QA Investigation Results

Pennsylvania Department of Health
1 HEART HOME HEALTH CARE LLC
Health Inspection Results
1 HEART HOME HEALTH CARE LLC
Health Inspection Results For:


There are  7 surveys for this facility. Please select a date to view the survey results.

Surveys don't appear on this website until at least 41 days have elapsed since the exit date of the survey.



Initial Comments:


Based on the findings of an unannounced onsite state re-licensure survey conducted April 23, 2019, 1 Heart Home Health Care, LLC., was found not to be in compliance with the requirements of 28 Pa. Code, Part IV, Health facilities, Subpart G. Chapter 601.



Plan of Correction:




601.21(e) REQUIREMENT
SUPERVISING PHYS OR REGISTERED NURSE

Name - Component - 00
601.21(e) Supervising Physician or
Registered Nurse. The skilled nursing
and other therapeutic services
provided are under the supervision and
direction of a physician or a
registered nurse (with at least one
year of nursing experience). This
person or similarly qualified
alternate, is available at all times
during operating hours and
participates in all activities
relevant to the professional services
provided, including the development of
qualifications and assignment of
personnel.

Observations:



Based on review of personnel files (PF) and interview with the Director of Nursing, it was determined the agency failed to ensure a qualified person was available at all times during operating hours to act in the absence of the director of nursing.

Findings include:

An interview was conducted with the Administrator/Director of Nursing on 4/23/2019 at approximately 11:30 A.M. revealed that there is currently no other nurse employed with the agency. The Administrator/Director of Nursing confirmed that there is no alternate Director of Nursing currently employed with the agency.




















Plan of Correction:

the 1 heart home health care administrative team, has place several adds on the internet a different jobs cite like indeed, they will serve as a substitute for the DON and supervision of all nursing staff. including the development of qualifications of Personnel (s) training. 2)The agency administrator will keep on file a pool of RN already cleared by the agency and state requirement, to insure the deficient practice does not reoccur in the future.#)3) the agency will have the back up nurse be part of the weekly staff nursing IDC nursing meeting, care conference planning. and other pool RN will be invited to participate Monthly IDC meetings once the hiring process is completed. all Hiring process should be accomplish on or by 6/15/2019

1 Heart home health Care Agency,has hire a back up Registered nurse on by 5/14/2019 to serve as a substitute/ back-up for the Director of Nursing,


601.21(f) REQUIREMENT
PERSONNEL POLICIES

Name - Component - 00
601.21(f) Personnel Policies.
Personnel practices and patient care
are supported by appropriate, written
personnel policies. Personnel records
include qualifications, licensure,
performance evaluations, health
examinations, documentation of
orientation provided, and job
descriptions, and are kept current.

Observations:



Based on a review of personnel files, review of policies and procedures, and an interview with the Director of Nursing, the agency did not conduct testing for mycobacterium tuberculosis according to the Center for Disease Control guidelines for six (6) of ten (10) personnel files reviewed. (Personnel file #'s 3, 5, 7, 8, 9 & 10).

Findings include:

The CDC guidelines state that all Health Care Workers (HCW) should receive baseline tuberculosis screening upon hire, using a two-step tuberculin skin test (TST) of a single blood assay for tuberculosis (TB) to test for infection with tuberculosis. After baseline testing for infection with tuberculosis, HCWs should receive TB screening annually. HCWs with a baseline positive or newly positive test for tuberculosis infections should receive one chest radiograph result to exclude tuberculosis disease.
CDC. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. Morbidity and Mortality World Report 2005;(RR-17) http://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf.


Review of Policy No. D.240 titled, "Health Screening" on 4/23/19 at approximately 12:30 PM states, " An employee or contract personnel providing direct client care, there shall be documentation of completion of Tuberculin (TB) skin test, via the Mantoux method using two-test testing."

A review of the personnel files was conducted on 4/23/19 between approximately 10:30 A.M. to 2:00 P.M.


1.) PF#3, Date of Hire (DOH): 4/15/19, file revealed a one step TST completed on 8/27/18. There was no documentation of the second step of the initial two-step TST completed.

2.) PF#5, DOH: 2/20/19, file revealed a one step TST completed on 12/17/18. There was no documentation of the second step of the initial two-step TST completed.

3.) PF#7, DOH: 7/12/16, file revealed no TB Screening completed in 2017.

4.) PF#8, DOH: 12/14/15, file revealed no TB Screening completed in 2017.

