| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017027 | (X3) Date Survey Completed 09/26/2018 |
| Name of Provider or Supplier Hga Homecare, Llc | Street Address, City, State 2050 Beltline Rd Sw, Decatur, AL | |
| For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency. | ||
| (X4) ID Prefix Tag | Summary Statement of Deficiencies
(Each deficiency should be preceded by full regulatory or LSC identifying information) |
| G0606 | 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: Based on medical record (MR) reviews, agency policies and procedure and interviews, it was determined the agency staff failed to ensure all initial evaluations were completed to meet patient needs and according to agency policy. This included physical therapy (PT), occupational therapy (OT), speech therapy (ST) and Medical Social Services (MSW) services and affected HV's # 1 and # 2, MR's # 2, # 10, # 1, which was 5 of 11 records reviewed with therapy and MSW services ordered. This had the potential to affect all patients who received therapy and MSW services. Findings include: Policy Number: 2.1.002 Subject: Patient Assessment, Initial and Reassessment Revised Date: 02/01/18 ...Policy: All patients admitted to the agency will receive an initial assessment...the assessing clinician may obtain input from...other healthcare personnel... Procedure: c. Physical Therapist, Speech Therapist, Occupational Therapist, Medical Social Worker...may make initial evaluations of the patient status to determine the need for specific therapists. This initial discipline specific evaluation)s) will occur within 5 days from the referral or sooner if medically necessary... 7. Patient/caregiver will be notified of any changes in the Plan of Care, including notification in changes in services and frequency of visits. Documentation of such communication shall be evident in the medical record... **** Policy Number: 2.1.017 Subject: Coordination of care, From Admit thorough Discharge Revision Date: 01/01/18 Policy: ...provides care and services within an integrated continuum of care system...by: Identifying patient needs through assessment and communication with other health care providers Procedure: 3. During time of referral transfer, or discharge... a. Patients are referred to alternative agencies when the patient requires services that unable to be met by the agency and/or for continuing care needs. 4. Coordination of care with physician... b. When changes occur in caregiver support or the environment that affect patient treatment ...Coordination of care among disciplines: c. Appropriate, timely communication with the patient, caregivers, and staff involved in then patient's care regarding patient needs, goals, and care... d. Completed visit notes submitted...within 24 hours of visit... 7. Coordination of care with patient and caregiver: Written information obtained from the plan of care will be provided to the patient and caregiver outlining: a. Visit schedule including frequency of visits by agency staff... d. Pertinent instructions related to the patient's care and treatments...specific to the patient's needs **** 1. HV # 1 was admitted to the agency 8/18/18 with diagnoses including Dizziness and Giddiness, Other Pancytopenia, Personal History of Nicotine Dependency and History of Falling. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 8/18/18 to 10/16/18 included a physician's verbal order dated 8/28/18 for MSW to make a visit to assess community resources. Further review revealed a physician's order dated 8/31/18 to omit order for MSW Week of 8/26/18. MSW to EVAL (evaluation) week of 9/2/18. Review of the MSW documentation dated 9/4/18 revealed an add-on evaluation visit was completed 7 days after the initial MSW eval order was obtained. There was no documentation the MSW attempted to complete an evaluation visit within the 5 day period and no documentation the MSW communicated with HV # 2 regarding delay in services. In an interview on 9/26/18 at 9:35 AM, Employee Identifier (EI) # 3, Performance Improvement Coordinator confirmed the aforementioned findings. 