Right Care Home Healthcare, LLC

“Condition of Participation: Patient rights. CFR(s): 484.50 Condition of participation: Patient rights. The patient and representative (if any), have the right to be informed of the patient’s rights in a language and manner the individual understands. The HHA must protect and promote the exercise of these rights. This Condition is not met as evidenced by: Based on document review and staff interview, the agency failed to ensure staff immediately reported an incidence of alleged abuse to the home health agency. This affected one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The active census was 29. Findings include: See G488”

“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 medical record review and staff interview, the agency failed to ensure patients received the home health services as written in the plan of care. This affected three of three medical records reviewed (Patients #1, #2, and #3). The agency census was 29. Findings include: 1. Review of the medical record for Patient #1 revealed a plan of care dated 07/28/24 to 09/25/24 with orders for skilled nursing 12 hours per day, seven days per week. The medical record contained documentation of 48 hours of skilled nursing care the week of 08/04/24, with two eight hour shifts on two of the days. The medical record contained 32 hours of skilled nursing the weeks of 08/11/24 and 08/18/24, with four eight hour shifts. The medical record contained documentation of only eight hours of skilled nursing the week of 08/25/24, one eight hour shift. The most recent visit was made on 08/27/24. The medical record lacked documentation the physician was notified that care was not provided as ordered. On 09/05/24 at 10:55 AM, Staff A and B verified the above findings. 2. Review of the medical record for Patient #2 revealed a plan of care dated 08/14/24 to 10/12/24 with orders for skilled nursing 12 hour shifts twice a week. Review of the medical record revealed skilled nursing for only one 12 hour shift the week of 08/25/24, with the last visit on 08/25/24. The medical record lacked documentation the physician was notified that care was not provided as ordered. On 09/05/24 at 1:05 PM, Staff A verified the above findings. 3. Review of the medical record for Patient #3 revealed a plan of care dated 07/11/23 to 09/08/24 with orders for daily skilled nursing visits for 148 hours per week. The medical record also contained a recertification order for 07/11/24 to 09/08/24 dated 06/25/24 for 112 hours of private duty nursing per week. From 08/11/24 through 08/31/24, the medical record contained documentation of 104 to 112 hours per week of nursing. The medical record lacked documentation the physician was notified that care was not provided as ordered. On 09/05/24 at 1:05 PM, Staff A verified the above findings.”

“Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This Element is not met as evidenced by: Based on document review and staff interview, the agency failed to ensure staff immediately reported an incidence of alleged abuse to the home health agency. This affected one of three patients reviewed (Patient #1). This could affect all patients receiving services from the agency. The active census was 29. Findings include: Review of the “Identifying and Reporting Possible Victims of Alleged/Suspected Abuse, Neglect or Exploitation” policy , revised 2014, revealed staff will immediately report an assessment which might indicate exploitation, abuse or neglect to the Director of Clinical Services who will assign a supervisor to asses the patient. The Director will communicate assessment findings to the physician. All findings and communication will be documented in the patient’s medical record. Review of the “Incident Reporting” policy, revised 2009, revealed the agency will document and report all incidents that result in injury or potential harm including alleged/suspected abuse. The patient incident report will be submitted to the case manager and physician within 24 hours of the incident. On 09/04/24 at 1:38 PM, Staff A was interviewed. On 08/26/24, Staff B notified Staff A that there was an alleged report of sexual abuse against Staff D. Staff A called Patient #1’s mom and the staff assigned to Patient #1 for their statements. Staff D denied everything and stated that there was a camera in the room and to check the footage. Staff A then called the case manager to report the incident. All staff for Patient #1 were removed from all patient care pending investigation. Staff D was removed from all patient care on 08/26/24 and Staff E was removed from all patient care on 08/27/24. On 09/04/24 at 2:00 PM, Staff B was interviewed. Staff B stated that on Saturday, 08/24/24, she had met Staff E at another patient’s home for a joint visit. After the visit, Staff E told Staff B that Patient #1’s mom had reported alleged sexual abuse by Staff D towards Patient #1. Staff E stated that mom had shown her part of a video on Friday 08/23/24 and implied there was a sexual nature to it. Staff B asked her why she had not reported it sooner and Staff E claimed to not know what to do. Staff B asked if mom had reported it to anyone else and was told no. Staff E was seeking guidance on what to do. Staff B stated she would reach out to Staff E on Monday after discussing this with Staff A. Staff E did not have Staff D’s name and Staff B did not know who the nurse was at that time. Staff B instructed Staff E that there would be discipline forthcoming as she should have reported this right away. On 09/04/24 at 2:43 PM, Staff E was interviewed by phone. Staff E stated that late Thursday night, 08/22/24, Patient #1’s mom had called her upset and angry. Staff E was told that mom had seen a video of Staff D messing with Patient #1. Staff E tried to calm mom down and told her they would discuss it in the morning. The next morning, Patient #1’s mom showed Staff E a video. Staff E did not look at the entire video but Staff D appeared to be fondling Patient #1 in an inappropriate manner that was not right. It was a very busy day that day with Patient #1 and it slipped her mind. Staff E also knew she would be seeing Staff B the next day and could ask her what to do. Staff E stated that she had never had this happen before. On Monday, 08/26/24, Staff E wrote her statement and filed a police report as instructed. Patient #1’s mom told everyone who came into the home that there were cameras in the home that were recording. Patient #1’s mom was looking for something on the recordings and found this alleged incident by accident. Patient #1’s mom called Staff E instead of the agency. Review of the medical record for Patient #1 revealed a diagnosis of anoxic brain injury. Patient #1 needed constant supervision and was bedridden. The medical record contained a communication note dated 08/26/24 that the case manager was called to report an incident. The communication note was noted to be copied to Patient #1’s physician. Additional communication notes on 08/26/24 document that staff were interviewed, staff were removed from seeing all patients, and an incident report was filed. The medical record lacked any details regarding the alleged incident, just that there was an incident. The medical record lacked documentation the physician had been notified of the allegation of abuse or the details of the alleged incident. On 09/05/24 at 10:55 AM, Staff A and B verified that there had been no detailed report made to the physician regarding the incident. On 09/05/24 at 1:15 PM, Staff A stated the physician had been called on this date and updated on the incident as well as Patient #1’s mom not wanting replacement staff during the investigation.”