Vika Medical Services LLC

“12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This Standard is not met as evidenced by: Based on record review and interview, the agency failed to ensure that one of one home health aide (Employee D) whose record was reviewed, had completed at least 12 hours of in-service training during the 12-month period for the year 2022. The failure could place patients who received care from the employee at risk to not receive safe, quality and appropriate care and services due to lack of continuing education. Review of the active employee list that was provided by the Administrator on 11/09/2023 revealed Employee D’s date of hire was 04/09/2018. HHA Personnel Record: Review of the personnel record for home health aide (Employee D) included signed home health aide job descriptions that were dated 04/09/2018, 4/09/2019, 04/09/2020, 4/08/2021, 4/08/2022, 04/08/2023. The personnel record for Employee D did not include any in-service hours for 2022. Review of the agency in-service records for 2022 did not include any in-service hours for Employee D. During an interview with the Administrator on 11/10/2023 at approximately 1:15 p.m., the surveyor discussed the above findings of why the in-service training for Employee D was not completed for 2022. The Administrator stated, “She didn’t really do in-services in 2022. She didn’t have any clients, so she didn’t really do them.” The surveyor asked if Employee D was employed by the agency as a home health aide in 2022. The Administrator stated, “Yes, but she did not have patients.” The surveyor asked the Administrator if the agency had a patient that required a home health aide would Employee D have provided the service to the patient. The Administrator stated, “Yes, she would.” Review of agency undated policy titled “HR.12 In-services and Administrator Training” The policy read in part: “PURPOSE: To define the in-service/continuing education/administrative training requirements for Agency staff...POLICY: … All home Health Aides are required to have at least twelve (12) hours of in-service training in each 12-month period...PROCEDURE...G. A record of in-service attendance and CNE’s is maintained and kept in the employee personnel file or in-service manual.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: THIS IS A CONTINUING DEFICIENCY PREVIOUSLY CITED FROM THE SURVEY DATED 01/08/2021 PREVIOUSLY CITED AT G-0574 Based on record review and interview, the agency failed to individualize Plans of Care to include patient interventions and treatments. In 2 (Patient #1 and #2) of 2 clinical records reviewed where the patients had a diagnosis of ESRD and received services from a dialysis facility, the agency failed to include instructions on the plans of care for the skilled nurses to assess/monitor the patients’ AV fistulas. The failure of the agency to individualize the Plans of Care placed Patients #1 and #2 at risk for infection, bleeding or obstruction of the AV fistulas with complications that could cause a permanent decline in the patients’ functional status or death. Definition: Arteriovenous fistulae and grafts are artificial blood vessel connections between an artery and a vein. They are used to facilitate kidney dialysis - a treatment that uses a special machine to remove waste materials from the body. Definition: A healthy AV fistula has: A bruit (a rumbling sound that you can hear) A thrill (a rumbling sensation that you can feel) Good blood flow rate. Definition: End Stage Renal Disease (ESRD) - When the kidneys no longer work to clean the blood from toxins, impurities, and excess water. Patient #1: Record review of the clinical record included a POC with a SOC date 08/25/2023 for the certification period 08/25/2023 – 10/23/2023. The POC included the diagnosis ESRD and Dependence on renal dialysis. Physician orders included, “... SN to assess other co-morbidities including hypertensive heart with chronic kidney disease, chronic kidney disease stg. 5... and other conditions that present themselves during this episode of care....” The POC did not include orders for the SN to assess/monitor the AV Fistula site for the following: signs or symptoms of infection, bleeding and a bruit and thrill. A SOC Comprehensive assessment dated 08/25/2023, was completed by the Director of Nurses/RN, Employee B. Included on page 2 of the assessment was a section titled, “Special Treatments, Procedures, and Programs” which contained the following checked marked boxes: “J1. Dialysis…J2. Hemodialysis.” Patient #2: Record review of the clinical record included a POC with a SOC date 12/11/2020 for the certification period 07/29/2023 – 09/26/2023. The POC included the diagnosis ESRD and Dependence on renal dialysis. Physician order included, “... SN to assess…conditions that present themselves during this episode of care. SN to recognize and intervene to minimize complications.” The POC did not include orders for the SN to assess/monitor the AV Fistula site for the following: signs or symptoms of infection, bleeding and a bruit and thrill. A Recertification comprehensive assessment dated 07/24/2023, was completed by Employee B. Included on page 6 of the assessment was a section titled, “ “ELIMINATION STATUS/Genitourinary Assessment” which contained the following checked marked boxes: “Dialysis... Hemodialysis.... Dialysis Treatment Schedule: Monday; Wednesday and Friday…Comments Patient…Dialysis access is with no s/s of infection.” In an interview with the Administrator, Employee A and Director of Nursing, Employee B on 11/16/2023 at approximately 11:11 AM, the surveyor reviewed the survey findings and asked who at the agency is responsible for creating the plan of care and assuring all required information is included in the plan of care. Employee B stated, “I do the plan of care.” The surveyor asked if Employee B created the plan of care for Patient #1 and #2. Employee B stated, “Yes.” The surveyor asked why the agency did not ensure the plan of care for Patients #1 and #2 included instructions for the SN to assess the patients AV fistula’s. Employee B stated, “They are all nurses they should be able to know that the need to look at the AV fistula.” The surveyor asked if the plan of care is used by the agency nurses to tell them what care needs to be provided and what assessments need to be done for the patient. Employee B stated, “Yes.” The surveyor asked why the plan of cares did not include instructions for agency skilled nurses to assess the patients’ AV fistulas. Employee B stated, “It should have been put in the plan of care when I fill it out in the OASIS. I don’t know why it wasn’t in the plan of care. We will have to talk to the software to have them add it in.” The surveyor reviewed the citations from the previous survey that was completed on 01/08/2021. The surveyor explained that the agency was cited for the same thing during that survey. The surveyor asked why the agency did not make the corrections from the previous survey. Employee B stated, “I didn’t… I don’t know that it was the same. I thought it was about not documenting the Dialysis Center. We will have to talk to the software to get it fixed.””

“Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This Element is not met as evidenced by: THIS IS A CONTINUING DEFICIENCY FROM SURVEY DATED 01/08/2021, PREVIOUSLY CITED AT G-0606 Based on record review and interview, the agency failed to ensure coordination of services between the agency and all disciplines providing care for 2 (Patients #1 and #2) of 2 active patients who received dialysis services and whose records were reviewed. Failure of the agency to ensure effective coordination of care and services provided by other health care providers placed patients at a risk of harm, due to a lack of shared information regarding the ongoing care and service needs. Definition: Arteriovenous fistulae and grafts are artificial blood vessel connections between an artery and a vein. They are used to facilitate kidney dialysis - a treatment that uses a special machine to remove waste materials from the body. Patient #1: Record review of the clinical record included A SOC Comprehensive assessment dated 08/25/2023, was completed by the Director of Nurses/RN, Employee B. Included on page 2 of the assessment was a section titled, “Special Treatments, Procedures, and Programs” which contained the following checked marked boxes: “J1. Dialysis…J2. Hemodialysis.” Further review of the record failed to include any documentation of the name, address or phone number for the dialysis facility for Patient #1. Review of the clinical record failed to include documentation that the agency had notified the dialysis facility that Patient #1 was receiving home health care for skilled nurse services. Patient #2: Record review of the clinical record included A Recertification comprehensive assessment dated 07/24/2023, was completed by Employee B. Included on page 6 of the assessment was a section titled, “ “ELIMINATION STATUS/Genitourinary Assessment” which contained the following checked marked boxes: “Dialysis... Hemodialysis.... Dialysis Treatment Schedule: Monday; Wednesday and Friday…Comments Patient…Dialysis access is with no s/s of infection.” Further review of the record failed to include any documentation of the name, address or phone number for the dialysis facility for Patient #2. Review of the clinical record failed to include documentation that the agency had notified the dialysis facility that Patient #2 was receiving home health care for skilled nurse services. In an interview with the Administrator, Employee A and Director of Nursing, Employee B on 11/16/2023 at approximately 11:11 AM, the surveyor asked why the agency failed to coordinate services with the dialysis facilities for Patients #1 and #2. Employee B stated, “sometimes they d on’t even know with these patients they don’t even know the numbers for dialysis centers when I am doing the OASIS I always ask them but sometimes they don’t know.” The surveyor asked if Employee B is referring to the patient does not know the contact information for the dialysis center. Employee B stated, “yes, I ask them but they don’t ever know.” The surveyor asked if it’s the agency responsibility to coordinate services with the dialysis center. Employee A stated, “Yes.” The surveyor asked if the agency communicated with the dialysis center for Patient #1 or #2. Employee B stated, “If we do need to, we will communicate with them and then we put it in a communication.” The surveyor asked if the agency has any communication forms with the dialysis center for Patient #1 or Patient #2. Employee B stated, “no, we don’t have any of them documented.” The surveyor asked who was ultimately responsible for making sure that coordination of services is done between the agency and the dialysis center. Employee A stated, “Employee B and I have to take responsibility for this too. I have to make sure it gets done.” The surveyor reviewed the citations from the previous survey that was completed on 01/08/2021. The surveyor explained that the agency was cited for the same thing during that survey. The surveyor asked why the agency did not make the corrections from the previous survey. Employee B stated, “We have the forms, and the nurse needs to document on the form. I don’t know why it was not done.” Agency policy, revised date 01/01/21, reads in part, “Administrative Policy Manual, TX. 8 Coordination of Care...To ensure an interdisciplinary approach to coordination of care, treatment, and services. Policy... A. The agency will use an interdisciplinary approach to coordinate services with all healthcare providers... D. All coordination of care will be appropriately documented in the clinical record, coordination of care form with other providers and entities, one on one verbal communication, formal case conference, written communication either hand written or electronic....””