Medco Home Healthcare, Inc.

“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 that the goals on the Plan of Care were objectively measurable to determine the patient’s progress towards obtaining the goals in 1 of 7 (MR#5) records reviewed. Findings included: MR#5: The Plan of Care for the certification period 11/1/23 to 12/30/23 included a primary diagnosis of Chronic Inflammatory demyelinating polyneuritis, other malaise, and bed confinement. The patient was receiving Physical Therapy and Home Health Aide Services. Upon review of the record, it was noted the goals on the Plan of Care were not objectively measurable in 1 of 7 (P-5) records reviewed. Examples include: “Patient will demonstrate compliance with Home Exercise Program each visit; Patient will demonstrate progression of HEP each visit; Patient will improve transfers technique with mod-max assist in 9 weeks. These goals are not objectively measurable to determine the patient’s progress towards obtaining the goals. These findings were reviewed and acknowledged with the Administrator and Clinical Manager on 5/13/24 at 1:00 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, drug interactions, or adverse effects, and failed to ensure the physician was notified of potential significant drug interactions or duplicate therapy in 1 of 7 (P-3) records reviewed, resulting in the potential for harmful medication effects for all patients serviced by this agency. Findings include: P-3: This patient was admitted to home care on 8/21/23 with diagnoses of dementia, malaise, and lack of coordination. During record review on 5/13/24, it was noted on the 8/21/23 comprehensive assessment completed by the physical therapist the Drug Regimen Review (section M2001) indicates no issues found during review. On 5/13/24, the agency’s medical record software was utilized to run a medication interaction report. The report notes 3 major drug-drug interactions (Buspirone + Mirtazapine, Buspirone + Citalopram, and Mirtazapine + Citalopram). There was no documentation to indicate the physical therapist conducted a review of the patient’s medications and was aware of the major drug-drug interactions. There was no documentation that the physician was informed. The findings were reviewed with the Administrator (Staff-A) and the Clinical Manager (Staff-B) during an interview on 1/9/24 at 2:20 p.m. Staff-B explained that she failed to notify the physician of the major drug-drug interactions.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure skilled professionals provided services as ordered by the physician in the plan of care for 2 of 7 (P-1 and P-6) records reviewed, resulting in the potential for a poor outcome for this patient. Findings include: P-1: This patient was admitted to home care on 6/2/23 with diagnoses of poly arthritis, muscle weakness, and low back pain. During record review on 5/13/24, it was noted that the 6/2/23 plan of care ordered the physical therapist to provide two visits each week for six weeks and then one visit for one week. The week of 7/3/23, the PT documented a visit on 7/11/23. There was no second visit in that week as ordered by the physician. There was no documentation to indicate the patient had declined the visit and no evidence that the physician was informed that the second visit had not been provided. The finding was reviewed with and acknowledged by the Administrator (Staff-A) and the Clinical Manager (Staff-B) during an interview on 5/16/24 at 10:30 a.m. P-6: The Start of Care was dated 6/11/2023. The Plan of Care for the certification period 6/11/2023 to 8/9/2023 identified a principal diagnosis of Diabetes type 2 (DM2) and other diagnoses of Chronic Obstructive Pulmonary Disease (COPD), Hypertensive Heart Disease (HTN), and muscle weakness. This patient was receiving Skilled Nursing (SN) and Physical Therapy (PT) services. Orders included frequency and duration of visit for Skilled Nursing as 2 visits a week for 1 week and 1 visit a week for 4 weeks; Physical Therapy visits were ordered as 1 visit a week for 1 week, 2 visits a week for 5 weeks, and 1 visit a week for 1 week. Upon review of the record, it was noted the following missed visits and missed visit notes that included the reasons for the missed visits: Skilled Nursing: 6/25/23 (No answer to phone call); 7/2/2023 (No answer to phone call). Physical Therapy: 6/26/23 (No answer to multiple attempts to call pt’s wife); 6/30/23 (No answer to multiple calls to pt’s wife, went to pt’s house for a drive-by visit, pt’s wife said pt is not home); 7/3/23 (Caregivers wife not answering calls); 7/7/23 (No answer to phone call). There were no documented attempts to reschedule the missed visits, nor was there any documentation of notification of the physician of the missed Physical Therapy visit on 6/30/23; or notification for the Skilled Nursing missed visits on 6/25/23 and 7/2/23. The Administrator and Clinical Manager were asked during an interview on 5/16/24 at 1:00 p.m. if any attempts had been made to reschedule the missed visits? The Clinical Manager stated, “I know the patient’s wife was the caregiver, and was very difficult to contact, but I’m not sure if any attempts were made to reschedule the missed visits.” These findings were reviewed and acknowledged during an interview with the Administrator and Clinical Manager on 5/16/24 at 1:00 p.