Advanced Home Health Services, Inc.

“HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator’s name, business address, and business phone number in order to receive complaints. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder, observation during home visits and staff interview, it was determined the Agency failed to provide the Pt./patient’s representative information regarding the Administrator. This was found in 7 of 7 (Pts. #1, 2, 3, 4, 5, 6 and 7) clinical records reviewed. Findings include: 1. The Agency’s Pt. admission folder was reviewed on 5/22/24. The folder lacked the Administrator’s name, address, and phone number to file a complaint and/or grievance. 2. On 5/20/24 and 5/21/24, home visits were conducted on the following Pts. Pt. #1. SOC 10/16/23 Pt. #2. SOC 5/6/24 Pt. #3. SOC 4/29/24 During the home visits, the patient’s admission folder was observed and lacked the name and contact information of the Administrator. 3. The clinical records of the following Pts. were reviewed from 5/21/24 at 10:30 AM to 5/22/24 at 2:00 PM: Pt. #1. SOC 10/16/23 Pt. #2. SOC 5/6/24 Pt. #3. SOC 4/29/24 Pt. #4. SOC 10/21/23 Pt. #5. SOC 4/30/24 Pt. #6. SOC 9/30/23 Pt. #7. SOC 12/5/23 The clinical records lacked documentation that the Pt./patient’s representative was provided the name and contact of the Administrator to file a complaint or grievance. 4. During an interview with the Administrator and Director of Nursing (DON) on 5/22/24 at 3:00 PM, the administrative team confirmed the Agency failed to provide the Pt./patient’s representative with the Administrator’s name and contact information.”

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder, clinical records, observation during home visits and staff interviews, it was determined in 7 of 7 (Pts. #1, 2, 3, 4, 5, 6 and 7) clinical records reviewed, the Agency failed to ensure Pts. were informed in writing of the disciplines to provide care/service, and the frequency of visits provided by each discipline. Findings include: 1. The patient’s admission folder was reviewed on 5/20/24 and included the form titled, “Service Agreement, Consent and Authorization”. The Agency requires the SN to complete the Agreement form during the SOC visit. The form lacked a section that includes all the services the Agency’s offers, and the disciplines to provide services and the frequency of their visits. 2. The clinical records were reviewed from 5/21/24 to 5/22/24, and included documentation that the following services were provided: Pt. #1. SOC 10/16/23. SN and HHA. Pt. #2. SOC 5/6/24. SN Pt. #3. SOC 4/29/24. SN and PT Pt. #4. SOC. 12/7/23. SN and HHA. Pt. #5. SOC 4/30/24. SN, HHA and PT. Pt. #6. SOC 9/30/23. SN, HHA and PT. Pt. #7. SOC 12/5/23. SN and PT. The records included the form titled, “Service Agreement, Consent and Authorization” completed by the RN, signed by the Pt./patient’s representative, and dated with the SOC date. The records lacked documentation that the Pt. or Pt.’s representative was notified of each discipline providing services and frequency of visits, prior to providing Pt. care and services. 3. During interviews with the Administrator and Director of Nursing on 5/22/24 at 3:00 PM, the administrative team confirmed the above findings.”

“Name/contact information of clinical manager CFR(s): 484.60(e)(5) Name and contact information of the HHA clinical manager. This Element is not met as evidenced by: Based on review of the Agency’s Pt. admission folder and staff interviews, it was determined in 7 of 7 (Pts. #1, 2, 3, 4, 5, 6, and 7) the Agency failed to provide information regarding the Clinical Manager (Director of Nursing) and their contact information. Findings include: 1. The Agency Pt. admission folder was reviewed on 5/22/24. The folder lacked information identifying the Clinical Manager’s name and contact information. 2. The clinical records of the following Pts. were reviewed from 5/20/24 to 5/22/24: Pt. #1. SOC 10/16/23 Pt. #2. SOC 5/6/24 Pt. #3. SOC 4/29/24 Pt. #4. SOC 10/21/23 Pt. #5. SOC 4/30/24 Pt. #6. SOC 9/30/23 Pt. #7. SOC 12/5/23 The clinical records reviewed lacked information identifying the Clinical Manager’s name and contact information. 3. The following home visits were conducted on 5/20/24 from 1:30 PM to 5/21/24 at 2:30 PM. Pt. #1. SOC 10/16/23 Pt. #2. SOC 5/6/24 Pt. #3. SOC 4/29/24 4. During the home visits, on 5/20/24 from 1:30 PM to 5/21/24 at 2:30 PM, the Pt. admission folders were reviewed. The folders lacked the name and contact information of the Clinical Manager. 5. During staff interview with the Administrator and Clinical Supervisor on 5/22/24 at 3:00 PM, it was indicated the same admission folder is given to all Patients. The administrative staff also confirmed the above findings.”