Tru Home Health, Inc.

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on interview and record review the home health agency failed to identify and report concerns to the provider of changes in a patient’s condition when outcomes were not being met for 1 of 3 patients (P1) reviewed for provider notification. P1 was experiencing incontinence, food, and safety concerns in his home. Findings include: P1’s skilled nursing note dated 1/22/25 indicated upon arrival P1 was wrapped in a blanket and stated he was out of incontinence briefs. P1’s home had increased garbage and crumbs throughout. RN-A was orientating HHA-A to P1 for home health aide and homemaking services. P1 care coordination noted dated 1/24/25 indicated home health aide (HHA)-A called registered nurse (RN)-A to report P1 was incontinent of bowel and had no incontinence products in the home. In addition, P1 did not have any cleaning supplies. RN-A’s resolution and follow-up indicated she had attempted to call P1’s family member (FM)-A for the ne necessary supplies. P1’s Plan of Care for certification period 1/29/25 – 3/29/25 indicated P1’s pertinent diagnoses were Type II Diabetes, alcohol dependence, and post-traumatic stress disorder. P1 received home health aide and homemaker services twice a week to assist with personal cares, activities of daily, and light housekeeping. Skilled nursing, registered nurse (RN)/licensed practical nurse (LPN) weekly visits and three as needed (PRN) visits for change in condition per certification period. P1’s plan of care did not indicate P1’s bowel and bladder status. P1’s care coordination note dated 1/31/25 indicated HHA-A left a voicemail to the agency stating P1 was incontinent of bowel that required cleaning out of the carpet. In addition, when RN-A returned a call to HHA-A, HHA-A stated P1 was sitting in his own bowel movement, P1 was starving, and he wanted to go into a nursing home. RN-A’s response and follow-up to HHA-A was P1 seated in bowel movements was unusual for him and HHA-A should inquire with P1 if he was feeling well and if he had been incontinent any other time. RN-A was at P1’s home three days prior and P1 had easy to heat soups, tv dinners, and snacks. RN-A explained to HHA-A that P1 was his own decision maker and had refused assisted livings in the past. HHA-A was not responsible for cleaning P1’s carpet the family would be responsible for carpet cleaning. P1’s HHA visit note dated 3/19/25 indicated P1 was very confused. He required extra reminders to drink and eat. When it came to sign the visit note P1 did not understand what he was doing. He seemed “hyper focused and fidgety” with a broken flashlight. P1 refused his shower. This was reported to RN-A. P1’s nursing visit note dated 3/20/25 indicated P1 had a life alert box (emergency response system that allows patients to call for help by pressing a button usually worn around their neck). RN-A placed a call to P1’s family regarding the box. The note did not indicate a response to HHA-A’s concerns of 3/19/25. Upon interview on 3/21/25 at 10:12 a.m. HHA-A stated P1 stated every time she visited him, he was incontinent or urine and at times feces. She stated P1 attempted to clean himself along with the areas he had soiled in his home and that made matters worse. P1 had fallen in his home on a Saturday and FM-A found him on the floor in urine and feces. HHA-A reported the fall to the agency. HHA-A also reported to the agency her visits P1’s incontinence, the odor in the home and having a little bit of food he cannot prepare on his own because his microwave did not work. FM-A would bring P1 brownies and chips from a convenient store even though P1 was diabetic. HHA-A stated on her visit this a.m. P1 was seated on the floor again and emergency medical services were called. Upon interview on 3/21/25 at 10:45 a.m. P1 stated he wanted writer to visit his home because he needed help. He then gave the phone to HHA-A. Upon interview on 3/21/25 at 1:45 p.m. RN-B a clinical manager stated RN-A and HHA-A had spoken about the conditions of P1’s home in 1/2025. She was not certain how P1 obtained increased home health aide hours on 2/14/25, a faxed order from P1’s provider came to the agency and the agency filled the increased home health aide hours. She was aware that self-neglect, incontinence, and lack of food in the home was reported to the agency. The agency did not report self-neglect to adult protection. RN-B stated the nurse case manager should have reported the allegations to the provider. Upon interview on 3/21/25 at 2:11 p.m. an Occupational Therapist (OT)-A stated she was at P1’s home this a.m. for a home safety evaluation and to assess P1 for equipment needs. She stated HHA-A was still at his home upon her arrival. P1 had fallen earlier in morning, and the paramedics came and placed P1 in his chair. P1 then refused to shower, and he was unable to transfer out of the chair. OT-A stated P1 was a vulnerable adult, and her evaluation was due to concerns about P1’s safety for many weeks noted by the medical provider upon an office visit. OT-A had no correspondence with the agency prior to her visit with P1. OT-A’s orders for care came straight from the provider. OT-A called 911 and asked for transport to a hospital in a larger nearby city. Upon interview on 3/21/25 at 3:00 p.m. RN-A stated that in 1/2025 HHA-A had concerns about P1 being neglected because he was found having incontinence of bowel movements. He was incontinent of urine. RN-A had been to his home prior that week and did not have concerns with P1. RN-A educated HHA-A that bowel incontinence was not normal for P1, that he wears incontinent briefs which he managed himself. P1 had food in his home and was able to use his microwave. RN-A found a business card and a safety plan in P1’s home from county Adult Protection Social Worker (SW)-A. RN-A reached out to the SW-A and found out SW-A ordered meals on wheels, the increased hour for the home health aide and, having FM-A check on P1 when the agency was not in the home, and SW-A had ordered the life alert system. Upon interview on 3/21/25 at 3:36 p.m. the providers clinical nurse (RN)-C stated the provider had concerns as P1 would show-up for appointments with a strong urine odor, was dirty appearing and had reported falls in the home. Upon interview on 3/21/25 at 3:44 p.m. the providers clinical social worker (SW)-B stated she was aware that P1 had fallen in the home which was the reason the provider ordered occupation therapy to assess for new equipment and the life alert system. The provider also ordered meals on wheels due to concerns reported that P1 did not have adequate food and a way to prepare it. SW-A stated the providers correspondence for P1’s safety, hygiene and dietary concerns came from the county Vulnerable Adult social worker, not the home care agency. Upon interview on 8:35 a.m. SW-B the adult protection worker stated the initial concerns for P1 were caregiver neglect and financial exploitation. He stated he addressed caregiver concerns and made a safety plan. He made sure FM-A was checking on P1 when the agency was not there, increasing agency services and proper meals were being delivered. SW-B stated P1’s microwave was out of his reach and when he moved the microwave it did not work. P1 was not refusing other housing options but wanted to try SW-B’s new plan. There was not a financial exploitation concern identified by SW-B. Upon email correspondence on 3/24/25 at 11:13 a.m. with the chief operating officer provided the dates and reasons the agency notified the provider regarding P1: 1/8/25 – SNV Note – Notified provider of missed medication doses. 1/13/25 – SNV Note – Notified provider of missed medication doses. 1/22/25 – SNV Note – Notified provider of missed medication doses and start of HHA services. 2/12/25 – SNV Note – Notified provider of missed medication doses. 2/26/25 – SNV Note – Notified provider of missed medication doses. 3/12/25 – SNV Note – Notified provider of missed medication doses. 3/21/25 – Report of Incident – Updated provider on fall/ED visit 3/24/25 – Physician Order – Updated provider on hospitalization An agency policy titled Monitoring Patient’s Response/Reporting to Physician with a revision date of 10/17/24 indicated: The patient’s physician and/or the DON will be contacted on the same day when any of the following occur: a. Changes in the patient’s condition b. Changes in the patient’s psychosocial status c. Changes in family/caregiver support or home environment d. Inability to achieve goals within the specified time. e. Changes in the patient’s expected response to home care or medications f. Changes occur regarding diagnosis, prognosis, or treatment (including procedures, medications, precautions, and limitations)”