One Staffing Agency LLC

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on the Home Health Agency (HHA)’s Policy review, record review and interview, the HHA failed to ensure that the patient’s physician was promptly alerted regarding the patient not receiving the Skilled Nurse shifts ordered, as per the Plan of Care for 2 of 2 sampled pediatric patients (Patient #1 and #2). The findings included: 1) Review of the Home Health Agency’s Policy titled, “Coordination of Care- Assessment, Comprehensive” reviewed on 09/01/23, documents, “…when a visit is missed, the agency will be notified by the clinician. The data entry enters the missed visit in the EMR (Electronic Medical Record) system. The Director of Nursing will send an order to the physician to notify the physician…”. Review of Patient #1’s Home Health Certification and Plan of Care for the period from 11/08/23 to 01/06/24 documents physician’s orders for discipline as Skilled Nurse 1 week 1 and then a Private Duty Nurse (PDN) 24 hours, seven days a week. On 01/16/24 at 10:42 AM an interview and a side-by-side review of Patient #1’s record was conducted with the HHA’s Quality Assurance and Performance Improvement (QAPI) Nurse; the QAPI Nurse stated that the HHA received an insurance authorization to provide a Skilled Nurse 24 hours every day and the start of care was done on 11/08/23. Further review of Patient #1’s record reveals a lack of a written Skilled Nurse Shift Note on the following dates: 11/18/23- 7:00 AM to 7:00 PM shift 11/19/23- 7:00 AM to 7:00 PM shift 11/21/23- 7:00 AM to 3:00 PM shift 11/22/23- 7:00 AM to 7:00 PM shift Review of the patient’s Discharge Summary to the physician, reveals documentation that it was dated 11/22/23. During the review and interview, on 01/16/24 at 10:42 AM, the QAPI Nurse stated that she did not see any written documentation of the HHA informing Patient #1’s physician of the missed visits; the QAPI Nurse stated the HHA must inform the patient’s physician when the visits are not done. On 01/16/24 at 12:33 PM, an interview was conducted with the HHA Office Manager who was asked to provide any written evidence of Patient #1’s physician’s notification of the lack of Skilled Nurse visits for the dates 11/18/23, 11/19/23, 11/21/23 and11/22/2; the Office Manager stated that the patient’s parent was aware of all missed visit and scheduling, but that he was not aware that he needed to inform the patient’s physician; the Office Manager stated that Patient #1 was discharged on 11/22/23 and the last Skilled Nurse visit was done on 11/21/23 from 2:30 PM to 7:00 AM (next day 11/22/23). 2) Review of Patient #2’s Home Health Certification and Plan of Care for the period from 12/02/23 to 01/30/24 documents physician’s orders for a Private Duty Nurse (PDN) 24 hours seven days a week to provide disease process teaching, medication administration and Gastrostomy (a surgical opening into the stomach, from the abdominal wall for the introduction of food) tube feedings and teaching. On 01/16/24 at 2:36 PM, a side-by-side review of Patient #2’s record was conducted with the HHA Quality Assurance and Performance Improvement (QAPI) Nurse; the QAPI Nurse stated that the HHA received an insurance authorization to provide a Skilled Nurse 24 hours every day and the start of care was done on 08/04/23. Review of Patient #2’s record reveals the lack of a written Skilled Nurse Shift Note on the following dates: 12/04/23- 7:00 PM to 7:00 AM shift 12/17/23- 7:00 AM to 7:00 PM shift 12/25/23- 7:00 PM to 7:00 AM shift 12/31/23- 7:00 AM to 6:30 PM shift 12/31/23- 10:30 PM to 7:00 AM shift 01/01/24- 7:00 AM to 7:00 PM shift 01/01/24- 7:00 PM to 7:00 AM shift During the review and interview, on 01/16/24 at 2:36 PM, the QAPI Nurse stated that she did not see written documentation of the HHA informing Patient #1’s physician of the missed visits; the QAPI nurse stated the HHA must inform the patient’s physician when visits are not done. On 01/16/24 at 3:33 PM, an interview was conducted with the Office Manager who stated that he did not notify Patient #2’s physician regarding the missed Skilled Nurse Shifts.”