QA Investigation Results

Pennsylvania Department of Health
EKIDZCARE
Health Inspection Results
EKIDZCARE
Health Inspection Results For:


There are  13 surveys for this facility. Please select a date to view the survey results.

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Initial Comments:Based on the findings of an unannounced onsite Medicare recertification and state re-licensure survey conducted on March 18 - 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.
Plan of Correction:




Initial Comments:Based on the findings of an unannounced onsite Medicare recertification and state re-licensure survey conducted on March 18 - 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.
Plan of Correction:




484.60(a)(1) STANDARD
Plan of care

Name - Component - 00
Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan.

Observations:

Based on review of clinical records (CRs), agency policies, and interview with agency administrator, the agency failed to ensure that patient's care, treatments, and services were administered by agency staff in accordance with written orders of the physician in three (3) of seven (7) patients reviewed (CRs #1-3).

Review conducted on March 19, 2024, at approximately 9:00 AM to 10:15 AM, of clinical records (CFs) revealed:

CF#1 start of care (soc) 10/2/22, certification period 1/30/23 to 3/30/23, Discharge/transfer on 3/27/23 to a new care agency.
-Physician orders are: Skilled nurse orders -- EKIDZCARE staff hours: nights 6-9.5 hours Sunday, 4-7 hours Monday - Wednesday, and 9-9.5 hours Thursday (up to 40 hours/week) and days 6-9 hours a day 3-4 days a week Monday through Friday, effective 11/22/22.
Missed care visits on:
-2/1/23 9:00 AM to 5:00 PM, no staff available
-2/9/23 12:00 AM to 6:30 AM and 9:00 AM to 5 PM, no staff available.
-2/17/23 9:00 AM to 5:00 PM, no staff available
-2/24/23 9:00 AM to 5 PM, 9:00 PM to 12:00 AM, no staff available
-2/27/23 8:00 AM to 5 PM staff call-off.
-3/2/23 9:00 AM to 5 PM, no staff available.
-3/10/23 9:00 AM to 5 PM, no staff available.
-3/17/23 9:00 AM to 5 PM, no staff available.
-3/22/23 2:00 PM to 4:00 PM, no staff available.
-3/23/23 2:30 PM to 4 PM, no staff available.
-3/24/23 9:00 AM to 5 PM, no staff available.

CR#2 soc 3/5/2018, certification period 8/6/23 to 10/4/23, discharge/transfer review - discharge date 9/28/23, reason family request for new care agency.
Physician orders: Skilled nursing services 6-8.5 hours /day, 1-3 days per week Monday, Thursday, and Friday
Missed care visits:
-8/10/23 8:00 AM to 4:30 PM, no staff available.
-8/11/23 8:00 AM to 4:30 PM, no staff available.
-8/25/23 8:00 AM to 4:30 PM, no staff available.
-9/1/23 8:00 AM to 4:30 PM, no staff available.
-9/6/23 8:00 AM to 4:30 PM, no staff available.
-9/8/23 8:00 AM to 4:30 PM, no staff available.
-9/11 to 15/23 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday, Friday shifts.
-9/18 to 22/23 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday, Friday shifts.
-9/25 to 28 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday shifts.
-9/28/23 patient transferred to new agency.