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 a transfer summary was sent to the receiving facility within 2 days of becoming aware of an unplanned transfer for 2 of 2 (P-3, 6) records reviewed in which the patient was transferred, and failed to ensure a discharge summary was sent to the physician within 5 business days of the patient’s discharge for 3 of 3 (P-1, 3, 7) records reviewed in which the patient was discharged from the agency, resulting in the physician or receiving facility not having knowledge of the patient’s health status at the time of transfer/discharge and the potential for unidentified, unmet care needs. Findings include: P-1: This patient was admitted to home care on 6/2/23 with diagnoses of poly arthritis, muscle weakness, and low back pain. During record review on 5/13/24, it was noted that the patient was discharged from the agency on 7/17/23. The discharge summary was faxed to the physician on 8/11/23, which is 25 days post discharge. The finding was reviewed with and acknowledged by the Administrator (Staff-A) and the Clinical Manager (Staff-B) during an interview on 5/16/24 at 10:30 a.m. The agency’s policy titled, Transfer and Discharge of Services Policy Number C334 (no date) states, “A discharge summary is completed for all discharged patients. A copy will be mailed to the primary physician upon his/her request...All discharge paperwork is due in the office within 2 weeks of discharge date. This includes the discharge summary...” The agency’s current policy fails to align with regulatory requirements. P-3: This patient was admitted to home care on 8/21/23 with diagnoses of dementia, malaise, and lack of coordination. A transfer summary was documented on 9/26/23. The patient was sent to the hospital due to blood in the stool. Home health care was resumed on 10/4/23. There was no documented evidence that a transfer summary was sent to the receiving hospital within 2 days of the agency becoming aware of an unplanned transfer. The agency’s policy titled, Transfer and Discharge of Services Policy Number C334 (no date) states, “Criteria for transfer or referral... The receiving organization is provided with relevant written or verbal information within 72 hours of transfer.” The agency’s current policy fails to align with regulatory requirements. The patient was discharged from the agency on 10/16/23. The discharge summary was faxed to the physician on 11/3/23, which is 18 days post discharge. P-6: The Start of Care was dated 6/11/2023. The Plan of Care for the certification period 6/11/2023 o 8/9/2023 identified a principal diagnosis of Diabetes type 2 (DM2) and other diagnoses of Chronic Obstructive Pulmonary Disease (COPD), Hypertensive Heart Disease (HTN), and muscle weakness. Upon review of the record, it was noted the patient was transferred to the hospital on 7/8/23 for “other than above reasons, and reason unknown.” Upon further review of the record, there was no evidence found that indicated the transfer summary had been sent to the receiving facility or to the Physican. Review of the Transfer OASIS under the category of “Copy of transfer summary sent to:” was blank, and there was no documentation to indicate the Physician or Inpatient receiving facility had been provided with a copy of the transfer summary. P-7: The Start of Care was dated 5/9/2024. The Plan of Care for the certification period 1/25/24 to 1/31/24 identified diagnoses of Polyarthritis, Chronic Pain Syndrome, Muscle Weakness, Abnormality of gait and mobility, and Hypertensive Heart Disease without Heart Failure. Upon review of the record on 5/13/2024, it was noted the patient was discharged from the agency on 1/31/24. The discharge summary documented the physician was notified, but there was no evidence found in the record that the discharge summary had been sent to the physician. These findings were reviewed and acknowledged by the Administrator and Clinical Manager during an interview on 5/16/24 at 1:00 p.m.”