the clinical record showed the DON completed a recertification comprehensive assessment on 3/13/24, pertaining to the certification period beginning 3/15/24. Review of the assessment revealed Patient #4 received SN services once weekly for eight weeks and and three visits PRN and CNA services once weekly for one week, twice weekly for eight weeks and once weekly for one week. The DON received a verbal order from the physician on 3/8/24 for the SN and CNA frequencies. Additional review of the record from 1/15/24 to 3/14/24 showed Patient #4 received SN visits once weekly and CNA visits twice weekly. However, the record failed to show evidence a recertification comprehensive assessment was conducted and the agency received physician orders for care and services after the end of the certification period on 1/14/24 and the beginning of the certification period on 3/15/24. During an interview on 3/20/24 at 11:47 a.m., Certified Nurse Aide (CNA) #7 confirmed she provided services to Patient #4 twice weekly. She stated the care plan she followed was maintained both in a folder in the patient’s home as well as electronically in the agency’s electronic medical record (EMR) system. However, she stated the only care plan she was able to access in the EMR was for the certification period dated 3/15/24 to 5/13/24. During an interview on 3/20/24 at 2:05 p.m., the DON stated the recertification comprehensive assessment for the recertification period beginning on 1/15/24 was supposed to be completed by Former RN #2, as the DON was out of the country. She stated she realized on 3/8/24 that the recertification comprehensive assessment had never been completed and she completed a follow-up comprehensive assessment on 3/8/24 and the recertification comprehensive assessment on 3/13/24. She further stated she had reached out to RN #2 to inquire if she had received a verbal order for the certification period dated 1/15/24 to 3/14/24 but had not received a return call from RN #2. During the same interview, the agency’s consultant stated the agency clinicians were following the orders received from the physician for the certification period dated 11/16/23 to 1/14/24, as the patient received routine care that did not vary from certification period and confirmed the patient had no change of condition during that time. Both the DON and the consultant confirmed the agency did not have orders for the care and services provided to Patient #4 from 1/15/24 to 3/14/24. 2. The clinical record for Patient #1 was reviewed on 3/18/24. The plan of care for the certification period dated 12/25/23 to 2/22/24 revealed a start of care date of 12/30/22; diagnoses included malignant neoplasm of rectum, Crohn’s disease, ileostomy status, anxiety and depression and long term use of anticoagulants. Plan of care orders included SN visits once weekly for one week, twice weekly for seven weeks, once weekly for one week and three visits PRN for change of condition or medications. Review of the subsequent plan of care for the certification period dated 2/23/24 to 4/22/24 revealed orders for SN visits twice weekly for one week, seven times weekly for eight weeks, twice weekly for one week and three visits PRN for daily medication administration and colostomy care, medication box filling weekly and administration of Humira via injectable pen every two weeks; and CNA visits once weekly for one week, three times weekly for eight weeks and once weekly for one week for assistance with activities of daily living (ADLs). a) The agency failed to ensure clinicians provided services only in accordance with the physician ordered plan of care. Clinical record review revealed a physician’s order, effective 1/27/24, to increase SN visit frequency to once weekly one week, seven times weekly for one week, six times weekly for one week, twice weekly for one week and once weekly for one week for colostomy care and medication management. Further review revealed an order, effective 1/30/24, to add CNA services twice weekly for one week, three times weekly for two weeks and twice weekly for one week to assist with ADLs and bathing. Review of the record from 1/1/24 to 3/18/24 failed to show Patient #1 received SN visits seven times weekly and CNA visits three times weekly as ordered. Specifically, Patient #1 did not receive a SN visit on 2/10/24 and did not receive CNA visits on 2/16/24, 2/19/24 and 2/21/24. Further review of the record failed to show any documentation of a missed visit or how the patient’s needs were met on those days. During an interview on 3/20/24 at 1:12 p.m., the DON stated there were no completed visit notes or missed visit notes for the missing SN and CNA visits for Patient #1. She stated she had a call out to CNA #7 to find out if visits were conducted to Patient #1 or not but had not gotten a return call from CNA #7. Licensed Practical Nurse (LPN) #1, who conducted visits to Patient #1 until 3/12/24, was no longer employed by the agency and unavailable for interview.”

“Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient’s condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This Element is not met as evidenced by: Based on interviews and record reviews, the agency failed to ensure each patient’s individualized plan of care was reviewed by the physician at least every 60 days for 4 of 4 patient records reviewed who were on services for more than 60 days (Patients #1, #2, #3 and #4). Findings include: 1. The clinical record for Patient #4 was reviewed on 3/19/24. The plan of care for the recertification period dated 3/15/24 to 5/13/24 revealed a start of care date of 1/20/23; diagnoses included paroxysmal atrial fibrillation, chronic obstructive pulmonary disease (COPD), diabetes mellitus, type 2, hypertensive chronic kidney disease, anemia, heart disease, occlusion and stenosis of carotid arteries, hyperlipidemia, gastro-esophageal reflux disease (GERD) and depression. Plan of care orders included skilled nursing (SN) visits zero times for one week, once weekly for eight weeks, zero times for one week and once weekly for one week for medication complications and changes and change of condition; and certified nurse aide (CNA) visits once weekly for one week, once weekly for eight weeks and once weekly for one week. a) The agency failed to ensure the physician reviewed and signed Patient #6’s individualized plan of care every 60 days as required. Review of the plan of care for the certification period dated 11/16/23 to 1/14/24 showed the director of nursing (DON) received verbal orders for the SN and CNA frequencies on 11/15/23. However, there was no evidence to show the physician reviewed the plan of care, as it was never returned with a physician’s signature. 2. Similar findings of patient records failing to show evidence the physician reviewed the plans of care every 60 days was found with Patient’s #1, #2 and #3. 3. On 3/20/24, the physician signed plans of care for Patients #1, #2, #3 and #4 were requested from the agency. During an interview on 3/20/24 beginning at 1:12 p.m., the DON confirmed the agency did not have any signed plans of care for Patients #1, #2, #3 and #4. She stated a previous employee was supposed to be sending them to the physicians for signature, but realized during the survey that the previous employee had not done so. She stated she was not sure for how long. The DON further stated she would be working closely with the agency’s consultant to ensure all plans of care would be provided to the physicians for review, signed and returned to the agency. During an interview on 3/20/24 at 2:08 p.m., the agency’s consultant confirmed some plans of care had been sent to physicians via facsimile (fax) and some had not. She stated there was no way to know for certain which plans of care had been sent to physicians and so the agency was sending all current plans of care to physicians and would then work on sending all previous plans of care for current patients to physicians for review and signature.”