Emerest Home Health Care of Long Island

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on clinical record review and staff interview the agency failed to ensure that all orders for changes in the patient’s treatment(s) are included/ recorded in the patient’s Plan of Care for continuity of care. This was evident for one (1) of three (3) patient care records reviewed (Patient #1). Failure to review, revise and record all orders in the patient’s Plan of Care has the potential for negative patient outcome. The findings are: 1.Patient #1 has a Start of Care date of 04/26/2024 and discharge date of 05/28/2024 with the following diagnosis “Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left Non-dominant Side, Parkinson’s Disease without Dyskinesia, Essential (Primary) Hypertension, Retention of Urine” documented on the Home Health Certification and Plan of Care for the Certification Period 04/26/2024 to 06/24/2024. The Home Health Certification and Plan of Care for the Certification Period 04/26/2024 to 06/24/2024 signed by MD (Medical Doctor) on 05/23/2024 documents: “ Skilled Nurse to instruct patient/caregiver in indwelling urinary catheter management including care of Foley catheter, signed and symptom of complication, perineal care, tube and bag placement. Skilled Nurse for insertion of urinary catheter maintenance with catheter 16 FR/30 CC balloon, change 4 weeks and PRN (as needed), sign and symptoms of complications, perinea care, tube and bag placement.” The Clinical Coordination Note dated 05/12/2024 (Sunday) documents: “As per RN (Registered Nurse) - She received a call from the patient’s grandson that the “cath” (catheter) is out. The family reports is voiding and did not want to go to ER (Emergency Room). The patient was instructed by RN (Registered Nurse) to follow up with ER (Emergency Room) if no urinary occurred. RN (Registered Nurse) Manager called NP (Nurse Practitioner) #2.” The Client Coordination Note dated 06/13/2024 documents: “ RN (Registered Nurse) (Clinical Manager) reached out NP (Nurse Practitioner) #2 via text on 05/13/24. Per NP (Nurse Practitioner) #2, hold off on Foley catheter until she has completed her visit 5/15/24.” The NP (Nurse Practitioner) Visit Note documents:” Seen on 05/16/2024. Received the bladder ultrasound which shows some urine retention, 500 ml. Called the patient and spoke with the husband and explained what the plan is, to give 2 days of Lasix 20 mg and repeat bladder sonogram on Monday. Patient is urinating with no problem, no discomfort. Patient phone message: - will order loop diuretic to take for 2 days -repeat sonogram on Monday” The NP (Nurse Practitioner) Visit Note documents:” Seen on 05/23/2024. Had called the portable company to get the result of bladder and I was told it was not done because the husband refused. Also, the RN (Registered Nurse) from the agency informed me that patient had refused to take the Lasix I had ordered. Called the husband, no answer, called and spoke with the daughter who refused all my plan of care, patient and family not compliant therefore I had advised the agency to discharge patient since she does not want me as a provider and does not follow my instructions. -Instructed agency to discharge the patient due to noncompliance.” The Interim Physician Order dated 05/24/2024 documents: “NP #2 (Nurse Practitioner name) ordered Lasix 20 mg tablet, once a day by mouth for two days. Patient’s husband/son verbalized that prescription was called into the local pharmacy.” The agency’s “Physician Participation in Plan of Care” policy, number 2-019.1 documents: “If the patient is under the care more than one (1) physician, the nurse will be responsible to the physician who signs the certification and plan of care. All other physicians should be made aware of the services being provided to the patient. The primary physician will be informed of the involvement of the medical clinicians. Orders provided by the other physicians involved in the patient’s care will be obtained in writing as well.” The Interim Physician Order dated 05/24/2024 documents: “NP #2 (Nurse Practitioner) ordered Lasix 20 mg tablet, once a day by mouth for two days. Patient’s husband/son verbalized that prescription was called into the local pharmacy.” The Clinical record lacks documented evidence of the order for holding off on the Foley catheter until Nurse Practitioner completed visit on 05/15/2024, and order for Lasix and Sonogram prior 05/24/2024 (changes in the Foley care) and communication with the other physicians. (MD who signed 485 and NP (Nurse Practitioner) #1) On 05/12/2024 at 04:00 pm, the Quality Assurance Supervisor was interviewed and did not provide an explanation for the findings.”

