Green Cross Home Care Services, Inc

The provider failed to ensure the Condition of Participation for Clinical Records requirement was met by failing to: Consult the physician to clarify contradictory orders on the plan of care (refer to G572); Ensure the plan to care includes directions for care and necessary equipment (refer to…

The provider failed to ensure the Condition of Participation for Clinical Records requirement was met by failing to: Ensure the accuracy of the clinical record by documenting care during times it could not have been provided (refer to G1012); Ensure documentation of interventions, including…

The provider failed to implement its policies and procedures and to document viable individualized emergency plans for 2 of 5 sampled patients (Patients #1 and #5).

The provider failed to obtain the signature of 1 of 5 sample patients (Patient #5) or, in the case of a minor child, their legal representative for notice of their rights and responsibilities.

The provider failed to inform patients and/or their representatives of charges and expected payment sources in advance of care for 1 of 5 patients (Patients #5).

The provider failed to notify the physician when orders could not be followed and the plan of care needed to be altered for 1 of 5 sampled patients (Patient #1).

The Administrator failed to be responsible for all day-to-day operations to ensure corrective actions were developed and carried out to correct deficient practices.

The Administrator failed to ensure 1 of 15 staff (Staff A) who provide services directly to patients had an eligible level 2 background screen as required by the state; and failed to ensure 5 of 8 sampled staff (Staff A, C, E, F, and G) were entered in the clearinghouse roster (Background Screening…

The Director of Nursing failed to assure plans of care were complete and implemented with updates every 60 days for 2 of 5 patients (Patients #1 and 5).

The provider failed to ensure documentation of interventions, including the medications and tube feedings administered to 1 of 5 sampled patients (Patient #1).

The provider failed to document and maintain relevant accurate contact information for 2 of 5 sampled patients (Patients# 3 and 5).

The agency failed to ensure the Condition of Participation for Quality Assessment/Performance Improvement (QA/PI) requirement was met by failing to ensure implementation of a Quality Assessment Program to monitor effectiveness, safety of services, and quality of care as well as develop, implement…

The Home Health Agency failed to provide proof of having conducted exercises to test the emergency plan at least annually.

The Home Health Agency failed to electronically transmit each completed Outcome and Assessment Information Set (OASIS) assessment to the Centers for Medicare and Medicaid Services (CMS) system, within 30 days of completing the assessment of the patient for 5 out of 6 patients reviewed.

The Home Health Agency failed to show measurable improvement in indicators for which there is evidence that improvement in those indicators will improve health outcomes, patient safety, and quality of care.

The Home Health Agency failed to a QAPI program was in place that utilized relevant data in the design of its program.

The Home Health Agency failed to provide proof of performance improvement activities for review.

The Home Health Agency failed to track adverse patient events, analyze their causes, and implement preventive actions.

The Home Health Agency failed to conduct performance improvement projects.

The Home Health Agency Governing Body failed to ensure that an ongoing program for quality improvement and patient safety is defined, implemented, and maintained.

The Home Health Agency failed to conduct training in emergency preparedness policies and procedures to new and existing on 10 out of 10 Staff (Staff A, Staff B, Staff C, Staff D, Staff E, Staff F, Staff G, Staff H, Staff I, and Staff J), consistent with their expected role.

This HHA failed to demonstrate that they conducted a community-based or individually based exercise; failed to document any full scale exercise, a table top exercise, and failed to demonstrate analysis to support the exercises conducted.

The home health agency is unable to demonstrate it has provided the patient and representative (if any) of the right to be informed of the Home Health Agency's policies for transfer and discharge on 3 out of 10 Sampled Patients (SP).

The home health agency failed to have a completed comprehensive assessment for 3 out of 10 Sampled Patients (SP).

The home health agency failed to develop an individualized Plan of Care (POC) that identifies patient-specific measurable outcomes and goals for 6 out of 10 Sampled Patients (SP).

The home health agency failed to have skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are provided directly through agency employees.

The home health agency failed to have a Registered Nurse (RN) conduct the initial assessment visit to determine the immediate care and support needs of the patient for 1 out of 10 Sampled Patients (SP).

The home health agency failed to include in the individualized plan of care the following; the patient's mental, and cognitive status; supplies, and equipment required; rehabilitation potential; functional limitations; a description of the patient's risk for emergency department visits and hospital…

The home health agency is unable to demonstrate Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician and after an assessment of the patient to determine for contraindications.

