Quality Care Nursing Services

“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 record review and interview, the agency failed to ensure each patient received home health services as written in the individualized plan of care and failed to notify the physician of missed visits. This affected three (Patient’s #1, #6 and #14) of three patients reviewed. The active census was 126. Findings include: 1. Review of Patient #14 revealed a 04/10/24 start of care and a current certification period 08/08/24 to 10/06/24. Diagnosis included quadriplegia, neurogenic bowel, neuromuscular dysfunctional of bladder, and C4 and C5 level cervical injury. The patient uses a power chair, hospital bed, special mattress overlay, and had a Lifeline. He had functional limitations with bowel and bladder, paralysis, endurance issues and weakness. He had prescribed exercises. He was a Hoyer lift. He had a fair prognosis and is depressed and anxious. The 485 Home Health Certification and Plan of Care indicated the patient was to receive 14 to 16 hours weekly of personal care however, a 05/01/24 Ohio Home Care Waiver plan revealed Home Health Aide hours were increased to 31 hours weekly for assistance with activities of daily living services. Review of the 08/08/24 certification revealed the resident received 21.5 of 31 hours the week on 08/04/24, 25 of 31 hours the week of 08/11/24, 26 of 31 hours the week of 08/18/24, 23 of 31 hours the week of 08/25/24 and 09/01/24, 19.5 of 31 hours the week of 09/08/24, and 26.5 of 31 hours the week of 09/15/24. There was no evidence of physician notification of missed visits. Interview 09/26/24 at 11:50 A.M. with Staff B verified she does not notify the physician of missed visits just the case manager. The facility did not have a policy directing staff to notify the physician of missed visits. 2. Review of Patient #6 revealed a 04/03/24 start of care and a current certification period 08/01/24 to 09/29/24. Diagnosis included quadriplegia, neuromuscular dysfunction of bladder, and cervical injury from motor vehicle accident. The patient used a power and manual chair, hospital bed, and catheter. She had functional limitations with bowel and bladder, paralysis, contractures, endurance issues, ambulation, and dyspnea. She was a Hoyer lift. She had a fair prognosis and is oriented, depressed and agitated. The 485 Home Health Certification and Plan of Care indicated the patient was to receive 40 to 42 hours weekly of personal care. The schedule was six hours seven days a week. Review of the 08/01/24 certification revealed the resident received 39.25 of 42 hours the week of 08/04/24, 39 of 42 hours the week of 08/11/24, 36.5 of 42 hours the week of 08/18/24, 39 of 42 hours the weeks of 08/25/24 and 09/01/24, 39.5 of 42 hours the week of 09/08/24, and 37 of 42 hours the week of 09/15/24. There was no evidence of physician notification of missed visits. Interview 09/26/24 at 11:50 A.M. with Staff B verified she does not notify the physician of missed visits just the case manager. 3. Review of Patient #1 revealed a 07/24/24 start of care and a current certification period 07/24/24 to 09/21/24. Diagnosis included hemiplegia, type 2 diabetes, chronic obstructive pulmonary disease, and end stage renal disease. The patient used a power chair, quad cane, Lifeline and glucometer. He had functional limitations paralysis, contractures, endurance issues, ambulation, speech and dyspnea. He had a fair prognosis and is forgetful, depressed, and has short and long term memory issues. The 485 Home Health Certification and Plan of Care indicated the patient was to receive 33 to 35 hours weekly of personal care. The schedule was five hours seven days a week from 12:00 noon to 5:00 P.M. Review of the 07/24/24 certification revealed the resident received 23.75.of 35 hours the week of 0729/24, 29 of 35 hours the week of 08/11/24, 28 of 35 hours the week of 08/18/24, 34.5 of 35 hours the week of 08/25/24, 09/01/24, 33 of 35 hours the week of 09/08/24, and nine of 35 hours the week of 09/15/24. The patient did not have an aide 09/16/24, was short an hour 09/17/24, the aide quit 09/18/24 resulting in nine total hours provided the week of 09/15/24. There was no evidence of physician notification of missed visits. The residents aide quit resulting in extended days without an aide. There was no evidence of the physician being notified of the patient being without an aide. Interview 09/26/24 at 11:50 A.M. with Staff B verified she does not notify the physician of missed visits just the case manager.”

“Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This Element is not met as evidenced by: Based on interview, record review, and Complaint Log review, the facility failed to document the resolution of a complaint for five of five complaints logged for 2024. This affected four (Patients #1, #6, #14 and #126) current patients. This had the potential for affect all 126 patients receiving services from the agency. Findings include: Review of the facility’s Quality Care Nursing Complaint Log 2024 revealed a column for patient name, date and brief description. There was a complaint logged 07/09/24 for Patient #126 alleging the Home Health Aide (HHA) stole clothing. A complaint logged 08/10/24 for Patient #14 of the HHA leaving early. A complaint logged 08/14/24 for Patient #6 of a privacy violation by the HHA. A 09/02/24 complaint logged for Patient #6 related to a care issue for mother. A 09/11/24 complaint logged for Patient #1 alleging the aide was not returning change and receipt. Review of the log revealed no evidence of a resolution documented on the log. Interview 09/25/24 at 1:54 P.M. with the Administrator Staff A verified there was not a resolution to the complaints documented on the log.”

“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 record review and staff interview, the facility failed to ensure new orders were recorded in the plan of care. This affected one (Patient #14) of three patients reviewed. The current census was 126. Findings include: Review of Patient #14 revealed a 04/10/24 start of care and a current certification period 08/08/24 to 10/06/24. Diagnosis include quadriplegia, neurogenic bowel, neuromuscular dysfunctional of bladder, and C4 and C5 level cervical injury. The patient used a power chair, hospital bed, special mattress overlay, and had a Lifeline. He had functional limitations with bowel and bladder, paralysis, endurance issues and weakness. He had prescribed exercises. He was a Hoyer lift. He had a fair prognosis and is depressed and anxious. The 485 Home Health Certification and Plan of Care indicated the patient was to receive 14 to 16 hours weekly of personal care. Review of a 05/01/24 Ohio Home Care Waiver plan revealed Home Health Aide hours were increased to 31 hours weekly for assistance with activities of daily living services. Interview 09/25/24 at 4:28 P.M. with Office Manager Staff B revealed the patients hours were increased to 31 hours a week on 05/02/24. The schedule was Monday, Tuesday and Wednesday five hours a day and Thursday and Friday eight hours a day. Interview 09/25/24 at 5:30 P.M. with Administrator Staff A verified the 485 Home Health Certification and Plan of Care was not updated for the certification period including 05/01/24 and certification periods starting 06/09/24 and 08/08/24. The Staff A included they normally do a 437 (to change plan of care) and modification when there is a change in the plan of care. It should of been done and was not.”