Extended Family Care

“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 review of clinical records, agency policies and procedures, and interview with agency administrator, the agency failed to provide the prescribed frequency and duration of skilled nurse home health services documented in the individualized plan of care as prescribed by the physician in one (1) of seven (7) clinical records (CR) reviewed (CR#3).; and failed to notify physician of missed skilled nursing service hours in one (1) of seven (7) clinical records (CR) reviewed (CR#3). Review conducted on April 16, 2024, at approximately 2 PM, of clinical records revealed: CR#3, start of care (soc) 11/6/2013, certification period 3/13/24 to 5/11/24: * Denotes missing SN service hours. -Plan of Care document - physician order for frequency and duration of skilled nursing (SN) care services documented as “SN up to 16 hours per day x 7 days per week. Hours of service not provided may be used for coverage for any shift needs on days, evenings, and/or nights beyond the 16 hour/day, … effective 2/7/2024.” -April 1, 2024, Plan of Care document, updated physician order for frequency and duration of skilled nursing (SN) care services: “SN 18 hours/day, Monday-Friday, x 60 days; 16 hours/day Saturday and Sunday, x 60 days, Start Effective 4/1/24.” Frequency and duration of SN provided hours revealed: * denotes missed SN service hours. -March 13 – 21, 2024, 16 hours of SN services provided each day. -*March 22, 2024, 14 hours of SN services provided. -*March 23, 2024, 2 hours of SN services provided. -*March 24,2024, 11.5 hours of SN services provided. -March 25 – 26, 2024, 16 hours of SN services provided each day. -*March 27, 2024, 9 hours of SN services provided. -March 28 – 29, 2024, 16 hours of SN services provided each day. -*March 30, 2024, 10 hours of SN services provided. Physician notified of missing SN shift coverage, no available SN staff. -*March 31, 2024, 10.5 hours of SN services provided. **New physician orders for frequency and duration effective April 1,2024. -*April 1, 2024, 14 hours of SN services provided. -*April 2 - 4, 2024, 16 hours of SN services provided each day. -April 5, 2024, 18 hours of SN services provided. -*April 6, 2024, 10 hours of SN services provided. Physician notified of missing SN shift coverage, no available SN staff. -*April 7, 2024, 10.5 hours of SN services provided. -*April 8, 2024, 14 of SN services provided. -*April 9 -11, 2024, 16 hours of SN services provided each day. -April 12, 2024, 18 hours of SN services provided. -*April 13, 2024, 10 hours of SN services provided, open SN shift from 8 AM to 4 PM. -*April 14, 2024, 10.5 hours of SN services provided. -*April 15-16, 2024, 14 hours of SN services provided. Review conducted on April 17, 2024, at approximately 1:00 PM, of agency policies revealed: -Policy 310, Staffing Cases, page 2 of 2, Item 7: “In the event that a shift is unable to be staffed or staffed outside of the frequency/duration that was approved by the payor source, the Patient Care Advocate will be responsible to entering a missed shift report and/or communication note documenting the reason for the variance in hours.” -Policy 309, Continuity of Care, page 3 of 3, Item 7: “If agency staff misses visits or services as required by the plan of care, the agency must notify the responsible physician of the missed visit if that is any potential for clinical impact upon the patient. The physician will determine whether the patient visit may be skipped or additional interventions are required by the agency.” -Policy 328, Medical Supervision/Medical Orders: Page 2 of 11, Item 4. “Medical orders are established and documented for the health care services the Organization provides to those patients who: a. Are being actively treated by a medical practitioner for a diagnosed health care problem that is directly related to the home care services being provided.”; page 3 of 11, “item 6. Medical orders must contain the following: b. Types, amounts, and duration of services; c. Frequency of services.”; … page 7 of 11, “2. Organizational Responsibilities a. Communicate information regarding the home care plan, including outcomes, to physician in a reasonable time frame. … c. Carry out physician orders as stated in the plan of treatment, notify the physician of the need for review and/or revision.”; and … page 8 of 11, “e. A missed visit that was scheduled or treatment that could not be given (done by MD request) may not need to notify physician, but notify the office.” Interview conducted on April 17, 2024, at approximately 3:15 PM, with agency administrator revealed: Missing SN service hours on Sundays (3/24/24, 3/31/24, 4/7/24, and 4/14/24) reflected CR#3’s family decision to provide skilled care while at church services; this verbal communication request from the family was never documented in CR#3’s clinical record; notification of physician for missing SN service hours were not always performed; and confirmation of missing SN provided service hours.”