Procare Home Health Services

The agency’s QAPI binder was provided for review on 01/04/2024, and evidenced comparison scores for quarter 3 2023, which indicated the agency did not meet national and state averages for managing daily activities, improving at getting in/out of bed, improving at bathing, improvement in breathing…

The agency failed to coordinate care delivery to meet the patient’s needs, and involve the patient’s caregivers, as appropriate, in the coordination of care activities for 1 of 1 active pediatric patients.

The agency failed to ensure the comprehensive assessment was patient-specific in 5 of 7 complete active clinical records reviewed with a comprehensive assessment (Patient #1, 2, 3, 5, and 7); the home health agency failed to complete the initial assessment within 48 hours of referral (See G0514)…

The agency failed to ensure home health aides (HHA) successfully completed a competency evaluation program in 1 of 1 personnel record reviewed of home health aide with their first patient contact after 11/01/23 (HHA 3).

The agency failed to ensure written notice of the patient’s rights and responsibilities were provided in a manner understandable 1 on 1 clinical record reviewed with English not the primary language.

The agency failed to ensure the initial assessment visit was conducted within 48 hours of referral in 3 of 5 active clinical records reviewed with start of care dates since the date of the last survey of 8/30/2023. (Patient #2, 6, 8) The findings include: 1. A clinical record review for Patient #2…

The agency failed to ensure the comprehensive assessment was completed within 5 days of the start of care in 3 of 4 active clinical records reviewed with therapy services ordered upon referral since the last survey on 8/30/2023. (Patients #2, 6, 9) The findings include: 1. Clinical record review…

The agency failed to ensure a comprehensive assessment was completed for 1 of 2 closed records reviewed with a discharge for goals met (Patient #12).

The agency failed to ensure the home health aide (HHA) competency evaluation program was not offered by the agency which was subjected to a fully extended survey and found to have furnished substandard care in the last 2 years in 1 of 3 personnel records reviewed of home health aides.

The clinical manager failed to provide oversight of the assignment of staff in 4 of 9 active clinical records reviewed.

1. Review of an agency policy revised 1/21/2021, titled “Patient Discharge Process” stated, “… Discharge planning is initiated for every home care patient at the time of the patient’s admission for home care … The physician will be involved in the discharge plan and specific ongoing care needs will…

The home health agency failed to develop and maintain a comprehensive emergency preparedness plan.

The home health agency failed to follow its policies for discharge planning, failed to establish an agency policy (see G560) and failed to send all necessary medical information pertaining to the patient’s current course of illness and treatment to the receiving health care practitioner to ensure a…

The home health agency failed to ensure: the agency met the patient needs (see G570); the plan of care was reviewed by the physician, individualized and followed by all agency staff (See tag G0572); the plan of care included all required information / elements for the treatment of the patient (See…

The home health agency failed to develop and maintain a QAPI (quality assessment performance improvement) program that included aggregation of data, identification of issues, projects to address issues, and measurable patient outcomes related to health and safety.

The skilled professional failed to provide the services as indicated in the plan of care (See tag G0710); failed to provide the patient and caregiver education (See tag G0714); failed to prepare clinical notes (See tag G0716); and failed to communicate with the physician and other health care…

The home health agency failed to ensure the organization and management of the home health agency as follows: the administrator failed to maintain the day-to-day operations of the agency (see tag G0948); the clinical manager failed to coordinate referrals (see tag G0964); the clinical manager…

The home health agency failed to ensure all patients had an individualized emergency preparedness plan for 3 of 3 home visits conducted.

The agency failed to ensure the discharge/transfer summary contained all necessary information regarding the patient’s discharge including medications and post-discharge goals of care and failed to ensure the discharge summary was sent to the patient’s physician responsible for the plan of care…

The agency failed to establish a plan of care and failed to ensure services were provided as directed in the plan of care in 5 of 9 clinical records reviewed.

The agency failed to ensure conformance with physician orders in 3 of 3 clinical records reviewed with wounds.

The home health agency failed to ensure all employees practiced standard/universal precautions to prevent the transmission of infections and failed to follow agency infection control policies and procedures in 2 of 3 home visits.

The agency failed to ensure the staff was educated per agency policy on infection prevention and control.

The agency failed to ensure the home health aide (HHA) was oriented to the HHA care plan as assigned by the registered nurse for 3 of 3 clinical records reviewed with home health aide (HHA) services.

The home health agency failed to ensure all electronic entries were authenticated to include the name and date of the clinician responsible for 3 of 3 clinical records reviewed with home health aide (HHA) services.

The agency failed to ensure the patient’s rights to participate in care and be informed in advance of the care to be furnished, the disciplines providing the care, and the frequency of the care to be furnished in 7 of 9 clinical records reviewed.

The agency failed to document patient complaints and resolution in 1 of 1 clinical record reviewed with a patient complaint.