-CR#3 soc 9/4/22, certification period 12/28/23 to 2/25/24, active patient CR review:
Physician orders: Skilled nursing care 8-10 hrs./night for 2-5 nights per week Monday through Friday (parents' sleep); 6-8 hours/night, Saturday and Sunday; and 1-2 hrs./day on Saturday and Sunday, to be used flexibly at parents' discretion.
Missed care services:
-12/29/23 10:00 PM to 12:00 AM, no staff available.
-12/30/23 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-12/31/23 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/5/24 10:00 PM to 12:00 AM, no staff available.
-1/6/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/7/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/8/24 12:00 AM to 8:00 AM, no staff available.
-1/12/24 10:00 PM to 12:00 AM, no staff available.
-1/13/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/14/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/15/24 12:00 AM to 8:00 AM, no staff available.
-1/19/24 10:00 PM to 12:00 AM, no staff available.
-1/20/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/21/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/22/24 12:00 AM to 8:00 AM, no staff available.
-1/26/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/27/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/28/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/29/24 12:00 AM to 8:00 AM, no staff available.
-2/2/24 10:00 PM to 12:00 AM, no staff available.
-2/3/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/4/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/5/24 12:00 AM to 8:00 AM, no staff available.
-2/9/24 10:00 PM to 12:00 AM, no staff available.
-2/10/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/11/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/12/24 12:00 AM to 8:00 AM, no staff available.
-2/16/24 10:00 PM to 12:00 AM, no staff available.
-2/17/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/18/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/19/24 12:00 AM to 8:00 AM, no staff available.
-2/23/24 10:00 PM to 12:00 AM, no staff available.
-2/24/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/25/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
Agency can only staff care hours for services Monday - Thursday evenings 10:00 PM to 12:00 AM and nights 12
Review conducted on March 13, 2024, at approximately 11:30 AM, of agency policies revealed: -Nursing Assessment and Plan of Care, pages 2 -3, "Plan Of Care C. The RN will develop the home health plan of care in accordance with the physician's written orders. ... b. The plan of care will instruct and reflect staff efforts to: ii. Deliver services at the convenience of the patient/family and caregiver. ... v. Bridge the gaps in the patient's caregiving network. ... c. The plan of care will include: ... iv. Frequency and duration of visits as ordered by physician.";
-Missed Shift Policy, "Procedure: A. The Case Managers are the office staff members responsible for scheduling the field staff in the homes and for monitoring their attendance.";
-Acceptance of Patients, "eKidzCare only admits patient whose needs can be met by the services it provides and provides these services in compliance with Medicare Conditions of Participation. ... Procedure: 1. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the patient's place of residence and/or school/daycare/developmental facility. ... 3. The patient's care will follow a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine at least every 60 days. ... 5. If the patient's needs were such that the eKidzCare could not adequately provide the care required, then every effort will be made to assist the patient and/or family member to secure services elsewhere."
-Job Description: Case Manager, "the Case Manager is responsible for scheduling and coordinating the day-to-day care delivered by field staff members who are working in the homes of clients. Individual will lead field staff in providing excellent customer service and quality home care with focus on delivery and coordination of client services ... and on-going case management. The Case Manger will also act as a liaison between our offices and external payers, working to obtain authorizations for care, and interact with insurance companies to advocate for our clients. Duties and responsibilities - Manage a caseload of clients including staffing, scheduling, operations, and administration, Consult with clients to identify and understand the needs of patients and to provide appropriate staffing solutions, Coordinate the scheduling needs of our clients with appropriately matched caregivers schedules."

Interview conducted on March 13, 2024, at approximately 3:00 PM, with agency administrator revealed confirmation of many missed patient care visits due to inadequate skilled nurse staffing and resultant agency' non-conformance with physician orders.









Plan of Correction:

New Note Type added to AlayaCare Software Patient Documentation titled "Unstaffed Hours." The scheduler will use this note subject to document all attempts and processes implemented in trying to fill open hours and shifts. Every 60 days at recertification the schedulers will insert a 60-day summary of all efforts that will be accessed by the RN Supervisors in the note section-communication will be added to the recertification POC, 485 for the physician. All departments have access to read notes which will be used as a form of department communication. Information included in schedulers notes: Family communications on unfilled hours/shifts.
Communication with co-vending and other agencies offering the same service.
Company recruiting efforts.
Section added to the Supervisory Visit Note as section H) to be completed on recertifications and added to the POC physician's order. Section to be labeled as "Unstaffed Hours" and contain all communications and measures implemented by scheduling to fulfil open hours and shifts. Completed by RN Supervisors.
An Audit will be conducted on every patient who will have a recert completed within the plan of correction time period. To be completed by Quality Assurance Director.
All involved internal employees (Scheduling department and Clinical department) will be educated on new processes. To be completed by Director of Scheduling, Quality Assurance Director.
The auditing of new processes as a result of the plan of correction will be added to PIP and QAPI for ongoing monitoring so the deficient practice does not recur.







Initial Comments:

Based on the finding of an unannounced, onsite home health agency state re-licensure survey conducted on March 18 - 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE was found to be not in compliance with the requirements of 28 PA. Code, Part IV, Health Facilities, Subpart G. Chapter 601.





