The Care Team

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure the registered nurse prepared written patient care instructions that included safety parameters and skin care instructions for 2 of 8 (P-12, 15) records reviewed in which aide services were provided, resulting in a lack of direction regarding the needs of these patients. Findings include: P-12: This patient was admitted to home care on 4/3/23 with diagnoses of stage 2 sacral pressure ulcer, type 2 diabetes with polyneuropathy, and urinary tract infection. The 4/3/23 plan of care ordered skilled nursing, physical therapy, and occupational therapy services. Aide services were added the week of 4/16/23. During record review on 2/14/24, it was noted that the aide care plan failed to include the following safety precautions that were on the plan of care: diabetic precautions, fall precautions, pressure ulcer prevention, and wound precautions. The plan of care instructed the skilled nurse to perform/teach pressure ulcer care to stage 2 sacral pressure ulcer: cleanse with wound cleanser, pat dry with gauze, apply nickel thick layer of Santyl ointment to wound bed using cotton tipped applicator, cover with Optifoam dressing using clean/aseptic technique, change dressing every other day and as needed if soiled or dislodged by skilled nursing or trained caregiver. The aide care plan instructed the aide to provide a bath/shower each weekly visit. The skilled nurse failed to include instructions for the aide regarding the care of the sacral ulcer during the bath/shower. The findings were reviewed with and acknowledged by Staff-1 (Administrator) during an interview on 2/15/24 at 12:30 p.m. P-15: This patient was admitted to home care on 12/4/23 with diagnoses of poly osteoarthritis and hypertensive heart disease with heart failure. The 12/4/23 plan of care ordered skilled nursing, physical therapy, occupational therapy, and aide services. During record review on 2/13/24, it was noted that the 12/5/23 aide care plan failed to include the following safety precautions that were on the plan of care: bleeding precautions, diabetic precautions, fall precautions, pressure ulcer prevention, infection precautions, and wound precautions.”

“HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator’s name, business address, and business phone number in order to receive complaints. This Element is not met as evidenced by: Based on observation, record review and interview, the agency failed to ensure patients were informed of the Administrator’s name and contact information to receive complaints for 6 of 7 (P-4, 5, 7, 11, 16, 17) joint surveyor home visits, resulting in the potential for patient complaints or concerns to go unaddressed which could negatively affect the quality of care for the agency’s 370 current patients. Findings include: P-11: A joint surveyor home visit with the physical therapist was conducted on 2/14/24 at 3:00 p.m. During the visit the agency’s start of care folder was reviewed. It was observed that on the inside page of the front cover of the booklet there was a dedicated space to write the Administrator’s name and contact information. This area was blank of information regarding the Administrator’s name and contact information. The findings were reviewed with Staff-1 (Administrator) during an interview on 2/15/24 at 12:30 p.m. Staff-1 stated that the agency had conducted a mock survey two weeks ago and are in the process of fixing this matter. P-16: A joint surveyor home visit with the physical therapy assistant was conducted on 2/14/24 at 12 noon. During the visit the agency’s start of care folder was reviewed. It was observed that on the inside page of the front cover of the booklet there was a dedicated space to write the Administrator’s name and contact information. This area was blank of information regarding the Administrator’s name and contact information. P-17: A joint surveyor home visit with the physical therapist was conducted on 2/13/24 at 2:30 p.m. During the visit the agency’s start of care folder was reviewed. It was observed that on the inside page of the front cover of the booklet there was a dedicated space to write the Administrator’s name and contact information. This area was blank of information regarding the Administrator’s name and contact information. P-4: The Start of Care (SOC) was dated 1/26/24. The Plan of Care (POC) identified diagnoses of Right Knee Effusion, Osteoarthritis of Right Knee and Left Hip, and History of Falls. A joint surveyor home visit with the Occupation Therapist was conducted on 2/13/24 at 10:00 am. During review of the start of care folder provided by the agency, it was noted that the designated section on the inside cover to write the Administrators name and contact information in case of the need to lodge a complaint, was left blank. P-5: The Start of Care (SOC) was dated 1/20/24. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease, Bronchitis and Pneumonia. A joint surveyor home visit with the Registered Nurse was conducted on 2/14/24 at 9:30 am. During review of the start of care folder provided by the agency, it was noted that the designated section on the inside cover to write the Administrators name and contact information in case of the need to lodge a complaint, was left blank. P-7: The Start of Care (SOC) was dated 1/12/24. The Plan of Care (POC) identified diagnoses of Fracture of 5Th Cervical Vertebrae, COVID-19 and Hyponatremia. A joint surveyor home visit with the Registered Nurse was conducted on 2/15/24 at 9:00 am. During review of the start of care folder provided by the agency, it was noted that the designated section on the inside cover to write the Administrators name and contact information in case of the need to lodge a complaint, was left blank. These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Clinical Manager) during an interview on 2/15/24 at 1:15 pm. P-4: The Start of Care (SOC) was dated 1/26/24. The Plan of Care (POC) identified diagnoses of Right Knee Effusion, Osteoarthritis of Right Knee and Left Hip, and History of Falls. A joint surveyor home visit with the Occupation Therapist was conducted on 2/13/24 at 10:00 am. During review of the start of care folder provided by the agency, it was noted that the designated section on the inside cover to write the Administrators name and contact information in case of the need to lodge a complaint, was left blank. P-5: The Start of Care (SOC) was dated 1/20/24. The Plan of Care (POC) identified diagnoses of Chronic Obstructive Pulmonary Disease, Bronchitis and Pneumonia. A joint surveyor home visit with the Registered Nurse was conducted on 2/14/24 at 9:30 am. During review of the start of care folder provided by the agency, it was noted that the designated section on the inside cover to write the Administrators name and contact information in case of the need to lodge a complaint, was left blank. P-7: The Start of Care (SOC) was dated 1/12/24. The Plan of Care (POC) identified diagnoses of Fracture of 5Th Cervical Vertebrae, COVID-19 and Hyponatremia. A joint surveyor home visit with the Registered Nurse was conducted on 2/15/24 at 9:00 am. During review of the start of care folder provided by the agency, it was noted that the designated section on the inside cover to write the Administrators name and contact information in case of the need to lodge a complaint, was left blank. These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Clinical Manager) during an interview on 2/15/24 at 1:15 pm. P-11: A joint surveyor home visit with the physical therapist was conducted on 2/14/24 at 3:00 p.m. During the visit the agency’s start of care folder was reviewed. It was observed that on the inside page of the front cover of the booklet there was a dedicated space to write the Administrator’s name and contact information. This area was blank of information regarding the Administrator’s name and contact information. The findings were reviewed with Staff-1 (Administrator) during an interview on 2/15/24 at 12:30 p.m. Staff-1 stated that the agency had conducted a mock survey two weeks ago and are in the process of fixing this matter. P-16: A joint surveyor home visit with the physical therapy assistant was conducted on 2/14/24 at 12 noon. During the visit the agency’s start of care folder was reviewed. It was observed that on the inside page of the front cover of the booklet there was a dedicated space to write the Administrator’s name and contact information. This area was blank of information regarding the Administrator’s name and contact information. P-17: A joint surveyor home visit with the physical therapist was conducted on 2/13/24 at 2:30 p.m. During the visit the agency’s start of care folder was reviewed. It was observed that on the inside page of the front cover of the booklet there was a dedicated space to write the Administrator’s name and contact information. This area was blank of information regarding the Administrator’s name and contact information.”

