Every finding on record at 1st Call Home Health Services

On 10/24/23 through 10/27/23, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at Attendant Care Services. This was a standard survey. The requirements for participation in Medicare at 42 CFR Part § 484.102 Emergency Preparedness were not reviewed.

On 10/24/23 through 10/27/23, the Michigan Department of Licensing and Regulatory Affairs conducted a recertification survey at: Attendant Care Services 51145 Nicolette Dr New Baltimore, Michigan 48047 The agency has no branch locations. Records reviewed: 5 records with home visits; 8 records without home visits; for a total of 13 records reviewed. At the conclusion of the survey the agency was found to be out of compliance with standard level deficiencies for the Conditions of Participation for Home Health Agencies at: 42 CFR Part § 484.

A review of all current medications CFR(s): 484.55(c)(5) A review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and noncompliance with drug therapy. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the physician was informed of any potential adverse effects such as: side effects, drug interactions, and duplicate drug therapy for 1 of 13 (P-10) records reviewed, resulting in the potential for harmful medication effects for this patient. Findings include: P-10: This 81-year-old patient was admitted to home care on 9/20/23 with a diagnosis of hypertensive urgency, vascular dementia, and failure to thrive. During record review on 10/25/23 at 3:00 p.m., it was noted on the Outcome and Assessment Information Set (OASIS) that the RN documented (in Section M2001) no issues were found during medication review. The RN also documented that there was a severe interaction noted for Eliquis and aspirin and the caregiver was educated on high risk for bleeding and to take care with sharp objects. The agency policy Medication Regimen Review (dated October 2023) states, “severe interactions…will be communicated to the physician who will be notified by midnight of the next calendar day as well as documented in the clinical record.” There was no evidence that the physician was notified of this severe interaction. This finding was reviewed and acknowledged by the owner (ADM-1), the administrator (ADM-2), and the clinical director (CD-1) during an interview on 10/27/23 at 11:00 a.m.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure the plan of care included patient-specific interventions in 5 of 13 (P-1, 5, 6, 8, 9) records reviewed, resulting in the potential for poor patient outcomes and unmet care needs. Findings include: P-1: The start of care date was 8/22/23, with diagnoses of congestive heart failure, respiratory failure, and type II diabetes mellitus. During record review on 10/24/23, it was noted that the initial start of care comprehensive assessment failed to document whether the recorded weight was actual or stated and failed to document a baseline blood glucose level. P-5: The start of care date was 7/19/23, with diagnoses of hypertension, chronic kidney disease, and type II diabetes mellitus. During record review on 10/26/23, it was noted that the initial start of care comprehensive assessment failed to include a baseline blood glucose level. P-6: The start of care date was 9/8/23, with diagnoses of congestive heart failure, arthritis, and pain. During record review on 10/27/23, it was noted that the initial start of care comprehensive assessment failed to document whether the recorded weight was actual or stated. These findings were reviewed and acknowledged by the owner (ADM-1), the administrator (ADM-2), and the clinical director (CD-1) during an interview on 10/27/23 at 12:30 p.m. P-8: This 45-year-old patient was admitted to home care on 10/10/23 with a diagnosis of Hemiplegia (muscle weakness or paralysis on one side of the body) following cerebral infarction (stroke) and type II diabetes mellitus. During record review on 10/26/23 at 12:45 p.m., it was noted that the initial start of care assessment failed to include a baseline blood glucose level for ongoing diabetes monitoring. P-9: This 70-year-old patient was admitted to home care on 10/2/23 with a diagnosis of aortic abdominal aneurysm, peripheral vascular disease, and diabetes mellitus. During record review on 10/26/23 at 2:45 p.m., it was noted that the initial start of care assessment failed to include a baseline blood glucose level for ongoing diabetes monitoring. These findings were reviewed and acknowledged by the owner (ADM-1), the administrator (ADM-2), and the clinical director (CD-1) during an interview on 10/27/23 at 11:00 a.m.