Loving Care and More

“State toll free HH telephone hotline CFR(s): 484.50(c)(9) Be advised of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local HHAs. This Element is not met as evidenced by: Based on review of patient records and staff interview, it was determined the agency failed to provide accurate contact information for the Department of Health and Welfare and the home health agency hotline. This had the potential to affect all patients at the agency who wished to file a complaint with the state regarding their home health agency care. Findings include: The Patient Bill of Rights was included in the admission packet for all patients. Within this document, it stated, “The patient has the right to be advised of the availability of the toll free HHA hotline in the state...The HOTLINE number is: 1-800-377-3529”. This number was incorrect. There was no mailing address or email listed as an alternate contact. The Administrator was interviewed on 7/22/24, beginning at 3:00 PM. The Patient Bill of Rights was reviewed in his presence. The Administrator confirmed the hotline number printed on the form was incorrect. He stated the document had been updated 2 years ago, apparently with this incorrect hotline number. Patients were not provided a contact number to file complaints regarding the agency.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on policy review, medical record review, and staff interview, it was determined the facility failed to follow the POC for 2 of 11 patients (Patient #6 and #7) whose records were reviewed. This created a lack of pain assessment and potential for pain to be unrecognized and not addressed in a timely fashion. Findings include: A facility policy titled, “Pain Assessment/Management” dated 2018, stated, “Pain is assessed on every home visit and documented on a pain or symptom flow sheet.” The policy further documented, “the nurse/therapist will use a standardize agency accepted pain assessment tool that evaluates …severity (rating scale) … and response to treatment.” This policy was not followed. Examples include: Patient #6 was a 66-year-old female admitted to the agency 5/08/24 with a primary diagnosis of pressure ulcer of right buttock, stage 3. Additional diagnoses included pressure ulcer of sacral region, fitting and adjustment of urinary device, chronic pain syndrome and mild cognitive impairment, major depressive disorder, essential hypertension, Type II diabetes and COPD. She received SN, OT, ST and PT services. Patient #6’s POC documented that interventions and goals included “Assess: Pain level” as well as goal “Pt will verbalize/demonstrate measures to manage pain r/t chronic pain/RA”. Patient #6’s medical record had no pain assessment documented for visits on 5/17/24, 5/20/24, 5/30/24, 6/04/24, and 6/11/24. The DON was interviewed beginning at 7/23/24 at 11:35 AM and Patient #6’s record was reviewed with him. The DON confirmed that pain was not assessed at every visit for Patient #6. 2. Patient #7 was a 79-year-old male admitted to the agency 5/29/24 with a primary diagnosis of pressure ulcer of other site, stage 3. Additional diagnoses included non-pressure ulcer of low leg, localized edema, unspecified atrial fibrillation, COPD, essential hypertension and hypokalemia. He received SN services. Patient #7’s POC documented that interventions and goals included “Pain levels r/t chronic pain” and “Pt/pcg will verbalize/demonstrate measures to manage pain.” Patient #7’s medical record had no pain rating documented for visits on 6/21/24, 6/28/24, or 7/05/24. Additionally, on visit days 7/17/24 and 7/19/24, pain ratings of 8 were documented with no discussion, intervention or contact to doctor documented. The DON was interviewed beginning at 7/23/24 at 11:35 AM and Patient #7’s medical record was reviewed with him. The DON confirmed that pain was not assessed at every visit for Patient #7. When asked what follow up was needed for a pain rating of 8, the DON reported the doctor would need to be contacted. The DON confirmed the doctor was not contacted when the pain rating was documented at 8 for Patient #7. The agency failed to ensure pain was fully assessed at each visit.”

“Nursing services supervised by RN CFR(s): 484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k). This Element is not met as evidenced by: Based on medical record review, policy review, observation, and staff interview, it was determined the HHA failed to ensure the LPN was supervised by a Registered Nurse and documented on a regular and consistent basis to ensure patient care was followed according to the individual plan of care. This had the potential to affect all patients seen by an LPN. Findings include: Policy C-320, Licensed Practical Nurse Supervision, updated 2018, was reviewed. The policy stated, “Supervisory visits are to be documented in the patient’s chart. The patient/caregiver will be notified of any changes in care. The supervision will occur at a minimum of every to(sic) 14 days.” This policy was not followed. Example included: Patient #9 was a 70 year old female admitted to the agency on 2/07/24 for wound care. Patient #9 received SN and PT services. An observation visit by the surveyor was conducted with the LPN on 7/23/24 at 10:40 AM. Patient #9’s chart was reviewed. LPN visits occurred on the following dates: 6/17/24, 6/21/24, 6/24/24, 6/27/24, 7/02/24, 7/08/24, 7/15,24, and 7/23/24. Patient #9 was seen by an RN on 7/05/24, 7/13/24 and 7/20/24. There was no note regarding the supervision of the LPN in these documented visits. The DON was interviewed on 7/23/24, beginning at 2:00 PM. He confirmed there were no documented supervisory visits completed for Patient #9. LPN visits were not provided under the direction and supervision of an RN.”