Pruitthealth at Home - Cumming

“Discharge plans communication CFR(s): 484.60(c)(3)(ii) (ii) Any revisions related to plans for the patient’s discharge must be communicated to the patient, representative, caregiver, all physicians or allowed practitioner’s issuing orders for the HHA plan of care, and the patient’s 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). This Element is not met as evidenced by: Based on record reviews, staff interviews, and review of agency policy, it was determined the agency failed to communicate discharge plans to one patient (#3) from a total of three sampled patients. On 4/29/24 at approximately 12:30 p.m., a telephone interview was conducted with Patient (P) (P#3) who confirmed that she did call the agency to complain that she had not received Physical Therapy services. P#3 stated she had called several times and was told repeatedly that someone would be out to her home. P#3 reported that she was 90 years old and did not feel that the agency had treated her right. P#3 stated she wanted therapy to get her strength back so that she can do things on her own. She stated that the agency finally “got it together” and she was pleased with the services currently. On 4/30/24 at 1:00 p.m., an interview was conducted with the Administrator, who confirmed that an order was received on 2/29/2024, for P#3 for Nursing services, Physical Therapy services and a Medical Social Worker (MSW). The Administrator acknowledged that the agency failed to follow the physician orders and the physical therapy services were delayed. Review of the clinical record revealed that P#3 was scheduled to be discharged on 4/25/2024, for refusing visits from the agency. The agency failed to document or inform P#3 of the pending discharge. At the time of the survey the patient had not been discharged from services. On 4/30/24 at 1:30p.m., an interview was conducted via phone with Physical Therapist (PT) (PT BB) who confirmed that he had documented the missed visit on 3/22/24. PT BB stated P#3 asked him to leave her home on 3/22/24, for not allowing P#3 to talk in a condescending manner toward him. PT BB stated that P#3 was meeting her therapy goals. Review of policy titled “Patient discharges from home health” revised date 9/08/22 revealed the agency will advise the patient that a discharge for cause if being considered. The agency will make efforts to resolve problem(s) presented by the patient’s behavior.”

“Assure implementation of plan of care CFR(s): 484.105(c)(5) Assuring the development, implementation, and updates of the individualized plan of care. This Element is not met as evidenced by: Based on record reviews, staff interviews, and review of agency policy, it was determined the agency failed to ensure the implementation of plan of care for one patient (#3) from a total of three patients. Review of the plan of care for patient (P) P#3 revealed a physician’s order to admit to home health care for Skill Nurse, Physical Therapy and Medical Social Worker (MSW) services was received on 2/19/24. P#3 was admitted by Registered Nurse (RN) AA on 2/21/24. At the time of admission, the nurse submitted an order for physical therapy. The plan of care was to include nursing visits scheduled 1 every 3 weeks for 9 weeks, MSW for evaluation and Physical therapy to evaluate. MSW made a visit with P#3 on 2/23/24. The agency failed to send a physical therapist (PT) to evaluate. On 4/30/24 1:00 p.m., an interview with RN AA revealed that P#3 was admitted on 2/21/24 and at the time of admission the patient requested that the skilled nurse visit be scheduled every 3 weeks as she felt that therapy was all that she needed. RN AA stated she requested PRN visits to cover if P#3’s condition declined. An interview on 4/30/24 at 2:30 p.m. with Physical Therapist (PT) AA confirmed he admitted P#3 to physical therapy services but was unable to recall why the visit was started so late or why he called in a missed visit to the MD. PT AA stated he was unable to recall why he failed to implement the plan of care as ordered. On 4/30/24 at 1:30p.m., an interview was conducted via phone with Physical Therapist (PT) (PT BB) who confirmed that he had documented the missed visit on 3/22/24. PT BB stated P#3 asked him to leave her home on 3/22/24, for not allowing P#3 to talk in a condescending manner toward him. PT BB stated that P#3 was meeting her therapy goals. On 4/30/24 at 1:00 p.m., an interview was conducted with the Administrator, who confirmed that an order was received on 2/29/2024, for P#3 for Nursing services, Physical Therapy services and a Medical Social Worker (MSW). The Administrator acknowledged that the agency failed to follow the physician orders and the physical therapy services were delayed. Administrator further stated she was unable to give a reason for the missed visit. She confirmed that P#3 did not receive services as ordered by physician. Review of policy titled “Plan of care for home health patients” revised date 11/6/22 revealed the agency will develop and implement an individualized plan of care for each patient admitted for care/services. Review of policy titled “Therapy Services” revealed that each patient referred for therapy services will receive in-depth assessment within 72 hours (or on physician order date) of receiving the referral, by a professional therapist appropriate to the type of therapy services indicated and provided.”