“Discharge plans communication CFR(s): 484.60(c)(3)(ii) (ii) Any revisions related to plans for the patient’s discharge must be communicated to the patient, representative, caregiver, all physicians or allowed practitioner’s issuing orders for the HHA plan of care, and the patient’s primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any). This Element is not met as evidenced by: Based on clinical record review, and staff interviews, the agency failed to communicate with all physicians/caregiver(s)/patient regarding patient’s discharge. This was evident for one (1) of three (3) patient care records reviewed (Patient #1). Failure to communicate with all physicians/caregiver(s)/patient regarding patient’s discharge has the potential for negative patient outcomes. The findings are: 1.Patient #1 has a Start of Care date of 04/26/2024 and discharge date of 05/28/2024 with the following diagnosis “Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left Non-dominant Side, Parkinson’s Disease without Dyskinesia, Essential (Primary) Hypertension, Retention of Urine” documented on the Home Health Certification and Plan of Care for the Certification Period 04/26/2024 to 06/24/2024. The Home Health Certification and Plan of Care for the Certification Period 04/26/2024 to 06/24/2024 signed by MD on 05/23/2024 documents: “ Skilled Nurse to instruct patient/caregiver in indwelling urinary catheter management including care of Foley catheter, signed and symptom of complication, perineal care, tube and bag placement. Skilled Nurse for insertion of urinary catheter maintenance with catheter 16 FR/30 CC balloon, change 4 weeks and PRN (as needed), sign and symptoms of complications, perinea care, tube and bag placement.” The Interim Physician Order dated 05/24/2024 documents: “NP #2 (Nurse Practitioner) ordered Lasix 20 mg tablet, once a day by mouth for two days. Patient’s husband/son verbalized that prescription was called into the local pharmacy.” The Client Coordination Note dated 05/28/2024 documents: “As per DPS (Director of Patient Services) and provider NP (Nurse Practitioner) patient/family are still noncompliance with NP’s request for patient to take Lasix and have a second bladder scan prior to deciding if Foley catheter is medically necessary. RN (Registered Nurse) (Clinical Manager) spoke with patient’s son on Friday (05/24/24), who stated he would speak to patient and her husband as well as his sister in Israel and pick up prescription from the local pharmacy for the two tablet of Lasix (one tablet a day). RN (Registered Nurse) (Clinical Manager) spoke with the patient’s husband today 05/28/24, who stated Lasix was not taken as directed and asked if Royal RN (Registered Nurse) would arrive at the house to place a Foley catheter. The RN (Registered Nurse) (Clinical Manager) explained RN (Registered Nurse) cannot place a catheter without an order. Husband stated they had not contacted NP (Nurse Practitioner) #2. RN (Clinical Manager) notified the provider, who stated to discharge the patient from Royal services for noncompliance with her Care Plan.” 05/28/2024 (date of discharge) and last OT (Occupational Therapy) visit. The Client Coordination Note dated 05/28/2024 documents: RN (Clinical Manager) spoke with patient’s daughter and explained that patient is being discharged for noncompliance with provider NP’s#2 Plan of Care. Daughter is insistent that NP (Nurse Practitioner) #1 has seen patient and sent Foley insertion orders, however daughter stated that NP (Nurse Practitioner) #1 was not responding to any calls or messages. Clinical Manager explained that NP (Nurse Practitioner) #2 was the provider that was active in the case. Especially if NP (Nurse Practitioner) #1 had not responded back. Therefore, per NP (Nurse Practitioner) #2 and DPS (Director of Patient Services), patient will be discharged from Royal services. Update 05/29/24 - RN (Registered Nurse) (Clinical Manager) unable to reach NP (Nurse Practitioner) #1. Left detailed voicemail regarding patient’s discharge from Royal care CHHA’s (Certified Home Health Agency) services. Patient’s daughter also aware of the discharge and no order from NP (Nurse Practitioner) #1 to reinsert Foley Catheter found.” The Client Coordination Note dated 05/31/2024 documents: “This morning, 5/31/24 NP (Nurse Practitioner) #1 reached out and acknowledged my call to inform them of patient’s discharge from Royal and also that they are in fact very late in responding to messages and calls (during the case and after discharge of this case). I explained the reason for discharge and requested a referral to another CHHA (Certified Home Health Agency) and