5.) PF #9, DOH: 4/10/10, File revealed no Initial two-step TST completed as well as no TB screenings completed in 2011, 2012, 2013, 2014, 2015, 2016, 2017 and 2018.

6.) PF #10, DOH: 12/6/18, file revealed no TB Screening completed in 2018.


Interview with the Director of Nursing on 4/23/19 at approximately 4:00 PM confirmed the above findings.










Plan of Correction:

as plan of Correction as per our policy all agency staff direct or in direct contact with patient care, will have to undergo a new TB testing 2 (steps) testing, if past testing cannot be proven. the agency will request to all staff as mandate.2)The agency has hired a new Human Resource personnel and staff development personal to oversee all personal files and maintain compliance with all records and a timely manner, 3) there will a monthly monitoring system that must be reported to the office manager, who will verify all accuracy and satisfaction and the office will report all records to the DON and administrator. and the yearly screening will be conducted 25 days to expiring.
1 heart home health Care Agency will keep a monthly tracking system that will alert when all annual screening is due dates this will give 30 days prior notice to all employees of what is due, to stay in compliance.this will include all physical examination,TB testing, license renewal and all other identifications
all corrected action will be done by 6/22/2019



601.31(b) REQUIREMENT
PLAN OF TREATMENT

Name - Component - 00
601.31(b) Plan of Treatment. The
plan of treatment developed in
consultation with the agency staff
covers all pertinent diagnoses,
including:
(i) mental status,
(ii) types of services and equipment
required,
(iii) frequency of visits,
(iv) prognosis,
(v) rehabilitation potential,
(vi) functional limitations,
(vii) activities permitted,
(viii) nutritional requirements,
(ix) medications and treatments,
(x) any safety measures to protect
against injury,
(xi) instructions for timely
discharge or referral, and
(xii) any other appropriate items.
(Examples: Laboratory procedures and
any contra-indications or
precautions to be observed).

If a physician refers a patient under
a plan of treatment which cannot be
completed until after an evaluation
visit, the physician is consulted to
approve additions or modifications to
the original plan.

Orders for therapy services include
the specific procedures and modalities
to be used and the amount, frequency,
and duration.
The therapist and other agency
personnel participate in developing
the plan of treatment.

Observations:




Based upon clinical record review, and an interview with the Director of Nursing, it was determined the agency failed to ensure a plan of treatment/physician orders developed in consultation with the agency staff covers all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral, for six (6) out of six (6) clinical records (CR) reviewed (CR#1-6).

Findings include:

Clinical records were reviewed on 4/23/19 from approximately 2:00 PM-4:00 PM, revealing the following:

1. CR#1 (Start of Care (SOC): 10/18/18): No documentation of a plan of treatment/physician orders developed in consultation with the agency staff covering all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral.

2. CR#2 (SOC: 2/22/19): No documentation of a plan of treatment/physician orders developed in consultation with the agency staff covering all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral.

3. CR#3 (SOC: 9/18/18): No documentation of a plan of treatment/physician orders developed in consultation with the agency staff covering all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral.

4. CR#4 (SOC: 4/4/19): No documentation of a plan of treatment/physician orders developed in consultation with the agency staff covering all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral.

5. CR#5 (SOC: 9/16/18): No documentation of a plan of treatment/physician orders developed in consultation with the agency staff covering all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral.

6. CR#6 (SOC: 7/30/18): No documentation of a plan of treatment/physician orders developed in consultation with the agency staff covering all pertinent diagnoses, including: mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments,any safety measures to protect against injury, instructions for timely discharge or referral.


An interview the director of nursing on 4/23/19 at approximately 4:00 PM confirmed the above findings.





























Plan of Correction:

As a corrective measure for all patients wither they are medicare or medicaid, the agency will follow its policies and procedure Manuel and treat all patient/ participant as standard care of practice, by the home care guidelines by contacting all Primary care physician for an authorization or scrip for home care services, once received the medical plan of care (485) will be written and forwarded to the primary physician for authorization and this plan will be executed for a period of 60, then will be re-evaluated by the RN and the primary physician to continue with care or goals based on the patients needs wither long term or short term. the process has began the following day of the exiting survey, as per the commencement of the plan of corrective action. 2) the agency will and is currently reviewing all patients charts and contacting all pharmacies and doctors office to request necessary record and authorization to create all medical plan of care. a license practical was hired to follow-up with skill care and compliance as per patient needs. 05/07/2019 was start date. 3) the agency has and will monitory each patient condition and plan of care in the weekly IDC care team meeting with the DON. who will oversee all standard care plan and co-signed all nursing plan of care.

