Vakolane Home Healthcare LLC

“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 interview and record review, the agency failed to ensure each patient had an individualized plan of care signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration for two of three patients reviewed (Patient’s #14 and #22). This could affect all patients receiving services from the agency. The census was 22. Findings include: 1. Review of Patient #22’s medical record revealed a start of care date 04/23/23. Review of the physician ordered plans of care for the certification periods dated 04/23/23 to 06/21/23, 06/22/23 to 08/20/23 and 08/21/23 to 10/19/23 revealed orders for 23 hours of home health aide services a week for personal care services, four and a half to five hours a day Monday through Friday, five visits a week for nine weeks. Services were to include hands on assistance with bathing, dressing, toileting, hygiene, cleaning, laundry, meal preparation, shopping and errands. The three plans of care were not signed by the physician. There were fax communications of faxing the plans of care to the physician without response. Interview on 12/27/23 at 2:50 P.M. with Staff H verified the agency provided services to Patient #22 from 04/23/23 to 10/20/23 without a signed plan of care from the physician. Staff H stated he called the physician’s office and the office said they would give the physician the paperwork. Initially the physician office said they wanted aide and physical therapy services from the same agency. The facility told the office they could provide physical therapy however, the physician still did not sign the paperwork. Patient #22 also took the paperwork with her to an appointment and the physician would not sign. Staff H had no communication notes outlining his efforts to get the physician to sign the plan of care. They faxed a new plan of care on 10/19/23 for the certification period dated 10/20/23 to 12/18/23 but discontinued services on 10/20/23 when they did not get a signed copy in return. There were no communication notes but emails starting 10/20/23 to Case Manager O about stopping aide services due to the physician not signing the plan of care. Staff H said the Case Manager O wanted to talk to the doctor. She spoke to the doctor and he still did not sign the care plan so the agency officially discharged the patient on 11/17/23. Review of email responses back and forth with Case Manager O revealed they could not make any headway with the physician either. Interview on 12/27/23 at 5:27 P.M. with Staff H revealed they did not have a policy for the physician signing plans of care, although he knew they needed to. 2. Review of Patient #14’s record revealed a start of care date of 11/24/23. The physician ordered plan of care for the certification period dated 11/24/23 to 01/22/24 revealed an order for 15 hours of home health aide services a week to provide minimal assist mainly for housekeeping, laundry, meal preparation, and standby bathing assist as he tends to be a fall risk in the shower. The physician was faxed the plan of care on 11/24/23, but there was no evidence the physician signed the plan of care. There was no evidence of the facility reaching out in an attempt to get the faxed plan of care signed. The facility has been seeing the patient without a signed order since 11/24/23. Interview on 12/27/23 at 4:58 P.M. with Staff H verified the facility had been providing services to Patient #14 without a signed plan of care since 11/24/23.”