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure that 2 (P-1 and 3) of 17 patients were included in their overall planning of care including informing the patient/caregiver in advance of the days in which services would be provided and disciplines that will furnish care, resulting in a lack of inclusion in planning, lack of informed consent, the potential for missed visits and unmet care needs. Findings include: P-1: The Start of Care (SOC) was dated 11/7/23. The Plan of Care (POC) identified diagnoses of Right Hip Fracture, Diabetes Type 2, Falls and Congestive Heart Failure. During record review on 2/12/24, it was noted that the referral stated, “Discharge with the Agency on 11/2/23 with PT (Physical Therapy)/OT (Occupational Therapy), Nursing, CNA (Certified Nursing Assistant/Home Health Aide) and SW (Medical Social Worker).” The consent signed by the patient on 11/7/23 was blank under MSW and documented “N/A” under Home Health Aide. The comprehensive assessment completed by Registered Nurse on 11/7/23 stated, “SN (Skilled Nurse) 1w6 (1 time a week for 6 weeks), PT/OT eval and treat.” There was no documentation of the patient refusing Home Health Aide or Medical Social Worker. P-3: The Start of Care (SOC) was dated 8/22/23. The Plan of Care (POC) identified diagnoses of Congestive Heart Failure, Atrial Fibrillation, and Atherosclerosis Heart Disease. During record review on 2/12/24, it was noted that the referral stated, “Resident to discharge home with Nurse, Wound Care, Aide (Home Health Aide), PT (Physical Therapy), OT (Occupational Therapy), and Social Worker.” The comprehensive assessment completed by Registered Nurse on 8/22/23 stated, “SN (Skilled Nurse) 1w4, PT/OT eval, HHA 1w1, 2w3, 1w3.” There was no documentation of the patient refusing Medical Social Worker. These findings were reviewed with and acknowledged by the Staff-A (Administrator) and Staff-B (Clinical Manager) during an interview on 2/15/24 at 1:00 pm.”