Advantage Home Care, Inc. DBA Corus Home Health

“Discharge Planning CFR(s): 484.58(a) Standard: Discharge planning. An HHA must develop and implement an effective discharge planning process. For patients who are transferred to another HHA or who are discharged to a SNF, IRF or LTCH, the HHA must assist patients and their caregivers in selecting a post-acute care provider by using and sharing data that includes, but is not limited to HHA, SNF, IRF, or LTCH data on quality measures and data on resource use measures. The HHA must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences. This Standard is not met as evidenced by: Based on record review, staff interviews, and policy review, the agency failed to ensure one of five sampled patients (Patient (P) 14) being discharged to a post-acute care provider was assisted in selection by using quality measures data and data on resource use measures, thereby preventing patients from making informed decisions about the performance of other providers. This has the potential to affect all patients being discharged to a post-acute care provider. Findings include: Review of the agency’s policy titled, “Discharge Criteria and Planning,” revised February 2024, did not include criteria for assisting patients with a list of post-acute providers. Review of the “Plan of Care” tab of the electronic medical record (EMR) indicated P14 was admitted to the agency on 10/27/23 and discharged to another home health agency on 11/10/23. There was no evidence that the agency provided P14 with a list of home health agencies which included quality measures data and data on resource use measures. During an interview on 05/05/25 at 10:00 AM, the Chief Operating Officer (COO) confirmed that patients were not being provided with a list of post-acute providers using quality measures and data on resource use measures. The COO stated that he/she was not aware of that requirement and did not know where to find quality measures for other providers. During an interview on 05/05/25 at 10:30 AM, the Administrator confirmed that patients were not being provided with a list of post-acute providers. The Administrator stated, “I did not know that was a requirement.””

“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 observation, document review, interview, and policy review, the agency failed to provide a written, individualized, complete, plan of care that identified patient-specific measurable outcomes, goals, and diet for one of seven sampled patients (Patient (P) 5) reviewed for care plans. This deficient practice has the potential to allow different healthcare providers to provide inconsistent or conflicting care and affects all patients. Findings include: Review of the facility’s agency policy titled, “Plan of Care-CMS#485 (Centers for Medicare & Medicaid Services (CMS) Form 485) and Physician/Practitioners Orders,” revised February 2024, revealed under “PROCEDURE 2,” it read “Each patient must receive an individualized written plan of care, including and revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, … and measurable outcomes that the Agency anticipates will occur because of implementation and coordinating the plan of care.” During an observation on 05/06/25 at 1:30 PM, a home visit was conducted at P5’s residence while observing Home Health Aide (HHA) 1. Review of P5’s admission packet, provided by the facility, revealed it lacked a complete plan of care which included prognosis, rehabilitation potential, activities permitted, and nutritional requirements. The packet included an agency form titled “Home Health Care Plan” which contained handwritten notes and was not individualized, and complete. Review of the agency form “Home Health Care Plan” provided by the facility, did not include all the information included on P5’s CMS Form 485. It lacked the patient’s prognosis, rehabilitation potential, activities permitted, and nutritional requirements. An interview with P5 on 05/06/25 at 1:40 PM revealed that all the paperwork provided by the agency was placed in the admission packet and P5 was not aware of what a plan of care was. During an interview on 05/06/25 at 3:00 PM, the Administrator confirmed that CMS Form 485 was not given to patients. The Administrator stated that the patient was provided with the agency form titled “Home Health Care Plan” as their plan of care. When asked if different patients received different forms, the Administrator replied “No.””

“Competency evaluation CFR(s): 484.80(c)(1)(2)(3) Standard: Competency evaluation. An individual may furnish home health services on behalf of an HHA only after that individual has successfully completed a competency evaluation program as described in this section. (1) The competency evaluation must address each of the subjects listed in paragraph (b)(3) of this section. Subject areas specified under paragraphs (b)(3)(i), (iii), (ix), (x), and (xi) of this section must be evaluated by observing an aide’s performance of the task with a patient or pseudo-patient. The remaining subject areas may be evaluated through written examination, oral examination, or after observation of a home health aide with a patient, or with a pseudo-patient as part of a simulation. (2) A home health aide competency evaluation program may be offered by any organization, except as specified in paragraph (f) of this section. (3) The competency evaluation must be performed by a registered nurse in consultation with other skilled professionals, as appropriate. This Standard is not met as evidenced by: Based on document review and staff interview, the agency failed to ensure initial competency evaluations supervised by a Registered Nurse (RN) were conducted prior to providing patient care, thereby potentially allowing aids to perform essential tasks incorrectly, and/or inadequate patient care for seven of eight Home Health Aides (HHA) 1, HHA2, HHA3, HHA4, HHA5, HHA7, and HHA8. This has the potential to affect all patients receiving HHA services. Findings include: Review of the agency’s policy titled, “Staff Competency Program,” revised February 2024, revealed under “PROCEDURE 4.” It read “Examples of qualified individuals to perform competency assessment may include: Home Health Aide; competency assessed by a RN.” Review of the “Training Records,” provided by the facility, for HHA1, HHA2, HHA3, HHA4, HHA5, HHA7, and HHA8 revealed the records did not contain documentation verifying that the agency had performed initial competency testing under the supervision of a registered nurse before allowing them to provide patient care. The records did indicate that yearly competency testing was being conducted. During an interview on 05/07/25, at 9:00 AM, the Administrator confirmed that aide competency evaluations were not being conducted by an RN before patient care was provided. The Administrator explained that HHAs participated in a home visit, during which they observed another HHA performing personal hygiene and grooming tasks for a patient. The Administrator stated after a single observation, the HHA was deemed competent and permitted to conduct these functions independently. The Administrator stated, “We do not conduct initial competency training. We have them observe another home health aide to ensure they are performing correctly, but they are not assessed by a registered nurse.””

“Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This Element is not met as evidenced by: Based on a request for documents and staff interview, the agency failed to develop a policy addressing the pneumococcal vaccine administration for patients, thereby increasing the risk of transmitting preventable diseases. This deficient practice potentially affects all patients. Findings include: During a request submitted to the Administrator for a policy outlining the administration of the pneumococcal vaccine for the patients on 05/07/25 at 10:00 AM, the Administrator was unable to provide the requested policy. During an interview on 05/07/25 at 10:15 AM, the Administrator revealed that the agency had not established a policy regarding the administration of the pneumococcal vaccine for patients. The Administrator stated that all patients were asked about the vaccine upon admission, and if they chose to receive it, the agency coordinated with their physician to facilitate its administration.”

“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 observation, document review, interviews, and policy review, the agency failed to promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes were not being achieved and/or that the plan of care should be altered for one of seven sampled home visit patients (Patient (P) 4). This lack of communication led to delays in necessary interventions and adjustments to the care plan. Findings include: Review of the agency’s policy titled, “Coordination of Patient Care” revised February 2024, revealed under “Procedure 1. The Agency must: Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines.” Review of the “Plan of Care” tab of the electronic medical record (EMR), with the certification period from 11/11/24 to 01/09/25 listed a medical diagnosis of right total knee replacement, following a hospital stay from 10/30/24 to 11/06/24. Review of the undated “Disciplines to see patient” section of the EMR, noted a “Physical Therapy (PT) evaluation,” with no documented evidence that skilled nursing services were ordered. Review of the hospital’s “Discharge Summary,” provided by the facility, indicated P4 was admitted from 12/13/24 to 12/16/24 for generalized edema (fluid retention) and shortness of breath, due to volume overload with pleural effusion (excessive fluid between the lungs and chest wall). Additional diagnoses include hypothyroidism, chronic atrial fibrillation, hypertension, lupus, and end-stage kidney disease with in-center dialysis. Review of the “Plan of Care” under “Medical Diagnosis for Continued Home Health” for the certification period from 03/11/25 to 05/09/25 and provided by the facility, listed congestive heart failure, characterized by weakened heart function leading to fluid buildup in the body. The ordered service for this period remained physical therapy. There was no evidence that skilled nursing services were ordered, nor was there evidence that interventions for congestive heart failure were prescribed or communicated to the patient’s physician. During an observation on 05/06/25 at 9:00 AM, a home visit was conducted at P4’s residence to observe Physical Therapist (PT) 2 provide strength and gait training. P4 was seen sitting at the kitchen table, eating breakfast, and appeared frail. With assistance from PT2 and the use of a gait belt, P4 attempted to stand but was only able to do so for approximately 15 seconds. During an interview on 05/06/25 at 9:15 AM, P4 shared that P4 previously underwent peritoneal dialysis at home but experienced an infection in the port (a small, surgically implanted reservoir used to withdraw excess fluid). P4 stated as a result, dialysis treatments were delayed, leading to fluid buildup in the lungs. P4 stated now had a fistula/graft in the right arm and received dialysis treatments at an in-center facility three days a week for four hours per session. P4 remarked, “I’ve lost almost 20 pounds since going to the in-center dialysis center.” During an interview on 05/06/25 at 9:45 AM, when questioned if there had been any communication or coordination with nursing services, PT2 stated, “No.” When asked if the patient’s physician was notified about the diagnosis of congestive heart failure, PT2 replied, “No.” During an interview on 05/07/25 at 10:00 AM, the Administrator reviewed the electronic medical record of P4 and stated, “I agree, there should have been skilled nursing services ordered, and the physical therapist should have contacted the patient’s physician.””