NP (Nurse Practitioner) said they’d work on it.” The Discharge-Transfer Summary documents: “ Physician: NP (Nurse Practitioner) #1 name Discharge to home or self-care:/reason: Non-compliant with plan of treatment. Episode End Date:05/28/2024 DC(Discharge) Coordination Note: Date of Discipline Discharge: 5/28/24 Reason for Discharge: Noncompliance with POC (Plan of Care) Declined further treatment, evaluation from NP (Nurse Practitioner) Patient discharged for non-compliance.” The agency’s “Discharge Criteria and Process” policy, number 2-044.1 documents: “Procedure: 1. The organization will verbally notify the patient of the decision to terminate services as soon as a discharge date is known but not late than the next to the last visit when discharge has been planned. Prior notice will not be necessary when services are discharge by the patient or physician; however, information and action taken regarding the request discharge must be documented in the clinical record. 2. Patient and/or family/caregiver and the patient’s physician will be informed at least one week in advance of the intended discharge date followed by written notice when feasible where discharge is for cause such as: Failure to cooperate or comply with the plan of care.” The Clinical record lacks documented evidence of the communication with the MD (who signed 485), NP (Nurse Practitioner) #1(prior 05/29/2024) and the caregiver/patient regarding the patient’s discharge planning in advance. On 05/12/2024 at 03:00 pm, the Quality Assurance Supervisor was interviewed and did not provide an explanation for the findings.”

“Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This Element is not met as evidenced by: Based on clinical record review and staff interview the agency failed to ensure ongoing communication with all physicians is maintained. This was evident for one (1) of three (3) patient care records reviewed (Patient #1). Failure to ensure ongoing communication with all physicians is maintained has the potential for negative patient outcome. The findings are: 1.Patient #1 has a Start of Care date of 04/26/2024 and discharge date of 05/28/2024 with the following diagnosis “Hemiplegia and Hemiparesis following Cerebral Infarction affecting Left Non-dominant Side, Parkinson’s Disease without Dyskinesia, Essential (Primary) Hypertension, Retention of Urine” documented on the Home Health Certification and Plan of Care for the Certification Period 04/26/2024 to 06/24/2024. The Home Health Certification and Plan of Care for the Certification Period 04/26/2024 to 06/24/2024 documents: “Increased pain or ineffective pain control measures will be identified and promptly reported to the Physician.” The OT (Occupational Therapy) Visit dated 05/03/2024 documents: “Indicate Client’s Current Pain Scale Rating: 5 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:7 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:8” The OT (Occupational Therapy) Visit dated 05/07/2024 documents: “Indicate Client’s Current Pain Scale Rating: 5 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:8 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:8” The OT (Occupational Therapy) Visit dated 05/09/2024 documents: “Indicate Client’s Current Pain Scale Rating: 5 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:6 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:7” The OT (Occupational Therapy) Visit dated 05/16/2024 documents: “Indicate Client’s Current Pain Scale Rating: 7 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:4 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:8” The OT (Occupational Therapy) Visit dated 05/17/2024 documents: “Indicate Client’s Current Pain Scale Rating: 5 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:8 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:10” The OT (Occupational Therapy) Visit dated 05/21/2024 documents: “Indicate Client’s Current Pain Scale Rating: 6 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:8 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:9” The OT (Occupational Therapy) Visit dated 05/28/2024 documents: “Indicate Client’s Current Pain Scale Rating: 6 Indicate Client’s Pain Scale Rating for Best/Least Intensity of Pain:8 Indicate Client’s Pain Scale Rating for Worst/Most Intensity of Pain:8” 05/28/2024 (date of discharge) and last OT (Occupational Therapy) visit. The Clinical Record lacks documented evidence of the communication with the Physician(s) regarding the patient’s pain before discharge on 05/28/2024. On 05/12/2024 at 04:00 pm, the Quality Assurance Supervisor was interviewed and did not provide an explanation for the findings.”