Lighthouse Home Health Care LLC

“Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA’s policies and procedures. This Standard is not met as evidenced by: Based on clinical record reviews and interview with the agency personnel, for one of ten patients (Patient #6) in the survey sample, the agency nurses failed to ensure initial, comprehensive and ongoing assessments of a surgical incision were completed in accordance with the agency’s policies. The findings include: a. Patient #6 had a start of care date of 06/27/2024 with diagnoses that included a right hip fracture, right hip repair on 05/30/2024, type II diabetes, chronic heart failure, and a history of falls. The physician’s orders for the certification period of 06/27/2024 to 08/25/2024 included nursing services three times per week for eight weeks for nursing assessments, and physical therapy twice per week for two weeks. Review of Patient #6’s start of care nursing summary and care plan dated 06/27/2024, failed to identify the Patient had a surgical incision. Review of Patient #6’s nursing note dated 07/01/2024, failed to identify the Patient had a surgical incision. Review of Patient #6’s nursing note dated 07/03/2024, identified Licensed Practical Nurse (LPN) #1 observed Patient #6 had a surgical incision to the right hip which was approximated with a total of thirty-five staples. Review of a communication note by the Administrator dated 07/03/2024, identified LPN #1 reported observing a surgical incision to Patient #6’s right hip which was approximated with staples during the 07/03/2024 visit. The Administrator further indicated a review of the start of care nursing summary and care plan dated 06/27/2024, failed to identify the Patient’s right hip was assessed and a surgical incision was present. i. Interview and review of Patient #6’s clinical record with the Administrator on 07/18/2024 at 11:00 AM, identified the agency’s nurses failed to conducted initial, comprehensive and ongoing assessments of Patient #6’s right hip surgical incision in accordance with the agency’s Initial, Comprehensive and Ongoing Assessments and Wound Care policies. Review of the agency’s Initial and Comprehensive Assessment policy identified the assessment would be patient specific and comprehensive to include the patient’s needs. The Assessment policy further identified the purpose was to provide thorough, ongoing, patient care based on accurate assessments, which gives basis for interventions and realistic expected outcomes. Review of the agency’s Ongoing Assessments policy identified during each home visit the appropriate clinician would re-evaluate the patient according to the problems identified during the initial visit and thereafter. Review of the agency’s Wound care policy identified the purpose was to provide comprehensive treatment for simple and complex wounds to achieve wound healing providing the patient’s needs. The primary care nurse would be responsible for assessing the wound/incision, obtain and carry out wound care orders”

“Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This Standard is not met as evidenced by: Based on review of clinical records, review of an agency policy and interview with agency personnel, for one (Patient #7) of ten patients in the survey sample who received nursing services, the agency’s nurse failed to ensure clinical records were complete and incorporated into the patient’s record. The findings include: a. Patient #7 had a start of care date of 06/14/2024 with diagnoses that included cardiac surgery, hypertensive heart disease with heart failure, type II diabetes, high cholesterol, and falls. The physician’s orders for the certification period of 06/14/2024 to 08/12/2024 included nursing services twice per week for four weeks for nursing assessments, occupational therapy services once per week for four weeks and physical therapy services twice per week for four weeks. i. Interview and review of Patient #7’s clinical record with the Administrator on 07/17/2024 at 1:30 PM, identified nursing notes dated 06/24/2024, 06/27/2024, 07/01/2024, 07/05/2024 and 07/08/2024, were incomplete. The Administrator further identified the agency’s Registered Nurse (RN) #1 failed to ensure nursing notes were completed on the date services were rendered and incorporated into Patient #7’s clinical record within twenty-four to forty-eight hours after the visit. Review of the agency’s Ongoing Assessments policy identified visit notes were to be written within 24-48 hours after the visit and incorporated into the patient’s clinical record.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on clinical record reviews, review of an agency policies and interview with agency staff, for one of three patients (Patient #1) in the survey sample who required weight monitoring, the agency nurses failed to follow physician’s orders. The findings include: Patient #1 had a start of care date of 6/24/2024 with the diagnoses to include hypertension, atrial fibrillation, coronary artery disease, and malignant neoplasm of prostate. The physician orders for the certification period of 6/24/24 to 8/22/24 included skilled nursing services two times per week for one week, to assess fluid retention, cardiovascular status, and for the monitoring of patient weights at every nursing visit, and report a weight gain of five (5) pounds in a week, and/or a weight gain of two (2) pounds or greater in twenty-four hours. Interview and review of Patient #1’s clinical record with the Administrator on 7/18/ 24 at 10am, identified the agency nurses failed to weigh the Patient on five of the six visits, on 6/24, 6/27, 7/2, 7/5, and 7/10/24. The only weight was obtained on 7/16/24, 144 pounds. Review of the Assessment policy identified the purpose was to provide thorough , ongoing, patient care based on accurate assessment, which gives basis for interventions and realistic expected outcomes.”

“Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This Element is not met as evidenced by: Based on clinical record reviews, review of agency policies and interviews with agency personnel, for one of three patients (Patient #1) in the survey sample who required weight monitoring and one of one patient (Patient #6) in the survey sample who required surgical incision monitoring, the agency nurse failed to provide the necessary assessments. The findings included: Patient #1 had a start of care date of 6/24/2024 with the diagnoses to include hypertension, atrial fibrillation, coronary artery disease, and malignant neoplasm of prostate. The physician orders for the certification period of 6/24/24 to 8/22/24 included nursing services two times per week for one week to assess fluid retention, cardiovascular status, and weigh patient every visit and report a weight gain of five pounds in a week or greater than two pounds in twenty-four hours. Interview and review of Patient #1’s clinical record with the Administrator on 7/18/ 24 at 10am, identified the agency nurses failed to weigh the Patient on five of the six visits, on 6/24, 6/27, 7/2, 7/5, and 7/10/24. The only weight was obtained on 7/16/24, 144 pounds. Review of the Assessment policy identified the purpose was to provide thorough , ongoing, patient care based on accurate assessment, which gives basis for interventions and realistic expected outcomes. b. Patient #6 had a start of care date of 06/27/2024 with diagnoses that included a right hip fracture, right hip repair on 05/30/2024, type II diabetes, chronic heart failure, and a history of falls. The physician’s orders for the certification period of 06/27/2024 to 08/25/2024 included nursing services three times per week for eight weeks for nursing assessments, and physical therapy twice per week for two weeks. Review of Patient #6’s start of care nursing summary and care plan dated 06/27/2024, failed to identify the Patient had a surgical incision. Review of Patient #6’s nursing note dated 07/01/2024, failed to identify the Patient had a surgical incision. Review of Patient #6’s nursing note dated 07/03/2024, identified Licensed Practical Nurse (LPN) #1 observed Patient #6 had a surgical incision to the right hip which was approximated with a total of thirty-five staples. Review of a communication note by the Administrator dated 07/03/2024, identified LPN #1 reported observing a surgical incision to Patient #6’s right hip which was approximated with staples during the 07/03/2024 visit. The Administrator further indicated a review of the start of care nursing summary dated 06/27/2024, failed to identify the Patient’s right hip was assessed. ii. Interview and review of Patient #6’s clinical record with the Administrator on 07/18/2024 at 11:00 AM, identified the agency’s nurses failed to conducted an initial and comprehensive assessment of Patient #6’s right hip surgical incision in accordance with the agency’s policy. Review of the agency’s Initial and Comprehensive Assessment policy identified the assessment would be patient specific and comprehensive to include the patient’s needs. Review of the agency’s Ongoing Assessments policy identified during each home visit the appropriate clinician would re-evaluate the patient according to the problems identified during the initial visit and thereafter.”

“Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This Element is not met as evidenced by: Based on review of agency documentation and interview with the agency personnel, the agency failed to ensure the Administrator was available onsite during operating hours on a consistent basis. The findings include: During the entrance conference on 07/16/2024 at 09:20 AM with the Administrator, she identified functioning as the full-time (forty-hours per week) Administrator for the home health agency. Review of the Administrator and agency nurses’ schedules for the month of April, May, June, and July of 2024, identified the Administrator made six nursing visits in April, five nursing visits in May, fifteen nursing visits in June and ten nursing visits in July of 2024. Interview with the Administrator on 07/18/2024 at 11:30 AM, identified she was functioning as the full time (forty-hours per week) Administrator for the home health agency and was responsible for all day-to-day operations of the provider and supervision of the provider staff, interpreting and executing agency policies, and maintaining the agency’s compliance with licensure regulations and standards. In addition to the role of Administrator, she was responsible for conducting nursing visits to patients in the community. The agency failed to ensure the Administrator was available onsite during operating hours on a consistent basis and available to the home health agency staff, patients and representatives and failed to ensure the Administrator was available to consistently supervised patient care services throughout patient episodes to ensure high quality care.”