Continental Home Health Care, Inc.

“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, interview and policy review, the agency failed to ensure the physician had been notified of all missed visits. This affected three (Patients #1, #2 and #3) of four patients reviewed. The census was 138. Findings include: 1. Review of the medical record for Patient #1 revealed the start of care was 01/27/24. Diagnoses included chronic obstructive pulmonary disease, high blood pressure and right above the knee amputation. The physician’s plan of care dated 01/27/24 ordered the home health aide (HHA) to provide care 14 hours per week to assist with activities of daily living. No HHA time sheets were found in the medical record. A missed visit report dated 02/16/24, signed by Staff G, was for missed visits 02/12/24, 02/13/24, 02/14/24, 02/15/24 and 02/16/24 due to no coverage. A second missed visit report dated 03/04/24, signed by Staff G, was for missed visits 02/26/24, 02/27/24, 02/28/24, 02/29/24 and 03/01/24 due to no coverage. There was no documentation the physician had been notified. Per interview on 06/25/24 at 9:44 AM the Director of Nursing (DON) confirmed there were no HHA time sheets available from admission 01/27/24 to discharge 03/15/24 and confirmed there were no HHA services provided. The DON confirmed there was no documentation that the physician had been notified of the missed visits from admission 01/27/24 to discharge 03/15/24. 2. Review of the medical record for Patient #2 a revealed start of care 11/28/23. Diagnoses included diabetes, impulse disorder, drug-induced obesity and muscle weakness. The physician’s plan of care, dated 01/29/24, ordered the HHA to provide 28 hours per week, four hours per day, seven days per week for assistance with activities of daily living. Review of the medical record for Patient #2 revealed no HHA time sheets from 03/09/24 to 03/17/24. During an interview on 06/26/24 at 9:24 AM, Staff B confirmed there were no HHA time sheets or service provided from 03/09/24 to 03/17/24 and confirmed the physician had not been notified of the missed visits. 3. Review of the medical record for Patient #3 a revealed a start of care 07/17/24. Diagnoses included chronic respiratory failure, diabetes and high blood pressure. The physician plans of care dated 02/27/24 to 04/26/24 and 04/27/24 to 06/25/24 ordered the HHA to provide services of 42 hours per week; six hours per day, seven days per week to assist with activities of daily living. Review of the medical record for Patient #3 and the HHA, Staff F, time sheets from 03/24/24 to 05/19/24 revealed the HHA worked less than the ordered 42 hours. The week of 03/24/24 the HHA only worked 30 hours; the week of 03/31/24, 36 hours; the week of 04/07/24, 35.75 hours; the week of 04/14/24, 25 hours; the week of 04/21/24, 27 hours; the week of 04/28/24, 21 hours; the week of 05/05/24, 34.75 hours; the week of 05/12/24, 17.75 hours; and the week of 05/19/24, 12.50 hours. There was no documentation the physician had been notified of the missed visits. During an interview on 06/26/24 at 4:38 PM, the DON confirmed the HHA did not work the ordered 42 hours per week and the physician had not been notified of the missed visits. Review of the agency policy titled “Coordination of Patient Care Missed Visit Protocol” revised 02/2021, revealed notifying the physician and making sure that he/she is aware of missed visits and must document. Review of the agency policy titled “Management of Missed Visits/Services Not Provided as Ordered” with no effective date, revealed the agency office staff will notify the physician of all missed visits or deficiencies in service hours provided that do not coincide with the services indicated on the 485/Plan of care orders. This notification may be sent as soon as possible but no later the Monday of the following week. Documentation of MD notification, and if applicable the Case Manager, must be placed in the patient chart and may be in the form of a doctor order, missed visit form with fax confirmation, or a communication note.”