Plan of Correction:




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 (CRs), agency policy, and interview with agency administrator, the agency failed to ensure that patient's care, treatments, and services were administered by agency staff in accordance with written orders of the physician in three (3) of seven (7) patients reviewed (CRs #1-3).


Review conducted on March 19, 2024, at approximately 9:00 AM to 10:15 AM, of clinical records (CFs) revealed:
CF#1 start of care (soc) 10/2/22, certification period 1/30/23 to 3/30/23, Discharge/transfer on 3/27/23 to a new care agency per family request.
-Physician orders are: Skilled nurse orders -- EKIDZCARE staff hours: nights 6-9.5 hours Sunday, 4-7 hours Monday - Wednesday, and 9-9.5 hours Thursday (up to 40 hours/week) and days 6-9 hours a day 3-4 days a week Monday through Friday, effective 11/22/22.
Missed care visits:
-2/1/23 9:00 AM to 5:00 PM, no staff available
-2/9/23 12:00 AM to 6:30 AM and 9:00 AM to 5 PM, no staff available.
-2/17/23 9:00 AM to 5:00 PM, no staff available
-2/24/23 9:00 AM to 5 PM, 9:00 PM to 12:00 AM, no staff available
-2/27/23 8:00 AM to 5 PM staff call-off.
-3/2/23 9:00 AM to 5 PM, no staff available.
-3/10/23 9:00 AM to 5 PM, no staff available.
-3/17/23 9:00 AM to 5 PM, no staff available.
-3/22/23 2:00 PM to 4:00 PM, no staff available.
-3/23/23 2:30 PM to 4 PM, no staff available.
-3/24/23 9:00 AM to 5 PM, no staff available.

CR#2 soc 3/5/2018, certification period 8/6/23 to 10/4/23, discharge/transfer review - discharge date 9/28/23, reason family request for new care agency.
Physician orders: Skilled nursing services 6-8.5 hours /day, 1-3 days per week Monday, Thursday, and Friday
Missed care visits:
-8/10/23 8:00 AM to 4:30 PM, no staff available.
-8/11/23 8:00 AM to 4:30 PM, no staff available.
-8/25/23 8:00 AM to 4:30 PM, no staff available.
-9/1/23 8:00 AM to 4:30 PM, no staff available.
-9/6/23 8:00 AM to 4:30 PM, no staff available.
-9/8/23 8:00 AM to 4:30 PM, no staff available.
-9/11 to 15/23 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday, Friday shifts.
-9/18 to 22/23 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday, Friday shifts.
-9/25 to 28 8:00 AM to 4:30 PM, no staff available on Monday, Wednesday shifts.
-9/28/23 patient transferred to new agency.

-CR#3 soc 9/4/22, certification period 12/28/23 to 2/25/24, active patient CR review:
Physician orders: Skilled nursing care 8-10 hrs./night for 2-5 nights per week Monday through Friday (parents' sleep); 6-8 hours/night, Saturday and Sunday; and 1-2 hrs./day on Saturday and Sunday, to be used flexibly at parents' discretion.
Missed care services:
-12/29/23 10:00 PM to 12:00 AM, no staff available.
-12/30/23 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-12/31/23 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/5/24 10:00 PM to 12:00 AM, no staff available.
-1/6/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/7/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/8/24 12:00 AM to 8:00 AM, no staff available.
-1/12/24 10:00 PM to 12:00 AM, no staff available.
-1/13/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/14/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/15/24 12:00 AM to 8:00 AM, no staff available.
-1/19/24 10:00 PM to 12:00 AM, no staff available.
-1/20/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/21/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/22/24 12:00 AM to 8:00 AM, no staff available.
-1/26/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/27/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/28/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-1/29/24 12:00 AM to 8:00 AM, no staff available.
-2/2/24 10:00 PM to 12:00 AM, no staff available.
-2/3/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/4/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/5/24 12:00 AM to 8:00 AM, no staff available.
-2/9/24 10:00 PM to 12:00 AM, no staff available.
-2/10/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/11/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/12/24 12:00 AM to 8:00 AM, no staff available.
-2/16/24 10:00 PM to 12:00 AM, no staff available.
-2/17/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/18/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/19/24 12:00 AM to 8:00 AM, no staff available.
-2/23/24 10:00 PM to 12:00 AM, no staff available.
-2/24/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
-2/25/24 12:00 AM to 8:00 AM, 10:00 PM to 12:00 AM, no staff available.
Agency can only staff care hours for services Monday - Thursday evenings 10:00 PM to 12:00 AM and nights 12:00 AM to 8:00 AM with one skilled nurse (40 hours).