The agency failed to ensure all medications were reviewed for potential adverse effects and drug reactions and /or failed to follow the agency policy on reporting any identified problems to the physician in 5 of 9 clinical records reviewed.

The agency failed to ensure the comprehensive assessment included the availability, ability, and willingness of the caregiver in 3 of 9 clinical records reviewed.

The agency failed to ensure the plan of care was individualized to include interventions, medications, medical supplies, measurable outcomes and goals, and discharge plans for 9 of 9 clinical records reviewed.

The agency failed to ensure the services and treatments were provided only as ordered by a physician in 6 of 9 clinical records reviewed.

The agency failed to have the physician review and revise the plan of care no less than every 60 days for 2 of 3 clinical records reviewed receiving services greater than 60 days.

The agency failed to ensure physician notification for services not provided as ordered on the plan of care for 3 of 6 clinical records reviewed with therapy services ordered.

The agency failed to ensure the plan of care was revised as needed with any changes in 3 of 9 clinical records reviewed.

The home health agency failed to coordinate care with between disciplines and with other entities providing care to the patient in 6 of 9 clinical records reviewed.

The agency failed to provide the patient a written visit schedule in 3 of 3 home visits.

The agency failed to provide the patient a written medication schedule and instructions in 3 of 3 home visits.

The agency failed to provide the patient in writing the services and treatments to be provided by the agency in 3 of 3 home visits.

The agency failed to provide in writing the name and contact information of the clinical manager to the patient in 1 of 1 home visit with a home health aide (HHA).

The skilled professional failed to provide services as directed in the plan of care in 5 of 9 clinical records reviewed.

The skilled professional failed to educate the patient/caregiver in 1 of 1 clinical record reviewed with parameters for blood sugar levels without a glucometer (a device used to check blood sugar) (Patient #1) and 1 of 1 clinical record reviewed with a fall (Patient #2).

The skilled professional failed to accurately, completely, and timely prepare clinical notes in 8 of 9 clinical records reviewed.

The skilled professionals failed to ensure changes in patient conditions were reported to the physician for 5 of 9 clinical records reviewed (Patient #1, #2, #5, #6, #7).

The agency failed to ensure all home health aides (HHA) followed the plan of care for 1 of 3 patients who received HHA services, from a total sample of 7 clinical records reviewed with orders for an HHA (patient #9).

The agency failed to ensure the overall quality of care provided by a home health aide (HHA) in 1 of 1 home visit conducted with a HHA.

The administrator failed to provide oversight of the day-to-operations of the agency to include ensuring the initial assessments were completed within 48 hours of the referral date, ensuring adequate staffing for the services the agency offered, ensuring protection of patient information, ensuring…

The agency failed to ensure the clinical manager provided oversight of the coordination of referrals in 6 of 9 clinical records reviewed resulting in a patient hospitalization.

The clinical manager failed to assure the development and implementation of the plan of care based on the patient’s orders and assessed needs in 4 of 9 clinical records reviewed.

The agency failed to ensure current clinical practice was maintained in accordance with professional standards of practice in 1 of 1 clinical record reviewed with urine collection.

The home health agency failed to ensure a discharge or transfer summary was sent when appropriate per agency policy for 2 of 2 closed clinical records reviewed.

The home health agency failed to ensure all orders on the plan of care were individualized to the patient’s needs for 2 of 2 patients who received home health aide services, from a total of 3 active clinical records reviewed.

The skilled nurse failed to ensure caregiver training was provided for 1 of 1 clinical record review where a tracheostomy (opening in the front of the neck for airway access) was present.

The home health agency failed to ensure home health aide (HHA) supervisory visits were conducted every 14 days for 1 of 1 clinical record reviewed where HHA and skilled services were provided.

The home health agency failed to: ensure patients were accepted for care based on the expectation the home health agency was able to meet their needs (see tag G0570); ensure each patient received home health services written in their plan of care and the plan of care was individualized (see tag…

The agency failed to update the comprehensive assessment due to a major decline in the patient’s health status in 1 of 1 clinical records reviewed in which there was a decline in patient status.

The home health agency failed to ensure patients received the home health services which were written in the individualized plan of care in 4 of 5 clinical records reviewed.

The home health agency failed to ensure services and treatments were administered only as ordered by the physician in 3 of 3 clinical records reviewed with wounds.

The home health agency failed to ensure the plan of care was reviewed and revised by the physician responsible for the home health plan of care as frequently as the patient’s need or condition required in 1 of 3 clinical records reviewed with wounds.

The home health agency failed to promptly alert the relevant physician of changes in patient condition that suggested that outcomes were not being achieved and the plan of care should have been altered in 3 of 5 clinical records reviewed.

The home health agency failed to ensure the plan of care was revised to include current information from the patient’s comprehensive assessment and information concerning patient’s progress toward measurable outcomes and goals on the plan of care in 1 of 5 clinical records reviewed.