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on observation, record review, facility policy review, and staff interview, it was determined that the home health agency failed to follow accepted standards of practice to prevent the transmission of infection by not changing gloves during wound care and dressing change for one patient (P) (P#15) of seven home visits. Findings include: During a visit in a residential home on 12/18/2023 at 3:00 p.m., Registered Nurse (RN) DD was observed performing wound care and dressing change on the left lower leg of P#15. RN DD donned disposable gloves prior to wound care and on the same pair of gloves RN DD was observed rubbing hand sanitizer on the gloves prior to taking items in and out of the nursing bag. RN DD failed to change gloves and don clean gloves after handling the dirty wound dressing for P#15. Review of policy titled, “Infection Prevention – Hand Hygiene,” revised 3/8/19, reveals the following: 3. Do not wash gloves between uses and reuse with different residents. 4. Perform hand hygiene and change gloves during resident care if moving from contaminated body site to a clean body site. On 12/20/23 at 1:30 p.m., an interview was conducted with the Administrator who confirmed that RN DD was not following their policy entitled “Infection Prevention – Hand Hygiene,” revised 3/8/19.”

“At discharge CFR(s): 484.55(d)(3) At discharge. This Element is not met as evidenced by: Based on record reviews, and staff and patient interview, it was determined that the agency failed to ensure that a comprehensive discharge summary was completed to include the administration of the Outcome and Assessment Information Set (OASIS) at discharge to assist in the continuity of care post discharge for one patient (P) (P#7) of four sampled discharge patients. Findings include: Review of the document titled “Home Health Certification and Plan of Care” for P#7 revealed that P#7 was admitted to services on 9/25/2023 with a diagnosis of fusion of spine cervical region (connect two or more bones in any part of the spine) and muscle weakness. Review of the “Discharge from agency” order dated 12/19/2023 reveled: “Patient began outpatient therapy, please discharge from home health from last billable visit on 10/20/2023”. Further review of the clinical record for P#7 failed to include a discharge summary and lacked the OASIS data assessment. On 12/19/2023 at 5:45 p.m., a telephone interview was conducted with P#7, revealed that patient has started outpatient therapy since 11/1/2023 and has been discharged from the home health agency . On 12/20/2023 at 1:40 p.m., an interview was conducted at the agency with the Administrator who confirmed the discharge summary, and the discharge OASIS was not completed at discharge. The Administrator additionally confirmed the nurses, and the therapists complete the discharge summaries and OASIS discharge assessments at the time of the discharge.”

