Premiere Home Health Services

“Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This Element is not met as evidenced by: Based on record reviews, interviews and observations, the agency failed to ensure that patients were provided with a visit schedule in 3 of 3 home visits conducted. Citing Patient # 8, Patient # 10 and Patient #11. This failure could prevent the patient and personnel from being aware of the patient’s schedule and could cause scheduling conflicts and missed visits leading to poor patient outcomes. Findings: Patient #8 Review of the EMR for Patient #8 revealed a plan of care with a certification period of 7/4/2024 - 9/1/2024. Further review of the plan of care revealed orders for the Skilled Nurse to visit 1 time per week for 9 weeks. A home visit was conducted with Patient #8 on 9/20/2024. During the visit, the surveyor attempted to reviewed Patient #8’s admission packet however, it was covered with roaches inside and out. There was no dated or filled out visit schedule anywhere in the patient’s immediate surroundings. An interview was conducted with Patient #8 on 9/20/2024 at approximately 10:40 a.m. The surveyor inquired if the agency ever filled out a visit schedule. Patient #8 stated “No.” The surveyor inquired how Patient #8 knew when agency staff was going to visit. Patient #8 stated “... She comes every Monday...” Patient #10 Review of the EMR for Patient #10 revealed a plan of care with a certification period of 7/23/2024 - 9/20/2024. Further review of the plan of care revealed orders for the Skilled Nurse to visit 1 time per week for 9 weeks and for the Home Health Aide to visit 7 days per week for 9 weeks. A home visit was conducted with Patient #10 on 9/20/2024. Patient #10’s admission packet was reviewed. There was no dated or filled out visit schedule in the admission packet. There was no dated or filled out visit schedule anywhere in the patient’s immediate surroundings. An interview was conducted with Patient #10 and Family Member AA on 9/20/2024 at approximately 11:40 a.m. The surveyor inquired if the Agency ever filled out a visit schedule. Family Member AA stated, “...No...” The surveyor inquired how Patient #10 knew when the agency staff was going to visit. Family Member AA stated, “...I know the nurse comes every Monday...” Patient #11 Review of the EMR for Patient #11 revealed a plan of care with a certification period of 718/2024 - 9/15/2024. Further review of the plan of care revealed orders for the Skilled Nurse to visit 1 time per week for 9 weeks and for the Home Health Aide to visit 5 days per week for 9 weeks and for Physical Therapy to evaluate and treat. A home visit was conducted with Patient #11 on 9/20/2024. Patient #11’s admission packet was reviewed. There was no dated or filled out visit schedule in the admission packet. There was no dated or filled out visit schedule anywhere in the patient’s immediate surroundings. An interview was conducted with Patient #11 on 9/20/2024 at approximately 12:05 p.m. The surveyor inquired if the Agency ever filled out a visit schedule. Patient #11 stated “...No...” The surveyor inquired as to how Patient #11 knew when agency staff was going to visit. Patient #11 stated, “...They call me...” An interview was conducted with the agency Administrator and the Office Assistant on 9/23/2024 at approximately 11:30 a.m. The surveyor reviewed the above findings with the Administrator and the Office Assistant and inquired as to why the agency was not filling out the visit schedules to leave in the Patient’s homes. The Office Assistant stated, “...We have never been told to do that... We just put a schedule in the chart...” The Administrator did not respond to the question. Review of the agency’s online policies and procedures did not reveal a policy regarding filling out a visit schedule to be left with the patients. An interview was conducted with the agency Administrator on 9/24/2024 at approximately 11:15 a.m. The surveyor inquired as to why there was no policy regarding patient visit schedules. The Administrator stated, “...I’ll have to call and find out...” No explanation or policy was given to the surveyor by the end of the survey.”

“Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) (1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech language pathology services— (A) A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient’s plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days; and (B) The home health aide does not need to be present during the supervisory assessment described in paragraph (h)(1)(i)(A) of this section. This Element is not met as evidenced by: Based on record review and interview the agency’s Director of Nursing failed to make onsite supervisory visits every 14 days in 7 of 7 patients who were receiving care from the agency’s Home Health Aide. Citing Patient # 3, Patient # 4, Patient # 5, Patient # 7, Patient #9, Patient #10 and Patient #11. This failure could place the patients at risk for receiving substandard care from a home health aide who does not have the required skills to adequately care for the patient. Findings: Patient #3 Review of the EMR for Patient #3 revealed a plan of care for the certification period of 8/17/2024 - 10/15/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #3 was receiving from the Home Health Aide. Patient #4 Review of the EMR for Patient #4 revealed a plan of care for the certification period of 8/3/2024 - 10/1/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #4 was receiving from the Home Health Aide. Patient #5 Review of the EMR for Patient #5 revealed a plan of care for the certification period of 7/28/2024 - 9/25/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #5 was receiving from the Home Health Aide. Patient #7 Review of the EMR for Patient #7 revealed a plan of care for the certification period of 5/22/2024 - 7/20/24. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #7 was receiving from the Home Health Aide. Patient #9 Review of the EMR for Patient #9 revealed a plan of care for the certification period of 7/20/2024 - 9/17/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #9 was receiving from the Home Health Aide. Patient #10 Review of the EMR for Patient #10 revealed a plan of care for the certification period of 7/23/2024 - 9/20/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #10 was receiving from the Home Health Aide. Patient #11 Review of the EMR for Patient #11 revealed a plan of care for the certification period of 7/18/2024 - 9/15/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #11 was receiving from the Home Health Aide. Review of an undated binder titled “...Sup Visits HHA...” revealed no supervisory visits for the Home Health Aides for patients and certification periods mentioned above. A telephone interview was conducted with the Director of Nursing on 9/23/2024 at approximately 11:30 a.m. The surveyor inquired as to why there were no supervisory visits in the EMR. The surveyor also inquired if the agency does supervisory visits for the Home Health Aides. The Director of Nursing stated, “...absolutely we do them every 2 weeks...” The surveyor inquired as to where was the documentation. The Director of Nursing stated, “...It’s either scheduled in the EMR or I call the office and it’s put on paper...” The telephone call then was disconnected. An interview was conducted with the Administrator on 9/24/2024 at approximately 11:00 a.m. The surveyor reviewed the above findings and inquired why there were no supervisory visits for the Home Health Aides done. The Administrator stated, “...I don’t know...” The surveyor inquired as to whose responsibility it was to see to it that the supervisory visits are done and documented. The Administrator stated “...That’s part of my responsibility...” A telephone interview was conducted with the Director of Nursing on 9/24/2024 at approximately 11:10 a.m. and the Administrator was also in the room during the interview. The surveyor inquired as to why the supervisory visits documentation was not in the binder. The Director of Nursing stated, “...They should be all in there...” The Administrator stated, “...Some of the supervisory visits were taken out...” The surveyor inquired as to why they were taken out. The Administrator stated, “...I don’t know...” No supervisory visits documentation was given to the surveyor by the end of the survey. Review of the agency’s policy titled, “AIDE SUPERVISORY VISITS MAC Legacy 2Q/2022 Page 1 of 2 Section 4.0 HH-FED...” read, in part, “POLICY A supervisory visit will be performed by an RN...every 14 days or less frequency and as needed in order to evaluate the quality and appropriateness of care provided by a CNA and to provide on-going training as appropriate and necessary...””

“HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient’s plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient’s condition; and (vi) Honoring patient rights. This Element is not met as evidenced by: Based on record review and interview the agency’s Director of Nursing failed to make onsite supervisory visits every 14 days in 7 of 7 patients who were receiving care from the agency’s Home Health Aide. Citing Patient # 3, Patient # 4, Patient # 5, Patient # 7, Patient #9, Patient #10 and Patient #11. This failure could place the patients at risk for receiving substandard care from a home health aide who does not have the required skills to adequately care for the client. Findings: Patient #3 Review of the EMR for Patient #3 revealed a plan of care for the certification period of 8/17/2024 - 10/15/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #3 was receiving from the Home Health Aide. Patient #4 Review of the EMR for Patient #4 revealed a plan of care for the certification period of 8/3/2024 - 10/1/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #4 was receiving from the Home Health Aide. Patient #5 Review of the EMR for Patient #5revealed a plan of care for the certification period of 7/28/2024 - 9/25/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #5 was receiving from the Home Health Aide. Patient #7 Review of the EMR for Patient #7 revealed a plan of care for the certification period of 5/22/2024 - 7/20/24. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #7 was receiving from the Home Health Aide. Patient #9 Review of the EMR for Patient #9 revealed a plan of care for the certification period of 7/20/2024 - 9/17/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #9 was receiving from the Home Health Aide. Patient #10 Review of the EMR for Patient #10 revealed a plan of care for the certification period of 7/23/2024 - 9/20/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #10 was receiving from the Home Health Aide. Patient #11 Review of the EMR for Patient #11 revealed a plan of care for the certification period of 7/18/2024 - 9/15/2024. Further review of the plan of care revealed orders for the Home Health Aide to visit 7 days per week for 9 weeks and for the Skilled Nurse to visit 1 day per week for 9 weeks. Further review of this certification period revealed that the Home Health Aides followed the plan of care and all of the visits were made. Nowhere in the EMR was there any documentation that there had been any supervisory visits to evaluate the care that Patient #11 was receiving from the Home Health Aide. Review of an undated binder titled “...Sup Visits HHA...” revealed no supervisory visits for the Home Health Aides for Clients and certification periods mentioned above. A telephone interview was conducted with the Director of Nursing on 9/23/2024 at approximately 11:30 a.m. The surveyor inquired as to why there were no supervisory visits in the EMR. The surveyor also inquired if the agency does supervisory visits for the Home Health Aides. The Director of Nursing stated, “...absolutely we do them every 2 weeks...” The surveyor inquired as to where was the documentation. The Director of Nursing stated, “...It’s either scheduled in the EMR or I call the office and it’s put on paper...” The telephone call then was disconnected. An interview was conducted with the Administrator on 9/24/2024 at approximately 11:00 a.m. The surveyor reviewed the above findings and inquired why there were no supervisory visits for the Home Health Aides done. The Administrator stated, “...I don’t know...” The surveyor inquired as to whose responsibility it was to see to it that the supervisory visits are done and documented. The Administrator stated “...That’s part of my responsibility...” A telephone interview was conducted with the Director of Nursing on 9/24/2024 at approximately 11:10 a.m. and the Administrator was also in the room during the interview. The surveyor inquired as to why the supervisory visits documentation was not in the binder. The Director of Nursing stated, “...They should be all in there...” The Administrator stated, “...Some of the supervisory visits were taken out...” The surveyor inquired as to why they were taken out. The Administrator stated, “...I don’t know...” No supervisory visits documentation was given to the surveyor by the end of the survey. Review of the agency’s policy titled, “AIDE SUPERVISORY VISITS MAC Legacy 2Q/2022 Page 1 of 2 Section 4.0 HH-FED...” read, in part, “POLICY A supervisory visit will be performed by an RN...every 14 days or less frequency and as needed in order to evaluate the quality and appropriateness of care provided by a CNA and to provide on-going training as appropriate and necessary...””