Bsa Compassion Home Care

“Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This Element is not met as evidenced by: Based on interview and record review, the agency failed to ensure the HHA provided services that were consistent with the home health aide training for 1 of 3 (Patient #1) patients reviewed in that HHA E failed to provide lifting/transferring services to Patient #1 consistent with the HHA’s training during the home health aide visit conducted on 01/13/25. This failure could have resulted in harm to Patient #1 including bruising, dislocation (a medical condition in which the bones of a joint are separated from their normal position which can result in pain), or fractures (broken bones). The findings included: Record review of Intake #113037, dated 02/04/25, indicated on 02/04/25 it was reported to HHSC that video footage of care provided to Patient #1 by HHA E showed HHA E being rough with the patient. During an interview conducted on 02/19/25 at 9:01 a.m., APS Investigator #1 said she had reviewed video of HHA E providing care to Patient #1. APS Investigator #1 said what she observed on the video was an unsafe transfer. APS Investigator #1 said she was a CNA for many years, and she did not observe HHA E to provide care as per CNA training on the video she observed. APS Investigator #1 said the patient was receiving a blood thinner medication (a medication used to prevent blood clots which can result in bruising more easily). APS Investigator #1 said HHA E did not provide appropriate care to the patient with respect to the patient being on blood thinners and being fragile. During an interview conducted on 02/19/25 at 9:45 a.m., the alternate administrator said the agency did not directly employee HHAs and instead contracted with another company, Home Health Agency #2, for home health aide services. The alternate administrator said HHA E was employed by Home Health Agency #2 and was providing services to agency patients under the agency’s contract with Home Health Agency #2. During an interview conducted on 02/19/25 at 12:28 p.m., HHA E said she had worked as a HHA since 2017. HHA E said she currently worked at Home Health Agency #2 and provided services to agency patients under a contract between the agency and Home Health Agency #2. HHA E said she had previously provided services to Patient #1 and said she had worked for the patient for several months. HHA E said she assisted Patient #1 with transfers and said this was a hands-on assist. HHA E said it would depend on the day how much assistance the patient required to transfer. HHA E said sometimes the patient would require total assistance and she (HHA E) would physically transfer the patient and other times the patient was able to assist some with the transfer. HHA E said it depended on how strong or weak the patient was on that day. A written statement including the information reported by HHA E during this interview was completed and reviewed and signed by HHA E on 02/19/25. During an interview conducted on 02/19/25 at 2:43 p.m., RN CM F said she was Patient #1’s case manager. RN CM F said the staff who provided care to Patient #1 reported to her. RN CM F said the patient was very unsteady when walking and sometimes her knees would give out. RN CM F said the agency did a skills checkoff (the HHA demonstrated skills for providing patient care and if done appropriately during the visit would be checked off to indicate the HHA was competent to provide that type of care) with HHA E and Patient #1 in the patient’s home with no concerns about the care provided by HHA E at the time of that visit. During an interview conducted on 02/19/25 at 3:28 p.m., RN/QA Coordinator H said she completed a HHA skills checkoff with the HHAs when they were hired and annually thereafter. RN/QA Coordinator H said she completed the skills checkoff with HHA E and Patient #1 during the year of 2024. RN/QA Coordinator H said the family would not allow HHA E to use a gait belt (a belt-like medical device used by placing the device around the patient to assist with lifting or moving the patient safely) the patient. RN/QA Coordinator H said she felt the care demonstrated by HHA E during the skills checkoff was safe and appropriate. RN/QA Coordinator H said Patient #1 needed assistance to transfer. During an interview conducted on 02/19/25 at 6:35 p.m., Patient #1’s Family Member #1 said he had video of the incident with HHA E and Patient #1. Family Member #1 said the video footage showed HHA E being rough with the patient. Family Member #1 said the family took the patient to her physician, Physician #1, and told the physician what happened, and the physician referred the patient to another home health agency, HHA #3. During an interview conducted on 02/20/25 at 11:35 a.m., Physician #1’s CCMA #1 said the physician was not in the office but said the patient had last been seen by the physician on 02/06/25. CCMA #1 said on that visit the physician documented the patient and family had come in to discuss changing the patient’s home health agency and discussed concerns with the caregiver from the agency. CCMA #1 said the physician referred the patient to another home health agency. During an interview conducted on 02/20/25 