At Home Quality Care - Lombard

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on clinical record review, interview during a home visit, Agency policy review and staff interview, it was determined in 1 of 1 (Pt. #2) clinical record reviewed, wherein Home Health Aide services are provided, the Agency failed to ensure the RN provides accurate written instructions to the Home Health Aide. Findings include: 1. Pt. #2 was admitted to home health services on 8/7/23 with the primary diagnosis of Not Elsewhere Classified Lymphedema. The clinical record was reviewed on 4/9/24. The record contained the Home Health Aide Care Plans completed by the RN, effective 2/4/24 and 4/3/24 that included instructions for the Home Health Aide to provide a “Partial Bed Bath, Tub, Shower, QV (Every Visit)”. A home visit was conducted with E #1 on 4/9/24 at 2:00 PM. During the home visit, an interview was conducted with E #1 that stated Pt. #2 “...has swollen legs... it’s unsafe for her to lift her legs to get in the bath tub, so I give her a sponge bath...” The Home Health Aide Care Plans lacked appropriate and safe bathing instructions for the Home Health Aide. 2. The Agency policy titled, “Home Health Aide Plan of Care” was reviewed on 4/10/24. The policy required: “...2. The home health aide plan of care will be individualized to the specific patient...” 3. During an interview with the Administrator, Alternate Administrator, Director of Nursing, and the Quality & Regulatory Specialist on 4/10/24 at 12:03 PM, the Alternate Administrator, Quality & Regulatory Specialist and the Director of Nursing confirmed the above findings.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on clinical record review, policy review and staff interviews, it was determined for 1 of 7 (Pt. #3) clinical records reviewed, the Agency failed to ensure that the wound treatment was provided as ordered by the Physician. Findings include: 1. Pt. #3 was admitted to home health services on 2/21/24 with the primary diagnosis of Pulmonary Embolism. The clinical record was reviewed on 4/10/24 and contained documentation as follows: SN Visit Note dated 2/28/24, “Narrative: Upon SN assessment, patient has new bilateral top of feet reddened areas with some blistering and edema…Patient Wounds: Type: Erythema; Location: Feet; Length: 5 Width: 5 Depth: SN Visit Note dated 3/13/24: “Patient Wounds: Type: Erythema; Location: Feet; Length: 5 Width: 5 Depth: SN Visit Note dated 3/20/24: “Patient Wounds: Type: Erythema; Location: Feet; Length: 5 Width: 5 Depth: The Physician note with the encounter date of 3/9/24 and signed on 3/13/24 included documentation: “assessment/plan: 2. Ulcer of right foot due to type 2 diabetes mellitus…Neosporin and cover – refer to wound care, SN to perform wound care; 3. Ulcer of the left foot due to diabetes mellitus…Neosporin and cover – refer to wound care, SN to perform wound care.” As of 4/10/24, the record lacked documentation that SN performed wound treatment per Physician order. 2. The policy titled “Physician Participation in Plan of Care” was reviewed on 4/11/24, and required, “The care will be provided in compliance with the therapeutic and diagnostic orders and accepted standards and practice.” 3. During an interview with the Administrator, Assistant Administrator, Director of Nursing, Chief Executive Officer and Quality & Regulatory Specialist on 4/10/24 at 4:00 PM, the Director of Nursing stated the wound treatment is performed in conformance with the Physician’s orders. During the same interview, the above finding was confirmed.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on a review of the clinical records and staff interview, it was determined in 1 of 1 (Pt. #2) clinical records reviewed, wherein Home Health Aide services are provided, the Agency failed to ensure the Home Health Aide was supervised every 14 days. Findings include: 1. Pt. #2 was admitted to home health services on 8/7/23 with the primary diagnosis of Not Elsewhere Classified Lymphedema. The clinical record was reviewed on 4/9/24. The record contained documentation the RN supervised the Home Health Aide on 2/2/24, the Home Health Aide provided service on 2/5/24, 2/8/24, 2/12/24, 2/15/24 and 2/19/24, the RN supervised the Home Home Health Aide on 2/22/24 (19 days without Home Health Aide supervision). The record lacked documentation the Home Health Aide was supervised every 14 days. The RN supervised the Home Health Aide on 2/22/24 (as indicated above). Home Health Aide services were provided on 2/26/24, 2/29/24, 3/4/24, 3/7/24, 3/11/24, 3/14/24 and 3/18/24, the RN supervised the Home Health Aide on 3/19/24 (25 days without Home Health Aide supervision). The record lacked documentation the Home Health Aide was supervised every 14 days. 2. During an interview with the Administrator, Alternate Administrator, Director of Nursing, and the Quality & Regulatory Specialist on 4/10/24 at 12:03 PM, the Alternate Administrator and the Director of Nursing confirmed the Agency failed to ensure that Home Health Aide supervision was conducted every 14 days.”