CR#4, soc 3/20/23, active records, certification period 1/14/24 to 3/13/24, home visit, no findings.
CR#5, soc 9/15/23, active records, certification period 1/8/24 to 3/7/24, no findings.
CR#6, soc 7/24/23, active records, certification period 1/20/24 to 3/19/24, no findings.
CR#7, soc 1/24/23, active records, certification period 1/19/24 to 3/18/24, no findings.

Review conducted on March 13, 2024, at approximately 11:30 AM, of agency policies revealed: -Nursing Assessment and Plan of Care, pages 2 -3, "Plan Of Care C. The RN will develop the home health plan of care in accordance with the physician's written orders. ... b. The plan of care will instruct and reflect staff efforts to: ii. Deliver services at the convenience of the patient/family and caregiver. ... v. Bridge the gaps in the patient's caregiving network. ... c. The plan of care will include: ... iv. Frequency and duration of visits as ordered by physician.";
-Missed Shift Policy, "Procedure: A. The Case Managers are the office staff members responsible for scheduling the field staff in the homes and for monitoring their attendance.";
-Acceptance of Patients, "eKidzCare only admits patient whose needs can be met by the services it provides and provides these services in compliance with Medicare Conditions of Participation. ... Procedure: 1. Patients are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the patient's place of residence and/or school/daycare/developmental facility. ... 3. The patient's care will follow a written plan of care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine at least every 60 days. ... 5. If the patient's needs were such that the eKidzCare could not adequately provide the care required, then every effort will be made to assist the patient and/or family member to secure services elsewhere."
-Job Description: Case Manager, "the Case Manager is responsible for scheduling and coordinating the day-to-day care delivered by field staff members who are working in the homes of clients. Individual will lead field staff in providing excellent customer service and quality home care with focus on delivery and coordination of client services ... and on-going case management. The Case Manger will also act as a liaison between our offices and external payers, working to obtain authorizations for care, and interact with insurance companies to advocate for our clients. Duties and responsibilities - Manage a caseload of clients including staffing, scheduling, operations, and administration, Consult with clients to identify and understand the needs of patients and to provide appropriate staffing solutions, Coordinate the scheduling needs of our clients with appropriately matched caregivers schedules."

Interview conducted on March 13, 2024, at approximately 3:00 PM, with agency administrator revealed confirmation of many missed patient care visits due to inadequate skilled nurse staffing and resultant agency' non-conformance with physician orders.






Plan of Correction:

New Note Type added to AlayaCare Software Patient Documentation titled "Unstaffed Hours." The scheduler will use this note subject to document all attempts and processes implemented in trying to fill open hours and shifts. Every 60 days at recertification the schedulers will insert a 60-day summary of all efforts that will be accessed by the RN Supervisors in the note section-communication will be added to the recertification POC, 485 for the physician. All departments have access to read notes which will be used as a form of department communication. Information included in schedulers notes: Family communications on unfilled hours/shifts.
Communication with co-vending and other agencies offering the same service.
Company recruiting efforts.
Section added to the Supervisory Visit Note as section H) to be completed on recertifications and added to the POC physician's order. Section to be labeled as "Unstaffed Hours" and contain all communications and measures implemented by scheduling to fulfil open hours and shifts. Completed by RN Supervisors.
An Audit will be conducted on every patient who will have a recert completed within the plan of correction time period. To be completed by Quality Assurance Director.
All involved internal employees (scheduling department and Clinical department) will be educated on new processes. To be completed by Director of Scheduling, Quality Assurance Director.
The auditing of new processes as a result of the plan of correction will be added to PIP and QAPI for ongoing monitoring so the deficient practice does not recur.







Initial Comments:Based on the findings of an unannounced onsite state re-licensure survey conducted on March 18 - 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE, 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 unannounced onsite state re-licensure survey conducted on March 18 - 20, 2024, and completed offsite on March 26, 2024, EKIDZCARE, was found to be in compliance with the requirements of 35 P.S. § 448.809 (b).

Plan of Correction: