Select Home Care, Inc.

“EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.542(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, REHs at §485.542, OPO, “Organizations” under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility’s] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility’s] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient’s home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice’s response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice’s emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility’s] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility’s] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE’s response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE’s emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility’s emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID’s emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA’s emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO’s response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI’s and OPO’s] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI’s response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI’s emergency plan, as needed. This Standard is not met as evidenced by: Based on review of the Emergency Preparedness plan and staff interview, it was determined that the Agency failed to conduct required testing of the Emergency Preparedness plan. This has the potential to affect all Pts. receiving services from the Agency. Findings include: 1. The Agency’s Emergency Preparedness plan was reviewed on 9/11/24 at 11:30 AM. The Emergency Preparedness plan lacked documentation that the Agency conducted / participated in any facility-based or community-based functional exercises, from 2021 to 2023. 2. The findings were confirmed during the interview, with the Administrator and Clinical Manager on 9/11/24 at 12:00 PM.”

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on review of the Error Summary report and staff interview, it was determined that the Agency failed to submit OASIS assessments within the required time frame for a 12 month period, resulting in a warning. Findings include: 1. The Error Summary report for 10/1/23 to 9/10/24 (12 months) was reviewed on 9/9/24. The report included a warning for 11 of 23 (47.83%) assessments with Error # -3330 Record submitted late, more than 30 days after completing the assessment. 2. During an interview conducted with the Administrator on 9/11/24 at 12:00 PM, the above findings were confirmed.”

“Patient’s or legal representative’s signature CFR(s): 484.50(a)(2) Obtain the patient’s or legal representative’s signature confirming that he or she has received a copy of the notice of rights and responsibilities. This Element is not met as evidenced by: Based on a review of clinical records and staff interviews, it was determined that for 3 of 7 (Pts. #4, #5 and #6) clinical records reviewed, the Agency failed to ensure that a Pt. or Representative signature was obtained prior to initiating an initial assessment. Findings include: 1.The clinical records of the Pts. listed below were reviewed on 9/10/24. The clinical records lacked documentation of Patients’ or Representatives’ signature confirming receipt of notices of rights and responsibilities. Pt. #4 SOC: 1/17/24 Pt. #5 SOC: 7/28/23 Pt. #6 SOC: 11/10/23 2. During interviews conducted with the Administrator and Clinical Manager from 9/10/24 at 3:15 PM and on 9/11/24 at 10:30 AM, the above findings were confirmed.”

“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 a review of clinical records and staff interviews, it was determined that in 5 of 7 (Pts. #3, 4, 5, 6 and 7) clinical records reviewed, the Agency failed to ensure the Pt./Representative consent to treatment prior to providing Pt. care/service; or informed of the services to be provided, and the frequency of visits in advance of treatment. 5. Pt. #7 was admitted to home care services on 4/24/24 with diagnosis of Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. The clinical record was reviewed on 9/11/24. The clinical record lacked documentation that the Pt./Representative was notified of the service to be provided, and the frequency of each service. 6. During an interview with the Administrator and Clinical Manager, on 9/10/24 at 3:15 PM, 9/11/24 at 10:30 AM, and 9/11/24 12:15 PM, the Administrator confirmed the above findings. 4. Pt. #6 was admitted for home health services on 11/10/23 with the diagnosis of Burn of Second Degree of Buttock. The clinical record was reviewed on 9/10/24. The record contained documentation that Pt. #6 received SN services but lacked documentation that at the SOC, the Pt./Representative was informed in writing of the service and frequency of the visits, prior to providing Pt. care. Findings include: 1. Pt. #3 was admitted for home health services on 9/5/24 with the diagnosis of Schizoaffective Disorder, Unspecified. The clinical record was reviewed on 9/10/24. The clinical record contained the Agency’s consent form which included a section titled, “Service – Frequency…” This section was left blank, it lacked documentation that SN and PT services were to be provided, and the frequency of the visits. 2. Pt. #4 was admitted for home health services on 1/17/24 with the diagnosis of Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified. The closed clinical record was reviewed on 9/10/24. The closed clinical record contained documentation that SN and PT services were provided between 1/17/24 to 2/9/24. As of 9/10/24, the record lacked a written consent for treatment/service. The record lacked documentation that the Agency informed the Pt./Representative in writing that SN and PT services would be provided, and their frequency of visits, prior to providing Pt. care/service. 3. Pt. #5 was admitted for home health services on 7/28/23 with the diagnosis of Bilateral Primary Osteoarthritis of Knee. The closed clinical record was reviewed on 9/10/24. The closed clinical record contained documentation the SN and PT provided service from 7/28/23 to 11/17/23. As of 9/10/24, the record lacked a written consent for treatment/service. The record lacked documentation that the Agency informed the Pt./Representative in writing that SN and PT services would be provided, and their frequency of visits, prior to providing Pt. care/service.”

“Payment from federally funded programs CFR(s): 484.50(c)(7)(i, ii, iii, iv) Be advised, orally and in writing, of- (i) The extent to which payment for HHA services may be expected from Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (ii) The charges for services that may not be covered by Medicare, Medicaid, or any other federally-funded or federal aid program known to the HHA, (iii) The charges the individual may have to pay before care is initiated; and (iv) Any changes in the information provided in accordance with paragraph (c)(7) of this section when they occur. The HHA must advise the patient and representative (if any), of these changes as soon as possible, in advance of the next home health visit. The HHA must comply with the patient notice requirements at 42 CFR 411.408(d)(2) and 42 CFR 411.408(f). This Element is not met as evidenced by: Based on a review of clinical records and staff interviews, it was determined that for 3 of 7 (Pts. #4, #5 and #6) clinical records reviewed, the Agency failed to ensure Pts. are advised of the extent of their financial liability for care, and/or services before care is initiated. Findings include: 1. The clinical records of the Pts. listed below were reviewed on 9/10/24. The clinical records lacked documentation of information regarding their financial liability. Pt. #4 SOC: 1/17/24 Pt. #5 SOC: 7/28/23 Pt. #6 SOC: 11/10/23 2. During an interview conducted with the Administrator and Clinical Manager from 9/10/24 at 3:15 PM and on 9/11/24 at 10:30 AM, the above findings were confirmed.”

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on a review of clinical records, and staff interviews, it was determined that in 4 of 7 (Pts. #4, 5, 6, and 7) clinical records reviewed, the Agency failed to ensure a referral was obtained to initiate service or that the initial assessment visit was done within 48 hours of receipt of the referral. 4. Pt. #7 was admitted to home care services on 4/24/24 with diagnosis of Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. The clinical record was reviewed on 9/11/24 and included the Face-to Face form dated 5/8/24 and faxed to home health agency on 5/17/24 required: “Skilled Nursing for comprehensive medical supervision, medication monitoring and compliance, to educate disease control and home safety procedures to avoid falls and injuries.” The OASIS documents on admission the Pt, was discharged from skilled nursing facility. The record lacked a Physician ordered SOC date or documentation the Pt. was discharged from the skilled nursing facility. As of 9/12/24, the record lacked a referral for the SOC effective 4/24/24 and documentation the Agency initiated service within the required time frame. 5. During an interview with the Administrator and Clinical Manager, on 9/10/24 at 3:15 PM, 9/11/24 at 10:30 AM, and 9/11/24 12:15 PM, the Administrator confirmed the above findings. 3. Pt. #6 was admitted for home health services on 11/10/23 with a diagnosis of Burn of Second Degree of Buttock. The clinical record was reviewed on 9/10/24. The initial comprehensive assessment was conducted by the RN on 11/10/23. The record contained a Physician face-to-face encounter document with a visit date of 12/1/23, which included: “Plan: SN for 9 weeks... patient requires Skilled Nursing Services for comprehensive medical supervision, medication monitoring and compliance, to educate disease control and home safety procedure to avoid falls and injuries...” The record lacked documentation the Pt. was discharged from an inpatient facility and lacked a referral containing a SOC date specified by the Physician. Findings include: 1. Pt. #4 was admitted for home health services on 1/17/24 with the diagnosis of Type 2 Diabetes Mellitus with Diabetic Neuropathy, Unspecified. The closed clinical record was reviewed on 9/10/24. The closed clinical record contained the SOC comprehensive assessment form completed by the RN and dated 1/17/24. The record lacked a Physician ordered SOC date, or documentation the Pt. was discharged from an inpatient facility. As of 9/10/24, the record lacked a referral indicating service was initiated within 48 hours after receiving a referral. 2. Pt. #5 was admitted for home health services on 7/28/23 with the diagnosis of Bilateral Primary Osteoarthritis of Knee. The closed clinical record was reviewed on 9/10/24. The closed clinical record contained the referral/Face-to-Face Physician Encounter form signed by the Physician and faxed to the Agency on 7/13/23. The SOC comprehensive assessment was conducted by the RN on 7/28/23. The record lacked documentation the Pt. was discharged from an inpatient facility or that the Physician ordered a specific SOC date. As of 9/10/24, the record lacked documentation the Agency initiated service within 48 hours after the Agency received the referral.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the 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) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on review of clinical records and staff interviews, it was determined that in 3 of 4 (Pts. #5, 6 and 7) closed/discharged clinical records reviewed, the Agency failed to ensure the Physician was sent a copy of the discharge summary. 3. Pt. #7 was admitted to home care services on 4/24/24 with diagnosis of Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. The clinical record was reviewed on 9/11/24. The discharge date was 8/18/24. As of 9/12/24, the clinical record lacked evidence that the discharge summary was sent to the physician. 4. During interview with the Administrator and Clinical Manager, on 9/10/24 at 3:15 PM, 9/11/24 at 10:30 AM, and 9/11/24 at 12:00 PM the above findings were confirmed. 2. Pt. #6 was admitted to home health services on 11/10/23 with a diagnosis of Burn of Second Degree of Buttock. The clinical record was reviewed on 9/10/24. The record contained the Discharge comprehensive assessment dated 12/1/23, indicating that Pt. #6 was discharged from the Agency. As of 9/11/24, the record lacked documentation that a copy of Pt. #6’s discharge summary was sent to the Physician. Findings include: 1. Pt. #5 was admitted for home health services on 7/28/23 with the diagnosis of Bilateral Primary Osteoarthritis of Knee. The closed clinical record was reviewed on 9/10/14. The closed clinical record contained the Agency’s discharge summary dated 11/17/23. The record lacked documentation that a copy of the discharge summary was forwarded to the Physician.”