QA Investigation Results

Pennsylvania Department of Health
ACCENTCARE HOME HEALTH OF CENTRAL PENNSYLVANIA
Health Inspection Results
ACCENTCARE HOME HEALTH OF CENTRAL PENNSYLVANIA
Health Inspection Results For:


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Initial Comments:

Based on the findings of an unannounced, on-site Medicare complaint investigation survey completed December 14, 2022, AccentCare Home Health of Central Pennsylvania 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(d)(2) ELEMENT
Integrate all orders

Name - Component - 00
Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient.

Observations: Based on review of medical records (MR) and interview with staff the agency failed to ensure all relevant orders were contained on the plan of care for one (1) of one (1) record reviewed. MR #1. Review of medical records completed December 14, 2022, between approximately 11:30 AM and 2:00 PM revealed: MR #1, start of care (SOC): 11/3/2022; certification period reviewed: 11/3/2022-1/1/2023; Primary Diagnosis: encounter for attention to gastrostomy, Dysphasia following cerebral infarction (difficulty swallowing after a stroke), COVID-19, Pneumonia due to coronavirus disease 2019. Physician's orders: " Skilled nursing 1 time per week for 5 weeks, 1 time every 2 weeks for 4 weeks... Skilled nurse to evaluate and develop plan of care to be countersigned by physician... ". Plan of care contained no orders regarding recent procedure to insert a pleural catheter. Medical record contained no verbal orders regarding catheter or addendums to plan of care. Interview with agency staff completed December 14, 2022, between approximately 11:00AM and 11:30 AM confirmed the above findings.

Plan of Correction:

G0604 INTEGRATE ALL ORDERS
Commitment to Compliance
To demonstrate the commitment to compliance and provide immediate correction, the Agency
Administrator Debra Pronzato or designee Amber Adair will ensure Clinical Staff are compliant with integrating orders from all physicians or allowed practitioners involved in the Plan of Care to ensure coordination of all services and interventions provided to the patient.

To demonstrate the commitment to compliance and immediate correction, the Agency
Administrator Debra Pronzato to meet with with Clinical Supervisor/Clinical Manager Amber Adair and Clinical Staff by January 25,2023 regarding appropriate integration of orders from all physicians onto the Plan of Care to include but not limited to education and care of pleural catheter.
Continued non-compliance with policies will be reported to the Administrator for further disciplinary action as appropriate.
Corrective Action
The Agency Administrator/designee will conduct education with all clinical and supervisory staff by January 25, 2023 regarding policies and require signed attestation of education: HH 2.1.4 Care Planning and Coordination
Resolution and Monitoring
As part of ongoing monitoring to ensure clinical supervision is executed/performed
according to the plan of care and coordinated with the case manager/supervising nurse, the Administrator or designee shall review 15% of clinical records each month for 60 days or until 95% threshold attained for compliance with appropriate Plan of Care revision related to integration of all physicians orders onto the Plan of care. First month audit will be completed by 2/14/23.
Clinical record review results tabulated for 60 days, and compliance threshold reported to and monitored by the Administrator or designee, QAPI committee and the Professional Advisory Committee (PAC).
Responsible Position: Administrator Debra Pronzato



Initial Comments:

Based on the findings of an unannounced, onsite home health agency complaint investigation survey completed December 14, 2022, AccentCare Home Health of Central Pennsylvania 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(h) REQUIREMENT
COORDINATION OF PATIENT SERVICES

Name - Component - 00
601.21(h) Coordination of Patient
Services. All personnel providing
services maintain liason to assure
that their efforts effectively
complement one another and support the
objectives outlined in the plan of
treatment. (i) The clinical record
or minutes of case conferences
establish that effective interchange,
reporting, and coordinated patient
evaluation does occur. (ii) A
written summary report for each
patient is sent to the attending
physician at least every 60 days.

