Renaissance Home Health Care

“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, policy review, and staff interview, the agency failed to ensure all patients had a physician’s plan of care. (G572) The agency failed to ensure there were signed physician orders for all services provided. (G580) The agency failed to ensure the physician signed the plan of care orders within the 60 days certification period. (G588)”

“Home health aide services CFR(s): 484.80 Condition of participation: Home health aide services. All home health aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section. This Condition is not met as evidenced by: Based on policy and record review, the agency failed to ensure the home health aide (HHA) plan of care was updated every 60 days. (G798) The agency failed to ensure the home health aides (HHA) followed the HHA Plan of Care. (800) The agency failed to ensure the registered nurse did a home visit to supervise the home health aide every 60 days. (814)”

“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, policy review, and staff interview, the agency failed to ensure all patients had a physician’s plan of care. This affected two (#3 and #4) out of five patients reviewed. The census was 145. 1. Review of the medical record for Patient #3 revealed a start of care date of 03/08/2022. The medical record did not reveal a physician’s plan of care. Interview on 01/08/25 at 11:32 AM the Office Manager stated Patient #3 does not have a physician’s plan of care or physician’s orders for the home health aide (HHA) to provide care. The Office Manager stated the HHA provides care 15 hours per week Patient #3. Interview on 01/09/25 at 10:09 AM, Staff G confirmed the physician’s plan of care was not updated since 03/08/22. 2. Review of the medical record for Patient #4 revealed no physician’s plan of care after 04/15/24. Review of the home health aide (HHA) time sheets revealed the HHA provided service to Patient #4 from 04/16/24 through 05/02/24. Review of the agency policy titled “Plan of Care – CMS #485 and Physician’s Orders,” revised 05/2024, revealed each patient must receive an individualized written plan or care. 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 disciplines and the measurable outcomes that the Agency anticipates wi1l 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. Recertification of the Plan of Care is required at least every 60 days when there is a need for continuous home health care after an initial 60-day episode. Interview on 01/13/25 at 10:20 AM, Staff D confirmed this finding.”

“Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This Standard is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure the home health aide (HHA) plan of care was updated every 60 days. This affected three (#3, #4, and #5) out of three patients reviewed. The census was 145. 1. Review of the medical record for Patient #3 revealed the only home health aide (HHA) Care Plan was dated 03/08/22. Interview on 01/09/25 at 10:09 AM, Staff C confirmed the HHA care plan for Patient #3 was not updated since admission on 03/08/22. 2. Review of the medical record for Patient #4 revealed the last updated HHA Care Plan was dated 02/16/24. 3. Review of the medical record for Patient #5 revealed the last updated HHA Care Plan was 10/05/23. Interview on 01/09/25 at 1:54 PM Staff C confirmed these findings.”

“A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This Element is not met as evidenced by: Based on record review, staff interview, and policy review, the agency failed to ensure every patient had an updated medication profile. This affected three (Patients #3, #4 and #6) out of five patients reviewed. The census was 145. 1. Review of the medical record for Patient #3 revealed start of care was 03/08/22. Patient #3 did not have a medication profile. Interview on 01/09/25 at 10:33 AM Staff G confirmed there was no medication profile in the medical record. On 01/09/25 at 10:48 AM Staff G provided a medication list dated 07/19/24 and stated it was the last updated medication list from the physician’s office, from six months ago. Staff G stated the registered nurse (RN) did not go out to Patient #3’s home. 2. Review of the medical record for Patient #4 revealed a start of care date 02/16/24. The last medication profile was dated 02/16/24. 3. Review of the medical record for Patient #6 revealed a start of care 10/17/24. There was no medication profile. Review of the policy titled “Medication Profile,” revised 05/2024, revealed the comprehensive assessment (OASIS) performed at time of admission includes a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicative drug therapy and noncompliance with drug therapy. The medication profile will be reviewed every home visit and updated as changes occur. Interview on 01/09/25 at 12:41 PM Staff C confirmed this finding.”

