Kidcare Nursing Services

“At discharge CFR(s): 484.55(d)(3) At discharge. This Element is not met as evidenced by: Based on record review and interview the home health agency failed to have a documented discharge summary within the records of Sample Patient #1. Findings Include: Record review of the home health agencies discharged patients revealed that 1 patient has been discharged from services in the past 3 months. That is Sample Patient #1. However, within that patient records there are no notes or a discharge summary present. Patient was hospitalized 01/15/2025 and to date has not been released from the hospital. 01/23/2025 11:30am, the surveyor had a conversation with the director of nursing, and she could not explain why there was no discharge within the records.”

“Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA’s services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This Standard is not met as evidenced by: Based on interview and record review the home health agency (HHA) failed to provide documentation demonstrating the scope, complexity, and past performance of the HHA’s services and operations, and the quality improvement projects undertaken, the reasons for conducting the projects, and the measurable progress achieved on these projects for an annual Quality Improvement Special Project. Findings Include: The surveyor conducted an interview with the Director of nursing on 12/21/23 at 10:00am. The surveyor requested a copy of the agency’s Special Quality Assurance Project. The director of nursing came back and handed the surveyor a graph. When asked what work the home health agency (HHA) did to come up with the graph, the director of nursing did not provide an answer. The surveyor was not provided with any more information demonstrating the scope, complexity, and past performance of the HHA’s services and operations, and the home health agency’s reasons for conducting the projects.”

“Executive responsibilities for QAPI CFR(s): 484.65(e)(1)(2)(3)(4) Standard: Executive responsibilities. The HHA’s governing body is responsible for ensuring the following: (1) That an ongoing program for quality improvement and patient safety is defined, implemented, and maintained; (2) That the HHA-wide quality assessment and performance improvement efforts address priorities for improved quality of care and patient safety, and that all improvement actions are evaluated for effectiveness; (3) That clear expectations for patient safety are established, implemented, and maintained; and (4) That any findings of fraud or waste are appropriately addressed. This Standard is not met as evidenced by: Based on interview and record review the agency was unable to provide documentation that showed an ongoing program for quality improvement and patient safety was implemented and maintained. Findings Include: The surveyor conducted an interview with the Director of nursing and Human Resource manager on 12/22/23 at 12pm. They provided their QAPI manual and their policy on quality assurance. The surveyor reviewed the documentation provided and determined the documentation omitted a special Quality assurance project for the 2023 year nor was the agency able to provide documentation of quality assurance measures being performed for the agency.”

“Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This Element is not met as evidenced by: Based on closed record review and interview with the Director of nursing, the agency failed to provide all services stated within the individual plans of care for 2 out of 7. Sampled Patient’s (SP), SP #6 and SP#7. Findings include: The surveyor conducted chart reviews on SP#6 and SP#7, as well as calendar review confirmed that 24 hours/7 days a week nursing services were not being provided. The surveyor interviewed the Director of nursing on 12/22/23 at 1:26pm. The Director of Nursing confirmed some complete shifts were missed while others only partially; 12 out of 24 hours were staffed. The Director of Nursing contacted direct nursing staff , but could not provide information to determine the reason for the missed shifts for SP#6 and SP#7. The surveyor interviewed SP#7’s parent on 12/21/23 at 1PM, who confirmed many visits were not made to provide nursing services to SP#7.”

“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 record review and interview with the director of nursing, the home health agency failed to ensure the plan of care included all medications, treatments, and nutritional requirements for 1 (SP#3) out of 7 patients reviewed. Finding include: The surveyor conducted closed record review which included nursing notes and interview with the director of nursing on 12/22/23 at 1:26pm. The Director of Nursing acknowledged the Plan of care was incomplete for SP#3. SP#3 has a G-Tube. The surveyor reviewed the nursing notes which documented that the nurse was flushing the G-Tube with 5milliliters of water after medication administration. The Plan of care did not contain flushing the G-Tube with 5milliliters of water after medication administration.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on record review and interview with the Director of nursing, the home health agency failed to ensure staff followed the physician ordered plan of care for 4 out of 7 Sampled Patient’s (SP). SP#1, SP#2, SP#3 and SP#4. Findings include: The surveyor reviewed closed chart reviews and found the following discrepancies: SP#4 Plan of care states flush G-tube with 10 ml water before and after each medication administration and flush with 30 ml of water before and after administration of feeding. The chart revealed nurse flushed with 50ml water. SP#1 Plan of Care revealed flush with 10ml water between medication administration and after feedings. Chart review revealed 4 separate nursing notes all with different number of fluids being flushed. Nurse 1 provides 30ml flush, nurse 2 provides 60ml flush, nurse 3 provides 120ml flush and nurse 4 provides 60ml flush. SP#3 Plan of care has no order for G-tube SP#4 Plan of care reads flush with 30 milliliters (ml) water after medication administration. Nurses’ notes within flush of any kind. Plan of care is incomplete. The nursing notes show nursing flushed the g-tube with 5ml of water after medication administration and between feeding flushes as well. SP#2 Plan of Care reads before and after medication administration flush with 5-10ml water, nursing notes confirm nurse is following plan of care and flushed with 6ml of water. The plan of care reveals the order for after feeding flush with 10ml of water, but the nursing notes reveal flushes are being done with 6ml of water. The surveyor conducted an interview with the Director of nursing 12/22/23 at 1:26pm. She could not explain the discrepancies.”

