Initial Comments:Based on the findings of an onsite unannounced home health agency Medicare and state licensure complaint survey conducted on 4/23/25 Advantage Home Health and Hospice, 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(b)(1) ELEMENT
Only as ordered by a physician
Name - Component - 00
Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner.
Observations:
Based on a review of admission book, policies and procedures, medical records (MR) and staff interview the agency failed to ensure that services were provided as ordered by a physician for two (2) of five (5) MR's reviewed (MR#3 &; MR#4)
Review of admission handbook on 4/23/25 at 10:00 AM states, Admission to Advantage Home Health Services, LLC can only be made under the direction of physician or other allowed practitionerof policies and procedures on 4/23/25 at 10:30 AM reveled the following:
Plan of Care Policy states, Each plan of care must be signed and dated by the physician/allowed practitionerpatient must receive home health services that re written in an individualized plan of careby a physician or authorized practitioner and services provided will be provided according to physician/practitioner orders. Orders are current and updatedclinical services are implemented only in accordance with a plan of care established by aa physicians/practitioners written order. The Agency: accepts orders on referral communicated verbally by n institutions discharge planner, nurse practitioner, physicians assistant or other authorized staff member followed by written, signed and date physician orders, in order to begin services as soon as possiblereview of medical records (MR) on 4/23/25 at 12:00 PM revealed the following:
MR#3 Start of Care 4/8/25 A referral order was obtained on 4/8/25. A Physical therapy (PT) evaluation was completed on 4/8/25. The plan of care was pending with no orders for services. A PT visit had been completed on 4/22/25.
MR#4 Start of Care 3/14/25. On 4/1/25 documentation from Hamilton Health Center states, See notes from PCP. Shes declining to sign orders. She did not give these orders. Our records show she ordered OPPT (out patient physical therapy) with Achieva Rehab.
A patient care order with an order date of 3/30/25 written by the Occupational Therapist (OT) states, Discontinue: effective 3/31/25 12:01 AM-Occupational Therapy 1 wk 3 wk read back and confirmed (ordered on 3/18/25 1:26 PM). A signed handwritten note on this document by the nurse practitioner stated, I did not give verbal orders for these services. I ordered outpatient therapy for patient with Achieva.
Physical therapy visits had been conducted on 3/14, 3/18, 3/21, 3/25, 3/28 and 4/1/25 with no orders.
Interview on 4/23/25 at approximately 12:45 PM with the clinical director and VP of quality assurance confirmed the above findings
Plan of Correction:At the staff meeting on 4/30/25, the clinical director will educate staff on verbal order requirements and updated verbiage needed on the plan of care. Any staff who are not present will be educated and signed off by 5/9/25.
All new admissions, as well as current patients, will be audited by the clinical director or other assigned designee beginning week of 5/4/25 to ensure compliance with following verbal order requirements and completed plan of care. The Clinical Director or assigned designee will continue to audit all new admissions weekly to ensure verbal orders are present on the plan of care and the plan of care is completed and faxed to the physician for a signature, until compliance of 95% or greater is met for 2 weeks. This will be included in agencies QAPI program for continued oversight by the Clinical Director of other assigned designee.
484.60(b)(3)(4) ELEMENT
Verbal orders
Name - Component - 00
(3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies.
(4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies.
Observations:
Based on a review of admission book, policies and procedures, medical records (MR) and staff interview the agency failed to ensure that services were provided as ordered by a physician for two (2) of five (5) MR's reviewed (MR#3 &; MR#4)
Review of admission handbook on 4/23/25 at 10:00 AM states, Admission to Advantage Home Health Services, LLC can only be made under the direction of physician or other allowed practitionerof policies and procedures on 4/23/25 at 10:30 AM reveled the following:
Plan of Care Policy states, Each plan of care must be signed and dated by the physician/allowed practitionerpatient must receive home health services that re written in an individualized plan of careby a physician or authorized practitioner and services provided will be provided according to physician/practitioner orders. Orders are current and updatedclinical services are implemented only in accordance with a plan of care established by a physicians/practitioners written order. The Agency: accepts orders on referral communicated verbally by an institutions discharge planner, nurse practitioner, physicians assistant or other authorized staff member followed by written, signed and date physician orders, in order to begin services as soon as possiblereview of medical records (MR) on 4/23/25 at 12:00 PM revealed the following:
MR#3 Start of Care 4/8/25 A referral order was obtained on 4/8/25. A Physical therapy (PT) evaluation was completed on 4/8/25. The plan of care was pending with no orders for services. A PT visit had been completed on 4/22/25.
MR#4 Start of Care 3/14/25. On 4/1/25 documentation from Hamilton Health Center states, See notes from PCP. Shes declining to sign orders. She did not give these orders. Our records show she ordered OPPT (out patient physical therapy) with Achieva Rehab.
