Accentcare Home Health of Central Pennsylvania

“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/procedures, and interview with agency staff, the agency failed to provide ordered frequency of skilled care and notify the physician of missed skilled care visits in one (1) of three (3) clinical records (CRs) reviewed (CR#1). Review conducted on August 16, 2024, at approximately 9:45 AM to 11:20 AM, of agency clinical records (CRs) revealed: CR#1, start of care (soc) 6/15/2024, certification period #1 6/15/24 to 8/13/24: Physician Plan of Care orders: “Skilled nurse (SN) 1 visit per week x1 week, two visits per week for 8 weeks, one visit per week for 1 week.”; and week of June 30, 2024, to July 6, 2024, no scheduled SN visits. and no missed visits notification sent to physician by agency. Review conducted on August 16, 2024, at approximately 1:50 PM, of agency policies/procedures revealed: Policy HH 2.1.4 Care Planning and Coordination, page 1 “Purpose: … 4. Coordinate care through regular communication among the staff providing care, visit management and scheduling, consistent patient education, and patient incorporation in the care planning process.; … Procedure: 1. The plan of care is ordered by the physician … and contains all pertinent diagnoses, including mental status, types of services and equipment required, frequency of visits, … and treatments … .”; and HH 2.2.12 Home Care Staffing Guidelines Policy: The Agency manages and administers its resources to meet workload demands and patient-family needs in accordance with current staffing guidelines. … Home Health service agencies … B. If the Agency misses a visit, a treatment, or service as required by the plan of care, then the Agency shall promptly notify the responsible physician/allowed practitioner of such missed treatment or service and any actual or potential clinical impact upon the patient.” Interview conducted on August 16, 2023, at approximately 10:00 AM, with agency Clinical Manager revealed no information regarding the missing two SN visits for CR#1 and no documentation for notification of missing visits to CR #1’s physician.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on review of clinical records, agency policy/procedure, and interview with agency staff, the agency failed to provide ordered frequency of skilled care and notify the physician of missed skilled care visits in one (1) of three (3) clinical records (CRs) reviewed (CR#1). Review conducted on August 16, 2024, at approximately 9:45 AM to 11:20 AM, of agency clinical records (CRs) revealed: CR#1, start of care (soc) 6/15/2024, certification period #1 6/15/24 to 8/13/24: Physician Plan of Care orders: “Skilled nurse (SN) 1 visit per week x1 week, two visits per week for 8 weeks, one visit per week for 1 week.”; and week of June 30, 2024, to July 6, 2024, no scheduled SN visits. and no missed visits notification sent to physician by agency. Review conducted on August 16, 2024, at approximately 1:50 PM, of agency policies/procedures revealed: Policy HH 2.1.4 Care Planning and Coordination, page 1 “Purpose: … 4. Coordinate care through regular communication among the staff providing care, visit management and scheduling, consistent patient education, and patient incorporation in the care planning process.; … Procedure: 1. The plan of care is ordered by the physician … and contains all pertinent diagnoses, including mental status, types of services and equipment required, frequency of visits, … and treatments … .”; and HH 2.2.12 Home Care Staffing Guidelines Policy: The Agency manages and administers its resources to meet workload demands and patient-family needs in accordance with current staffing guidelines. … Home Health service agencies … B. If the Agency misses a visit, a treatment, or service as required by the plan of care, then the Agency shall promptly notify the responsible physician/allowed practitioner of such missed treatment or service and any actual or potential clinical impact upon the patient.” Interview conducted on August 16, 2023, at approximately 10:00 AM, with agency Clinical Manager revealed no information regarding the missing two SN visits for CR#1 and no documentation for notification of missing visits to CR #1’s physician.”

“Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This Element is not met as evidenced by: Based on review of employee files (EFs), agency policies/procedures, Center for Disease Control (CDC) Guidelines for Tuberculosis screening, and interview with agency staff, the agency failed to ensure direct care workers, prior to consumer contact, that the individual had been screened for and was free from active mycobacterium tuberculosis (TB) for one (1) of three (3) EFs (EF#2); and failed to document onhire TB risk symptom assessments for two (2) of three (3) EFs reviewed (EFs #1, #3). Review conducted on August 16, 2024, at approximately 11:30 AM to 12:45 PM, of agency employee files (EFs) revealed: EF#1 date of hire (doh) 8/8/22, missing onhire Tuberculosis (TB) risk symptom assessment questionnaire (TB-RAQ). EF#2 doh 8/22/22, missing chest x-ray results. EF#3 doh 12/6/21, missing onhire Tuberculosis (TB) risk symptom assessment questionnaire (TB-RAQ) and annual TB-RAQ education for 2022. Review conducted on August 16, 2024, at approximately 12:15 PM, of CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005, revealed: “...Baseline testing for M. Tuberculosis infection is recommended for all newly hired health care workers [HCWs]...If TST [tuberculin skin testing] is used for baseline testing, two-step testing is recommended for HCWs whose initial TST results are negative...If the first-step TST result is negative, the second-step TST should be administered 1--3 weeks after the first TST result was read...A second TST is not needed if the HCW has a documented TST result from any time during the previous 12 months. If a newly employed HCW has had a documented negative TST result within the previous 12 months, a single TST can be administered in the new setting...This additional TST represents the second stage of the two-step testing...” *Baseline (preplacement) screening and testing, in addition to the IGRA (interferon-gamma release assay) or TST, shall include a symptom screen questionnaire and an individual TB risk assessment. Serial screening and testing not routinely recommended. Annual TB education is recommended. (CDC/MMWR/May 17, 2019/Vol. 68/No. 19). Review conducted on August 16, 2024, at approximately 1:30 PM, of agency policies/procedures revealed: Policy C 5.3 Tuberculosis Screening, page 1, “Procedure: … At hire, prior to patient contact: TB skin test or Interferon-Gamma Release Assay (IGRA)/QuantiFERON-TB Gold/TB Spot test.; … Baseline chest X-ray report for person with a previously positive TB skin test, TB disease treatment, or BCG vaccine history.; … Complete the TB screening questionnaire – all groups require completion.; … page 2 Annually: … Complete the TB screening questionnaire.; “… and page 3 Pennsylvania: 28 Pa Code 611.56 Health Screening (a) and (b)” sections requirements for onhire TB screening of direct care workers and office staff and annual TB-RAQ documentation.; and Job Description/Performance Appraisal, page 3 “III. Compliance Responsibilities 1. Complies with applicable legal responsibilities, standards, policies and procedures including but not limited to those within the Compliance Process, Code of Conduct and HIPAA. 2. Participates in required orientation, Compliance and HIPAA training programs.” Interview conducted on August 16, 2024, at approximately 1:30 PM, of agency Clinical Manager confirmed above findings.”