1 Heart home health care will have a tracking tool called monitoring plan; this will monitor all new and old patients record for Physician orders, relating to patients services needs and disease management. with theses orders the medical plan of care will created and executed, as ordered, on day 53 to 55 to re- certify of services of the 60 days plan of care will be forwarded to the primary care physician for renewal orders. this tool will be implemented on or by 6/22/2019



601.31(c) REQUIREMENT
PERIODIC REVIEW OF PLAN OF TREATMENT

Name - Component - 00
601.31(c) Periodic Review of Plan of
Treatment. The total plan of
treatment is reviewed by the attending
physician and agency personnel as
often as the severity of the patient's
condition requires, but at least once
every 60 days. Agency professional
staff promptly alert the physician to
any changes that suggest a need to
alter the plan of treatment

Observations:




Based on a review of clinical records, agency policy, and an interview with the director of nursing the agency failed to provide a review of the total plan of treatment by the attending physician and agency personnel at least every sixty days for three (3) of six (6) clinical records (CR). CR #3, 5 and 6.

Findings include:

A review of policy occurred on 4/23/19 at approximately 10:00 AM. Policy entitled "Comprehensive Client Assessment" stated "The depth and frequency of ongoing assessments will depend on client needs, goals, and the care treatment and services provided, but will be done at least once in every sixty (60) day period."

A review of CRs was conducted on 4/23/19 from approximately 2:00 PM until 4:00 PM.

CR#3 start of care 9/18/18, OLTL Waiver program certification dates from 9/30/18 until 6/30/19. File did not contain a physician plan of treatment/physician orders. The record did not contain a sixty day summary for physician review.

CR#5 start of care 9/16/18, OLTL Waiver program certification dates from 9/16/18 until 5/31/19. File did not contain a physician plan of treatment/physician orders. The record did not contain a sixty day summary for physician review.

CR#6 contained a start of care date 7/30/18. OLTL Waiver program certification dates from 7/30/18 until 2/28/19. File did not contain a physician plan of treatment/physician orders. The record did not contain a sixty day summary for physician review.


An interview with the Director of Nursing on 4/23/19 at approximately 4:00PM confirmed the above findings.


















Plan of Correction:

As a corrective measure for all patients wither they are medicare or medicaid, the agency will follow its policies and procedure Manuel and treat all patient/ participant as standard care of practice, by the home care guidelines by contacting all Primary care physician for an authorization or scrip for home care services, once received the medical plan of care (485) will be written and forwarded to the primary physician for authorization and this plan will be executed for a period of 60 days, then will be re-evaluated by the RN and the primary physician to continue with care or goals based on the patients needs wither long term or short term. the process has began the following day of the exiting survey, as per the commencement of the plan of corrective action. 2) the agency will and is currently reviewing all patients charts and contacting all pharmacies and doctors office to request necessary record and authorization to create all medical plan of care. a license practical was hired to follow-up with skill care and compliance as per patient needs. the agency has and will monitory each patient condition and medication management and disease .Agency nurse will provide teaching to patient and care givers during visit to educate and prevent medication errors and poly-pharmacy. Agency will document and report finding as per agency guide line and in patient/consumers charts and doctors will be notified,and plan of care in the weekly IDC care team meeting with the DON, will discuss goals and nursing actions on a case by case bases. who will oversee all standard care plan and co-signed all nursing plan of case (485)

1 Heat Home health agency will use the monitoring tracking tool to monitor all medical plan of care or (485) prior to day 53 to 55 of the 60 days expiring or rectification of the medical plan of care to guarantee the orders are reviewed and signed by the primary care physicians and agency nurse will follow plan of care. this monitoring tool will be effective on or by 6/22/2019


601.31(d) REQUIREMENT
CONFORMANCE WITH PHYSICIAN'S ORDERS

Name - Component - 00
601.31(d) Conformance With
Physician's Orders. All prescription
and nonprescription (over-the-counter)
drugs, devices, medications and
treatments, shall be administered by
agency staff in accordance with the
written orders of the physician.
Prescription drugs and devices shall
be prescribed by a licensed physician.
Only licensed pharmacists shall
dispense drugs and devices. Licensed
physicians may dispense drugs and
devices to the patients who are in
their care. The licensed nurse or
other individual, who is authorized by
appropriate statutes and the State
Boards in the Bureau of Professional
and Occupational Affairs, shall
immediately record and sign oral
orders and within 7 days obtain the
physician's counter-signature. Agency
staff shall check all medicines a
patient may be taking to identify
possible ineffective drug therapy or
adverse reactions, significant side
effects, drug allergies, and
contraindicated medication, and shall
promptly report any problems to the
physician.

