1 Amazing Home Health Care LLC

“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 record review, interview and policy review, the agency failed to ensure services were provided as ordered and failed to ensure the physician was notified of missed visits. This affected two (Patients #1 and #2) of five patients reviewed. This could affect all patients receiving services from the agency. The active census was 92. See G572 and G576.”

“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 services were provided as ordered and failed to ensure the physician was notified of missed visits. This affected two (Patients #1 and #2) of five patients reviewed. This could affect all patients receiving services from the agency. The active census was 92. Findings include: Record review revealed Patient #1’s start of care was 11/30/23. Diagnoses included hereditary hemorrhagic telangiectasia and hypertension. Review of the physician ordered plan of care for the certification periods dated 11/29/23 to 01/27/24 and 01/16/24 to 01/15/24 revealed orders for home health aide services four hours a day seven days a week, 28 hours a week for 60 days to assist with personal care, daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, light housekeeping, make bed, change linens weekly and when soiled. No skilled nurse needs were identified at this time. A start of care assessment was conducted 11/29/24. There was no evidence home health aide (HHA) services were provided until 12/04/23. There were missed visits on 12/10/23, 12/12/23 and 12/16/23. The facility provided a time sheet dated 12/11/23. There were no additional timesheets provided. There was no evidence the physician was notified of the missed visits. Patient #1 was discharged on 12/30/23 and readmitted on 01/16/24. Review of the timesheet for the week of 01/16/24 revealed there were missed visits on 01/17/24 and 01/20/24; review of the timesheet for the week of 01/21/24 revealed there were missed visits 01/21/23, 01/26/24 and 01/27/24; review of the timesheet for the week of 01/28/24 revealed there were missed visits 01/28/24, 01/29/24 and 02/03/24; and review of the time sheets for the week of 02/11/24 revealed there were missed visits 02/11/24 and 02/16/24. The facility provided no timesheets for the week of 02/04/24. There was no evidence the physician was notified of the missed visits. Patient #1 asked to be discharged 02/16/24. Review of the timesheets used to document hours and care included there was a check mark system to mark what services were provided each day. Services ordered included four hours a day seven days a week, 28 hours a week for 60 days to assist with personal care, daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, light housekeeping, make bed, change linens weekly and when soiled. Staff D, Staff F and Staff G all provided care for Patient #1. Two showers and one laundry day were documented while he was a patient of the facility. Daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, make bed, and change linens weekly and when soiled were not check marked as being provided. During an interview 07/16/24 at 4:32 P.M., Staff A verified Patient #1 did not receive services as outlined in the plan of care. Patient #1’s physician was not notified of missed visits. During an interview on 07/16/24 at 6:14 P.M., Staff H verified the facility failed to provide the services Patient #1 required. Staff H verified staff missed noticing the care was not being provided and the hours not provided when they collected time sheets and billed. 2. Record review revealed Patient #2’s start of care was 03/08/24. Diagnoses included chronic obstructive pulmonary disease, nicotine dependence, anxiety disorder, major depressive disorder, muscle weakness, malignant neoplasm of breast, opioid abuse, and chronic kidney disease. Review of Patient #2’s plan of care for the certification period dated 03/08/24 to 05/0624 ordered HHA services nine hours a week for 60 days. Patient #2 needed assist with dressing daily, weekly nail care, shampoo hair weekly, skin care daily, and shower three times a week. Review of aide time sheets starting 03/25/24 to 04/23/24 revealed there was no personal care provided as per plan of care; assisting with dressing daily, weekly nail care, shampoo hair weekly, skin care daily, and shower three times a week. None of the areas were check marked as completed. During an interview 07/16/24 at 6:24 P.M., Staff H verified the time sheets with associated documentation of care provided did not indicate the personal care was provided as care planned. Review of the policy titled “Management of Missed visits and Services Not Provided as Ordered”, undated, included the agency staff will notify the physician of any and 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 includes all nursing and aid services. The notification must be in writing must be sent as soon as possible. Documentation of physician must via fax with fax confirmation. Documentation of all visits be uploaded to the date , using the detail button next to the visit office staff is responsible for verifying that the previous weeks home health aide, timesheets, and nursing notes for the services that have been ordered by patient. Any 15 minute increments of a nursing shift missed is indicated to send a missed visit and a nursing visit that is awful filled during the week. It is indicated send a missed visit , the insurance chart check timesheets with each recertification that is completed to ensure the care provider flex what is ordered.”

