Bios Home Health Care 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 record review and interview, the agency failed notify the physician of missed SN visits for two (Patients #6 and 9) of ten patients. Patient #6 A review of the POC dated 10/25/23 to 12/23/23 showed a primary diagnosis of pressure ulcer of right buttock, stage 4. The POC also shows a SN frequency of two visits per week for one week and then three visits per week for eight weeks. A review of SN missed visit notes showed the following: A SN missed visit note the week of 10/23/23 to 10/29/23 (one of two visits) showed no notification was made to the physician of the missed visits. A SN missed visit note the week of 10/30/23 to 11/05/23 (two of two visits) showed no notifications were made to the physician of the missed visits. A SN missed visit note the week of 12/11/23 to 12/17/23 (one of three visits) showed no notifications were made to the physician of the missed visits. Patient # 9 A review of the POC dated 09/19/23 to 11/17/23 showed a primary diagnosis of paroxysmal atrial fibrillation. The POC also showed a SN frequency of one visit per week for nine weeks. A review of a SN missed visit note dated 09/21/23 showed no notification was made to the physician of the missed visit. On 01/04/24 at 12:25 pm, Staff A stated no notifications of the missed SN visits were made to the physician for Patient’s #6 and #9.”

“Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure: 1. SN assessed the blood sugar as ordered for one (Patient #1) of ten patients; 2. a medication order was completed as ordered for one (Patient #3) of ten patients; and 3. SN notified the physician of systolic blood pressure levels outside the ordered parameters for one (Patient #6) of ten patients. 1. Patient #1 A review of the POC dated 10/21/23 to 12/19/23 showed an order for SN to assess blood sugar via finger stick during each visit for Patient #1. Clinical records showed no finger sticks were completed and no blood sugar results were documented during SN visits dated 10/23/23, 10/30/23, 11/6/23, 11/14/23, 11/20/23, 11/27/23, 12/08/23, 12/12/23, and 12/18/23. Documents showed no refusal of services from the patient or caregiver and no changes in the physician’s order. 2. Patient #3 A review of a POC dated 10/21/23 to 12/19/23 showed a medication order for Rivaroxaban (common name: Xarelto) 15 mg to be taken by mouth daily. A physician’s order dated 11/16/23 showed an order to discontinue Xarelto and begin taking Apixaban 5 mg BID (twice a day), once Apixaban is received. A review of clinical records showed no Apixaban medication being administered, and no changes were made on Patient #3’s current medications list as ordered by the physician. Documents showed no refusal of medication from the patient or caregiver and no changes in the physician’s order. 3. Patient #6 A review of the POC dated 10/25/23 to 12/23/23 showed an order for SN to notify the physician of systolic blood pressure greater than 170. A review of SN visit dated 11/15/23 showed a systolic blood pressure reading of 178. Documents showed no physician notification for the systolic blood pressure reading greater than 170. On 01/04/23 at 1:15 pm, Staff A stated: 1. SN visits did not show documentation of blood sugar assessments as ordered by the physician for Patient #1; 2. the medication order was not completed as ordered by the physician for Patient #3; and 3. there was no documentation of physician notification of the systolic blood pressure being out of parameters for Patient #6.”

“Performance improvement projects CFR(s): 484.65(d)(1)(2) Standard: Performance improvement projects. Beginning July 13, 2018 HHAs must conduct performance improvement projects. (1) The number and scope of distinct improvement projects conducted annually must reflect the scope, complexity, and past performance of the HHA’s services and operations. (2) The HHA must document the quality improvement projects undertaken, the reasons for conducting these projects, and the measurable progress achieved on these projects. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure performance improvement projects were for all current patients and staff. A review of the agency’s documentation showed no records of performance improvement projects implemented, n in development, on-going or completed for calendar year 2022 and 2023. On 01/04/24 at 1:35 p.m., Staff A stated there were no performance improvement projects written out or documented for 2022 and 2023.”