Mangham Home Care, Inc.

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Based on record review and interview, the agency failed to meet the Condition of Participation of Care Planning, Coordination of Services, and Quality of Care as evidenced by: The home health agency failed to ensure patients received home health services as written in their individualized plan of care, as ordered by a doctor of medicine for 3 (#1, #4, #6) of 6 (#1,#2,#3, #4, #5, #6) sampled patients. The deficient practice was evidenced by the agency failing to ensure patients received the number of skilled nursing hours, per week, as ordered by the medical director in their individualized plan of care for 3 (#1, #4, #6) of 6 (#1,#2,#3, #4, #5, #6) sampled patients. (see findings in G-572).”

“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 record review and interview, the home health agency failed to ensure patients received home health services as written in their individualized plan of care, as ordered by a doctor of medicine. The provider failed to ensure patients received the number of skilled nursing hours, per week, as ordered by the medical director in their individualized plan of care for 3 (#1, #4, #6) of 6 (#1,#2,#3, #4, #5, #6) sampled patients. Review of the policy and procedure related to staffing (revised 10/01/2024) revealed in part: All extended care patients will be staffed according to physician orders and payor authorization. Patient #1 Record review revealed Patient #1 had a start of care date with the agency on 02/22/2018. Patient #1 had a primary diagnosis of spastic quadriplegia cerebral palsy and a secondary diagnosis of infantile scoliosis. The most recent certified plan of care had a start date of 07/24/2024 and an end date of 09/17/2024. The plan of care called for Patient #1 to receive up to 84 hours per week of skilled nursing care in the home, to be rendered by the provider. Review of the employee time management system revealed the following hours recorded per week (up to 84 hours/week) worked by the skilled nurses in the certification period from 07/20/2024 -09/17/2024: 07/21/2024-07/27/2024= 59.75 hours (24.25 hours not provided) 07/28/2024-08/03/2024= 70.75 hours (13.25 hours not provided) 08/04/2024-08/10/2024= 49.75 hours (34.25 hours not provided) 08/11/2024-08/17/2024= 65.25 hours (18.75 hours not provided) Patient #1 was approved for 336 hours and the Home Health Agency provided 245.5 hours for the above referenced certification period. The provider failed to provide 90.5 skilled nursing hours. Forty - eight of the 90.5 skilled nursing hours not provided were on Sundays (07/21/2024, 07/28/2024, 08/04/2024, 08/11/2024). Patient #4 Record review revealed Patient #4 had a start of care date on 04/01/2014 with the agency. Patient #4 had a primary diagnosis unspecified convulsions and secondary diagnosis of intellectual disabilities. The most recent completed certified plan of care started on 08/11/2024 and an ended on 10/09/2024. The individualized plan of care called for up to 56 hours per week of skilled nursing care in the home to be rendered by the provider. Review of the employee time management system revealed the following hours recorded per week worked by the skilled nurses in the certification period from 08/11/2024 -10/09/2024: 08/11/2024-08/17/2024= 45.24 hours (10.76 hours not provided) 08/18/2024-08/24/2024= 48.5 hours (7.5 hours not provided) 09/01/2024-09/07/2024= 46 hours (10 hours not provided) 09/15/2024-09/21/2024= 48 hours (8 hours not provided) 09/29/2024-10/05/2024= 48 hours (8 hours not provided) Patient #4 was approved for 280 hours of skilled nursing care. The Home Health Agency provided 235.74 hours for the above referenced certification period. The Home Health Agency failed to provide 44.26 skilled nursing hours. Eight of the 44.26 hours not provided were on a Sunday (08/11/2024). Patient #6 Record review revealed Patient #6 had a start of care date on 03/31/2014. Patient #6 had a primary diagnosis of reduction deficits of unspecified lower limbs and secondary unspecified defect of radius and bilateral disabilities. The most recent completed certified plan of care started on 08/05/2024 and ended on 10/03/2024. The individualized plan of care called for up to 56 hours per week of skilled nursing care in the home to be rendered by the provider. Review of the employee time management system revealed the following hours recorded per week worked by the skilled nurses in the certification period from 08/05/2024 -10/03/2024: 08/11/2024-08/17/2024= 48 hours (8 hours not provided) 08/18/2024-08/24/2024= 48 hours (8 hours not provided) 08/25/2024-08/31/2024= 40 hours (16 hours not provided) 09/01/2024-09/07/2024= 48 hours (8 hours not provided) 09/08/2024-09/14/2024= 48 hours (8 hours not provided) 09/15/2024-09/21/2024= 48 hours (8 hours not provided) 09/22/2024-09/28/2024= 48 hours (8 hours not provided) Patient #6 was approved for 392 hours of skilled nursing care and the Home Health Agency provided hours 328 for the above referenced certification period. The Home Health Agency failed to provide 64 skilled nursing hours. Thirty - two of the 64 hours not provided were on Sundays (08/11/2024, 08/25/2024, 09/08/2024, 09/22/2024). On 10/15/2024 at 8:15 a.m., an interview with S1 Program Director confirmed skilled nurse staffing on Sundays was an issue. On 10/15/2024 at 9:50 a.m., an interview with S1 Program Director confirmed Patient #1 did not receive 84 hours per week of skilled nursing service in the certification period from 07/24/2024 to 09/17/2024. S1 Program Director also confirmed Patient #4 did not receive 56 hours per week of skilled nursing service in the certification period from 08/11/2024 to 10/09/2024. S1 Program Director further confirmed Patient #6 did not receive 56 hours per week of skilled nursing service in the certification period from 08/05/2024 to 10/03/2024. S1 Program Director confirmed the agency was dependent on family as backup staff when skilled nursing hours could not be provided by the agency.”