Good Samaritan Home Health of Central Kansas

“Advise the patient of discharge for cause CFR(s): 484.50(d)(5)(i) (i) Advise the patient, representative (if any), the physician(s) or allowed practitioner(s), issuing orders for the home health plan of care, and the patient’s 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) that a discharge for cause is being considered; This Element is not met as evidenced by: Based on clinical record review, agency document review, policy review, and staff interview, the Home Health Agency (HHA) failed to notify the patient and physician of their desire to discontinue services for cause prior to discharging the patient for 2 (Patient 1 & 3) of 10 discharged records reviewed. This failed practice of not notifying the patient and physician of the discharge prior to discontinuing services placed the patients at risk of unmet needs and adverse outcomes. Findings Include: Review of agency policy titled, “Discharge and Transfer”, contained bullet points under a Section titled, “Procedure”, which indicated “A discharge or transfer may occur for the following reasons: ...Advise the patient/representative, the provider issuing the orders, and the patient’s primary practitioner, or other health care professional who will be responsible for providing care after discharge from the agency, that a discharge for cause is being considered...” Patient 1 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 07/05/23, indicated that the patient had filed a complaint regarding a nurse messing up her medications. The document also indicated that the patient had called in the complaint and had been loud and rude during the call. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) reached out to the patient and informed her due to her refusal to allow multiple staff into her home and due to her noncompliance with her medications she was being discharged from the agency. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 06/07/23 through the date of discharge, 07/05/23, revealed no documented noncompliance by the patient or of any agency staff informing the patient of an upcoming discharge due to noncompliance. Patient 3 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 11/03/23, indicated that the patient had filed a complaint regarding not receiving the wound care supplies she preferred and of the nurses’ missing visits. The complainant also indicated that she would be filing a complaint with the Kansas state board of nursing. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) and supervising nurse reached out to the patient to discuss her complaint and informed her due to her not being happy with the services provided that she should look for another agency. The patient was informed that she was being discharged from the agency. The supervising nurse also called the physician’s office and informed the nurse of the patient’s discharge. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 10/06/23 through the date of discharge, 11/03/23, revealed no documented noncompliance by the patient or of any agency staff informing the patient of an upcoming discharge due to noncompliance. During an interview on 01/23/24 at 8:40 AM, Staff A, Administrator confirmed the above finding of discharging patients prior to notifying the patient and physician of the discharge prior to discontinuing services.”

“Make efforts to resolve the problem(s) CFR(s): 484.50(d)(5)(ii) (ii) Make efforts to resolve the problem(s) presented by the patient’s behavior, the behavior of other persons in the patient’s home, or situation; This Element is not met as evidenced by: Based on clinical record review, agency document review, policy review, and staff interview, the Home Health Agency (HHA) failed to make efforts to resolve patient problems, behaviors and complaints prior to discharging the patient for 2 (Patient 1 & 3) of 10 discharged records reviewed. This failed practice of not making efforts to resolve patient problems and complaints prior to discontinuing services placed the patients at risk of unmet needs and adverse outcomes. Findings Include: Review of agency policy titled, “Discharge and Transfer”, contained bullet points under a Section titled, “Procedure”, which indicated “...Make efforts to resolve the problems, behaviors, or situations. Document all efforts made to resolve the problem, the assessment of the situation, all communication with agency management and the provider responsible for the POC (Plan of Care).” Patient 1 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 07/05/23, indicated that the patient had filed a complaint regarding a nurse messing up her medications. The document also indicated that the patient had called in the complaint and had been loud and rude during the call. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) reached out to the patient and informed her due to her refusal to allow multiple staff into her home and due to her noncompliance with her medications she was being discharged from the agency. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 06/07/23 through the date of discharge, 07/05/23, revealed no documented noncompliance by the patient or of any agency staff taking any actions to teach the patient what would occur due to the problem of noncompliance. Patient 3 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 11/03/23, indicated that the patient had filed a complaint regarding not receiving the wound care supplies she preferred and of the nurses’ missing visits. The complainant also indicated that she would be filing a complaint with the Kansas state board of nursing. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) and supervising nurse reached out to the patient to discuss her complaint and informed her due to her not being happy with the services provided that she should look for another agency. The patient was informed that she was being discharged from the agency. The supervising nurse also called the physician’s office and informed the nurse of the patient’s discharge. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 10/06/23 through the date of discharge, 11/03/23, revealed no documented noncompliance by the patient or of any agency staff taking any actions to teach the patient what would occur due to the problem of noncompliance. During an interview on 01/23/24 at 8:40 AM, the agency Administrator, Staff A, confirmed the above finding of not documenting any efforts to resolve patient problems or concerns prior to discontinuing services.”

