Benedictine Home Health

“RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient’s return home, or on the physician or allowed practitioner - ordered start of care date. This Element is not met as evidenced by: Based on interview and document review, the agency failed to ensure each patient had an initial assessment visit within 48 hours of their referral date for 1 of 5 residents, (P5), skilled clients reviewed. Findings include: P5 had been referred to the home care agency by his physician on 5/17/24 for skilled nurse visits. P5’s Home Health Certification and Plan of Care dated 5/20/24 through 7/18/24, indicated P5 did not start home health services until 5/20/24, three days after the physician’s referral date to the agency. The plan of care identified resident preferred care on Mondays-Wednesdays-Fridays (M-W-F), however, orders were not obtained to reflect desired delayed start of care. During interview with the agencies director of nursing (DON) on 10/15/24, at 3:43 p.m. stated the initial assessment was to be completed within 48 hours of the initial referral unless orders were obtained to delay the date of the start of care. DON stated although there had been information as to potentially changed date of SOC for P3, or preference with P5, there had not been orders to delay the SOC. DON stated the provider was to be updated with any potential for change start of care. On 10/16/24, at 9:00 a.m., the executive director (ED) stated the initial visit for admission was to be completed within 48 hours of the referral from the admitting provided unless a delay in start of care date authorization is received from the admitting provider. The facility policy, Comprehensive Patient Assessment, revised 1/2024, identified the client would receive an accurate and comprehensive assessment consistent with the patient’s immediate needs. The initial assessment must be conducted by a registered nurse (RN) of referral and/or with 48 hours of the patient’s return home, unless a physician specifies a specific time to conduct the assessment.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on interview and record review, the facility failed to provide supervision of home health aides for 2 of 2 residents (R2, R4) reviewed for home health aide services. R2’s Home Health Certification and Plan of Care certification period 10/2/24 to 11/30/24, included home health aide visits two times weekly and skilled nurse visits every other week. R2’s Aide Care Plan with start date 2/25/20, included R2 would receive one whirlpool bath and one shower per week, skin care and grooming. R2 had skilled nurse visits on 10/9/24, 9/25/24, 8/28/24, 8/14/24, 7/31/24, 7/17/24, 7/3/24, 6/29/24, 6/5/24, 5/22/24, 5/8/24, 4/24/24, and 4/10/24 and recertification visits on 10/1/24, 7/29/24, and 6/4/24. The last documented supervision visit was 4/22/24. During interview on 10/14/24 at 3:25 p.m., R2’s family member (FM)-B stated the home health aides were doing a good job and there were no concerns regarding care. FM-B stated the nurses do not ask at every visit how the home health aides are preforming but usually had during recertification visits. During interview on 10/15/24 at 12:15 p.m., the director of nursing (DON) stated home health aide supervision should have been completed every 14 days. The DON stated she typically completed the supervision on Mondays when R2 had a whirlpool bath, but had not documented the supervision. The DON confirmed it was important to document home health aide visit supervision to show R2’s needs were being met and that staff are treating him well. The DON confirmed she had not documented a supervision visit since April 2024. Facility policy titled Home Health Aide Services revised January 2024, included supervisory visits would be made at least every 2 weeks for patients receiving skilled care. R4’’s Home Health Certification and Plan of Care certification period 1/17/24 to 3/16/24, included home health aide (HHA) visits two times weekly and skilled nurse visits every other week. R4’s Aide Care Plan with start date 7/24/23, indicated R4 would receive a tub bath with shampoo of hair twice weekly. The narrative notes within the plan of care identified the aide was to receive a whirlpool or shower, as determined by client preference. The aide was to assist R4 to wash [body] and shampoo hair. The plan of care directed the aide to assist to dry after shower and get dressed. The plan also directed the staff to assist the client to shave, brush teeth, if needed and comb hair. The plan of care also directed the staff to assist to select clothes, assist with dressing, brush/comb hair, and shave. The plan of care also directed staff to assist to brush teeth. The plan of care was signed by director of nursing (DON) on 7/25/23. Upon review of the medical record, it was noted R4 had received skilled nurse visits by licensed practical nurse (LPN)-A on the following dates during the certification period of 1/17/24 to 3/16/24; 1/24/24, 2/7/24, 2/21/24, and 3/6/24. Although the skilled nurse documentation form had an area to complete when a supervisory visit was done for home health aide visits provided, this was not completed as the skilled visits were completed by a LPN, and supervisory visits were to be completed by a registered nurse. During interview on 10/15/24, at 3:51 p.m. DON stated a supervisory visit for the HHA would not be done when the skilled visit was completed by an LPN. DON stated this needed to be completed by a registered nurse (RN) and should have been placed on the calendar for completion. DON stated the medical record lacked indication the supervisory visits were completed, and identified “it’s not on here.” On 10/16/24, at 9:00 a.m. the executive director (ED) stated in person supervisory visits are to be completed every 14 days when the client was receiving HHA visits. ED stated if the skilled visit was completed by a LPN, the supervisory visit needed to be completed every 14 days in person by a RN.”