at 12:59 p.m., RN G said Patient #1 was receiving Plavix and had thin, fragile skin. During an interview conducted on 02/21/25 at 1:00 p.m., the surveyor attempted to interview Patient #1 with assistance from Interpreter #1 as the patient’s primary language was not English. Patient #1 did not respond to the questions asked by the surveyor through the interpreter and would only repeat that she wanted to stay in her home and did not want to leave her home. During an interview conducted on 02/21/25 at 1:00 p.m., Family Member #1 said when HHA E was providing care to the patient, Patient #1 had started to say that she was sore and frequently complained that her right arm hurt. Family Member #1 said the family became concerned and started looking at videos from cameras installed in the home which were recorded when HHA E was providing care to the patient. Family Member #1 said HHA E was seen on the video trying to pull the patient up by her right arm. When asked if the video shown/provided to the surveyor had been altered in any way, Family Member #1 said, “No.” Family Member #1 said APS Investigator #1 came to the home and he also showed her the video. During a record review conducted on 02/21/25 at 1:00 p.m., the surveyor viewed Video #1, with a date/time stamp of 01/13/25 at 12:21 p.m. In the video recording Patient #1 was observed to be sitting on the toilet and HHA E was observed to tell Patient #1 to stand up. HHA E was observed to assist the patient to stand by holding the patient’s right arm and pulling the patient upwards using only the patient’s right arm. HHA E was not observed to hold the patient around the pelvic region or to hold the patient using both hands. Patient #1 was observed to call out during the procedure and say something to HHA E in the patient’s primary language. HHA E was then observed on the video recording to assist Patient #1 to sit in the wheelchair by holding the patient by her right arm. HHA E was not observed to hold the patient around her pelvic area or to hold the patient using two hands during this procedure. When assisted by HHA E to sit down in the wheelchair Patient #1 was observed to cry out, say something to HHA E in the patient’s primary language, and rub her right arm. During an interview conducted on 02/21/25 at 1:00 p.m., Patient #1’s Family Member #1 reviewed Video #1 with the surveyor and said the patient said in her primary language, “I’m going to fall” when HHA E was assisting the patient to stand up from the toilet by holding the patient by her right arm and pulling upwards. Family Member #1 said the patient said in her primary language, “My arm is going to break” when HHA E assisted the patient to sit in the wheelchair by holding her right arm. Family Member #1 reported the bathroom observed on Video #1 was the only bathroom in the patient’s home. During a home visit conducted on 02/21/25 at 1:00 p.m. – 3:00 p.m., the surveyor observed the patient’s bathroom. The bathroom was observed to have adequate space for Patient #1 to sit on the toilet with the surveyor standing in front of the patient to allow the surveyor adequate room to lift the patient off the toilet by standing in front and holding the individual around the pelvic area. The surveyor observed the bathroom to be the same bathroom as that observed in Video #1. During an interview conducted on 02/24/25 at 1:08 p.m., with HHA E and RN/QA Coordinator H, when asked how she would assist Patient #1 to get up off the toilet in the patient’s bathroom, HHA E said it would depend on how the patient was doing that day. HHA E said sometimes she would hold the patient’s hands and assist her to get up and sometimes she would put her (HHA E’s) hands under the patient’s arms and assist her to stand. HHA E said she would either stand in front of the patient or off to one side when assisting the patient to stand up from the toilet. HHA E said she was trained to assist patients to get up from sitting to standing by putting her arms under the patient’s arms or around their waist and lifting them up. The surveyor reviewed Video #1 with HHA E and RN/QA Coordinator H. After reviewing Video #1 HHA E said she did grab the patient by the arm and pull her to standing in the video. When asked if in her opinion it sounded like this action hurt the patient based on the patient’s vocalization, HHA E said, “Yes.” When asked if she had assisted the patient to stand from the toilet by holding one of the patient’s arms and pulling her up on other occasions, other than the one on the video, HHA E said, maybe. When asked the reason she had assisted the patient up from the toilet by holding one arm and pulling the patient up, HHA E said she was just attempting to get the patient up and that she wanted the patient to grab the grab bar. When asked if holding the patient by one arm and pulling her up was how she was trained to assist the patient to stand up from the toilet, HHA E said, “No.” When asked if holding the patient by one arm and pulling her up could result in bruises to the patient’s arm, especially as the patient was receiving blood thinner medication, HHA E said possibly but she didn’t know. HHA E said. “There’s a possibility.” HHA E said it looked like it hurt the patient’s arm