The home health agency failed to assure communication with the patient's physician involved in the plan of care for 1 out of 10 Sampled Patients (SP).

The home health agency staff failed to prepare and record clinical notes for 2 out of 10 Sampled Patients (SP).

The home health agency failed to have in the clinical record current comprehensive assessment completed, clinical notes and plans of care for 6 out of 10 Sampled Patients (SP).

The home health agency failed to ensure the clinical record included a completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer…

The Home Health Agency failed to ensure that the Administrator or a pre-designated person is available during all operating hours.

The Home Health Agency failed to ensure an employee conformed to the physician's orders for 1 out of 3 Sampled Patients (SP).

The Home Health Agency failed to ensure one employee documented complete and accurate information in 1 out of 3 Sampled Patients (SP)'s record.

The provider failed to show that 1 out of 4 (Staff A) skilled nurses was currently licensed in the State of Florida.

The provider failed to ensure that 1 out of 3 sample patient records (#1) included completed clinical notes.

The Home Health Agency (HHA) failed to develop, establish and maintain a comprehensive emergency preparedness plan that must be reviewed and updated at least annually (E0004).

The Home Health Agency (HHA) failed to demonstrate it had provided written notice of the patient's rights and responsibilities (G412), The HHA failed to provide the contact information for the Home Health Agency's administrator, including the administrator's name, business address, and business…

The provider failed to develop, establish and maintain a comprehensive emergency preparedness plan that must be reviewed and updated at least annually.

The provider failed to develop and maintain an emergency preparedness plan that must be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach and include strategies for addressing emergency events identified by the risk assessment.

The provider failed to develop an emergency preparedness plan that addresses patient/client population, the type of services the [facility] has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.

The provider failed to develop an emergency preparedness plan that include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation, including…

The provider failed to develop and implement emergency preparedness policies and procedures that must be reviewed and updated at least annually.

The provider failed to ensure its emergency preparedness plan addressed the procedures to inform State and local emergency preparedness officials about patients in need of evacuation from their residences at any time due to an emergency situation based on the patient's medical and psychiatric…

The provider failed to ensure its emergency preparedness plan included procedures to follow up with on-duty staff and patients to determine services that are needed, in the event that there is an interruption in services during or due to an emergency, and procedures on how the home health agency…

The provider failed to develop emergency preparedness policies and procedures to address a system of medical documentation that preserves patient information, protects confidentiality of patient information, and secures and maintains availability of records.

The provider failed to develop and implement emergency preparedness policies and procedures that must address the use of volunteers in an emergency or other emergency staffing strategies.

The provider failed to develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least annually.

The provider failed to develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws that includes Names and Contact information for the following: Staff; Entities providing services under arrangement; Patients' physicians; Other [facilities] and…

The provider failed to ensure its emergency preparedness communication plan included contact information for Federal, State, tribal, regional, and local emergency preparedness staff and other sources of assistance.

The provider failed to develop and maintain an emergency preparedness communication plan that includes primary and alternate means for communicating with the staff and Federal, State, tribal, regional, and local emergency management agencies.

The provider failed to develop and maintain an emergency preparedness communication plan that include method for sharing information and medical documentation for patients under the [facility's] care, as necessary, with other health providers to maintain the continuity of care.

The provider failed to develop and maintain an emergency preparedness communication plan that include a means of providing information about the occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee.

The provider failed to develop an emergency preparedness training and testing program that is based on the emergency plan.

The provider failed to conduct initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role; provide emergency preparedness training at least annually; maintain…

The provider failed to participate in a full-scale exercise that is community-based and/or an individual facility-based exercise; failed to conduct additional exercise and failed to analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency…

The provider failed to ensure that OASIS (Outcome and Assessment Information Set) data is electronically transmitted regarding each beneficiary with respect to which information is required to be transmitted within 30 days of completing the assessment of the beneficiary on 4 out of 7 Sampled…

The provider failed to provide the patient and representative (if any) of the right to be informed of the Home Health Agency's policies for transfer and discharge on 2 out of 8 Sampled Patients (SP).

The provider failed to have a completed comprehensive assessment for 1 out of 8 Sampled Patients (SP).

The provider failed to develop an individualized plan of care (POC) that identifies patient-specific measurable outcomes and goals for 1 out of 8 Sampled Patients (SP).