“Advise the patient of discharge for cause CFR(s): 484.50(d)(5)(i) (i) Advise the patient, representative (if any), the physician(s) or allowed practitioner(s), issuing orders for the home health 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) that a discharge for cause is being considered; This Element is not met as evidenced by: Based on record review, interview and policy review, the facility failed to notify a patient that a discharge for cause was being considered and failed to notify the patient when the discharge became imminent. This affected one (Patient #1) of five patients reviewed. The active census was 92. Findings include: Record review revealed Patient #1’s start of care date was 11/30/23. Diagnoses included hereditary hemorrhagic telangiectasia and hypertension. Review of the physician ordered plan of care for the certification periods dated 11/29/23 to 01/27/24 and 01/16/24 to 01/15/24 revealed orders for home health aide services four hours a day seven days a week, 28 hours a week for 60 days to assist with personal care, daily dressing, weekly nail care, shampoo hair once a week, daily skin care, showers three times a week, light housekeeping, make bed, change linens weekly and when soiled. No skilled nurse services were ordered. The facility provided a discharge from services 12/30/23 for not having a face to face meeting with the physician within 90 days of admission or 30 days after admission. The facility was unable to produce any evidence related to the face to face meeting with the physician being required until 01/03/24, four days after he was discharged. The facility was unable to produce any evidence of the patient or caregiver being informed of an impending discharge and evidence of the discharge being carried out until four days after they discharged Patient #1. Staff B provided a communication note of the patient and caregiver being informed of the discharge and need for a face to face visit with the physician on 01/03/24 four days after discharge. During an interview on 07/16/24 at 4:32 P.M., Staff A verified Patient #1 was discharged from service 12/30/23 for not having a face to face visit with the physician per regulation. Staff A wrote the discharge without a home visit. Staff A check marked on the discharge the patient was discharged for noncompliance. The discharge was checked goals were met. Staff A checked marked discharge instructions, medically necessary appropriate follow-up advised, understanding of need for medical follow up verbalized, medications reviewed at discharge visit, able to comprehend discharge instructions, instructed to call agency of choice for future home care needs, informed of discharge prior to discharge date per agency policy and timeline were all checked yes, provided to the patient. Staff A verified she did not speak with the patient or caregiver related to the impending discharge and discharge. She thought Staff B informed Patient #1. Staff A revealed she did not provide discharge instructions to Patient #1 verbally or in writing. Review of the policy titled “Discharge Criteria, and Planning”, revised February 2024, included the patient is informed a discharge plan in a timely manner and acknowledges understanding reason. The evaluation of a patient’s discharge needs, and discharge plan must be documented in a timely manner. The evaluation must be included in the medical record and discussed with the patient or patient representative. All relative information from the agency will be incorporated into the discharge plan to avoid delays. The patient will receive verbal and written discharge instructions.”

“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 interview, the facility failed to ensure physician orders were recorded in the medical record. This affected one (Patient #3) of five records reviewed. The current active census was 92. Findings include: Record review revealed Patient #3’s start of care date was 01/25/24. Diagnoses include lymph-edema, ventricular premature depolarization, cardiomyopathy, severe persistent asthma, osteoarthritis and presence of an artificial knee. The patient was oriented to person, place and time. Review the plan of care for the certification period dated 05/24/24 to 07/22/24 revealed home health aide services of 28 hours a week for 60 days. Review of the physician orders revealed home health aide services four hours daily, seven days a week for 60 days. Review of the time sheets from 05/19/24 to 07/06/24 revealed the patient was receiving home health aide services three days a week for 9 hours. During an interview on 07/17/24 at 8:42 P.M., Patient #3 stated she agreed to home health aide services three days a week since she was getting better. She had bilateral knee replacements that were healing. However, she did say that she had an aide who wanted her to sign the time sheet when she hadn’t done the time and they were never able to provide her the services seven days a week. Review of an email 07/17/24 at 6:43 P.M. from Staff B verified the patient was not receiving the hours reflected on her plan of care because the order was not written for the change to three days a week for nine hours.”