when she assisted the patient to stand up and to get into the wheelchair by holding the patient by one arm and said the patient rubbed her arm in the video after sitting in the wheelchair. HHA E said she had no ill intent with these actions. A written statement including the information reported by HHA E during this interview was completed on 02/24/25 and reviewed by HHA E. During an interview conducted on 02/24/25 at 3:25 p.m., with HHA E and RN/QA Coordinator H, after reviewing the written statement completed during the interview on 02/24/25 at 1:08 p.m., HHA E said instead of the word “grabbing” when describing the action of taking the patient by the arm and pulling her to standing she would say she was assisting the patient by holding her arm and said the patient would usually grab the grab bar and the family did not want the HHA to use the gait belt. HHA E said during the week of 01/13/25, the patient was moaning and had been in pain. HHA E clarified that she would not know if the use of blood thinner medication could result in bruising. HHA E said she did not know if she had assisted the patient to stand up from the toilet by taking her by the arm and assisting her up to her feet on other occasions other than the one seen on Video #1. HHA E said the patient did make noises that sounded like she was in pain while she was assisting the patient to stand up from the toilet by taking her by the arm and assisting her up to her feet in Video #1, but the patient had been making noises that sounded like she was in pain at other times during the week of 01/13/25 when HHA E was not providing her with care. A written statement including the information reported by HHA E during this interview and the interview conducted on 02/24/25 at 1:08 p.m. was completed and reviewed and signed by HHA E on 02/24/25. During an interview conducted on 02/24/25 at 4:30 p.m., with the administrator and the alternate administrator, the surveyor reviewed Video #1 with the agency staff. The administrator and alternate administrator both confirmed the technique used by HHA E on Video #1 was not the correct technique for lifting/transferring and was not how HHA E had been trained to lift/transfer patients by the agency. The administrator and alternate administrator said the family had declined to allow the HHA to use a gait belt. The administrator and alternate administrator said the HHA needed to receive re-education on lifting techniques. During an interview conducted on 02/24/25 at 4:44 p.m., RN/QA Coordinator H confirmed she was able to see Video #1 when shown to herself and HHA E during the interview conducted on 02/24/25 at 1:08 p.m. RN/QA Coordinator H said during the visit to check HHA E off on the HHA skills in 2024 when assisting the patient to stand up from the toilet HHA E did not assist the patient to stand as she was observed to do in Video #1, by holding the patient by one arm and assisting her to her feet. RN/QA Coordinator H said ideally the HHAs would use a gait belt when assisting a patient to stand but if they were not able to do that then lifting the patient by holding the patient around the waist or under the arms and lifting her with both arms would be the correct way to lift the patient. RN/QA Coordinator H said she would not have trained HHA E to assist the patient to stand the way HHA E was observed to assist the patient to stand from the toilet in Video #1. During an interview conducted on 02/25/25 at 2:19 p.m., the supervising nurse said her expectation of how HHAs should lift a patient to a standing position from a sitting position was to do so by holding the patient around the waist and lifting the patient to their feet. The supervising nurse said ideally the HHA would use a gait belt to do this, but if the HHA was not able to use a gait belt this was what she would expect the HHA to do. During an interview conducted on 02/28/25 at 2:00 p.m., Physician #1 confirmed he had seen Video #1. When asked if Patient #1 could have sustained injuries, such as bruises, dislocations, and fractures, from HHA E assisting Patient #1 to stand from a sitting position by holding the patient by one arm and pulling the patient to her feet as HHA E was observed to do in Video #1, Physician #1 said, yes. During an interview conducted on 03/03/25 at 9:12 a.m., with the administrator and the alternate administrator, when asked if there could have been any potential adverse outcomes to Patient #1 related to HHA E’s failure to assist the patient with lifting/transferring as per her training, the administrator said she didn’t think so. When asked if the way that HHA E assisted Patient #1 to stand from sitting by holding one arm and lifting upwards as observed on Video #1 could result in injuries, such as bruising, dislocations, or fractures, the administrator said, yes, and said that was why the agency trained the HHAs to lift and transfer appropriately. The alternate administrator and administrator confirmed the way HHA E assisted Patient #1 to stand from sitting as observed in Video #1 could have resulted in injuries to the patient. Record review of the agency’s discharged patient roster indicated Patient #1 was discharged from the agency’s services at her physician’s request on 