The provider failed to ensure that the Physical Therapist Assistant (PTA) followed the written Plan of Care (POC) as ordered by the physician for 1 out of 8 Sampled Patients (SP).

The home health agency staff failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases for 3 out of 3 Sampled Patients(SP) with home visits made.

The provider failed to show that 2 out of 5 home health aide/certified nursing assistant received at least 12 hours of in-service training during each 12-month period.

The provider failed to ensure that a Registered Nurse (RN) provided written care instructions for the Home Health Aide (HHA) to follow for 1 out 8 Sampled Patients (SP) reviewed.

The provider failed to have skilled nursing services and at least one other therapeutic service (physical therapy, speech-language pathology, or occupational therapy; medical social services; or home health aide services) are provided directly through agency employees.

The provider failed to ensure the clinical record includes all entries must be legible, clear, complete, and appropriately authenticated (signature and a title), dated, and timed for 3 out of 8 Sample Patients (SP).

The provider failed to demonstrate it had provided written notice of the patient's rights and responsibilities, and the Home Health Agency's transfer and discharge policies for 2 out of 8 Sampled Patients (SP).

The provider failed to provide the contact information for the Home Health Agency's administrator, including the administrator's name, business address, and business phone number in order to receive complaints for 3 out of 6 Sampled Patient (SP) actively receiving care from the Home Health Agency.

The provider failed to demonstrate it had provided the OASIS (Outcome and Assessment Information Set) Privacy Notice for whom the OASIS data is collected at the time of the initial evaluation visit for 1 out of 8 Sampled Patients (SP).

The provider failed to demonstrate it had obtained the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities for 2 out of 8 Sampled Patients (SP).

The provider failed to demonstrate it had provided written notice of the patient's rights and responsibilities, and the Home Health Agency's transfer and discharge policies within 4 business days of the initial evaluation visit for 2 out of 8 Sampled Patients (SP).

The provider failed to demonstrate it had the patient(s) participate in, be informed about, and consent or refuse care in advance of and during treatment of the care to be furnished, the disciplines that will furnish the care, and the frequency of visits for 4 out of 8 Sampled Patients (SP).

The provider failed to demonstrate it advised the patient prior to initiation of service(s) the extent to which planned services would be covered by federally funded programs and the expected out-of-pocket cost to the patient for the services not covered by federally funded or federal aid program…

The provider failed to demonstrate it had provided the patient of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local Home Health Agency's for 2 out of 8 Sampled Patients (SP).

The provider failed to advise of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource…

The provider failed to demonstrate it had provided the patient with information related to be free from any discrimination or reprisal for exercising his or her rights or for voicing grievances to the Home Health Agency or an outside entity for 2 out of 8 Sampled Patients (SP).

The provider failed to demonstrate it had provided the patient with information of the right to access auxiliary aids and language services, and how to access these services for 2 out of 8 Sampled Patients (SP).

The provider failed to have the comprehensive assessment accurately reflect the patient's functional and cognitive current status for 3 out of 8 Sampled Patients (SP).

The provider failed to have the comprehensive assessment accurately reflect the patient's strengths current status for 2 out of 8 Sampled Patients (SP).

The provider failed to ensure that a review of all medications the patient is taking in 2 out of 3 Sampled Patients (SP) with home visits.

The provider failed to include in the individualized plan of care the following: cognitive status; frequency and duration of visits to be made; functional limitations; activities permitted; safety measures to protect against injury; nutritional requirements; a description of the patient's risk for…

The provider failed to have the home health agency staff administer drugs and treatments only as ordered by a physician for 1 out of 3 Sampled Patients (SP) with home visits done.

The provider failed to develop influenza and pneumococcal vaccines policies in consultation with a physician.

The provider failed to demonstrate the verbal order(s) contained signature, date, and time the order(s) in 1 out of 8 Sampled Patients (SP).

The provider failed to promptly alert the relevant physician(s) to any changes that suggest the plan of care should be altered for 1 out of 8 Sampled Patients (SP).

The provider failed to maintain documentation of any revision to the established plan of care by the physician issuing order for the home health agency plan of care for 1 out 8 Sampled Patients (SP).

The provider failed to demonstrate integration of orders from all physicians involved in the plan of care to assure the coordination of all services and interventions provided to the patient for 2 out of 8 Sampled Patients (SP).

