Initial Comments:
Based on the findings of an offsite Home Health Agency Complaint investigation conducted May 21 to 22, 2025 and May 28 to May 30, 2025, 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:
601.35(b) REQUIREMENT
ASSNMNT & DUTIES OF HOME HEALTH AIDE
Name - Component - 00
601.35(b) Assignment and Duties of
the Home Health Aide. The home health
aide is assigned to a particular
patient by a registered nurse. Written
instructions for patient care are
prepared by a registered nurse or
therapist as appropriate. Duties
include:
(i) the performance of simple
procedures as an extension of therapy
services,
(ii) personal care,
(iii) ambulation and exercise,
(iv) household services essential to
health care at home,
(v) assistance with medications
that are ordinarily self-administered,
(vi) reporting changes in the
patient's conditions and needs, and
(vii) completing appropriate
records.
Observations:
Based on a review of clinical records (CR), documentation from HHA eXchange (a platform used by managed care organizations to communicate with home health agencies), and correspondence with the administrator/director of nursing and the human resources/staffing coordinator, the home health agency (HHA) failed to assure that written instructions for patient care were prepared by a registered nurse (RN) for two (2) of three (3) CR's reviewed: CR#1 and CF#2, and failed to monitor that the plan of care (POC) was being correctly followed for three (3) of three (3) CR's reviewed: CR#1, CR#2, and CF#3.
Findings include:
A review of clinical records was conducted on May 22, 2025, May 28, 2025 and May 29, 2025 at various times throughout the day. The Start of Care (SOC) and Home Health Certification and Plan of Care (CP) are indicated below.
CR#1 SOC 12/14/2024, CP 04/14/2025 to 06/14/2025 found that the aide POC consisted of the POC generated from HHA eXchange, signed by an RN. The start date for the POC was 04/14/2025, stop date was 06/14/2025. While the POC listed tasks and the frequencies with which the tasks were to be performed, there was no detail or instruction provided for any of the tasks. For example, one task was "bathing." There was no instruction as to the type of bathing, i.e., bathtub, shower, sponge bath, etc. Another task was "prepare breakfast, lunch, dinner." There was no documentation as to whether the patient was to have any dietary restrictions given a diagnosis of hypertension. The POC also contained a task titled "Personal Care" that was intended to capture any personal care tasks not already listed, to be performed 7 days per week. There were no specific instructions as to the type(s) of additional personal care to be rendered.
A review of the Aide Time Sheets, which contained documentation of tasks performed for the patient, found that there was no documentation on the time/task sheets from April 1 to May 17 that bed linens were changed nor that incontinence care was provided at any time during that period, though bed linen change and incontinence care were listed as tasks to be performed on the POC.
CR#2 SOC 12/10/2024, CP 04/09/2025 to 06/07/2025 found that the aide POC consisted of the POC generated from HHA eXchange, signed by an RN. The start date for the POC was 04/09/2025. stop date was 06/07/2025. While the POC listed tasks and the frequencies with which the tasks were to be performed, there was no detail or instruction provided for any of the tasks. For example, one task was " bladder and bowel incontinence. " There was no instruction as to how to handle bladder and bowel incontinence. The POC also contained a task titled "Personal Care" that was intended to capture any personal care tasks not already listed, to be performed 7 days per week. There were no specific instructions as to the type(s) of additional personal care to be rendered.
A review of the Aide Time Sheets, which contained documentation of tasks performed for the patient, found that there was no documentation on the time/task sheets from April 1 to May 23 of the following tasks being performed per the POC: assistance with upper and lower dressing, bladder and bowel incontinence care, and reminders to take medications.
CR#3 SOC 08/13/2020, CP 04/03/2025 to 06/03/2025 found that the aide POC consisted of the POC generated from HHA eXchange, signed by an RN. The start date on the POC was 03/22/2023. There was no stop date, no evidence that the POC was updated since 2023 nor for the current certification period. The POC contained tasks and instructions except for the task titled "Personal Care." This task is intended to capture any personal care tasks not already listed, to be performed 7 days per week. The instruction stated, "HHA will provide T1019 care at all times; daily to patient." There were no specific instructions as to the type(s) of additional personal care to be rendered. The code T1019 is a billing code.
A review of the Aide Time Sheets, which contained documentation of tasks performed for the patient, found that during the week of 04/13/2025 to 04/19/2025, no tasks were documented for the entire week. A review of the Aide Time/Task Sheets from 04/20/2025 through 05/17/2025 found that the tasks being documented/performed by the aide were far greater than those listed on the POC.
An interview conducted with the administrator via phone on May 30, 2025 starting at 12:30 PM confirmed the above findings.
Plan of Correction:Immediate RN Review and Revision of All Aide Care Plans: All aide care plans for active clients will be reviewed and revised by an RN to include detailed, patient-specific instructions (e.g., type of bathing, specific dietary needs, incontinence care procedures).
Standardized POC Template Implementation: A POC template with required fields for individualized care instructions will be adopted and trained upon by June 10, 2025.
Weekly Clinical Record Audits: Clinical supervisors will begin weekly audits of 100% of new and current aide care plans to ensure compliance with RN-developed, detailed instructions.