“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 record review, policy review, timecard review, and staff interview, the agency failed to ensure there were signed physicians’ orders for all services provided. This affected three (#3, #4 and #5) out of three patients reviewed. The census was 145. 1. Review of the medical record for Patient #3 revealed a start of care date of 03/08/2022. The medical record did not reveal signed physician’s orders for the home health aide (HHA). Review of the HHA time sheets from 11/25/24 to 12/22/24 revealed the HHA worked three hours a day for 15 hours per week. 2. Review of the medical record for Patient #4 and physician’s plan of care dated 02/16/24 to 04/15/24 did not reveal signed physician’s orders for the HHA. Review of the HHA time sheets from 02/19/24 to 04/18/24 revealed the HHA worked 28 hours per week 3. Review of the medical record for Patient #5 and physician’s plan of care dated 09/29/24 to 11/27/24 did not reveal signed physician’s orders for the HHA. Review of the HHA time sheets from 09/30/24 to 11/27/24 revealed the HHA worked 14 hours per week. Review of the agency policy titled “Plan of Care – CMS #485 and Physician’s Orders,” revised 05/2024, revealed all clinical services are implemented only in accordance with a Plan of Care established by a physician’s written order. Interview on 01/09/25 at 10:09 AM, Staff G confirmed there were no signed physician’s orders for the HHA visits made.”

“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 policy review, record review, and staff interview, the agency failed to ensure the physician signed the plan of care orders within the 60 days certification period. This affected three (#4, #5 and #6) out of three patient records reviewed. The census was 145. 1. Review of the medical record for Patient #4 and physician’s plan of care dated 02/16/24 to 04/15/24 revealed no physician signature. Interview on 01/13/25 at 12:04 PM, Staff C confirmed this was the last physician’s plan of care done. Staff C stated the registered nurse left. 2. Review of the medical record for Patient #5 and physician’s plan of care dated 09/29/24 to 11/27/24 revealed no physician’s signature. 3. Review of the medical record for Patient #6 and physician’s plan of care dated 10/17/24 to 12/15/24 revealed no physician’s signature. Review of the agency policy titled “Plan of Care – CMS #485 and Physician’s Orders,” revised 05/2024, revealed the total Plan of Care will be reviewed and signed by the attending physician at least once every 60 days. Interview on 01/09/25 at 12:48 PM Staff C confirmed these findings.”

“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, time sheet review, and staff interview, the agency failed to ensure the home health aides (HHA) followed the HHA Plan of Care. This affected two (#6 and #7) out of two patients reviewed. The census was 145. 1. Review of the medical record for Patient #6 and the HHA Care Plan dated 12/16/24, revealed the HHA was to provide a bath, shampoo, perineal care, skin, hair and foot care and oral hygiene at every visit. Review of the HHA time sheets from 10/21/24 to 11/22/24 revealed Patient #6 did not receive a bath, shampoo, perineal care, skin, hair and foot care or oral hygiene at every visit. 2. Review of the medical record for Patient #7 and the HHA Care Plan last HHA Care Plan dated 10/19/23, revealed the HHA was to provide a bath, shampoo, skin care, hair care and oral hygiene at every visit. Review of the HHA time sheets from 09/30/24 to 11/22/24 revealed Patient #7 did not receive a bath, shampoo, skin, hair care or oral hygiene at every visit. Interview on 01/09/25 at 12:541 PM with Staff C confirmed these findings.”

“Non-skilled direct observation every 60 days CFR(s): 484.80(h)(2) If home health aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, — (A) The registered nurse must make an onsite, in person visit every 60 days to assess the quality of care and services provided by the home health aide and to ensure that services meet the patient’s needs; and (B) The home health aide does not need to be present during this visit. (ii) Semi-annually the registered nurse must make an on-site visit to the location where each patient is receiving care in order to observe and assess each home health aide while he or she is performing non-skilled care This Element is not met as evidenced by: Based on policy review, record review, time sheet review, and staff interview, the agency failed to ensure the registered nurse (RN) did a home visit to supervise the home health aide (HHA) every 60 days. This affected two (#3 and #4) out of three patients reviewed. The census was 145. 1. Review of the medical record for Patient #3 revealed the last RN visit and last supervisory visit of the HHA was 07/05/23. Interview on 01/09/25 at 10:49 AM, Staff G confirmed the last RN visit was 07/05/23 and confirmed the RN had not visited Patient #3 for one year and six months. Staff G stated the insurance company stopped payment on the RN visits. 2. Review of the medical record for Patient #4 revealed no supervisory visit was made after admission 02/16/24. Review of the HHA time sheets for Patient #4, from 02/19/24 through 05/02/24, revealed the HHA provided assistance with personal care. Review of the agency’s policy titled “Home Health Aide Supervision,” revised 05/2024, revealed if Home Health Aide services are provided to a patient who is not receiving skilled nursing care, physical or occupational therapy, or speech-language pathology services, the registered nurse will make an on-site visit to the location where the patient is receiving care, no less frequently than every 60 day in order to assess the quality of care and services provided by the home health aide and to ensure the services meet the patient’s needs. Interview on 01/13/25 at 11:16 AM, Staff G confirmed the supervisory visits for the patients with HHA service only were not done every 60 days. v”