Excelcare Home Health

“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 the review of the Error Summary report and staff interview, it was determined in 164 of 722 reports submitted for the last 12 months, the Agency failed to submit all timely reports, resulting in a warning. Findings include: 1. The Error Summary report for 06/2023 to 05/2024, was reviewed on 09/16/24 at 11:30 AM. The report included error # -3330 for 164 of 722 late submissions, 22.71 % of the OASIS reports submitted, were more than 30 days after the M0090. 2. During an interview with the Office Manager, Director of Nursing and QA Staff on 09/18/24 at 2:30 PM, the Director of Nursing confirmed that the error occurred.”

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on clinical record review and staff interviews, it was determined for 3 of 7 (Pts. # 2, 3 and 7) clinical records reviewed, the Agency failed to ensure care and/or services were provided as ordered by the Physician and as indicated in the POC. 2. Pt. #3 was admitted to the home health services on 05/09/24 with the diagnosis of: Unspecified Atrial Fibrillation. The clinical record was reviewed on 09/18/24. The clinical record contained a recertification POC dated 07/08/24 and 09/06/24, that required the SN to assess the patient, 1 time a week for 9 weeks. The SN did not assess/visit the patient during the week of 07/13/24 (week #1) and 07/20/24 (week #2). The same PsOC required the OT and PT evaluations. As of 09/18/24, the OT and PT did not evaluate the patient as ordered in the PsOC. 3. Pt. #7 was admitted to the home health services on 01/16/24 with the diagnoses of: Chronic Atrial Fibrillation Unspecified and Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. The clinical record was reviewed on 09/18/24. The clinical record contained a POC dated 01/16/24, that required the SN to notify the physician of the blood sugar greater than 200 or less than 70, 1 time a week for 9 weeks. The SN lacked the blood sugar assessment for weeks #1, 4, 5 and 9. 4. The findings were confirmed with the during the interview with the Office Manager, Director of Nursing and QA staff, on 09/18/24 between 1:30 PM – 3:00 PM. Findings include: 1. Pt. #2 was admitted for home health services on 07/25/24 with the diagnosis of Anemia. The clinical record reviewed on 09/18/24. The record included a Physician order dated 07/25/24 which required, “PT to check patient’s weight every visit, instruct patient to weigh daily and report weight changes of greater >2 lbs./day or >5 lbs./week.” The PT notes from the week of 07/21/24 through the week of 09/08/24 lacked Pt. #2’s weight. Pt. #2’s POC effective 7/25/24 also included documentation, “Occupational Therapy to assess functional status, home environment to eliminate structural barriers and improve safety, need for home modifications to promote functional independence…OT to establish a home exercise program and plan of care as approved by the physician…” As of 09/18/24, the clinical record lacked an OT evaluation.”

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: Based on clinical record review, and staff interviews, it was determined that for 3 of 7 (Pts. # 5, 6, and 7) clinical records reviewed, the Agency failed to ensure that concerns are communicated/coordinated within the healthcare team to ensure Pt. needs were identified and addressed. 3.Pt. #7 was admitted to the home health services on 01/16/24 with the diagnoses of: Chronic Atrial Fibrillation Unspecified and Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. The clinical record was reviewed on 09/18/24. The clinical record contained a POC dated 01/16/24, that required SN assess the patient’s blood pressure and weight 1 time a week for 1 week and 2 prn (as needed visits). The SN visit notes on 01/16/24 included a BP of 132/62. The SN exceeded/conducted 2 additional visits without orders. The SN visit notes 02/07/24, 02/15/24 and 02/20/24 included a continued decreasing Blood Pressure. On 03/14/24, the patient was discharged with the decreased BP of 104/68. The record lacked of coordination /integration orders with the physician regarding significant findings of the declining BP, with the use of Metoprolol 25 mg twice a day, prior to discharging the patient. 4.The findings were confirmed with the during the interview with the Office Manager, Director of Nursing and QA staff on 09/18/24 between 1:30 PM – 3:00 PM. Findings include: _Pt. #6 was discharged from home health services on 9/27/23 with the diagnosis of Essential (Primary) Hypertension. The clinical record was reviewed on 9/18/24. The MSW note included, “Pt has been referred to IDOA for community services that can help decrease stressors affecting pt’s health and wellbeing. Pt and family educated on following up with service providers.” The evaluation was conducted on 11/16/23, but the MSW did not coordinate with the patient and the RN related to the services. _During the interview with the Director of Nursing and Quality Assurance Clinical Coordinator on 9/18/24 at 2:15 PM, the Director of Nursing stated that the MSW documented concerns on their assessment note, but it was not coordinated with the RN. In the same interview, the above findings were confirmed. Findings include: 1. Pt. #5 was admitted for home health services on 05/30/24 with the diagnosis of Type 2 Diabetes Mellitus with hyperglycemia. The clinical record was reviewed on 09/18/24. The record contained the following PT notes: 07/24/24 - blood pressure: 114/40, 07/31/24 – blood pressure: 118/42, 08/07/24 – blood pressure: 112/42 and 08/14/24 – blood pressure:120/42; The SN notes from the weeks of 07/21/24 through 09/08/24, included that Pt. #5’s diastolic blood pressure results were always within the prescribed parameters. The record lacked PT communications to the SN and RN that during the PT treatments Pt.#5’s diastolic blood pressure results were not within the parameters prescribed on the POC. During an interview with the QA staff and Director of Nursing on 09/16/24, it was stated that the PT should coordinate with the SN, or the office/Director of Nursing regarding vital sign that are out of the parameters so that the Pt. could be also monitored by the SN.”

“Coordinate referrals; CFR(s): 484.105(c)(3) Coordinating referrals, This Element is not met as evidenced by: Based on the clinical record review, contract review and staff interview, it was determined in 3 of 7 records (Pts. #3, 4 and 7) with therapy orders, the Agency failed /delayed to coordinate the therapy services. Findings include: 1. Pt. #3 was admitted to the home health services on 05/09/24 with the diagnosis of: Unspecified Atrial Fibrillation. The clinical record was reviewed on 09/18/24. The clinical record contained recertification PsOC dated 07/08/24 and 09/06/24, that required the OT and PT evaluations. As of 09/18/24, the OT and PT referrals were not coordinated. 2. Pt. #4 was admitted to the home health services on 07/24/24 with the diagnosis of: Alcoholic Cirrhosis of Liver without Ascites. The clinical record was reviewed on 09/18/24. The clinical record contained a POC dated 07/24/24, that required and PT evaluations. The PT referrals were not coordinated until 07/30/24. 3. Pt. #7 was admitted to the home health services on 01/16/24 with the diagnoses of: Chronic Atrial Fibrillation Unspecified and Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. The clinical record was reviewed on 09/18/24. The clinical record contained a POC dated 01/16/24, that required and PT, ST and OT evaluations. The PT referrals were not coordinated until 01/24/24 (week #2). The ST referral was not coordinated until 01/28/24 (week #3). The OT referral was not coordinated until 02/27/24 (week #7). On 09/18/24 at 2:00 PM, during the interview with the Director of Nursing, it was stated therapy referrals should be coordinated within 48 hours of the referral-orders. 4. On 09/19/24 at 10:10 AM, the Agency’s contract was reviewed. The contract required “….vi. Staffing Company agrees to provide Client, upon request… within 48 hours of receipt of such request…” 5.The findings were confirmed, during the interview with the Office Manager, Director of Nursing and QA staff on 09/19/24 at 10:15 AM.”