Cambridge Caretenders

“Standard: Initial assessment visit. CFR(s): 484.55(a) Standard: Initial assessment visit. This Standard is not met as evidenced by: Based on record review, emails and interview, the facility failed to complete a start of care assessment for skilled nursing. This affected one (Patient #122) of three patients reviewed. The current active patient census was 121. Review of Patient #122 revealed a start of care assessment 07/25/23. Diagnosis included stage four adenocarcinoma, vertigo, chronic nausea, current use of immunotherapy, current use of tobacco products, history of illicit drug use, depression, generalized weakness, shortness of breath, and anxiety. The patient was independent for self medication administration. The home health aide was to assist with nail care, hair, hairdressing, bathing, toileting, ambulation, transfers, meal preparation, light housekeeping, picking up clutter, taking out trash, setting up transportation, laundry, shopping, errands, and chores. Review of emails between Staff C and the patients case manager (CM) included in a 08/07/23 email the CM asked if the facility would be able to provide nursing services one hour per week when Patient #122 returns from inpatient services. On 08/08/23 Staff C responded the facility would be able to provide nursing services. Upon release from the hospital the facility completed a resumption of care (ROC) 08/29/23 for home health aide services. The facility did not complete a start of care (SOC) for the addition of skilled nursing services and did not provide services until October 2023. Interview 03/13/24 at 3:42 P.M. with Staff C verified the facility agreed to provide nursing services and did not. The facility completed a ROC instead of a SOC to add skilled nursing. Staff C included prior to the inpatient stay a different agency was providing the skilled nursing and they were to only provide the aide. This deficiency represents non-compliance investigated under Substantial Allegation 104321.”

“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 Patient #105 received home health services as written in the individualized plan of care. This affected one patient (Patient #105) of three patients reviewed for home health services. Review of Patient #105 revealed a 07/26/23 SOC with diagnoses including type 2 diabetes mellitis without complications. chronic respiratory failure, Post Traumatic Stress Disorder and congestive heart failure. Review of the physician ordered plan of care for the certification period 01/24/24 to 03/21/24 revealed orders for home health aide services five days weekly included the home health aide was to assist with personal care, light housekeeping, companionship, safety monitoring and education. Review of the nurse aide visits revealed missed visits 01/24/24, 01/25/24, 01/26/24, 01/30/24, 01/31/24, 02/05/24, 02/06/24, 02/13/24, 02/21/24, 02/26/24, 02/27/24 and 03/12/24. There was no evidence of physician notification. Interview 03/13/24 at 4:34 P.M. with Staff C verified the missed nurse aide visits and verified the facility did not notify the physician of missed aide services. This deficiency represents non-compliance investigated under Substantial Allegation 104321.”

“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 record review, policy review and staff interview, the facility failed to ensure a home health aide (HHA) only provided services ordered by the physician included in the plan of care and consistent with the home health aide training for one of three patients reviewed (Patient #223). This could affect all patients receiving services from this agency. The census was 222 patients. Findings include: Review of Patient #223’s physician ordered plan of care for the certification period starting 09/04/23 revealed a 07/11/22 start of care date. Diagnoses included type one diabetes with neuropathy, functional quadriplegia, major depressive disorder, and iron deficiency anemia. Equipment included safety bars, transfer belt, sliding board, infusion pump, glucometer, safety measures, including fall safety measures. Functional limitations, including an amputation, paralysis, ambulation, bowel and bladder, and endurance. He was allowed to do prescribed exercises, transfer from bed, chair and wheelchair. He was oriented, but forgetful and had some neurological impairment, but was cooperative. The home health aide was to go in 50 hours weekly, 10 hours five days a week and was to assist with activities of daily living, light housekeeping, meal prep, feeding, laundry, errands, bathing, and companionship. There was no mention of transporting the patient to appointments as part of the plan of care. There was no order for the home health aide (HHA) to transport the patient to appointments. Review of the complaint log for 2023 revealed the agency received a request from an oversight agency on 10/04/23 regarding Patient #223. The record request indicated on 09/19/23 Patient #223 was provided services by Staff D. The aide was driving recklessly and the individual was very scared they were going to wreck. The patient’s mother was driving behind the van the aide was driving. The patient reported the aide was driving around turns in the country at 55-60 miles per hour and pulled out into two lanes of traffic almost causing an accident, however oncoming traffic stopped, or they would have been hit. The complaint investigation completed by the agency included interview of Staff D stated she was playing her guitar, and she and the patient were singing and having a good time. His mother came and said it was time to go to the doctor. It seemed normal that she should drive them. She did not understand why the mother followed them in her car. The aide said she was not used to the larger vehicle and did not think she was driving erratically. Further review of the investigation revealed on 09/19/23 Staff D was given education by Staff A that it is the agency policy home health aides do not drive any patients. The agency does not offer transportation. This includes neither in the client nor aide vehicle. Interview with Staff A 11/21/23 at 3:17 P.M. revealed the patient’s mother called 09/19/23 about the aide driving recklessly. When Staff A called Staff D she revealed the aide thought it was expected of her to drive the patient to appointments. She said she never drove a handicap van. The patient felt she was reckless and did not want her to return. She did not work with Patient #223 after the first day. Review Staff D’s personnel file revealed a hire date 09/08/23. This was Staff D’s first time to work for a home health agency. A 10/27/23 drug test was negative. There was no evidence of Staff D being educated that staff were not to drive patients’ vehicles or drive patients to appointments. The incident occurred on Staff D’s first day of work. Interview with Staff B 11/21/23 at 3:30 P.M. revealed when a new employee was hired, they had on boarding online and in-person orientation. Staff D had in-person orientation on 09/08/23. She signed that she received the employee handbook which included automobile safety. The employee handbook was to be read on their own time. Staff B acknowledged there was no evidence of staff being taught in orientation they were not to transport patients to appointments. Review of the Automobile Safety section of the employee handbook did not prohibit staff from transporting patients. It discusses operating “their” vehicles during work activities. Unless otherwise approved or required by your division, employees are prohibited from non-employee passengers in their vehicle during working hours. The policy did not address employees driving patients in their patients own vehicles. Review of the agency’s policy titled, Patients in Vehicles, revised 04/01/20, included all requests for transportation must be accurately documented in the patient’s service plan. Interview 11/21/23 at 4:18 P.M. with Staff B verified Patient #223’s plan of care did not include transporting the patient to appointments. Staff B further verified there was no evidence in orientation of staff education related to the transportation of patients. This deficiency represents non-compliance investigated under Substantial Allegation 101484.”