Primary Medical Staffing Inc.

“Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient’s behavior, the behavior of other persons in the patient’s home, or situation; This Element is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to implement interventions to resolve a lack of communication between the caregiver and the Home Health Agency for 1 of 3 sampled patients reviewed for communication between the caregiver and the Home Health Agency (Patient #1). The findings included: Review of the Electronic Health Record (EHR) of Patient #1 on 01/16/24 reveals a “Start of Care” of 06/07/19 with a principle diagnosis of Atrial Septal Defect and other diagnoses of Pulmonary Hypertension and Chronic Obstructive Pulmonary Disease. A review of the recent “visit notes,” recorded by Staff B, a Licensed Practical Nurse (LPN), reveals Staff B had visit notes in the EHR from 2019 until January 13, 2024. On 01/16/24 at 1:30 PM, Staff A, a Registered Nurse Case Manager (RN), was interviewed as to when the last time the patient was seen in the home with the Nurse present; Staff A responded that she believed the last time was 05/12/23; continued to say that she has not been able to speak with Patient #1’s parent and an RN not been able to enter the home since 05/12/23; Staff A stated the parent does not answer the telephone or return telephone calls; therefore, all supervisory visits have been done on the telephone with the other parent of the patient who does not live in the home. A review of the LVN (Licensed Vocational Nurse) “Supervisory Note,” dated 12/08/23 and done by Staff A, reveals Staff A was unable to get in touch with the parent and spoke to the other parent on the telephone for the visit. On 01/16/24 at 11:30 AM, an interview was conducted with Staff A. who was asked if she reported the lack of communication and lack of ability to make a home visit for Patient #1 with the Clinical Manager; she replied that she had not; she had only discussed this with the Staffing Coordinator. On 01/17/24 at 9:37 AM, during an interview, the Administrator was asked if she was aware that Staff A was not able to communicate with Patient #1’s parent or see the patient and she stated she was not aware until yesterday.”

“Assure patient needs are continually assessed CFR(s): 484.105(c)(4) Assuring that patient needs are continually assessed, and This Element is not met as evidenced by: Based on review of the Home Health Agency’s Policy, record review and interview; the Home Health Agency failed to continually assess 1 of 3 sampled patients through home visits or telephone communication (Patient #1). The findings included: Review of the Home Health Agency’s Policy titled, “Nursing Services” revised March 2018, reveals “Nursing care will be provided in accordance with the patient’s plan of care, under the supervision of a registered nurse. Professional nursing service will be provided by a registered nurse and include: Initial and ongoing comprehensive assessments of the patient’s needs, including Outcome and Assessment Information Set (OASIS) assessments at appropriate time points and Informing the physician and other staff of changes in the patient’s needs.” Review of the Electronic Health Record (EHR) revealed an OASIS was done based on a “ Pediatric Visit Note” dated 09/09/23. On 01/16/24 at 11:00 AM, an interview was conducted with Staff A, Registered Nurse Case Manager who stated that a LVN (Licensed Vocational Nurse) “Supervisory Note,” dated 10/09/23 was done using the “Pediatric Visit Note” also. Further review reveals that on 12/08/23, the LVN “Supervisory Note” was done with input from the parent of the patient. Continued review reveals that on 01/07/24, the OASIS E Recertification was done using visit notes from the Licensed Practical Nurse. On 01/17/24 at 9:30 AM, during an interview, the lack of supervision for the patient and Licensed Nurse was discussed with Staff A, Registered nurse Case Manager; Staff A stated that she could not reach the parent of the patient and could not get into the home; stated on 06/27/23, Patient #1 had a “gastric” (stomach) tube removed; she was asked where this was noted in the EHR, and she stated it was a “text” on her telephone and not put into the patient’s record. The Home Health Certification and Plan of Care for the certification period 01/12/24-03/11/24 reveals, under “Homebound Narrative -Pediatric patient with Atrial Septal Defect, Chronic Lung Disease, Pulmonary Hypertension, and feeding difficulties requiring G (Gastric)-tube.” Discussed with the Administrator on 01/17/24 at 9:37 AM who stated that patients should be assessed in the home, and she should have been informed that Staff A could not reach the parent of the patient or see the patient. Any change in the patient’s status should be in the EHR and updated in the Plan of Care.”