“Provide contact info other services CFR(s): 484.50(d)(5)(iii) (iii) Provide the patient and representative (if any), with contact information for other agencies or providers who may be able to provide care; and This Element is not met as evidenced by: Based on record review, policy review, and staff interview, the agency failed to provide the patient with contact number and name of other home health agency that might be able to provide services to the patient after discharge for 2 (Patient 1 & 3) of 10 discharged patients. This failed practice of not providing the patient with contact information of other agencies that might provide home health services to the patient prior to discontinuing services placed the patients at risk of unmet needs and adverse outcomes. Findings Include: Review of agency policy titled, “Discharge and Transfer”, contained bullet points under a Section titled, “Procedure”, which indicated “…Provide the patient/representative with contact information for other agencies/providers who may be able to provide appropriate care”. Patient 1 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 07/05/23, indicated that the patient had filed a complaint regarding a nurse messing up her medications. The document also indicated that the patient had called in the complaint and had been loud and rude during the call. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) reached out to the patient and informed her due to her refusal to allow multiple staff into her home and due to her noncompliance with her medications she was being discharged from the agency. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 06/07/23 through the date of discharge, 07/05/23, revealed that the agency did not document providing the patient with contact information of other agencies that might provide home health services to the patient after discharge. Patient 3 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 11/03/23, indicated that the patient had filed a complaint regarding not receiving the wound care supplies she preferred and of the nurses’ missing visits. The complainant also indicated that she would be filing a complaint with the Kansas state board of nursing. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) and supervising nurse reached out to the patient to discuss her complaint and informed her due to her not being happy with the services provided that she should look for another agency. The patient was informed that she was being discharged from the agency. The supervising nurse also called the physician’s office and informed the nurse of the patient’s discharge. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 10/06/23 through the date of discharge, 11/03/23, revealed that the agency did not document providing the patient with contact information of other agencies that might provide home health services to the patient after discharge. During an interview on 01/23/24 at 8:40 AM, the agency Administrator, Staff A, confirmed the above finding of not providing the patient with contact information of other agencies that might provide home health services to the patient after discharge.”

“Document efforts to resolve problems CFR(s): 484.50(d)(5)(iv) (iv) Document the problem(s) and efforts made to resolve the problem(s), and enter this documentation into its clinical records; This Element is not met as evidenced by: Based on clinical record review, agency document review, policy review, and staff interview, the Home Health Agency (HHA) failed to document efforts made to resolve patient problems, behaviors and complaints in the patient record for 2 (Patient 1 & 3) of 10 records reviewed. This failed practice of not documenting making efforts to resolve patient problems and complaints in the patient record placed the patients at risk of unmet needs and adverse outcomes. Findings Include: Review of agency policy titled, “Discharge and Transfer”, contained bullet points under a Section titled, “Procedure”, which indicated “A discharge or transfer may occur for the following reasons: ...Document all efforts made to resolve the problem... Patient 1 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 07/05/23, indicated that the patient had filed a complaint regarding a nurse messing up her medications. The document also indicated that the patient had called in the complaint and had been loud and rude during the call. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) reached out to the patient and informed her due to her refusal to allow multiple staff into her home and due to her noncompliance with her medications she was being discharged from the agency. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 06/07/23 through the date of discharge, 07/05/23, revealed no documented noncompliance by the patient or of any agency staff taking any actions to teach the patient what would occur due to the problem of noncompliance. They agency did not document the patient concerns, complaints in the clinical record, or or efforts to resolve the problems. Patient 3 Review of agency document titled, “Home Health Suggestion, Complaint/Concern or Grievance” dated 11/03/23, indicated that the patient had filed a complaint regarding not receiving the wound care supplies she preferred and of the nurses’ missing visits. The complainant also indicated that she would be filing a complaint with the Kansas state board of nursing. The indicated resolution to the complaint was documented as, the Skilled Nurse (SN) and supervising nurse reached out to the patient to discuss her complaint and informed her due to her not being happy with the services provided that she should look for another agency. The patient was informed that she is being discharged from the agency. The supervising nurse also called the physician’s office and informed the nurse of the patient’s discharge. The above document contained a statement which indicated, “This form is NOT part of the Medical Record”. Review of the clinical record for the episode dates beginning 10/06/23 through the date of discharge, 11/03/23, revealed no documented noncompliance by the patient or of any agency staff taking any actions to teach the patient what would occur due to the problem of noncompliance. The agency did not document the patient concerns, complaints in the clinical record, or efforts to resolve the problems. During an interview on 01/23/24 at 8:40 AM, the agency Administrator, Staff A, confirmed the above finding of not documenting any efforts to resolve patient problems or concerns in the patient record.”