Good Shepherd Health Care Services

“Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA’s internal policies. (4) When services are provided on the basis of a physician or allowed practitioner’s verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA’s policies, must document the orders in the patient’s clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA’s internal policies. This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure agency physician’s orders were authenticated and dated by the physician in accordance with applicable state laws and regulations, as well as the Agency’s internal policies in 2 of 2 (Patient #’s 1 and 3) Patients whose records were reviewed. This deficient practice placed Patients at risk of not receiving the necessary care and services. The findings included: Agency policy 5.6 Orders For Care revised 1/29/2020 read in part…” The Agency will obtain orders and provide care in accordance with physician’s, physician’s nurse practitioner and physician’s assistant orders which are stablished prior to initiating patient care and reviewed/revised by the physician, physician’s nurse practitioner or physician’s assistant every 60 days and as needed…Physician, physician’s nurse practitioner or physician’s assistant signatures are obtained on 485s and supplemental verbal orders within 30 days.”… Patient #1 record review revealed a plan of care/485 for episode 3/5/23 – 5/3/23 with a start of care as 3/5/23. The plan of care/485 failed to include a physician signature, nurse practitioner signature or a physician’s assistant signature within 30 days per agency policy or to date. Patient #3 record review revealed a plan of care/485 for episode of 5/8/23 – 7/6/23 with a start of care as 5/8/23. The plan of care/485 failed to include a physician signature, nurse practitioner signature or a physician’s assistant signature within 30 days per agency policy or to date. An interview was conducted on 5/23/25 at 10:00 am with the Administrator. The surveyor reviewed the finding for the plans of care/485’s for Patient #1 and #3 with the Administrator in that they had not been signed by a physician. The surveyor asked the Administrator how the agency tracked orders. The Administrator explained that the VA has case managers and everything goes through them. We send the POC/485 to the case manager to get it signed. The surveyor asked who is responsible for getting the POC/orders signed. The Administrator said, “Me, I’m responsible for all documents to be signed.” The Surveyor asked the Administrator did he keep a log to track the orders. The Administrator said, “No.” The Surveyor asked what was the agency policy for obtaining physician signatures. The Administrator did not respond. The surveyor reviewed the agency policy 5.6 Orders for Care with the Administrator in that it states the agency is to obtain physician signatures within 30 days and the agency had failed to follow the agency policy. The Administrator said, “The VA is so complicated, they just tell me. I can’t tell them what to do when I try to explain that I need the orders signed and I have just chosen not to accept skilled referrals anymore.” An interview was conducted on 2/27/25 at 10:40 am with the Administrator. The Surveyor asked the Administrator how not obtaining the physician signature could affect patient care. The Administrator said, “You have to get directions from the physician, but the VA does not want to sign.””