A patient care order with an order date of 3/30/25 written by the Occupational Therapist (OT) states, Discontinue: effective 3/31/25 12:01 AM-Occupational Therapy 1 wk 3 wk read back and confirmed (ordered on 3/18/25 1:26 PM). A signed handwritten note on this document by the nurse practitioner stated, I did not give verbal orders for these services. I ordered outpatient therapy for patient with Achieva.
Physical therapy visits had been conducted on 3/14, 3/18, 3/21, 3/25, 3/28 and 4/1/25 with no orders.
Interview on 4/23/25 at approximately 12:45 PM with the clinical director and VP of quality assurance confirmed the above findings
Plan of Correction:At the staff meeting on 4/30/25, the clinical director will educate staff on verbal order requirements and updated verbiage needed on the plan of care. Any staff who are not present will be educated and signed off by 5/9/25.
All new admissions, as well as current patients, will be audited by the clinical director or other assigned designee beginning week of 5/4/25 to ensure compliance with following verbal order requirements and completed plan of care. The Clinical Director or assigned designee will continue to audit all new admissions weekly to ensure verbal orders are present on the plan of care and the plan of care is completed and faxed to the physician for a signature, until compliance of 95% or greater is met for 2 weeks. This will be included in agencies QAPI program for continued oversight by the Clinical Director of other assigned designee.
Initial Comments:Based on the findings of an unannounced onsite home health agency Medicare and state licensure complaint survey Advantage Home Health and Hospice, 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:
601.31(a) REQUIREMENT
PATIENT ACCEPTANCE
Name - Component - 00
601.31(a) Patient Acceptance.
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. Care follows a written
plan of treatment established and
periodically reviewed by a physician
and care continues under the general
supervision of a physician.
Observations:
Based on a review of admission book, policies and procedures, medical records (MR) and staff interview the agency failed to ensure that services were provided as ordered by a physician for two (2) of five (5) MR's reviewed (MR#3 &; MR#4)
Review of admission handbook on 4/23/25 at 10:00 AM states, Admission to Advantage Home Health Services, LLC can only be made under the direction of physician or other allowed practitionerof policies and procedures on 4/23/25 at 10:30 AM reveled the following:
Plan of Care Policy states, Each plan of care must be signed and dated by the physician/allowed practitionerpatient must receive home health services that re written in an individualized plan of careby a physician or authorized practitioner and services provided will be provided according to physician/practitioner orders. Orders are current and updatedclinical services are implemented only in accordance with a plan of care established by a physicians/practitioners written order. The Agency: accepts orders on referral communicated verbally by an institutions discharge planner, nurse practitioner, physicians assistant or other authorized staff member followed by written, signed and date physician orders, in order to begin services as soon as possiblereview of medical records (MR) on 4/23/25 at 12:00 PM revealed the following:
MR#3 Start of Care 4/8/25 A referral order was obtained on 4/8/25. A Physical therapy (PT) evaluation was completed on 4/8/25. The plan of care was pending with no orders for services. A PT visit had been completed on 4/22/25.
MR#4 Start of Care 3/14/25. On 4/1/25 documentation from Hamilton Health Center states, See notes from PCP. Shes declining to sign orders. She did not give these orders. Our records show she ordered OPPT (out patient physical therapy) with Achieva Rehab.
A patient care order with an order date of 3/30/25 written by the Occupational Therapist (OT) states, Discontinue: effective 3/31/25 12:01 AM-Occupational Therapy 1 wk 3 wk read back and confirmed (ordered on 3/18/25 1:26 PM). A signed handwritten note on this document by the nurse practitioner stated, I did not give verbal orders for these services. I ordered outpatient therapy for patient with Achieva.
Physical therapy visits had been conducted on 3/14, 3/18, 3/21, 3/25, 3/28 and 4/1/25 with no orders.
Interview on 4/23/25 at approximately 12:45 PM with the clinical director and VP of quality assurance confirmed the above findings
Plan of Correction:At the staff meeting on 4/30/25, the clinical director will educate staff on verbal order requirements and updated verbiage needed on the plan of care. Any staff who are not present will be educated and signed off by 5/9/25.
All new admissions, as well as current patients, will be audited by the clinical director or other assigned designee beginning week of 5/4/25 to ensure compliance with following verbal order requirements and completed plan of care. The Clinical Director or assigned designee will continue to audit all new admissions weekly to ensure verbal orders are present on the plan of care and the plan of care is completed and faxed to the physician for a signature, until compliance of 95% or greater is met for 2 weeks. This will be included in agencies QAPI program for continued oversight by the Clinical Director of other assigned designee.
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