Observations: Based on review of medical records (MR) and interview with staff the agency failed to ensure all relevant orders were contained on the plan of care for one (1) of one (1) record reviewed. MR #1. Review of medical records completed December 14, 2022, between approximately 11:30 AM and 2:00 PM revealed: MR #1, start of care (SOC): 11/3/2022; certification period reviewed: 11/3/2022-1/1/2023; Primary Diagnosis: encounter for attention to gastrostomy, Dysphasia following cerebral infarction (difficulty swallowing after a stroke), COVID-19, Pneumonia due to coronavirus disease 2019. Physician's orders: " Skilled nursing 1 time per week for 5 weeks, 1 time every 2 weeks for 4 weeks... Skilled nurse to evaluate and develop plan of care to be countersigned by physician... ". Plan of care contained no orders regarding recent procedure to insert a pleural catheter. Medical record contained no verbal orders regarding catheter or addendums to plan of care. Interview with agency staff completed December 14, 2022, between approximately 11:00AM and 11:30 AM confirmed the above findings.

Plan of Correction:

M1009 CARE PLANNING, COORDINATION, QUALITY OF CARE
Commitment to Compliance
To demonstrate the commitment to compliance and provide immediate correction, the Agency
Administrator Debra Pronzato or designee will ensure Clinical Staff are compliant with Care Planning, Coordination and Quality of Care.

The Agency Administrator or designee will ensure that agency will ensure clinical efforts are coordinated effectively and ensure all relevant orders support the objectives necessary for patient care and patient/caregiver education.
Continued non-compliance with policies will be reported to the Administrator for further disciplinary action as appropriate.

Corrective Action

The Agency Administrator/designee will ensure that any changes identified by the clinician throughout the episode updated timely and accurately with physician notification and documentation.
The Administrator/designee will ensure the condition of participation for care planning, coordination of services and quality of care met by:
Educate clinicians by 1/25/23 that the plan of care revised to reflect the patient's condition and care needs identified during the initial and updated comprehensive assessments. Identify patient goals and the interventions needed to reach those goals. The patient is included in the care planning and goal-setting process. Patient/family preferences for treatment and concerns, including patient's strengths, goals, and care The Administrator/designee will ensure the condition of participation for care planning, coordination of services and quality of care met by:
1. Educate clinicians by 1/25/23 that the plan of care revised to reflect the patient's condition and care needs identified during the initial and updated comprehensive assessments. Identify patient goals and the interventions needed to reach those goals. The patient is included in the care planning and goal-setting process. Patient/family preferences for treatment and concerns, including patient's strengths, goals, and care preferences and information that may be used to demonstrate the patient's progress toward achievement of the goals identified by the patient and the measurable outcomes identified by the Agency.
2. Will ensure the care planning process begins upon the admission of the patient, involves the patient and or caregiver in the planning of care, in changes to the plan of care and continuing involvement in the process through discharge.
3. Conduct mandatory in-service with clinical staff by 1/25/23 and monitor education about the escalation process when unable to reach a physician with patient status change.
4. Providing education to staff of the following policies with signed attestations:
a. HH 2.1.4-Care Planning & Coordination
b. HH 2.1.5-Physician Plan of Care
5. .Educate all professional clinicians will maintain effective communication and collaboration with relevant physician(s), specifically in cases where there has been a change in patient condition, assessment findings are outside reportable parameters, or needs that suggest that outcomes are not being achieved and or that the plan of care should be updated or revised.
6. Educate clinicians that a change in the patient's condition or needs can suggest that outcomes were not being achieved and or that the plan of care should have been be revised/ updated.

Resolution and Monitoring
As part of ongoing monitoring to ensure clinical supervision is executed/performed
according to the plan of care and coordinated with the case manager/supervising nurse, the Administrator or designee shall review 15% of clinical records per month for 60 days or until 95% threshold attained for compliance with appropriate Plan of Care revision related to integration of all physician orders onto the Plan of care. First month audit will be completed by 2/14/23.
Clinical record review results tabulated quarterly, and compliance threshold reported to and monitored by the Administrator or designee, QAPI committee and the Professional Advisory Committee (PAC).
Responsible Position: Administrator