Angels of Care of Pa

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on review of agency policies/procedures, agency documentation, clinical record reviews and staff interviews the agency failed to ensure accurate start of care notification of the frequency of visits, regarding hours of care to be provided and disciplines that would be providing care for eleven (11) of eleven (11) clinical records reviewed (CR#1 through CR#11) Review of agency admission booklet, on 3/30/26 at 1:00 PM, containing the document Written Notice of Home Health Consumer Rights states, “As a consumer of home care and services you are entitled to receive notification of the following rights both orally and in writing. You have the following rights without retribution or retaliation from agency staff…Receive information about the care and services to be furnished, the disciplines that will furnish care, the frequency of proposed visits in advance and receive information about any changes in the care and services to be furnished.” Review of policy Provision of care Staffing assignments Policy on 3/30/26 at 11:30 AM states, “ The Supervising physician or registered nurse is responsible for the direction, coordination, and supervision of agency services…if a staff member is scheduled to provide services to a patient but is unable to do so due to illness, injury, etc, the supervising physician or registered nurse or administrative staff responsible for staff scheduling should promptly notify the patient and/or their representative and made every effort to find a competent replacement staff member. If the agency misses a visit, treatment, or service as required by the plan of cate, the supervising physician or registered nurse, designee, or administrative staff will make every attempt to reschedule the missed visit. If the visit cannot be rescheduled, the physician or allowed practitioner will be notified, the potential clinical impact of the missed treatment or services will be documented Review of consumer records (CR) from the parent and three branch locations, on 3/30/26 from approximately 1:00 PM through 3:00 PM and 3/31/26 from approximately 10:00 AM through 3:00 PM revealed the following: CR#1 Diagnosis: Hypoxic ischemic encephalopathy, the patient has a tracheostomy and gastrostomy tube. Start of services 11/10/25. For the certification period 1/9/26-3/2/26 the plan of care ordered up to 16 hours of care per day up to 7 days per week. The consent and admission agreement signed by the family, noted Registered Nursing (RN) services to be provided Monday, Tuesday, Friday and Sunday from 11:00 PM-7:00 AM. All routine shift services provided to this patient were provided by a licensed practical nurse (LPN) and not a RN as indicated on the signed consent form. The patient did not receive any services from the agency after the resumption of care on 2/20/26. Documentation revealed LPN (personnel record #2) was to have provided services on Sunday 2/22/26 but was a no call no show. No one from the agency provided services this week so the family discharged the agency. There was no documentation of any agency attempts to find a competent replacement or that any changes in the care and services was provided. Per agency policy requirements. The supervising physician or registered nurse or administrative staff responsible for staff scheduling did not promptly notify the patient and/or their representative or made every effort to find a competent replacement staff member. Interview with the regional director of nursing on 3/30/26 at approximately 2:00 PM confirmed the LPN scheduled for this client the week of 2/22/26 was a no call no show. There was another LPN (Personnel record #2) who told the agency she would have worked but no one informed her the patient had returned from the hospital. CR#2 (Springfield location) Diagnosis: Down Syndrome, breastbone and rib deformities, the patient has a gastrostomy tube. Start of services 1/9/26. For the certification period 3/10/26-5/8/26 the plan of care listed skilled nursing services (RN/LPN) to provide skilled nursing services 1:1/2:1/3:1 client to nurse ratio to be provided up to 20 hours per day. The consent and admission agreement signed by the family, noted Registered Nursing (RN) services to be provided 20 hours per day. There was no documentation on the consent form that one nurse could be providing care to two or three children in the home at the same time. CR#2, CR#3 & CR#4 reside in the same home On 3/10/26 the patient only received 8.25 hours of care On 3/11/26 the patient only received 12 hours of care On 3/12/26 the patient only received 4.25 hours of care On 3/13/26 there were no hours provided On 3/14/26 the patient only received 12.25 hours of care On 3/15/26 the patient only received 13.5 hours of care On 3/16/26 the patient only received 8 hours of care On 3/17/26 the patient only received 12.5 hours of care On 3/18/26 & 3/19/26 there were no hours of care provided On 3/20/26 the patient only received 3 hours of care On 3/21/26 the patient only received 12.25 hours of care On 3/22/26 the patient only received 8.25 hours of care On 3/23/26 the patient only received 14.5 hours of care On 3/26/26 the patient only received 12.25 hours of care On 3/27/26 the patient only received 12.25 hours of care On 3/29/26 the patient only received 13 hours of care CR#3 (Springfield location) Diagnosis: Left ventricular failure, the patient has a gastrostomy tube. Start of services 4/29/24. For the certification period 2/14/26-4/14/26 the plan of care listed skilled nursing services (RN/LPN) to provide skilled nursing services 1:1/2:1/3:1 client to nurse ratio to be provided up to 20 hours per day. The consent and admission agreement signed by the family, listed RN/LPN 20 hours day, not to exceed 140 hours a week. There was no documentation on the consent form that one nurse could be providing care to two or three children in the home at the same time CR#2, CR#3 & CR#4 reside in the same home On 2/18 & 2/19/26 only 12 hours of care had been provided On 12/20 only 12.15 hours of care has been provided On 2/22/26 no hours of care had been provided On 2/25/26 only 10.45 hours of care had been provided On 2/26/26 only 12.15 hours of care had been provided On 12/27/26 only 12 hours of care had been provided On 3/4/26 no hours of care had been provided On 3/8/26 only 8 hours of care had been provided On 3/9/26 only 10.45 hours of care had been provided On 3/10/25 only 11.45 hours of care had been provided On 3/11/26 only 12 hours of care had been provided On 3/12/26 no hours of care had been provided On 3/13/26 only 8.15 hours of care had been provided On 3/15/26 only 12.15 hours of care had been provided On 3/16/26 ony 13.15 hours of care had been provided On 3/17/26 only 12.30 hours of care had been provided On 3/18 & 3/19/26 no hours of care had been provided On 3/20/26 only 8.15 hours of care had been provided On 3/21/26 only 12.15 hours of care had been provided On 3/22/26 only 8 hours of care had been provided On 3/23/26 only 12.45 hours of care had been provided On 3/24 & 3/25/26 only 12 hours of care had been provided On 3/26 & 3/27/26 only 12.15 hours of care had been provided On 3/29/26 only 13.15 hours of care had been provided CR#4 (Springfield location) Diagnosis: Cerebral Palsy, the also patient has a gastrostomy tube. Start of Services 4/29/24. For the certification period 2/14/26-4/14/26 the plan of care listed skilled nursing services (RN/LPN) to provide skilled nursing services 1:1/2:1/3:1 client to nurse ratio to be provided up to 20 hours per day. The consent and admission agreement signed by the family, failed to note the disciplines that will furnish care and the frequency of proposed visits. There was no documentation on the consent form that one nurse could be providing care to two or three children in the home at the same time. CR#2, CR#3 & CR#4 reside in the same home CR#5 (Springfield location) Diagnosis: Congenital malformation of corpus collosum, the patient also has a gastrostomy tube. Start of Services 2/3/25 For the certification period 1/29/26-3/29/26 the plan of care listed skilled nursing services to be provided up to 16 hours a day, 7 days per week. The consent and admission agreement signed by the family lists skilled nursing services to be provided by an RN or LPN 16 hours a day, 7 days per week. On 1/29/26 only 15 hours of care had been provided On 1/30 and 1/31/26 only 12 hours of care had been provided On 2/1/26 no hours of care had been provided On 2/2 and 2/3/26 only 13 hours of care had been provided On 2/4/26 no hours of care had been provided On 2/5/26 only 13 hours of care had been provided On 2/6 and 2/7/26 only 12 hours of care had been provided On 2/8/26 only 13 hours of care had been provided CR#6 (Wyomissing location) Diagnosis: Presence of cerebral spinal fluid drainage device. The patient also has a gastrostomy tube. Start of Services 9/30/24 For the certification period 1/23/26-3/23/26 the plan of care lists skilled nursing (RN/LPN) 2:1 shared with sibling for 7-10 hours per night 3-6 nights per week The consent and admission agreement signed by the family lists skilled nursing services to be provided 10 hours a night x 7 nights a week. CR#6 & CR#7 reside in the same home On 1/24/26 & 1/15/26 no hours of care had been provided On 1/29/26 only 8.5 hours of care had been provided On 1/30, 1/31 & 2/1, 2/8, 2/13, 2/14, 2/15, 2/20, 2/21, 2/22, 2/27, 2/28, 3/1, 3/6, 3/7, 3/8, 3/13, 3/14, 3/15, 3/20, 3/21 & 3/22/26 no hours of care had been provided CR#7 (Wyomissing location) Diagnosis: Cerebral Palsy, the patient also has a gastrostomy tube. Start of Services 9/30/24 For the certification period 1/23/26-3/23/26, the plan of care lists skilled nursing (RN/LPN) 2:1 shared with sibling for 7-10 hours per night 3-7 nights per week The consent and admission agreement signed by the family lists 10 hours a night 7 nights a week. CR#6 & CR#7 reside in the same home On 1/24/26 & 1/15/26 no hours of care had been provided On 1/29/26 only 8.5 hours of care had been provided On 1/30, 1/31, 2/1, 2/8, 2/13, 2/14, 2/15, 2/20, 2/21. 2/22, 2/27, 2/28, 3/1, 3/6, 3/7, 3/8, 3/13. 3/14, 3/15, 3/20, 3/21 & 3/22/26 no hours of care had been provided CR#8 (Bethlehem location) Diagnosis: Failure to thrive, this patient also had a nasogastric tube. Start of Services 3/12/26 For the certification period 3/22/26-5/10/26, the plan of care lists SN (RN/LPN) to provide skilled nursing services up to 8 hours a day, up to 2 days a week shared 2:1 with sibling. The consent and admission agreement signed by the family, failed to note the disciplines that will furnish care and the frequency of proposed visits. There was no documentation on the consent form that one nurse could be providing care to two children in the home at the same time. CR#8 & CR#9 reside in the same home On 3/2/26 only 1 hour of care had been provided for the assessment visit No care was provided from 3/13/26 through 3/25/26 & 3/27/26 through 3/31/26 CR#9 (Bethlehem location) Diagnosis: Tracheostomy, chronic obstructive Pulmonary Disease, patient has a ventilator and gastrostomy tube. Start of Services 3/12/26 For the certification period 3/22/26-5/10/26, the plan of care lists SN (RN/LPN) to provide skilled nursing services up to 20 hours a day up to 7 days a week. Client to be staffed up to 12 hours a day up to 2 days a week with up to 8 of those hours to be shared as 2:1 with sibling. CR#8 & CR#9 reside in the same home The consent and admission agreement signed by the family, failed to note the disciplines that will furnish care and the frequency of proposed visits. There was no documentation on the consent form that one nurse could be providing care to two children in the home at the same time. On 3/2/26 only 1 hour of care had been provided for the assessment visit No care was provided from 3/13/26 through 3/25/26 & 3/27/26 through 3/31/26 CR#10 (Harrisburg location) Diagnosis: Encounter for attention to gastrostomy, failure to thrive. Start of care 8/18/23. For the certification period 3/22/26-5/20/26 the plan of care lists up to 10 hours a day of skilled nursing Monday through Friday on non school days. 10 hours a day Monday through Friday on school days. 8 hours a night 7 days a week. The consent and admission agreement signed by the family lists skilled nursing 10 hours a day Monday through Friday and 8 hours a night. CR#10 & CR#11 reside in the same home On 3/22/26 No hours of care had been provided On 3/23/26 Only 8.37 hours of care had been provided on dayshift On 3/24/26 Only 8.30 hours of care had been provided on dayshift On 3/25/26 Only 8.31 hours of care had been provided on dayshift On 3/26/26 Only 8.35 hours of care had been provided on dayshift On 3/27/26 Only 7.16 hours of care had been provided on dayshift On 3/28/26 No hours of care had been provided On 3/29/26 Only 8.11 hours of care had been provided on nightshift On 3/30/26 Only 8.01 hours of care had been provided on nightshift CR#10 & CR#11 reside in the same home Interviews with the Clinical Case Manager and Regional Director of Nursing on 3/31/26 at approximately 3:00 PM confirmed the above findings”

“Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This Element is not met as evidenced by: Based on review of agency policies/procedures, clinical record reviews and staff interviews the agency failed to Coordinate services for one (1) of one(1) resumption of care after a hospitalization patient (CR#1) Review of policy Provision of care Staffing assignments Policy on 3/30/26 at 11:30 AM states, “ The Supervising physician or registered nurse is responsible for the direction, coordination, and supervision of agency services…if a staff member is scheduled to provide services to a patient but is unable to do so due to illness, injury, etc, the supervising physician or registered nurse or administrative staff responsible for staff scheduling should promptly notify the patient and/or their representative and made every effort to find a competent replacement staff member. If the agency misses a visit, treatment, or service as required by the plan of cate, the supervising physician or registered nurse, designee, or administrative staff will make every attempt to reschedule the missed visit. If the visit cannot be rescheduled, the physician or allowed practitioner will be notified, the potential clinical impact of the missed treatment or services will be documented Review of consumer records (CR) from the parent and three branch locations, on 3/30/26 from approximately 1:00 PM through 3:00 PM and 3/31/26 from approximately 10:00 AM through 3:00 PM revealed the following: CR#1 (the complainant Springfield location) Diagnosis: Hypoxic ischemic encephalopathy, the patient has a tracheostomy and gastrostomy tube. Start of services 11/10/25. For the certification period 1/9/26-3/2/26 the plan of care ordered up to 16 hours of care per day up to 7 days per week. The consent and admission agreement signed by the family, noted Registered Nursing (RN) services to be provided Monday, Tuesday, Friday and Sunday from 11:00 PM-7:00 AM. All routine shift services provided to this patient were provided by a licensed practical nurse (LPN) and not a RN as indicated on the signed consent form. The patient did not receive any services from the agency after the resumption of care on 2/20/26. Documentation revealed LPN (personnel record #2) was to have provided services on Sunday 2/22/26 but was a no call no show. No one from the agency provided services this week so the family discharged the agency. There was no documentation of any agency attempts to find a competent replacement or that any changes in the care and services was provided. Per agency policy requirements. The supervising physician or registered nurse or administrative staff responsible for staff scheduling did not promptly notify the patient and/or their representative or made every effort to find a competent replacement staff member. There was no documentation the agency coordinated services with the family Interview with the regional director of nursing on 3/30/26 at approximately 2:00 PM confirmed the LPN scheduled for this client the week of 2/22/26 was a no call no show. There was another LPN (Personnel record #2) who told the agency she would have worked but no one informed her the patient had returned from the hospital.”