Health Connect Home Care

“Local, State, Tribal Collaboration Process CFR(s): 484.102(a)(4) §403.748(a)(4), §416.54(a)(4), §418.113(a)(4), §441.184(a)(4), §460.84(a)(4), §482.15(a)(4), §483.73(a)(4), §483.475(a)(4), §484.102(a)(4), §485.68(a)(4), §485.542(a)(4), §485.625(a)(4), §485.727(a)(5), §485.920(a)(4), §486.360(a)(4), §491.12(a)(4), §494.62(a)(4) [(a) Emergency Plan. The [facility] must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least every 2 years [annually for LTC facilities]. The plan must do the following:] (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation. * * [For ESRD facilities only at §494.62(a)(4)]: (4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials’ efforts to maintain an integrated response during a disaster or emergency situation. The dialysis facility must contact the local emergency preparedness agency at least annually to confirm that the agency is aware of the dialysis facility’s needs in the event of an emergency. This Standard is not met as evidenced by: Based on review of the agency’s Emergency Preparedness Program (EPP) and interview, the Home Health agency (HHA) failed to include information addressing the process for cooperation and collaboration with local, tribal, regional, state and federal emergency preparedness officials in their EPP. This affects all patients on services and could result in a delayed response to an emergency situation. Findings Include: Review of the agency’s Emergency Preparedness Plan updated in 2023 lacked evidence of cooperation and collaboration with the local tribal emergency preparedness officials. Observation during a home visit on 02/14/24 at 10:45 AM and record review for Patient 1, revealed residence to be on the reservation. During an interview on 02/14/24 between 12:30 PM and 2:30 PM, the RN Director of Quality Assurance and the Chief Operations Officer stated that there was no process for collaborating with the local tribal emergency preparedness officials.”

“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 record review, and staff interview, it was determined that the Home Health Agency (HHA) failed to conduct an initial assessment visit within 48 hours after receiving a referral to provide services for 1 (Patient 1) of 7 sample patients. This failure had the potential for the patients not to receive needed assessments and home care services that could have negatively impacted outcomes. Findings Include: Patient 1 Review of Patient 1’ clinical record indication patient referral information was received into the agency via fax on 01/05/24. Review of Patient 1’s “Home Health Certification and Plan of Care” (POC), dated 01/08/24 indicated that the patient was admitted with Hypertensive Heart Failure and orders for Skilled Nursing (SN) visits one time per week. Review of the Comprehensive Assessment dated 01/08/24, showed, that the initial assessment was performed on 01/08/24 with no documented evidence to indicate why there was a delay in the SOC or that the referring physician was notified of the delay in starting services. During an interview on 02/14/24 at 2:50 PM, the Administrator confirmed that the agency had failed to admit the patient within the 48-hour time frame.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on record reviews, visit observation, and staff interviews, it was determined that the agency failed to conduct a complete medication regimen review for 3 (Patient 1-3) of 7 sample patients. This failed practice had the potential for the patient not to receive education and guidance on the use of the medication, as well as a risk for drug interactions and side effects that could cause adverse outcomes. Findings Include: Patient 1 Review of Patient 1’s “Home Health Certification and Plan of Care (POC)”, dated 01/08/24, the same as the Start of Care (SOC) date, indicated a primary diagnosis of Hypertensive Heart Failure. Review of the Medication section of the Plan of Care revealed all the medications to be listed twice with no noted differences. Review of the SOC Comprehensive Assessment performed by the Registered Nurse (RN) on 01/08/24, indicated there were “no issues” found when the Drug Regimen Review was performed, as indicated by the answer to M2001 OASIS question. During a home observation visit on 02/13/24 at 10:45 AM, there were no written Medication instructions left for the patient. Patient 2 Review of Patient 2’s “Home Health Certification and Plan of Care (POC)”, dated 12/18/23, the same as the Start of Care (SOC) date, indicated a primary diagnosis to be Aftercare following joint replacement surgery. Review of the Medication section of the Plan of Care revealed all the medications to be listed twice with no noted differences. Review of the SOC Comprehensive Assessment performed by the Registered Nurse (RN) on 12/18/23, indicated there were “no issues” found when the Drug Regimen Review was performed, as indicated by the answer to M2001 OASIS question. Patient 3 Review of Patient 3’s “Home Health Certification and Plan of Care (POC)”, dated 01/23/24, the same as the Start of Care (SOC) date, indicated a primary diagnosis to be Cellulitis of Right Lower Limb. Review of the SOC Comprehensive Assessment performed by the RN on 01/23/24, indicated that there were “no issues” found when the Drug Regimen Review was performed, as indicated by the answer to M2001 OASIS question. However, surveyor noted medications on the POC with possible interaction risk and performed a drug to drug interaction check and found several noted interactions with some being considered “serious”. Listed medications with serious interactions noted included, Celecoxib and Apixaban as well as, Duloxetine and Apixaban which when used together increase anticoagulation. Also noted were Duloxetine and Trazodone which both increase serotonin levels. There were also several other interactions noted due to the use of Oxycodone with instructions to monitor closely due to increased sedation. There was no documented evidence of these possible drug interactions being noted or of the physician being made aware of the possible risk of interactions. During an interview conducted on 02/14/24 at 3:15 PM, Staff C, the Director of Quality Assurance confirmed the above findings of failure to conduct a complete medication regimen review for all patients.”

“Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on observation, record review and interview, the Home Health Agency (HHA) failed to provide the patient and/or caregiver a copy of written instructions outlining medication schedule/instructions, including medication name, dosage, frequency, and which medications would be administered by HHA personnel for 7 (Patients 1-7) of 7 sample patients. The home health’s failure to ensure the patients received written instructions regarding medication administration placed all patients, currently on services at risk for adverse medication outcomes, and unmet needs. Findings Include: Observation during home visit with Patient 1 on 02/13/24 at 10:45 AM, there were no written instructions regarding patient medications, a medication list or home health agency instructional documents found in the home. The patient stated that no list of current medications had been given to him. Observation during home visit with Patient 2 on 02/13/24 at 1:30 PM, there were no written instructions regarding patient medications, a medication list or home health agency instructional documents found in the home. Observation during home visit with Patient 3 on 02/13/24 at 3:00 PM, there were no written instructions regarding patient medications, a medication list or home health agency instructional documents found in the home. Review of Patient records 1 through 7 lacked documented evidence by agency professional staff regarding giving or delivering written instructions outlining medications to the patients or caregivers. During an interview on 02/14/24 at 1:00 PM with agency leadership staff, the Administrator confirmed that, the agency had not been giving the patients written information regarding their medications.”

“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 record review, and staff interview, it was determined the Home Health Agency (HHA) failed to send a transfer summary to the facility where the patient was receiving in-patient health care services for 3 (Patients 1, 5, 6) of 7 sample patients. The deficient practice had the potential to affect patient safety and to place the patients at risk for adverse outcomes related to the lack of care coordination with other health care services. Findings Include: Patient 1 Review of Patient 1’s clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 01/08/24. Review of visit notes for the current certification period showed a transfer to the hospital on 01/30/24. The HHA performed a Transfer to In-patient Facility (TIF) OASIS Assessment on 01/30/24 however, there was no documented evidence of a Transfer Summary being completed or sent to the receiving facility. Patient 5 Review of Patient 5’ clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 06/16/23. Review of visit notes for certification period from: 08/15/23 to 10/13/23 showed a transfer to the hospital on 08/30/23. The HHA performed a Transfer to In-patient Facility (TIF) OASIS Assessment on 08/30/23 however, there was no documented evidence of a Transfer Summary being completed or sent to the receiving facility. Patient 6 Review of Patient 6’s clinical record showed the Home Health Certification and Plan of Care with a Start of Care date of 12/19/23. Review of visit notes for the current certification period showed a transfer to the hospital on 12/27/23. The HHA failed to complete a Transfer to In-patient Facility (TIF) OASIS Assessment and a Transfer Summary. There was no documented evidence of a Transfer Summary being sent to the receiving facility. During an interview on 02/14/24 at 2:55 PM, the agency Administrator confirmed the above findings that the agency had not provided Transfer Summaries to the receiving facilities for the above patients.”