Observations:



Based on review of clinical records (CR) and interview with director of nursing, the agency failed to ensure that a comprehensive assessment included a review of all medications that the patient was currently using in order to identify any potential adverse effects, drug reactions, significant side effects, significant drug interactions, ineffective drug therapy and noncompliance with drug therapy per agency policy for six (6) of six (6) clinical records. (CR # 1-6.)

Findings include:

Review of Clinical records occurred on 4/23/19 from approximately 2:00 P.M until 4:00 P.M.

1. Review of CR # 1 (State of Care: 10/18/18) revealed no documentation of a review of all medications the patient is currently taking to identify: side effects, drug interaction, noncompliance, duplicate therapy, ineffective therapy, potential adverse effects and medication reactions for any time period since patient started care with the agency. In addition, there were no physican orders for treatment.

2. Review of CR # 2 (State of Care: 2/22/19) revealed no documentation of a review of all medications the patient is currently taking to identify: side effects, drug interaction, noncompliance, duplicate therapy, ineffective therapy, potential adverse effects and medication reactions for any time period since patient started care with the agency. In addition, there were no physican orders for treatment.

3. Review of CR # 3 (State of Care: 9/18/18) revealed no documentation of a review of all medications the patient is currently taking to identify: side effects, drug interaction, noncompliance, duplicate therapy, ineffective therapy, potential adverse effects and medication reactions for any time period since patient started care with the agency. In addition, there were no physican orders for treatment.

4. Review of CR # 4 (State of Care: 4/4/19) revealed no documentation of a review of all medications the patient is currently taking to identify: side effects, drug interaction, noncompliance, duplicate therapy, ineffective therapy, potential adverse effects and medication reactions for any time period since patient started care with the agency. In addition, there were no physican orders for treatment.

5. Review of CR # 5 (State of Care: 9/16/18) revealed no documentation of a review of all medications the patient is currently taking to identify: side effects, drug interaction, noncompliance, duplicate therapy, ineffective therapy, potential adverse effects and medication reactions for any time period since patient started care with the agency. In addition, there were no physican orders for treatment.

6. Review of CR # 6 (State of Care: 7/30/18) revealed no documentation of a review of all medications the patient is currently taking to identify: side effects, drug interaction, noncompliance, duplicate therapy, ineffective therapy, potential adverse effects and medication reactions for any time period since patient started care with the agency. In addition, there were no physican orders for treatment.



Interview with Director of Nursing on 4/23/19 at approximately 4:00 P.M. confirmed the above findings.






















Plan of Correction:

As a corrective measure for all patients wither they are medicare or medicaid, the agency will follow its policies and procedure Manuel and treat all patient/ participant as standard care of practice, by the home care guidelines by contacting all Primary care physician for an authorization or scrip for home care services, once received the medical plan of care (485) will be written and forwarded to the primary physician for authorization and this plan will be executed for a period of 60 days, then will be re-evaluated by the RN and the
primary physician to continue with care or goals based on the patients needs wither long term or short term. the process has began the following day of the exiting survey, as per the commencement of the plan of corrective action. 2) the agency will and is currently reviewing all patients charts and contacting all pharmacies and doctors office to request necessary record and authorization to create all medical plan of care. a license practical was hired to follow-up with skill care and compliance as per patient needs. the agency has and will monitory each patient condition and medication management and disease .Agency nurse will provide teaching to patient and care givers during visit to educate and prevent medication errors, duplication of medication teatment and poly-pharmacy. Agency will document and report finding as per agency guide line and in patient/consumers charts and doctors and any other specialist who is part of the patient team of doctors that they will have all medication profile current and new orders to be able to not duplicate or create an contraindication in the medications and disease management, these medication and treatment must be forwarded to patient primary care physician will be notified,and plan of care in the weekly IDC care team meeting with the DON, will discuss goals and nursing actions on a case by case bases. who will oversee all standard care plan and co-signed all nursing plan of case (485

1 Heart Home Health Care Agency will use the tracking tool to monitor all medication profiles and medication orders every 55 days to evaluate continuations of orders and effectiveness of medication treatment, theses order will be forwarded to primary care physician for approval to maintain compliance. this monitoring system will be effective on or by 6/22/2019


