Kayd Home Care LLC

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on record review and staff interview, the Home Health Agency (HHA) failed to ensure the individualized plan of care (POC) included the frequency and duration of visits to be made for 1 of 5 sampled patients (Patient #3). Failure to identify the frequency and duration of as needed (PRN) visits may result in inadequate or unnecessary home visits. Findings include: Review of Patient #3’s medical record occurred on January 6-8, 2025. The current POC for the certification period of 11/25/24 to 01/23/25, identified, “. . . Order: SN [skilled nurse] PRN visits to attend to indwelling suprapubic urinary catheter . . .” The POC lacked the frequency and duration of PRN nursing visits. During an interview on the afternoon of 01/07/25, a supervisory nurse (#1) confirmed the POC lacked the number of PRN visits for the current certification period.”

“Duties of a HH aide CFR(s): 484.80(g)(3) The duties of a home health aide include: (i) The provision of hands-on personal care; (ii) The performance of simple procedures as an extension of therapy or nursing services; (iii) Assistance in ambulation or exercises; and (iv) Assistance in administering medications ordinarily self-administered. This Element is not met as evidenced by: Based on observation, policy review, record review, and staff interview, the Home Health Agency (HHA) failed to assign appropriate duties to the home health aide for 1 of 2 sampled patients (Patient #2) observed receiving care from a home health aide. Failure to ensure an aide only provided assistance in administering medications could result in an adverse event for Patient #2 and limits the HHA’s ability to provide proficient, effective, and safe care. Findings include: Review of the agency policy titled “Medication Administration Procedure” occurred on 01/08/25. This policy, dated 2023, stated, “Only FDA [Food and Drug Administration] approved drugs, by FDA approved routes, and dosages, may be administered by RNs [registered nurses], and LPNs/LVNs [licensed practical nurses/licensed vocational nurses], in accordance with their skills, training, and applicable state regulations. . . .” Review of Patient #2’s medical record occurred on January 6-8, 2025. The plan of care identified home health aide services two times a week including “tasks as delegated by SN [skilled nurse]” for the certification period of 12/17/24 to 02/14/25. Patient #2’s orders included doxazosin 1mg daily for prostate enlargement, diltiazem 30 mg three times daily for hypertension, and aspirin 81 milligrams (mg) daily for coronary artery disease, per the patient’s gastrostomy tube (device inserted into the stomach through the abdomen). Observation of Patient #2’s medications on the morning of 01/07/25 occurred with a home health aide (#2). The aide stated she administered the patient’s medications at 10:00 a.m. (doxazosin) and 1:00 p.m. (diltiazem) on the days she visited, and sometimes at 4:00 p.m. (aspirin) according to a schedule hung on the wall above the bottles of medication. The aide stated the family administered the remaining doses and other medications. During an interview on 01/07/25 at 4:40 p.m., a supervisory nurse (#1) confirmed the home health aide (#2) administered Patient #2’s medications during her visits.”

“If concern identified, direct observation CFR(s): 484.80(h)(1)(ii) The supervisory assessment must be completed onsite (that is, an in person visit), or on the rare occasion by using two-way audio-video telecommunications technology that allows for real-time interaction between the registered nurse (or other appropriate skilled professional) and the patient, not to exceed 1 virtual supervisory assessment per patient in a 60-day episode. This Element is not met as evidenced by: Based on record review, policy review, and staff interview, the Home Health Agency (HHA) failed to ensure a registered nurse (RN) performed the supervisory visit on-site for 4 of 4 sampled patients (Patient #2, #3, #4, and #5) receiving home health aide services for more than two weeks. Failure to complete the supervisory visit in person at the patient’s home limited the HHA’s ability to assess the adequacy of aide services in relation to the needs of the patient/family and to ensure the aides furnished the appropriate care identified in the patient’s plan of care. - Review of Patient #5’s medical record occurred on January 6-8, 2025. The record identified a plan of care for home health aide services four times a week for the certification period of 12/17/24 to 02/14/25. An RN (#1) completed and documented a supervisory visit on 12/30/24. The record lacked evidence the RN made an on-site visit to Patient #5’s home on 12/30/24. - Review of Patient #3’s medical record occurred on January 6-8, 2025. The record identified a plan of care for home health aide services two times a week for the certification period of 12/14/24 to 02/11/25. An RN (#1) completed and documented a supervisory visit on 12/31/24. The record lacked evidence the RN made an on-site visit to Patient #3’s home on 12/31/24. - Review of Patient #4’s medical record occurred on January 6-8, 2025. The record identified a plan of care for home health aide services two times a week for the certification period of 11/25/24 to 01/23/25. An RN (#1) completed and documented a supervisory visit on 12/31/24. The record lacked evidence the RN made an on-site visit to Patient #4’s home on 12/31/24. Findings include: Review of the agency policy titled “Aide Supervision” occurred on 01/08/25. This policy, dated 2023, stated, “Statement of Standard . . . If home health aide services are provided to a patient who is receiving skilled nursing . . . services, a registered nurse . . . who is familiar with the patient, the patient’s plan of care, and the written patient care instructions or home health aide plan of care, must make an onsite visit to the patient’s home no less frequently than every 14 days. . . .” - Review of Patient #2’s medical record occurred on January 6-8, 2025. The record identified a plan of care for home health aide services two times a week for the certification period of 12/17/24 to 02/14/25. An RN (#1) completed and documented a supervisory visit on 12/31/24. The record lacked evidence the RN made an on-site visit to Patient #2’s home on 12/31/24. During an interview on 01/08/25 at 12:20 p.m., a nurse administrator (#1) confirmed she conducted the supervisory visits over the phone for Patient #2, #3, #4, and #5 during the time period of December 30-31, 2024.”