2. HV # 2 was admitted to the agency 9/1/18 with diagnoses including Sepsis due to Escherichia Coli, Bacteremia and History of Falling. Review of the HHC and POC dated 9/1/18 to 10/30/18 included a physician's verbal order dated 9/6/18 for MSW to eval for any services to assist patient with ADL (activities of daily living). Record review revealed a physician's order dated 9/7/1818 to reschedule MSW eval scheduled for week of 9/3/18 to 9/10/18 due to unable to schedule time with patient. There was no documentation the MSW attempted to schedule an eval visit with the patient. Review of the record revealed a physician's order dated 9/11/18 to reschedule MSW eval to week of 9/17/18 due to scheduling conflict. There was no documentation the MSW attempted to schedule an eval visit with the patient. On 9/18/18, which was 12 days after the initial MSW eval order dated 9/6/18, the MSW completed an add-on evaluation visit. There was no documentation the MSW attempted evaluation visits within the 5 day period and no documentation the MSW communicated with HV # 2 regarding the delay in services. In an interview conducted on 9/26/18 at 10:10 AM, EI # 1, Executive Director confirmed the above findings. 3. MR # 2 was admitted to the agency 2/9/18 with diagnoses including Traumatic Pneumothorax, Subsequent Encounter, Repeated Falls and Multiple Fractures of Ribs. Review of the HHC and POC dated 2/9/18 to 4/9/18 revealed physician orders for OT (evaluation) effective 02/18/18 1 WK (week) 1 (one visit for one week). Record review included documentation the OT Add-on Evaluation was completed on 2/21/18 which was 12 days after the start of care visit identified need for OT services. There was no documentation why the OT evaluation was scheduled 9 days after the start of care and not within 5 days per agency policy. There was no documentation the OT attempted to schedule the OT eval, the patient/caregiver refused the care and no documentation the delay on OT services was agreed upon by the patient/caregiver. During an interview on 9/26/18 at 9:35 AM, EI # 3, confirmed the aforementioned finding. 4. MR # 10 was admitted to the agency 9/7/18 with diagnoses including Hemiplegia Following Cerebral Infarct Affecting Left Nondominant Side and History of Falling. Review of the HHC and POC dated 9/7/18 to 11/5/18 included physician orders PT 1 WK 1 effective 9/16/18. There was no documentation why the PT evaluation was effective 9 days after the admission and no documentation the delay in PT services was reviewed with the patient/caregiver and agreed upon. Further review of the 9/7/18 HHC and POC revealed orders for Speech Therapy to evaluate/assess and develop speech therapy (ST) plan of care that will be approved by the physician prior to implementation. Record review revealed MR # 10 had a fall in the home on 9/12/18. Medical record review revealed a physician verbal order dated 9/13/18 with the following order description documented: ST eval to be moved to week of 9/23/18, message left at physicians office. There was no documentation the patient/caregiver was notified and agreed to the ST eval delay. The PT Add-On Evaluation was completed 9/18/18, 11 days after the start of care comprehensive assessment was completed and identified MR # 10's need for PT services. As of the record review date of 9/24/18 and 16 days after the comprehensive assessment identified MR # 10's need for ST services, there was no documentation ST had completed the evaluation. In an interview conducted on 9/26/18 at 11:30 AM, EI # 2, Clinical Director, confirmed the staff failed to document therapy service delays were agreed upon by the patient/caregiver and the staff failed to complete therapy evaluations per agency policy. 5. MR # 1 was admitted to the agency 5/9/18 with diagnoses including Encounter for Surgical Aftercare Following Surgery on the Circulatory System and Encounter for Orthopedic Aftercare Following Surgical Amputation. Review of the HHC and POC dated 5/9/18 to 7/7/18 revealed a physician's order for "Occupational Therapy (OT) to Evaluate/Assess and Develop OT Plan of Care..." with a frequency of "OT effective 5/13/18 1w1 (once a week for one week)". Review of the Client Coordination Note Report dated 5/18/18 revealed OT documentation of, "PCM (Patient Care Manager) - see patient next week for OT evaluation. No answer." Review of the Client Coordination Note Report dated 5/23/18 revealed OT documentation of, "Missed visit on 5/18/18, Reason no answer door/phone..." Further record review revealed no documentation the OT attempted an eval visit within the 5 days period or communicated with MR # 1 regarding delay in OT services. Review of the physician's order dated 5/18/18 revealed physician's order for "patient to be evaluated by OT week of 5/20/18. Frequency 1w1..." Record review revealed no documentation the OT attempted an eval visit or communicated with MR # 1 regarding delay in services from 5/20/18 to 6/6/18. Review of the physician's order dated 6/7/18 revealed the following physician's order, "Omit OT evaluation at patient request..." An interview was conducted on 9/26/18 at 10:33 AM with EI # 1, Executive Director, who confirmed the aforementioned finding. |