Professional Home Health Care 2, Inc.

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Based on medical record review, document review, and interview, the agency staff failed to coordinate care delivery to meet the patient’s needs (G608). The agency failed to ensure services are administered only as ordered by a physician or allowed practitioner (G580). The agency failed to ensure the individualized plan of care must be reviewed and revised by the physician or allowed practitioner as frequently as the patient’s condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date (G588). The cumulative effect of these systemic practices resulted in the agency’s inability to ensure that the patient’s needs would be met.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure services are administered only as ordered by a physician or allowed practitioner for one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The census was 84. Findings include: On 12/27/23 at 9:15 A.M. review of Patient #1’s medical record revealed a start of care of 04/19/20. The last physician ordered plan of care in the patient’s record was for the certification period dated 04/04/23 to 06/02/23. Orders for that certification period included home health aide (HHA) services for 14 hours every week plus 36 hours for waiver care. The plan of care for this certification period was signed by the physician on 10/17/23. Review of timesheets from this certification period revealed the HHA provided the services. Further review of the patient’s record revealed the HHA, the patient’s son, submitted timesheets for services provided between 05/28/23 and 07/08/23. These time sheets included the patient’s signature. An interview with Staff A during the medical record review confirmed the findings. Review of a hospital medical record for Patient #1 revealed the patient was admitted to the hospital on 05/15/23 and discharged from the hospital to her daughter’s home on 05/17/23.”

“Reviewed, revised by physician every 60 days CFR(s): 484.60(c)(1) The individualized plan of care must be reviewed and revised by the physician or allowed practitioner who is responsible for the home health plan of care and the HHA as frequently as the patient’s condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date. This Element is not met as evidenced by: Based on medical record review and staff interview, the agency failed to ensure the individualized plan of care must be reviewed and revised by the physician or allowed practitioner as frequently as the patient’s condition or needs require, but no less frequently than once every 60 days, beginning with the start of care date for one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The census was 84. Findings include: On 12/27/23 at 9:15 A.M. review of Patient #1’s medical record revealed a start of care of 04/19/20. The physician ordered plan of care for certification period dated 04/04/23 to 06/02/23 was signed by a physician on 10/17/23. The physician ordered plan of care for the certification period dated 04/04/23 to 06/02/23 was not reviewed or revised within 60 days. An interview with Staff A during the medical record review confirmed the findings.”

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on medical record review, document review, and interview, the agency staff failed to coordinate care delivery to meet the patient’s needs for one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The census was 84. Findings include: On 12/27/23 at 9:15 A.M. review of Patient #1’s medical record revealed a start of care date of 04/19/20 and the last physician ordered plan of care was signed by a physician on 10/17/23 for certification period dated 04/04/23 to 06/02/23. Orders included home health aide (HHA) services for 14 hours every week plus 36 hours for waiver care. Skilled nursing was ordered only for recertification every 60 days. Further review of the HHA’s time sheets revealed care was documented as being provided as ordered, but further review revealed the care was documented as being provided until 07/08/23 even though the last plan of care ended on 06/02/23. An interview with Staff A during the medical record review confirmed the findings and he reported the agency was trying to contact the patient and the HHA, who was the patient’s son. The physician was notified concerning the situation, but the agency staff did not know what was going on, and they did not know what to do when they could not reach the patient or the HHA so they contacted the case manager (CM) multiple times and emailed the CM multiple times including an email sent on 07/11/23 to report that the HHA turned in his last time sheet in person, and reported the patient was currently visiting family in Washington D.C. He stated the patient left on 07/09/23 and she was scheduled to return in seven days. Further interview revealed the agency attempted to contact the patient multiple times to confirm the situation, but the patient did not answer. Further interview during the medical record review revealed the only reason the staff had the time sheets listing the care provided was because the HHA dropped the time sheets into a drop box. The staff was not able to speak to the HHA or the patient until the HHA physically reported to the agency on 07/11/23. Care was placed on hold after the CM was notified. The CM informed the agency they would be notified when to resume services when the patient returned. On 12/27/23 at 1:20 P.M. a review of the agency incident report log revealed an incident dated 08/23/23 that involved Patient #1 and reported that a third party oversight agency called and shared complaint information (including potential misappropriation). The third party oversight agency notified the home health agency that Patient #1 was sent to the emergency department (ED) on 05/15/23. An interview with Staff A at this time revealed the HHA did not report the patient went to the ED, and there would be no other way to know that the patient went to the ED because no other care was provided by the agency. Further review revealed a wellness check was conducted by the police department after the agency’s nurse notified the CM because she could not reach the patient to schedule the 60-day recertification visit. An interview with Staff A revealed an investigation was initiated, but neither the patient nor the HHA would answer the phone on 08/23/23, and the patient was no longer a patient and the HHA no longer worked for the agency. On 12/27/23 at 2:37 P.M. an interview with Staff A revealed the recertification visit was due June 3rd so the nurse called ahead to schedule the visit on 05/15/23. The nurse was not able to contact the patient or the HHA and was concerned about the situation and called the CM. The patient’s care was not placed on “hold” until 07/08/23 because the HHA arrived at the office on 07/11/23 and reported his last day working was July 8th. Staff A revealed there had been a pattern of the patient not responding in the past to the agency, but the patient had responded to the CM staff more consistently. Further interview revealed Staff E had a professional relationship with the CM and Staff E has had the CM reach out to the patient to coordinate communication to assist with efficiency in the past. Further interview with Staff A revealed the care was provided between 06/03/23 and 07/08/23 without orders because the recertification visit could not be completed. Further interview revealed that if the nurse felt there was any imminent danger suspected the nurse would have called the police and then contacted the CM, but Staff A did not feel the nurse believed the patient was in imminent danger. On 12/28/23 at 8:10 A.M. a review of the Trotwood Police Department report (Case #TR230003498-001) revealed the police responded for reports of an elderly female being locked inside a residence for a welfare check regarding the patient (who is blind) and lives at the residence alone. The officer noticed the grass was not cut, and mail was “piling” in the mailbox. The officer was able to reach one daughter of the patient who reported she was concerned about the patient, and she gave the officer contact information for another daughter that lived in the area. The officer contacted the daughter that lived in the area, and she responded to the residence to make entry. The officer also contacted the sone (HHA) who reported he was at the laundromat and refused to cooperate with the well check and reported no one would be going into the house to see his mother because he/ is the only one that needed to see her. The son became extremely uncooperative and did not respond to the residence. After arriving the daughter that lived in the area realized the locks had been changed, and she could not enter the residence through the front door, but she was able to speak to the patient through the bedroom window and asked her to open the living room window. Once the daughter entered the residence the officer heard the daughter state that the officer would not be able to enter through the door because the son had placed an interior lock on the door so no one could enter but the son, and the back door was reported to be blocked by an appliance and other materials, but the daughter was able to move the items to create an entry for the officer. Upon entry the officer reported holes in the ceiling, rusty canned food that had been opened, the kitchen sink was barely attached to the counter and faucet, and frozen food items were stored in the refrigerator. Further reports included when the officer walked up the stairs to meet the patient, the officer observed used adult diapers laying on the living room floor. The officer reported she also observed food/trash lying on the floor and sitting on the table, and the officer reported the patient appeared to be weak and lethargic. Further review revealed the officer asked the patient if she was feeling well, and she reported feeling very frustrated. She reported she had not been able to leave the residence and she wanted out of the house. She reported the son did not allow her to go to the hair salon, the son took her phone so she could not call anyone, the son refuses to take her to the bank, and the son has promised to give her a key to the front door so she could get out of the house, but he has yet to do so. The patient did report the son visited her that morning and he was going to go to the laundromat to wash her clothes. The officer asked when the patient ate last, but she could not recall. When the officer observed a Wendy’s bag on the floor the patient reported “that was from a couple days ago”, and she reported she had a pot pie a few days ago as well, and a chicken pot pie box/trash was sitting on the table. The patient reported she wanted to move into her own apartment. Due to the patient’s appearance and reports of no food, Emergency Medical Services was contacted, and the patient agreed to go to the hospital. Further review revealed that the officer observed the medications in the patient’s purse, and they were dated 2020. The patient was transported to a Dayton area hospital. The officer conducted a follow-up with the hospital staff to ensure social workers were involved, and the officer also attempted to contact Adult Protective Services (APS), but the APS case manager could not be contacted. On 12/28/23 at 12:33 P.M. an interview with Staff E revealed Patient #1 was not compliant with the plan of care and reported she was no longer comfortable providing services for the patient. She stated that after she contacted the CM on 05/15/23, Staff E reported she made no effort to make any other contact with patient after that date. She had no other information related to this situation. On 01/03/24 at 11:47 A.M. an interview with Staff A and a review of the emails between the agency and the CM staff revealed the agency staff reported to the CM staff that there were concerns related to the HHA refusing to let the nurse see the patient in January 2023. Further review of the patient’s medical record revealed the nurse saw the patient for recertification visits on 11/30/22, 01/29/23, and 03/30/23, but no recertification was completed for the certification period that would have started 06/03/23. Further interview with Staff A revealed the email communication was worded in a way that made it look like the HHA refused when he simply made it difficult for the nurse to schedule the recertification multiple times, and the nurse may have been a bit jaded. Further interview revealed Staff A felt this was where the agency “dropped the ball” when the nurse should have communicated that the recertification had not been completed, and care was continued because the nurse did not communicate the recertification was not done. Staff A stated they did not know about this situation until 08/23/23 when the third party oversight agency contacted the home health agency about their investigation. “Before this we did not know”. On 01/03/24 at 1:35 P.M. a review of the patient’s hospital medical record revealed she was admitted to the hospital on 05/15/23 and discharged from the hospital to her daughter’s home on 05/17/23. There was no documentation staff attempted to follow up with Patient #1, the HHA, or the CM between 05/28/23 and 07/11/23 when the HHA was submitting time sheets or after Staff E contacted the CM on 05/15/23. This deficiency represents non-compliance investigated under Substantial Allegation 102750.”