Hcr / Hcr Home Care Chha (Oneonta)

“Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This Element is not met as evidenced by: Based on clinical record review the agency failed to ensure home health aides provide all services included in the plan of care (POC), are permitted to be performed under state law; and consistent with the home health aide training in one of one record reviewed of patients receiving paraprofessional aide services (Patient # 4). Failure to ensure home health aides provide all services included in the plan of care (POC), are permitted to be performed under state law; and are consistent with the home health aide training may result in poor quality of care and possible negative outcomes. Findings: Patient # 4 (start of care 02/06/2025) has diagnoses of Type 2 Diabetes Mellitus without Complications and Essential (Primary) Hypertension. The record contains an aide POC for the episode period 08/05/2025 through 10/03/2025 that instructs the aide to provide: Ambulate “assist as needed” every visit walker and clean/make/change beds weekly or as needed. An assessment of ‘as needed’ is outside the paraprofessional’s scope of practice. Also, the aide POC instructs the aide to provide: Ambulate assist as needed every visit walker. The Aide Care Plan Reports lack documented evidence this task was completed as directed stating “N (No)” and “Not required this visit” on the following dates: 08/11/2025, 08/14/2025, 08/25/2025, 08/28/2025, 09/08/2025, 09/11/2025 and 09/15/2025. The findings were confirmed on 09/15/2025 at 3:30 PM with the Executive Director and Director of Patient Services; no additional evidence was provided.”

“Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This Standard is not met as evidenced by: Based on the Home Health Agency (HHA) Error Summary by Agency Report for the period 01/01/2023 through 12/31/2023 and staff interview the agency failed to encode and electronically transmit each completed Outcome and Assessment Information Set (OASIS), regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within thirty days of completing the assessment of the beneficiary. Failure to encode and electronically transmit each complete OASIS assessment, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within thirty days of completing the assessment of the beneficiary has the potential for incorrect and incomplete reporting data. On 09/12/2024 the surveyors reviewed Certification and Survey Provider Enhanced Reports (CASPER), “Home Health Agency Error Summary Report by Agency” for report period 01/01/2023 - 12/31/2023. The report contains a warning code -3330 “Record Submitted Late”: The submission date is more than thirty days after M0090 “Date Assessment Completed” on this new record. The CASPER Report states 20 (0.75%) out of 2673 assessments processed were submitted more than thirty days after M0090. The agency lacks documented evidence the agency submitted required documents timely for 20 out of 2673, or for 0.75% of submissions. The finding was confirmed on 09/27/2024 at 9 AM with the Chief Nursing Officer/Administrator and Director of Patient Services; no additional evidence was provided.”

“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 clinical record review and staff interview the agency failed to ensure services are provided in accordance with the Plan of Care (POC) in three of seventeen records (Patient # 1, 4 and 17). Failure to follow the POC has the potential for patients to receive care inconsistent with the physician’s orders resulting in unmet patient needs and possible negative patient outcomes. Patient # 1 (start of care 08/28/2024) has diagnoses of Pressure Ulcer of Sacral Region, Stage 2 and Alzheimer’s Disease. The physician’s POC for certification period 08/28/2024 through 10/26/2024 contains an order for SN (skilled nurse) visits 1WK1 (one time a week for 1 week), 2WK4 and 1WK3. The record contains documentation of SN visits on 09/06/2024 and 09/13/2024. The record lacks documented evidence two SN visits were conducted for the weeks of 09/01/2024 through 09/07/2024 and 09/08/2024 through 09/14/2024. Patient # 4 (start of care 05/31/2024) has diagnoses of Type 2 Diabetes Mellitus with Foot Ulcer and Non-Pressure Chronic Ulcer Right Foot. The physician’s POC for certification period 07/30/2024-09/27/2024 contains orders for a Home Health Aide (HHA) 2WK1, 3WK8. The record lacks documented evidence of any HHA visits the week of 08/04/2024-08/10/2024. Also, the POC contains an order for “physical therapist to evaluate for physical impairments, functional limitations, home safety and rehabilitation potential”. The record lacks documented evidence a physical therapy evaluation was completed. Patient # 17 (start of care 08/19/2024) has diagnoses of ST Elevation (STEMI) Myocardial Infarction and Hypertensive Heart Disease with Heart Failure. The physician’s Resumption of Care (ROC) order dated 08/29/2024 contains an order for SN 1WK2, 2WK2, 1WK4. The record contains documentation of one SN visit conducted 09/16/2024 The record lacks documented evidence of a second SN visit for the week of 09/14/2024-09/20/2024. The findings were confirmed on 09/24/2024 at 3:30 PM, 09/25/2024 at 3:30 PM and 09/26/2024 at 3:30 PM with the Chief Nursing Officer/Administrator and Director of Patient Services; no additional evidence was provided.”