Training of All RNs and Aides: In-service training was conducted on June 5, 2025, on proper documentation of care tasks, individualized instruction, and verification of completion. Attendance logs are maintained.
Documentation Compliance Monitoring: All aide timesheets and task logs will be reviewed weekly by the Quality Assurance (QA) nurse to ensure tasks are completed and documented as per the plan of care.
Responsible Party: Director of Nursing
601.35(c) REQUIREMENT
SUPERVISION
Name - Component - 00
601.35(c) Supervision. The
registered nurse, or appropriate
professional staff member, if other
services are provided, makes a
supervisory visit to the patient's
residence at least every 2 weeks,
either when the aide is present to
observe and assist, or when the aide
is absent to assess the relationships
and determine whether goals are being
met.
Observations:
Based on a review of clinical records (CR), agency forms, and correspondence with the administrator/director of nursing and staffing/human resources coordinator, the home health agency (HHA) failed to assure that registered nurse (RN) supervisory visits were conducted at least every two (2) weeks at the patient's residence for three (3) of three (3) CR's reviewed: CR#1, CR#2, and CR#3.
Findings include:
A review of clinical records was conducted on May 22, 2025, May 28, 2025 and May 29, 2025 at various times throughout the day. The Start of Care (SOC) and Home Health Certification and Plan of Care (CP) are indicated below.
CR#1 SOC 12/14/2024, CP 04/14/2025 to 06/14/2025 found that RN Supervisory visits were documented on a form titled "Bi-weekly Homemaker Supervision Report" and were completed on 4/7/25, 4/21/25, 5/5/25, and 5/19/25. It was unclear if the RN was on site for the supervisory visits. The HHA was asked by the surveyor to provide attestations that the supervisory visits were conducted on site. The HHA returned attestation documents which read, "By execution of this document, I acknowledge that record entry for _____ (date) is a true and accurate representation of my observations. I affirm that the information provided is complete and correct to the best of my knowledge and understanding." However, the words "office" or "at office" were handwritten on the attestation forms. Upon further probe with the administrator/nurse director and human resources/staffing coordinator, the supervisory visits were not conducted at the patient's home. The visits were conducted from the administrator/nurse director's office at the agency via various means, i.e., phone or patient coming to the office.
CR#2 SOC 12/10/2024, CP 04/09/2025 to 06/07/2025 found that RN Supervisory visits were documented on a form titled " Bi-weekly Homemaker Supervision Report " and were completed on 4/15/25, 4/29/25, 5/13/25, and 5/27/25. It was unclear if the RN was on site for the supervisory visits. The HHA was asked to provide attestations that the supervisory visits were conducted on site. The HHA returned attestation documents which read, "By execution of this document, I acknowledge that record entry for _____ (date) is a true and accurate representation of my observations. I affirm that the information provided is complete and correct to the best of my knowledge and understanding." However, the words "at office" were handwritten on the attestation forms dated 4/15/25 and 4/29/25, and the words "zoom call" were handwritten on the attestation form dated 5/13/25. Upon further probe with the administrator/nurse director and human resources/staffing coordinator, the supervisory visits were not conducted at the patient's home. The visits were conducted from the administrator/nurse director's office at the agency via various means, i.e., phone, zoom call or patient coming to the office.
CR#3 SOC 08/13/2020, CP 04/03/2025 to 06/03/2025 found that RN Supervisory visits were documented on a form titled "Bi-weekly Homemaker Supervision Report" and were completed on 04/04/2025, 04/18/2025, 05/02/2025, 05/16/2025. It was unclear if the RN was on site for the supervisory visits. The HHA was asked to provide attestations that the supervisory visits were conducted on site. The HHA returned attestation documents which read, "By execution of this document, I acknowledge that record entry for _____ (date) is a true and accurate representation of my observations. I affirm that the information provided is complete and correct to the best of my knowledge and understanding." However, the words "at office" were handwritten on the attestation form dated 04/04/2025, the words "zoom call and at office" were handwritten on the attestation form dated 5/02/25, and the words "at home, zoom call or at office" were handwritten on the attestation form dated 05/16/2025. Upon further probe with the administrator/nurse director and human resources/staffing coordinator, the supervisory visits were not conducted at the patient's home. The visits were conducted from the administrator/nurse director's office at the agency via various means, i.e., phone, zoom call or patient coming to the office.
An interview conducted with the administrator via phone on May 30, 2025 starting at 12:30 PM confirmed the above findings.
Plan of Correction:Immediate Policy Revision: The supervision policy was revised on June 3, 2025, to clarify that RN supervisory visits must occur at the patient's residence every two weeks, whether or not the aide is present.
RN Field Supervisory Visit Schedule Created: A master schedule for all aide-supervised patients was developed by the DON on June 4, 2025, ensuring bi-weekly in-home supervisory visits are logged and verified.
Attestation Form Discontinued: Use of generic attestation forms was discontinued. Supervisory visits must be documented using a newly developed "On-site RN Supervisory Visit Form," signed by the patient and RN at the home.
Supervision Monitoring System: The QA nurse will audit 100% of supervisory visit records monthly to ensure adherence to in-home requirements.
RN Re-training: All supervisory RNs were retrained on state supervision requirements and documentation standards on June 6, 2025. Proof of training and evaluation is on file.
Responsible Party: Director of Nursing
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