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on record review and interview, the home health agency failed to ensure 7 out of 7 sampled patients (SP#1, SP#2, SP#3, SP#4, SP#5, SP#6, and SP#7) were provided with the frequency of visits to be provided. Findings include: The surveyor conducted clinical record reviews of SP#1, SP#2, SP#3, SP#4, SP#5, SP#6 and SP#7. Within their service agreements the agency omitted the amount and time of services being provided. The service agreements had for nursing services and Home Health Aide services a “yes” comment written. The surveyor interviewed the Director of nursing on 12/22/23 at 1:26pm. The Director of Nursing stated the forms were filled out correctly. The Director of Nursing was unable to demonstrate through documentation SP#1, SP#2, SP#3, SP#4, SP#5, SP#6, and SP#7 had been provided with a visit schedule at the time of the survey.”

“Activities lead to an immediate correction CFR(s): 484.65(c)(1)(iii) (iii) Lead to an immediate correction of any identified problem that directly or potentially threaten the health and safety of patients. This Element is not met as evidenced by: Based on record review, staff interviews and interview with the Director of Nursing the agency failed to follow the Plan of Care for 3 out of 7 Sampled Patients (SP). SP#1, SP#2 and SP#4. Findings include: The surveyor conducted closed record reviews of SP#1, SP#2, and SP#4 on 12/22/2023. SP#4’s Plan of care states flush G-tube with 10 ml water before and after each medication administration and flush with 30 ml of water before and after administration of feeding. The surveyor reviewed the clinical record and saw documented the nurse flushed with 50ml water. SP#1’s Plan of Care contained flush with 10ml water between medication administration and after feedings. The surveyor reviewed the clinical record and saw documented 4 separate nursing notes all with different number of fluids being flushed. Nurse 1 provided 30ml flush, nurse 2 provided 60ml flush, nurse 3 provided 120ml flush and nurse 4 provided 60ml flush. SP#2’s Plan of Care read before and after medication administration flush with 5-10ml water. The surveyor reviewed the plan of care, which contains the order for after feeding flush with 10ml of water. The surveyor reviewed the nursing notes which documented flushes were being done with 6ml of water. The surveyor conducted an interview with the Director of nursing on 12/22/23 at 1:26pm. The Director of nursing could not explain the discrepancies at the time of the survey.”

“Improvements are sustained CFR(s): 484.65(c)(3) The HHA must take actions aimed at performance improvement, and, after implementing those actions, the HHA must measure its success and track performance to ensure that improvements are sustained. This Element is not met as evidenced by: Based on the home health agency’s manual reviews and staff interviews, the home health agency failed to demonstrate that they have been conducting Quality Assurance measures. Findings include: The surveyors requested to review the home health agency’s Quality Assurance documentation that demonstrates what actions the home health agency had taken to address performance improvement, and after implementation of those improvements, how the home health agency measure the success of the actions taken. The Director of nursing presented the surveyors with a graph on 12/21/2023 at 10AM and proceeded to explain it was a Quality Assurance special project. The surveyors reviewed the graph provided, and requested the Director of Nursing provide the documentation demonstrating what actions were taken, the implementation of those actions, and the tracking of the performance to ensure that improvements were being sustained. The surveyors interviewed the Director of nursing and the Human Resource manager inquiring about the Quality Assurance documentation. The Director of Nursing and the Human Resource Manager could not find and provide the compilation of documentation demonstrating the source material for the graph completed at the time of the survey.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on record review and interview, the provider is unable to demonstrate a completed discharge summary for 2 out of 7 Sampled Patients (SP). SP #6 and SP#7 Findings include: The surveyor conducted closed record reviews of Sample Patient (SP). SP#6 and SP#7 on 12/19/2023 to 12/22/2023. SP#6 contained a discharge summary from the agency with a discharge date of 07/24/2023: and SP#7 contained a discharge summary from the agency with a discharge date of 10/30/2023. The discharge summaries for SP#6 and SP#7 omitted information such as listing the admission and discharge date, physician responsible for home health plan of care, reason for admission to home health, type of services being provided and frequency of services, laboratory data (if applicable), Medications the patient is on at the time of discharge, patient’s discharge condition, Patient outcomes in meeting the goals in the plan of care and Patient and family post-discharge instructions. The surveyor conducted an interview with the Director of Nursing on 12/22/2023 at 01:26pm and she acknowledged that the discharge summaries for SP#6 and SP#7 were incomplete, missing the required notations as previously mentioned.”