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on review of three clinical records of a patients receiving paraprofessional aide services and staff interview the agency failed to ensure in one of three records reviewed (Patient # 11) the aide Plan of Care (POC) was complete to meet the individualized needs of the patient. Failure to ensure the development of a comprehensive aide POC to reflect the patient’s needs has the potential to result in inappropriate care, unmet patient needs and possible negative outcomes. Patient # 11 (start of care 08/16/2024) has diagnoses of Age-Related Osteoporosis with Pathological Vertebrae Fractures and Hypertensive Heart Disease with Heart Failure. The record contains an Aide Care Plan Report dated 08/16/2024-10/14/2024 instructing the aide to provide: Bath/Shower Assist as needed every visit. The POC is incomplete as it does not contain parameters of when to provide assistance for this task; an assessment of ‘as needed’ is outside the paraprofessional’s scope of practice. The finding was confirmed on 09/26/2024 at 3:30 PM with the Chief Nursing Officer/Administrator and Director of Patient Services; no additional evidence was provided.”

“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 clinical record review and staff interview the agency failed to ensure a complete Plan of Care (POC) was developed to meet the individualized needs of the patient in eight out of seventeen records (Patient # 1, 2, 6, 8, 9, 11, 12 and 17). Failure to develop a comprehensive POC has the potential for unmet patient needs and places patients at risk for receiving incorrect and/or inappropriate care. Patient # 1 (start of care 08/28/2024) has diagnoses of Pressure Ulcer of Sacral Region, Stage 2 and Alzheimer’s Disease. The POC for certification period 08/28/2024-10/26/2024 contains an order for: Polyethylene Glycol 3350 17 gram/dose oral powder by mouth daily as needed (prn) for constipation maximum (max) daily dose 17 grams. The order is incomplete as it is lacking instruction for reconstitution. Patient # 2 (start of care 02/07/2024) has diagnoses of Type 2 Diabetes Mellitus with Diabetic Cataract and Major Depressive Disorder. The POC for certification period 06/06/2024-08/04/2024 contains an order for: Metamucil Fiber Singles 3.4 gram oral powder packet oral 1 packet bedtime. The order is incomplete as it is lacking instruction for reconstitution and Flonase Allergy Relief 50 micrograms (mcg)/actuation nasal 2 spray daily. The order is incomplete as it does not state whether to deliver the medication in the left or right nares or into both. Also, the POC for certification period 08/05/2024-10/03/2024 contains an order for: Flonase Allergy Relief 50 micrograms (mcg)/actuation nasal 2 spray daily. The order is incomplete as it does not state whether to deliver the medication in the left or right nares or into both and AYR Saline 0.65% Nasal Spray aerosol nasal 1 spray every 6 hours as needed/as needed (prn) for dry nose maximum daily amount 4 sprays. The order is incomplete as it does not state whether to deliver the medication in the left or right nares or into both. Patient # 6 (start of care 01/04/2024) has diagnoses of Type 2 Diabetes Mellitus with Other Skin Ulcer and Non-Pressure Chronic Ulcer Right Lower Leg. The POC’s for certification periods 07/02/2024-08/30/2024 and 08/31/2024-10/29/2024 contain an order for: Oxygen 2 Liter oxygen (O2) nightly. The order is incomplete as it is lacking the route of administration for the oxygen: mask and/or nasal canula. Also, the Skilled Nurse (SN) assessments conducted on 06/27/2024 and 08/26/2024 contain durable medical equipment (DME) of a walker. The POC’s for certification periods 07/02/2024-08/30/2024 and 08/31/2024-10/29/2024 do not contain an order for this DME. Patient # 8 (start of care 05/24/2023) has diagnoses of Hemiplegia following Cerebral Infarction Affecting Right Dominant Side and Pressure Ulcer of Sacral Region. The POC for certification period 07/17/2024-09/14/2024 contains orders for DME of: commode, glucometer, hospital bed, Reacher, shower/tub equipment, powered wheelchair, rolling walker and elbow protector. The SN assessment conducted on 07/16/2024 does not contain this DME. Also, the POC’s for certification periods 07/17/2024-09/14/2024 and 09/15/2024-11/13/2024 contain orders for: Nitrostat 0.4 milligrams(mg) sublingual tablet 1 tablet as needed/prn every 5 minutes under tongue as needed for chest pain maximum daily dose 3 tabs. The orders are incomplete as they do not direct the patient what to do if the pain persists after the 3 doses. Patient # 9 (start of care 02/22/2024) has diagnoses of Spastic Quadriplegic Cerebral Palsy and Gastrostomy Status. The POC’s for certification periods 06/21/2024-08/19/2024 and 08/20/2024-10/18/2024 contain orders for: Valtoco 10 mg/spray (0.1ml) spray nasal 1 spray as needed for seizure. The orders are incomplete as they do not state whether to deliver the medication in either the left or right nares or into both. Patient # 11 (start of care 08/16/2024) has diagnoses of Age-Related Osteoporosis with Pathological Vertebrae Fractures and Hypertensive Heart Disease with Heart Failure. The POC for certification periods 08/16/2024-10/14/2024 contains an order for: Bacitracin Plus 500 Unit-19mg/gram Topical Ointment 1 centimeter (cm) daily on the skin. The order is incomplete as it is lacking the anatomical location on the skin to apply the ointment. Patient # 12 (start of care 01/24/2024 and discharged 03/06/2024) has diagnoses of Type 2 Diabetes Mellitus with Chronic Kidney Disease and Hypertensive Chronic Kidney Disease Stage 5. The SN assessment conducted on 01/24/2024 contains DME of a hospital bed. The POC for certification period 01/24/2024-03/23/2024 is lacking an order for this DME. Patient # 17 (start of care 08/19/2024) has diagnoses of ST Elevation (STEMI) Myocardial Infarction and Hypertensive Heart Disease with Heart Failure. The POC for certification period 08/19/2024-10/17/2024 contains orders for: Levothyroxine 50 mcg capsule by mouth 1 capsule daily and Levothyroxine 50 mcg tablet by mouth 1.5 tablet daily. The orders require clarification as to the total daily dosage and form of the medication: tablet vs. capsule. The findings were confirmed on 09/24/2024 at 3:30 PM, 09/25/2024 at 3:30 PM and 09/26/2024 at 3:30 PM with the Chief Nursing Officer/Administrator and Director of Patient Services; no additional evidence was provided.”