“Before discharge for cause HHA must: CFR(s): 484.50(d)(5) The HHA determines, under a policy set by the HHA for the purpose of addressing discharge for cause that meets the requirements of paragraphs (d)(5)(i) through (d)(5)(iii) of this section, that the patient’s (or other persons in the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the HHA to operate effectively is seriously impaired. The HHA must do the following before it discharges a patient for cause: This Element is not met as evidenced by: Based on record review, interview and policy review, the agency failed to ensure a safe transfer and/or discharge. This affected two (Patients #1 and #2) of two patients reviewed for discharge. The census was 138. Findings include: 1. Review of the medical record for Patient #1 revealed a start of care date of 01/27/24. Diagnoses included chronic obstructive pulmonary disease, high blood pressure and right above the knee amputation. The physician’s plan of care, dated 01/27/24, ordered the home health aide (HHA) to provide care 14 hours per week to assist with activities of daily living Review of the medical record for Patient #1 revealed no home health aide time sheets. A 30-day notice was sent 02/20/24 with services ending on 03/21/24. The 30-day notice was issued due to the agency not being able to provide the services needed. Included was a list of current medications and local agencies in Patient #1’s area. There was no documentation this notice was sent via certified mail. Review of an email from Patient #1’s case manager, dated 02/27/24, revealed Patient #1 had notified the case manager of the discharge notice, which the case manager was not aware of. Patient #1’s discharge summary, dated 03/07/24, stated the discharge was due to unable to provide adequate staffing and contained a signed physician’s order dated 03/07/24 to discharge from services. During an interview on 06/25/24 at 9:58 AM, the Director of Nursing (DON) said the discharge notice was sent via regular mail. . During an interview on 06/25/24 at 12:45 PM, the DON did not know why the registered nurse discharged Patient #1 on 03/07/24 when the date to end services was not until 03/21/24. The DON confirmed the agency’s policy for discharge was not followed. During an interview on 06/26/24 at 1:04 PM the Chief Executive Officer (CEO) confirmed Patient #1 was “just dropped” and there was no documentation of why Patient #1 did not receive HHA services from admission 01/27/24 to discharge 03/07/24. The CEO confirmed Patient #1 did not receive the full 30-day notice and the agency did nothing to ensure a safe transfer to another agency. 2. Review of the medical record for Patient #2 revealed a 30-day discharge notice was issued on 03/18/24 with the last day of service to be 04/17/24. The reason for the discharge notice was staff were not available. Included with the discharge notice was a list of current medications and local agencies in Patient #2’s area. These were all sent by certified mail. Review of a fax transmittal sheet for Patient #2 revealed the Office Manager (Staff D), at the drop site location, faxed a missed visit report for visits 03/18/24 through 03/22/24 to the Nurse Practitioner and indicated the HHA no longer wished to work with Patient #2. A 30-day discharge notice was provided for cause. A physician’s order was dated 03/18/24 to notify the physician of the 30-day notice to Patient #2 for inappropriate behavior, staff quit, and no staff was available. A second physician’s order dated 04/17/24 to discharge Patient #2 after the 30-day notice. The discharge summary dated 04/17/24 documented goals were met and Patient #2 had reached their maximum potential. During an interview on 06/26/24 at 4:39 PM, the DON confirmed there was no documentation that described any efforts made to resolve the inappropriate behavior that caused the staff to not want to work with Patient #2. Review of the agency procedure titled “30 Day Notice for Consideration of Discharge for Cause” and Procedure Documentation revealed documentation should indicate reason for consideration of discharge for cause. The patient/POA, physician and case manager should be notified that a discharge for cause is being considered and a 30-day notice is being issued with documentation of the date, time and method. Documentation should describe the efforts made to resolve the problem leading to discharge for cause and entered in the patient’s medical record. Documentation should show the date the 30-day letter was sent, and the date services will end. A copy of the 30-day notice form letter, Certified mail receipt, list of local agencies and medication profile provided to the patient should be in the patient’s medical record. Review of the agency policy titled “Discharge Criteria and Planning” revised 02/2024 revealed the agency will arrange a safe and appropriate discharge to other care entities when the needs of the patient exceed the agency’s capabilities.”

“Direct support and administrative control CFR(s): 484.105(d)(2) The parent HHA provides direct support and administrative control of its branches. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure open communication and oversight of the branch location. This could potentially affect all patients and staff. The census was 138. Findings include: Review of time sheets for the home health aide (HHA), Staff F, revealed on 04/09/24 Staff F clocked in to take care of Patient #3 at 8:22 AM and clocked out at 2:23 PM. Review of the personnel file for Staff F revealed a written warning for clocking in on company time and being on the other side of Patient #3’s home, sleeping. The corrective action indicated Staff F would not be paid for the time they were sleeping on the clock. Pop-up visits will be made to ensure Staff F is present. During an interview on 06/26/24 at 2:10 PM Staff F confirmed she was sleeping on 04/09/24 while being clocked in on company time. During an interview on 06/27/24 at 1:48 PM, the Office Manager (Staff B) at the parent location confirmed Staff F was paid for working six hours on 04/09/24. Staff B stated the office manager at the Mansfield branch, Staff I, signed the written warning and was responsible for Staff F getting paid for 04/09/24. Staff B stated she didn’t know about the written warning and didn’t know not to pay Staff F for 04/09/24. Staff B confirmed there was a lack of communication between the branch and the parent locations. During an interview on 06/27/24 at 2:45 PM, the Director of Nursing (DON) stated they are not always aware of corrective actions taken at the branches. Review of the agency policy titled “Organization and Services Administration” revised 02/2024 revealed the Agency will continually monitor and manage all services provided at all its locations to ensure that services are delivered in a safe and effective manner and to ensure that each patient receives the necessary care and services outlined in the plan of care.”