Kayland Health Services

“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 each patient received the home health services that were written in the patient’s plan of care (G572). The agency failed to ensure services were provided only as ordered by the physician (G580). The agency failed to integrate all orders for all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient (G604). The agency failed to ensure the patient, and his or her caregiver(s) receive ongoing education and training provided by the agency, as appropriate, regarding care and services (G610). The cumulative effect of these systemic practices resulted in the agency’s inability to ensure that the patients’ nursing needs would be met.”

“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 each patient received the home health services that were written in the patient’s plan of care for one of three patients reviewed (Patient #3). The census was 94. Findings include: Review of the agency policy titled, “Plan of Care CMS 485 and Physician’s Orders,” revised 2011, revealed care and services will be provided according to Physician’s orders. Review of Patient #3’s medical record and physician ordered plan of care for the certification period dated 10/11/23 to 12/09/23 revealed orders were for skilled nursing once a week and home health aide services 40 hours per week. The physician ordered the nurse to continue to change the indwelling Foley catheter once a month. Review of the skilled nurse visit sheets from 10/03/23 to 11/07/23 and 11/17/23 to 12/19/23 did not reveal any documentation that the patient’s Foley catheter had been changed monthly as ordered. Interview on 01/16/24 at 2:50 PM with Staff O confirmed the lack of documentation the Foley catheter had been changed monthly. This deficiency represents non-compliance investigated under Substantial Allegation 103161.”

“Within 48 hours of the patient’s return CFR(s): 484.55(d)(2) Within 48 hours of the patient’s return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This Element is not met as evidenced by: Based on record review, policy review, and staff interview, the agency failed to ensure a comprehensive assessment was completed within 48 hours of the patient’s return home from a hospital admission of 24 hours or more for any reason other than diagnostic tests for one of one patient reviewed with a hospital discharge (Patient #3). The total sample was three patients. The census was 94. Findings include: Review of agency policy titled, “Reassessment/Update of Comprehensive Assessment,” revised 2010, revealed the comprehensive assessment (including Outcome Assessment and Information Set data elements) must be updated and revised after inpatient stay (Resumption of Care) within two calendar days of the facility discharge date or knowledge of patient’s return home. Review of Patient #3’s hospital medical record and discharge summary revealed Patient #3 was admitted to the hospital on 11/13/23 for abnormal labs and was discharged on 11/16/23 with diagnoses of urinary tract infection (UTI), suprapubic catheter, Cerebral Palsy, anxiety and epilepsy. Review of Patient #3’s home health agency medical record revealed no evidence a Resumption of Care (ROC) comprehensive assessment was completed following discharge from the hospital. Interview on 01/16/23 at 11:35 AM with Staff O confirmed as of 01/16/24, the ROC was not in Patient #3’s medical record.”

“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, and staff interview, the agency failed to ensure services were provided only as ordered by the physician for one of three patients reviewed (Patient #3). The census was 94. Findings include: Review of the agency policy titled, “Plan of Care CMS 485 and Physician’s Orders,” revised 2011, revealed care and services will be provided according to Physician’s orders. Review of Patient #3’s medical record and physician ordered plan of care for the certification periods dated 10/11/23 to 12/09/23 and 12/10/23 to 02/07/24 revealed the patient had diagnoses including Cerebral Palsy, quadriplegia and recurrent urinary tract infection. Physician orders were for skilled nursing once a week and home health aide services 40 hours per week. There were no orders for the patient’s peripherally inserted central catheter (PICC) line to be flushed or that the dressing was to be changed. Review of the skilled nurse visit sheets from 11/17/23 to 12/19/23 (seven visits) revealed the nurse flushed the patient’s PICC line and that the dressing had been changed on each visit. Interview on 01/16/24 at 3:10 PM with Staff O confirmed the patient’s PICC line was flushed and that the dressing was changed without a physician order.”

“Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This Element is not met as evidenced by: Based on record review and staff interview, the agency failed to integrate all orders for all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient for one of three patients reviewed (Patient #3). The patient census was 94. Findings include: Review of Patient #3’s medical record and physician ordered plan of care for the certification periods dated 10/11/23 to 12/09/23 and 12/10/23 to 02/07/24 revealed a start of care date of 03/06/19 and diagnoses including Cerebral Palsy, quadriplegia and recurrent urinary tract infection. Orders were for skilled nursing once a week and home health aide services 40 hours per week. There was no documentation in the patient’s record about any hospital admissions or discharges or any supporting documentation such as discharge paperwork including any new physician orders. Interview on 01/16/24 at 11:25 AM with Staff O revealed Patient #3 was admitted to the hospital on 11/19/23. Staff O did not know when the patient was discharged from the hospital. Staff O confirmed as of 01/16/24, there was no discharge paperwork in the patient’s medical record. Review of Patient #3’s hospital medical record revealed the patient was admitted to the hospital on 11/13/23, not 11/19/23, for abnormal labs and was discharged on 11/16/23 with diagnoses of urinary tract infection (UTI), suprapubic catheter, Cerebral Palsy, anxiety and Epilepsy. The patient was discharged on 11/16/23 at 1:06 PM with home health services with registered nurse assessment and peripherally inserted central catheter (PICC) line in place for intravenous (IV) antibiotic infusion. Review of the discharge plan from the hospital revealed the patient does have recurrent UTl’s requiring IV antibiotics secondary to chronic indwelling suprapubic catheter. The patient had complaints of fever at home. A urinalysis was positive on arrival. The patient’s Foley catheter was exchanged. He was started on Meropenem (antibiotic) based on prior culture sensitivities. The patient was evaluated by the Infectious Disease specialist and the plan is for an extended course of outpatient antibiotics for which a PICC line was placed. The patient will discharge home on Meropenem 1 gram every eight hours for at least three weeks. Will check complete blood count (CBC) and basic metabolic panel (BMP) once per week while on this high-risk medication. Further review revealed lab work (CBC, BMP, liver function tests) will be drawn every Monday while on IV antibiotics. Fax the results to the Infectious Disease office. Interview on 01/16/24 at 2:15 PM with the hospital case manager revealed the discharge order was faxed to the agency on 11/16/23 and included orders for the registered nurse to draw CBC, BMP and LFT every Monday while on IV antibiotics. The case manager received a confirmation that the fax was received by the agency. The course of treatment was for three to six weeks of IV Meropenum. A second interview on 01/17/24 at 9:09 AM with the case manager revealed that she did not keep copies of the fax confirmations, there were too many to keep, but did document where the fax went, when it was sent, and confirmation that the fax went through. The case manager stated she faxed the discharge summary and discharge orders to the agency on 11/16/23 around 4:30 PM and documented confirmation the fax went through to the agency. Review of the skilled nurse visit sheets from 11/17/23 to 12/19/23 (five weeks) revealed no documentation that the labs were drawn weekly. Interview on 01/16/24 at 11:12 AM with Staff O revealed the agency did not draw blood because the patient didn’t return from school until 4:30 PM and the nurse visited at 6:00 PM which was too late to draw blood. The Administrator stated the family would take the patient to a nearby lab. Staff O stated the physician’s office was notified on 11/30/23, two weeks after the patient was discharged from the hospital, of this and confirmed that this was not documented. Interview on 01/16/24 at 1:28 PM with the patient’s physician’s office revealed they contacted the agency on 11/30/23 looking for the lab results. On 01/16/24 at 12:15 PM Staff P was asked how the agency became aware of the need to draw blood if it was not documented in the patient’s medical record? Staff P stated a pharmacy notified the agency that blood work needed to be done. Staff P did not know the date of the notification, and this was not documented. Review of an undated and unsigned communication note revealed the physician’s office was notified that this agency did not have a lab order for the patient. On 12/04/23, three weeks after the patient was discharged from the hospital, the agency notified the physician’s office that they could not do the blood draws and the family would take the patient to a lab after school. On 12/05/23 the lab results were sent to the physician. This deficiency represents non-compliance investigated under Substantial Allegation 103161.”

“Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This Element is not met as evidenced by: Based on record review and staff interview, the agency failed to ensure the patient, and his or her caregiver(s) receive ongoing education and training provided by the agency, as appropriate, regarding care and services for one of one patient reviewed with a peripherally inserted central catheter (PICC) line (Patient #3). The total sample was three records. The census was 94. Findings include: Review of Patient #3’s hospital record revealed Patient #3 was discharged from the hospital on 11/16/23 with diagnoses of urinary tract infection (UTI). Review of the discharge plan from the hospital revealed Patient #3 does have recurrent UTls requiring intravenous (IV) antibiotics secondary to chronic indwelling suprapubic catheter. The plan is for extended course of outpatient antibiotics for which a PICC line was placed. Patient #3 will discharge home on Meropenem (antibiotic) 1 gram every eight hours for at least three weeks and will be discharged to home health services with registered nurse assessments and PICC line in place for IV antibiotic infusion. Interview on 01/16/24 at 12:15 PM with Staff B revealed the family gave the antibiotics through the PICC line. Staff B stated the family was trained to use the PICC line. Staff B was unable to say who trained the family and no documentation was provided to support this. Review of Patient #3’s home health agency medical record revealed no evidence the nurse had instructed the family on how to administer antibiotics through the patient’s PICC line during any visit conducted from 11/17/23 to 12/19/23. Interview on 01/16/24 at 12:40 PM with Staff O revealed the nurse had the documentation but was unable to provide it.”