“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 clinical record review and staff interview evidence is lacking in three of seventeen records (Patient #’s 1, 4 and 17) the physician was contacted regarding changes that alter or suggest the need to alter the Plan of Care (POC). Failure to consult with the physician when changes occur in the patient’s condition has the potential for unmet patient needs and/or negative patient outcomes. Patient # 1 (start of care 08/28/2024) has diagnoses of Pressure Ulcer of Sacral Region, Stage 2 and Alzheimer’s Disease. The physician’s POC for certification period 08/28/2024 through 10/26/2024 contains an order for SN (skilled nurse) 1WK1 (one time a week for 1 week) 2WK4 and 1WK3. The record lacks evidence the physician was notified of a missed SN visit for the weeks of 09/01/2024 through 09/07/2024 and 09/08/2024 through 09/14/2024. Patient # 4 (start of care 05/31/2024) has diagnoses of Type 2 Diabetes Mellitus with Foot Ulcer and Non-Pressure Chronic Ulcer Right Foot. The physician’s POC for certification period 07/30/2024-09/27/2024 contains orders for a Home Health Aide (HHA) 2WK1, 3WK8. The record lacks evidence the physician was notified there were no HHA visits the week of 08/04/2024-08/10/2024. Patient # 17 (start of care 08/19/2024) has diagnoses of ST Elevation (STEMI) Myocardial Infarction and Hypertensive Heart Disease with Heart Failure. The physician’s Resumption of Care (ROC) order dated 08/29/2024 contains an order for SN 1WK2, 2WK2, 1WK4. The record lacks evidence the physician was notified of missed SN visits for the weeks of 09/14/2024 through 09/20/2024. The findings were confirmed on 09/24/2024 at 3:30 PM, 09/25/2024 at 3:30 PM and 09/26/2024 at 3:30 PM with the Chief Nursing Officer/Administrator and Director of Patient Services; no additional evidence was provided.”