601.35(a) REQUIREMENT
SELECTION OF AIDES

Name - Component - 00
601.35(a) Selection of Aides. Home
health aides are selected on the basis
of such factors as sympathetic
attitude toward the care of the sick,
ability to read, write, and carry out
directions, and maturity and ability
to deal effectively with the demands
of the job. Aides are carefully
trained in assisting patients to
achieve maximum self-reliance,
principles of nutrition and meal
preparation, the aging process and
emotional problems of illness,
maintaining a clean, healthful, and
pleasant environment, changes in
patient's condition that should be
reported, work of the agency and the
health team, ethics and
confidentiality, and recordkeeping.

Home Health Aid Training. All home
health aides have completed a minimum
of 60 hours of classroom instruction
prior to or during the first 3 months
of employment.

They are closely supervised to assure
their competence in providing care.



Observations:


Based on review of personnel files, agency policy and interview with the Director of Nursing, the agency failed to follow their own policy regarding home health aide training of at least 75 hours of classroom instruction with at least sixteen (16) of those hours devoted to practical training for six (6) of eight (8) Home Health Aides Personnel Files (PF) . Personnel File #2, 3, 4, 5, 6, & 10.


Findings include:

Review of policy on 4/23/19 at approximately 12:00 P.M titled " Competency Evaluation of Home Care Staff" stated " The Home Health Aide must demonstrate evidence of: successful completion of a training program totaling at least seventy-five (75) hours. At least sixteen (16) of those hours must have been devoted to supervised practical training..." Agency Policy then incorrectly stated The Home Health Aide may demonstrate evidence of "Successful completion of a competency evaluation program" as one of the areas to complete training as a home health aide. It then lists 11 different topic areas that the competency will cover and stated "A Home health aide training and/or competency evaluation program may be offered by any organization..."

Review of personnel files on 4/23/19 from approximately 10:30 A.M to 2:00 P.M. revealed:

1.) PF # 2, date of hire (DOH): 1/22/19, no documentation of 75 hours of health aide training with at least 16 hours devoted to supervised practical training.

2.) PF # 3, DOH: 4/15/19, no documentation of 75 hours of health aide training with at least 16 hours devoted to supervised practical training.

3.) PF # 4, DOH: 11/28/18, no documentation of 75 hours of health aide training with at least 16 hours devoted to supervised practical training.

4.) PF # 5, DOH: 2/20/19, no documentation of 75 hours of health aide training with at least 16 hours devoted to supervised practical training.

5.) PF # 6, DOH: 3/1/18, no documentation of 75 hours of health aide training with at least 16 hours devoted to supervised practical training.

6.) PF # 10, DOH: 12/6/18, no documentation of 75 hours of health aide training with at least 16 hours devoted to supervised practical training.


Interview with the Director of Nursing on 4/23/19 at approximately 4:00 P.M. confirmed that the above findings.













Plan of Correction:

As per the Agency plan of correction all HOME HEALTH will be trained and receive a certificate of completion outlining the 75 hours of class room instruction with a least 16 hour dedicated for practical.)the agency will provide training for a period over 6 weeks for 12.5 hours to accommodate all employees and patients schedule. up stairs in the conference. the memo will be given to all employees on 5/09/2019. advising the classes will began 05/18/2019 starting from 9:00 Am to 8:30 pm.(2) all employees hired be 1 heart home health care agency going forward must have a certificate of training, or willnot be able to work until completed the requirement for Home health AIDS 75 hours as per guidelines. (3) All employees certificate will be mandated and placed in their personals folders to validate the employment requirements. the human resource personnel will maintain and monitor compliance will report to clinical director of Nursing

1 heart home health care agency will modify is polity to reflex 60 hours of education and training for home health aid requirement as to meet the state guidelines. and training will 06/18/2019 all employees will be trained and have a certification meeting the required educational hours as mandated by the state


Initial Comments:

Based on the findings of an onsite unannounced state re-licensure survey conducted on April 23, 2019, 1 Heart Home Health Care, LLC., was found to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 51, Subpart A.



Plan of Correction:




Initial Comments:

Based on the findings of an onsite unannounced state re-licensure survey conducted on April 23, 2019, 1 Heart Home Health Care, LLC., was found to be in compliance with the requirements of 35 P.S. 448.809 (b).




Plan of Correction: