Global Horizon Home Care

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on clinical record reviews, review of agency documentation, interviews with agency personnel, and review of agency policies and procedures, for one of ten patient’s (Patient #9) in the survey sample, the agency failed to perform the initial assessment visit for home care services within the prescribed time frame, and failed to follow the agency’s policy for initial and comprehensive assessment visit. Patient # 9 had a start of care date of January 13, 2023 with diagnoses that included chronic heart failure (diastolic), chronic kidney disease, cirrhosis of the liver, anxiety, and hepatomegaly. The physician order for the certification period 1/13/25 through 3/13/25 included skilled nursing one time a week for nine weeks for nursing assessments, recognize and intervene to minimize complications, and a physical therapy evaluation for safety. Interview and review of Patient #9 clinical record and inpatient discharge paperwork with the Administrator on 3/6/25 at 1:30 pm, identified that Patient #9 was discharged from an inpatient unit on 1/9/25, with a physician order for a start of care for home care services on or before 1/11/25, but failed to identify completion of the physician ordered start of care visit until 2 days later, 1/13/25, (4 days from inpatient discharge) and failed to identify compliance with the agency policy. Review of the nursing communication note dated 1/11/25, identified that the admitting nurse was unable to locate the patient for completion of the initial assessment visit 1/11/25. Review of the agency Initial and Comprehensive policy identified the admission visit and initial assessment must be completed within 48 hours of a referral to home health services, or within 48 hours of the client’s return home, or on a physician ordered start of care.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on clinical record reviews, review of agency documentation, interviews with agency personnel, for one of ten patient’s (Patient #9) in the survey sample, the agency failed to communicate a change in the start of care, initial assessment visit with the patient’s physician. Patient # 9 had a start of care date of January 13, 2023 with diagnoses that included chronic heart failure (diastolic), chronic kidney disease, cirrhosis of the liver, anxiety, and hepatomegaly. The physician order for the certification period 1/13/25 through 3/13/25 included skilled nursing one time a week for nine weeks for nursing assessments, recognize and intervene to minimize complications, and a physical therapy evaluation for safety. Interview and review of Patient #9 clinical record and inpatient discharge paperwork with the Administrator on 3/6/25 at 1:30 pm, identified that Patient #9 was discharged from an inpatient unit on 1/9/25, with a physician order for a start of care for home care services on or before 1/11/25, but failed to identify completion of the physician ordered start of care visit until 2 days later, on 1/13/25, (4 days after inpatient discharge). Review of the communication note dated 1/11/25, identified that the admitting nurse was unable to locate the patient for completion of the initial assessment visit 1/11/25, but failed to identify communication with the physician related to the missed visit and for a change in the start of care date.”

“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 clinical record review and interviews with agency personnel for one of two patients (Patient #1) in the survey sample, the agency failed to ensure an accurate and authentic record. The findings include: Patient #1 had a start of care date of 9/22/23 and diagnoses that included hemiplegia following a cerebral infarct affecting the right dominant side, type II diabetes mellitus and hypertension. The physician’s orders for the certification periods of 9/22/23 through 3/19/24 included nursing services twice daily for medication and insulin administration and assessments and home health aide services to assist with personal care. Physician’s orders included Humalog insulin 100 units/milliliter (u/ml) injectable subcutaneously (15 units) per sliding scale with meals and Lantus Solostar pen 100 u/ml, inject 29 units subcutaneously every twelve hours daily. Review of the November Medication Administration Record/MAR identified Humalog insulin 35 units was administered with breakfast and 25 units administered with lunch and dinner and Lantus insulin 29 units administered in the morning and evening. Interview and review of LPN #1’s twice daily nursing notes from 11/01/23 to 11/30/23 with the Administrator on 3/25/24 at 10 AM identified the twice daily administration of Humalog insulin, 25 units and Lantus insulin 45 units and failed to ensure an accurate record of the insulin doses given in accordance with the MAR.”

“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 review, review of agency policies and interview with agency personnel, for one of two patients (Patient #1) in the survey sample, the agency nurses failed to ensure the plan of care addressed the patient’s individual needs and failed to follow physician’s orders. Patient #1 had a start of care date of 9/22/23 and diagnoses that included hemiplegia following a cerebral infarct affecting the right dominant side, type II diabetes mellitus and hypertension. The physician’s orders for the certification period of 11/21/23 through 1/19/24 included nursing services twice daily for medication and insulin administration and assessments. i. Interview and review of the clinical record with the Administrator on 3/25/24 at 11 AM identified Patient #1 was receiving home health aide services seven days a week, although, review of the physician’s orders failed to identify home health aide services were included in the plan of care. Physician’s orders included Lantus Solostar pen 100 u/ml inject 29 units subcutaneously every twelve hours daily. ii. Interview and review of the November 2023 through February 2024 MAR’s with the Administrator on 3/25/24 at 2 PM, identified the Lantus insulin was administered in the “AM” and “PM”, but failed to identify specific times of administration and review of the twice daily nursing notes from November 2023 through February 2024 identified that the nurses visited between 8-9 AM and 5-6 PM daily and failed to follow physician’s orders for the Lantus insulin administration every twelve (12) hours. Review of the agency’s policy for Care Planning, identified clinicians would inform the patient’s physician of any changes that suggest a need to alter the plan of care. Changes would be written, dated, and signed by the qualified clinician and physician making the changes.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on review of the clinical record, review of agency policies and interview with agency personnel, for one of two patients (Patient #1) in the survey sample, the agency licensed nurses failed to communicate with the physician the need to clarify the interval of insulin administration. The findings include: Patient #1 had a start of care date of 9/22/23 and diagnoses that included hemiplegia following a cerebral infarct affecting the right dominant side, type II diabetes mellitus and hypertension. The physician’s orders for the certification periods of 9/22/23 through 3/19/24 included nursing services twice daily for medication and insulin administration and assessments and home health aide services to assist with personal care. Physician’s orders included Lantus Solostar pen 100 u/ml inject 29 units subcutaneously every twelve hours daily. Interview and review of the November 2023 through February 2024 MAR’s with the Administrator on 3/25/24 at 2 PM identified the Lantus insulin was administered in the “AM” and “PM”, failed to identify specific times of administration and review of the twice daily nursing notes from November 2023 through February 2024 identified that the nurses visited between 8-9 AM and 5-6 PM daily. Furthermore, the Administrator identified that the patient requested morning visits after 8 AM, but failed to communicate the request to the physician, and failed to clarify the insulin order from every 12 hours to twice daily at breakfast and dinner. Review of the agency’s policy for Care Planning, identified clinicians would inform the patient’s physician of any changes that suggest a need to alter the plan of care. Changes would be written, dated, and signed by the qualified clinician and physician making the changes.”