The home health agency failed to provide the visit schedule, including frequency of visits by the Home Health Agency personnel and personnel acting on behalf of the Home Health Agency to 2 out of 8 Sampled Patients (SP).

The home health agency failed to provide the medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by the agency's personnel and personnel acting on behalf of the agency to 1 out of 8 Sampled Patients (SP).

The home health agency failed to provide the name and contact information of the Home Health Agency clinical manager for 2 out of 6 Sampled Patient (SP) actively receiving care from the Home Health Agency.

The home health agency staff failed to prepare and record clinical notes for 1 out of 8 Sampled Patients (SP).

The provider failed to maintain documentation which demonstrates that an individual may furnish home health services on behalf of an Home Health Agency only after that individual has successfully completed a competency evaluation program for 5 out of 5 personnel file review.

The provider failed to ensure that an onsite visit to the patient's home no less frequently than every 14 days is conducted for supervision of the Home Health Aide (HHA) by a Registered Nurse or other appropriate skilled professional in 1 out of 8 Sampled Patients (SP).

The Administrator failed to ensure that the Home Health Agency employs qualified personnel, including assuring the development of personnel qualifications and policies on 1 out of 10 Staff.

The provider failed to have the clinical manager assure the implementation, and updates of the individualized plan of care for 1 out of 8 Sampled Patients (SP).

The home health agency staff failed to provide service in accordance with accepted professional standards of practice for 1 out of 3 sampled patients (SP) with home visits made, SP#3. Findings include: Review of SP#3's record revealed a start of care dated 04/05/19. A review of SP#3's POC for…

The provider failed to have in the clinical record all clinical notes, plans of care, and physician orders for 3 out of 8 Sampled Patients (SP).

The provider failed to maintain a complete and accurate medical record that included all interventions, treatments, and responses to those interventions for 2 out of 8 sampled patients (SP).

The provider failed to demonstrate it had provided written notice of the patient's rights and responsibilities, and the Home Health Agency's transfer and discharge policies for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had provided the contact information for the Home Health Agency (HHA) administrator, including the administrator's name, business address, and business phone number in order to receive complaints for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had provided the OASIS (Outcome and Assessment Information Set) Privacy Notice for whom the OASIS data is collected at the time of the initial evaluation visit for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had obtain the patient's or legal representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities. for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had provided written notice of the patient's rights and responsibilities, and the Home Health Agency's transfer and discharge policies within 4 business days of the initial evaluation visit for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had the patient participate in, be informed about, and consent or refuse care in advance of and during treatment for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it advised the patient prior to initiation of service(s) the extent to which planned services would be covered by federally funded programs and the expected out-of-pocket cost to the patient for the services not covered by federally funded or federal aid program…

The provider failed to demonstrate it had provided the patient of the state toll free home health telephone hot line, its contact information, its hours of operation, and that its purpose is to receive complaints or questions about local Home Health Agency's for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had provided the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and…

The provider failed to demonstrate it had provided the patient with information related to be free from any discrimination or reprisal for exercising his or her rights or for voicing grievances to the Home Health Agency or an outside entity for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had provided the patient with information of the right to access auxiliary aids and language services, and how to access these services for 1 out of 3 Sampled Patients (SP).

The provider failed to include in the individualized plan of care the following: all medications and treatments; 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; and information…

The provider failed to document the physician's verbal order in the patient's clinical record, and sign, date, and time the orders in 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate integration of orders from all physicians involved in the plan of care to assure the coordination of all services and interventions provided to the patient for 1 out of 3 Sampled Patients (SP).

The provider failed to demonstrate it had provided the name and contact information of the Home Health Agency's clinical manager for 1 out of 3 Sampled Patients (SP).

The home health agency staff failed to prepare and record clinical notes for 2 out of 3 Sampled Patients (SP).

The provider failed to have the clinical manager assure that patient needs are continually assessed for 1 out of 3 Sampled Patient (SP).

The provider failed to have the clinical manager assure the implementation, and updates of the individualized plan of care for 2 out of 3 Sampled Patient (SP).

The provider failed to maintain a clinical record that contained all physician(s) orders for 1 out of 3 Sampled Patients (SP).

The provider failed to maintain the content of clinical record that includes all interventions rendered by the home health agency staff for 1 out of 3 Sampled Patients (SP).

The provider failed to ensure the confidentiality of patients' records for 5 out of 16 (10, 12, 13, 15,16) sample patients (SP).