Michigan Home Health Services

“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 agency failed to ensure 2 of 10 (P-1, 6) patients received care and services as ordered, from a total of 10 sampled records reviewed, resulting in the potential for unmet care needs and further physical decline. Findings include: P-6: The patient was admitted to home care on 8/18/23 with a diagnosis of aftercare following a left knee joint replacement. The 8/17/23 hospital referral for home care services instructed the agency to provide skilled nursing, physical therapy, and home health aide services. The 8/18/23 start of care comprehensive assessment documents that the patient has her sister staying for one week to assist the patient. The assessment also notes that the patient needs assistance with grooming, putting on upper body clothing, bathing at sink or bed, and toileting. The patient depends entirely upon another person to dress the lower body. This indicates the patient could benefit from the provision of aide services. During record review on 4/15/24 it was noted that aide services were not provided. Aide services were not listed on the plan of care. There was no documentation in the comprehensive assessment to indicate the patient had declined aide services. There was no documentation on the plan of care that the patient had declined aide services. It was unable to be determined whether the patient had declined aide services or that the agency had not offered to provide aide services. During an interview on 4/18/24 at 9:50 a.m., the findings were reviewed with the Administrator (Staff-1) and the Director of Clinical Services (Staff-2). Staff-1 stated that most of their patients decline aide services but was unable to provide documentation that the patient had declined aide services. P-1: The patient’s SOC was 3/15/23, with diagnoses that included hemiplegia, pain, and falls. During record review on 4/15/24, it was noted that the POC ordered occupational therapy (OT) services to evaluate and treat. During review of the record, it was discovered that OT never made a visit to the patient. There was no documentation in the record to explain why OT services were not provided, and there was no documented evidence the physician had been notified of OT services not being provided as ordered. The above findings were reviewed with and acknowledged by the Administrator (Staff-1) during an interview on 4/18/24 at 2:10 p.m.”

“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 review and interview, the agency failed to ensure the comprehensive assessment included a review of all medications to determine any duplicate therapy or adverse effects and failed to ensure the physician was notified of potential drug interactions or duplicate therapy in 1 of 10 (P-6) records reviewed, resulting in the potential for harmful medication effects for the 365 patients serviced by this agency in the past 12 months. Findings include: P-6: This patient was admitted to the agency on 8/18/23 with diagnoses of aftercare following a left knee replacement. During record review on 4/15/24, it was noted that the written medication profile lists16 different medications for this patient. The plan of care lists 9 medications. The patient medication record lists 9 medications that were checked for duplicate drug therapy and drug interactions. There was no indication that the remaining 7 medications (Colace, Ferrous Sulfate, Lescal, Loratadine, Toprol XL, Prilosec, and Osteo Bi-Flex) were considered in total for duplicate therapy or drug interactions. There was no indication that the physician was informed that all the patient’s medications had been included in a review to determine duplicate drug therapy or potential drug interactions. The findings were reviewed with and acknowledged by the Administrator and the Director of Clinical Services during an interview on 4/18/24 at 9:50 a.m.”

“Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient’s updated comprehensive assessment, and contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This Element is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure the plan of care was updated to reflect changes in the patient’s medications for 1 of 10 (P-8) records reviewed, resulting in the potential for harmful medication effects for this patient. Findings include: P-8: This patient was admitted to the agency on 4/4/24 with diagnoses of aftercare following a right hip joint replacement. During a joint survey home visit with the physical therapist (PT) on 4/17/24 at 11:00 a.m., the patient was queried regarding her pain. The patient explained that she’s been taking Tramadol for pain, and it’s been helpful. She stopped taking Percocet and Tylenol. During review of the patient’s medication record, it was noted that Tramadol is not included in the patient’s medication list. Observation of the patient’s Tramadol medication bottle indicates the patient is to take Tramadol 50 mg 1 tablet every 6 hours as needed for pain. The pill bottle was filled on 4/9/24. The PT made visits to the patient on 4/10/24, 4/12/24, and 4/15/24 without noting the change in the patient’s medication. The PT failed to update the patient’s medication list and the plan of care to reflect the patient’s current information. The findings were reviewed with and acknowledged by the Administrator and the Director of Clinical Services during an interview on 4/18/24 at 9:50 a.m.”

“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 interview, the agency failed to ensure the discharge summaries were sent to the physician within 5 business days of discharge in 3 (P-1, 6, 7) of 3 records in which the patient was discharged from the agency’s services, from a total of 10 sampled records reviewed, resulting in the potential for unidentified continuing health concerns and unmet care needs. Findings include: P-6: This patient was admitted to home care on 8/18/23 with a diagnosis of aftercare following a left knee joint replacement. During record review on 4/15/24, it was noted that the patient was discharged from the agency on 9/29/23. There was no documented evidence that the discharge summary was sent to the physician within 5 days of discharge. The findings were reviewed with and acknowledged by Staff-1 and the Director of Clinical Services (Staff-2) during an interview on 4/18/24 at 9:50 a.m. P-7: This patient was admitted to home care on 11/20/23 with a diagnosis of aftercare following a left knee joint replacement. During record review on 4/16/24, it was noted that the patient was discharged from the agency on 12/15/23. There was no documented evidence that the discharge summary was sent to the physician within 5 days of discharge. The findings were reviewed with and acknowledged by Staff-1 and Staff-2 during an interview on 4/18/24 at 9:50 a.m. P-1: The patient’s SOC was 3/15/23, with diagnoses that included hemiplegia, pain, and falls. During record review on 4/15/24, it was noted that the patient’s discharge date was 4/27/23. There was no documented evidence in the record that the discharge summary had been sent to the physician. The above findings were reviewed with and acknowledged by the Administrator (Staff-1) during an interview on 4/18/24 at 2:10 p.m.”