02/07/25. Record review of the clinical record for Patient #1 included a plan of care, for the certification period of 11/28/24 – 01/26/25, which indicated the patient had a start of care date with the agency of 07/31/24 and had diagnoses of Alzheimer’s Disease (a progressive disorder which causes confusion, memory loss, and impairment of judgement), Dementia (a progressive disorder which causes confusion, memory loss, and impairment of judgement), Repeated Falls, and Age-related Osteoporosis (a condition which results in a decrease in bone mineral density which can result in fractures occurring more easily). The plan of care indicated the patient was on the following safety precautions: Fall Precautions, Bleeding Precautions, Prone to Fractures Precautions, and required precaution with Safety in ADLs (activities such as bathing, dressing, and transferring), Support During Transfer and Ambulation (walking), and Slow Position Changes. The plan of care indicated the patient was prescribed Clopidogrel Bisulfate (generic name for Plavix – a type of blood thinner medication) 75MG once a day by mouth. The plan of care indicated the agency was to provide HHA visits twice a week for once week and then five times a week for eight weeks. The plan of care indicated the HHA was to “provide assistance with personal care and ADLs as indicated by limitations on functional and physical status impeding self-care.” The plan of care also indicated, “Goals … Patient will receive safe and effective personal care during this episode of care …” The plan of care was signed by Physician #1 on 12/06/24. Record review of the clinical record for Patient #1 included a Home Health Aide Care Plan, for the time-period of 11/28/24 – 01/26/25, which indicated the patient had the following safety precautions, “Bleeding precautions, Fall precautions, … Prone to fractures precaution, Safety in ADLs, Support during transfer and ambulation, and Slow position changes.” The Home Health Aide Care Plan indicated the HHA was to assist the patient with transfers every visit. Record review of the clinical record for Patient #1 included a home health aide visit note, dated 01/13/25, signed by HHA E, which indicated HHA E provided care to Patient #1 on this date. The home health aide visit note indicated HHA E assisted Patient #1 with transferring during this visit. Record review of the clinical record for Patient #1 included a communication note, dated 01/20/25, signed by RN CM F, which indicated, “Spoke to [Family Member #1] concerning patients [sic] care and HHA. [Family Member #1] states they will go to [Name of Physician #1]’s for a referral for another company for the HHA. [Family Member #1] states to continue nursing but another company for the HHA. Asked [Family Member #1] why he was stopping HHA, states alot [sic] of reasons and would not elaborate.” Record review of the clinical record for Patient #1 included a communication note, dated 01/28/25, signed by RN CM F, which indicated, “[Name of Physician #1] order DC of patient ...” Record review of the clinical record for Patient #1 included a discharge summary, dated 02/11/25, signed by RN G, which indicated the patient was discharged for “Physician Request” and indicated the patient and physician agreed with the discharge. Record review of the agency’s contract with Home Health Agency #2, dated 02/01/23, indicated Home Health Agency #2 had contracted with the agency to provide home health aide services to agency patients and that contracted staff would “comply with … all applicable professional and medical standards of practice …” and indicated, “… both parties shall abide by and comply with all applicable State and Federal laws and regulations …” Record review of the personnel file for HHA E indicated she had a date of employment of 02/15/17 with Home Health Agency #2. The record indicated HHA E was checked off on the skill of safe transfer techniques on 09/25/17. Record review of a form titled, “Home Care Aide Skills Checklist,” dated 12/11/24, signed by HHA E and RN/QA Coordinator H, indicated HHA E was checked off on the skill of safe transfer techniques by RN/QA Coordinator H on 12/11/24. Record review of an email sent from the administrator to the surveyor, on 02/25/24 at 3:18 p.m., indicated, “I have attached multiple items. Let me explain: Back Safety Education – [Name of Home Health Agency #2] handout during orientation …” Record review of an attachment titled, “Back Safety Education,” dated 02/17/16, indicated, “Body Mechanics and Key Ideas for Good Balance … The greatest control over an object is exercised when held at its center of gravity. A person’s center of gravity is near the pelvis area. Lifting or supporting a client is accomplished with the least effort and is safest when you provide support at the client’s center of gravity and hold the client close to yours … Basic Transfers … Straddle the client to block their knees with your knees and their feet with your feet … Count to three and lift … Lift with your legs and keep their weight close to your body …” Record review of an agency policy titled, “Home Health Aide Qualifications,” dated October 2024, indicated, “HHA will provide services that are … consistent with the HHA training …””