“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 record reviews, agency policy reviews and staff and patient interview, it was determined that the Physical Therapist (PT) and Occupational Therapist (OT) failed to communicate with team members and physician to ensure their efforts were coordinated effectively and timely to support the objectives outlined in the plan of care for one patient (P) (P#7) of seventeen sampled patients. Findings include: Review of the plan of care for P#7 revealed that patient was admitted to services on 9/25/2023 with a diagnosis of fusion of spine cervical region (surgery to connect two or more bones in any part of the spine) and muscle weakness. Review of the plan care dated 9/25/2023 revealed the PT to visit P#7 once a week for nine weeks for soft tissue/joint mobilization and therapeutic exercises. Occupational Therapist to visit patient once a week for 5 weeks to educate patient and family on safety recommendations for home environment, Activities of Daily Living (ADL) training to increase independence and therapeutic exercises. Review of the care coordination note for P#7 revealed PT missed visits dated 11/3, 11/17, and 11/20/2023. The last PT visit was made on 11/6/2023. Further review of the clinical record revealed that no PT visits were made after 11/6/2023 and no OT visit was made after 10/17/2023. Review of care coordination note dated 11/14/2023 revealed case conference titled “Recert/DC decision” performed with care team for P#7. The case conference note revealed that P#7 to be scheduled for recertification as described in the plan of care and patient is progressing towards goals. Review of the Care coordination note dated 12/19/2023 revealed that PT AA documented patient refused multiple attempts to schedule a PT discharge visit. Patient started outpatient therapy. PT AA contacted Medical Doctor (MD) via medical assistant voicemail with no response. Review of the Client coordination note dated 12/19/2023 revealed that RN AA documented upon retroactive review, patient began outpatient as of November and refused discharge visit. Review of discharge from agency order dated 12/19/2023 revealed “Patient began outpatient therapy. Please discharge from home health from last billable visit on 10/20/23”. Further additional record review for P#7 revealed that there was no further communications or documentation in the clinical record to indicate the PT attempted to see the patient after 11/6/2023, and no documentation in the clinical record to indicate that patient was recertified as recommended on the team conference note dated 11/14/2023. The PT and OT failed to complete the visit frequencies as ordered in the plan of care. Further addition review of the record lacked communication and/or coordination efforts made with care team members to discuss any difficulty or inability to provide PT and OT services as requested. Additionally, no communication with the physician to inform the physician the ordered plan of care was not completed. The PT and OT failed to communicate timely with the care team members and the physician to effectively coordinate the patient’s care/treatment. Review of the policy titled “Coordination and Management of Home Health Services” dated 9/22/2022 revealed the following: · All partners providing services shall maintain effective interchange so that all services are effectively coordinated between the members of the Interdisciplinary team, clearly outlining each member’s responsibilities in an effort to: · Evaluate the adequacy of treatment and the effectiveness of services provided. · Determine whether services for a patient should be continues and or future plan for care. · Provide the attending physician with an ongoing assessment of the patient and the patient’s response to the services provided. · Team conference shall be conducted to evaluate the patient’s status and progress and respond to changes in the patient’s needs, services , goals and treatment. A written summary report for each patient is sent to the attending physician at least every 60 days. · The clinician will communicate with the team members and the physician regarding the patient’s status and response to the plan of treatment as often as indicated on an ongoing basis . The physician will be contacted when his/her approval for a change in the care plan is necessary. · All changes will be communicated to the appropriate team members within 24 hours of the change. Coordination of care efforts /outcomes will be documented in the patient’s medical record. Review of the undated policy titled “Home Health team /Case conference Process” revealed the following: · All team attendees will come prepared to discuss assigned caseload and provide input on patients to whom they provide care. · During this case conference the administrator or designee will review the missed visit by agent report. · Complete Recert/DC Decision workflow Task after conference discussion. · Review pending agency discharge patients. · Review patients who need to be recertified, Review recertification reports. On 12/19/2023 at 5:45 p.m., a telephone interview conducted with P#7 revealed that P#7 has started outpatient therapy since 11/1/2023 and has been discharged from home health agency. On 12/20/2023 at 1:40 p.m., an interview conducted at the agency with the Administrator revealed that P#7 was hard to get hold of to complete the visits. Administrator revealed the clinical record lacked evidence of coordination with the physician and team members regarding coordination of services to ensure the plan of care was followed as ordered and that the hospice agency failed to follow the policy for “Coordination and Management of Home Health Services” and policy for “Home Health Team /Case conference Process”.”