The agency failed to integrate all services provided directly and/or under arrangement, to assure identification of patient needs, coordination of care by all disciplines, and treatment effectiveness in 1 of 2 clinical records reviewed which were shared with another home health agency.

The agency failed to ensure skilled professionals accurately and completely prepared clinical notes in 3 of 3 clinical records reviewed with wounds.

The agency failed to ensure the registered nurse made an on-site visit every 60 days to observe and assess the home health aide for patients only receiving home health aide services in 1 of 1 clinical record in which no skilled services were provided.

The administrator failed to ensure an emergency preparedness policy was in place where volunteers could be utilized in 1 of 1 administrator.

The administrator failed to ensure staff received emergency preparedness training annually for the home health agency.

The agency failed to ensure accuracy of OASIS [Outcome and Assessment Information Set] data in 1 of 2 patients with home visits, out of a total of 8 records reviewed.

The agency failed to ensure patients received the services ordered in the plan of care and the plan of care had been established and signed by the primary care physician in 5 of 8 clinical records reviewed (#1, #2, #3, #7, #8) The findings include: 1. Record review of an undated agency policy…

The administrator failed to ensure a Quality Assessment and Performance Improvement (QAPI) program was implemented to show measurable data as required for a home health agency.

The skilled nurse failed to ensure hand hygiene was performed at the appropriate times to help prevent the spread of infection in 1 of 3 patient home visits.

The agency failed to ensure a skilled professional assistant was being supervised by a skilled professional in 1 of 3 patients receiving physical therapy services (#2), out of a total sample of 8 clinical records reviewed.

The agency failed to ensure the home health aide (HHA) care plan was followed in 1 of 3 patients with HHA services, in a total sample of 8 records reviewed.

The agency failed to ensure all clinical record entries are legible, clear, complete, and appropriately authenticated in 2 out of a total of 8 clinical records reviewed (#1, #4) The findings include: 1. Clinical record review on 10/13/2020 for patient #1, start of care 4/13/2020 and certification…

The agency failed to ensure patients were advised of the state toll free home health telephone hotline, its contact information, and that its purpose is to receive complaints or questions about local HHAs (home health agencies) in 1 of 2 patients with home health visits, out of a total of 8…

The agency failed to ensure patient care was furnished appropriately by the skilled nurse in 1 of 2 patients with a colostomy, in a total sample of 8 patient records reviewed.

The agency failed to document both the existence and resolution of a patient complaint in 2 of 3 discharged patients, in a total sample of 8 records reviewed.

The agency failed to ensure a complete current review of medications was performed in 4 of 8 clinical records reviewed.

The agency failed to ensure the individualized plan of care included a complete medication list and safety measures to protect against injury in 3 out of 3 patients who were prescribed medications to be taken as needed or were taking blood thinners (#2, #3, #4) from a total sample of 8 patients.

The agency failed to ensure physician orders were in place for all drugs, treatments, and services provided by the home health agency in 6 of 8 patient records reviewed.

The agency failed to ensure revisions to the plan of care were communicated to the physician in 1 of 3 patients receiving physical therapy (#3) out of a total sample of 8 patients.

The agency failed to integrate services to ensure coordination of care provided by all disciplines in 2 of 3 patients receiving physical therapy (#2, #4), out of a total sample of 8 patients.

The agency failed to ensure care coordination with other agencies in 1 of 1 shared patients, out of a total sample of 8 records reviewed.

The home health agency failed to ensure their patients received a written visit schedule in 4 of 4 patients with home visit or interviews out of 8 total clinical records reviewed (#1,#2,#4, #5).

The agency failed to ensure patients were provided a current written patient medication list in 3 of 3 clinical records reviewed with home visits (#1, #2, #5), out of a total of 8 clinical records reviewed.

The agency failed to ensure pertinent safety instructions were included in the patients care in 2 of 3 discharged records, in a total sample of 8 patient records reviewed.

The agency failed to ensure ongoing interdisciplinary assessment of the patient in 1 of 2 patients interviewed (#4), out of a total of 8 clinical records reviewed.

The agency failed to ensure the physical therapist followed the PT (physical therapy) Plan of Care as ordered by the physician in 2 of 5 clinical records reviewed for patients receiving PT services, in a total sample of 8 records.

The agency failed to ensure the physical therapist (PT) supervised the physical therapist assistant (PTA) in _ of _ patients receiving PT services, out of a total sample of 8 records reviewed.

The agency failed to supervise the home health aide (HHA) every 14 days in 2 of 3 patients with HHA services, in a total sample of 8 patient records reviewed.

The agency failed to ensure the supervising registered nurse ensured home health aide care was complete, safe, and effective in 2 of 2 patients where home visits were conducted (#1, #2) The findings include: 1. Review of an undated agency policy titled "CHARTING".

The administrator failed to maintain administrative control of the home health agency.