Every finding on record at Acadian Homecare of New Iberia, LLC

Acadian Homecare of New Iberia is in compliance with federal emergency preparedness requirements.

Recertification Survey

Plan of care CFR(s): 484.60(a)(1) 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. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient's written individualized POC (Plan of Care) was followed as evidenced by the SN (Skilled Nurse) failing to perform and record blood glucose readings for patient (#8) for 1 out of 17 sampled patients. Patient #8. Review of the patient's electronic clinical record revealed the start of care date was 10/07/2024. The patient's diagnoses included Coronary Artery Bypass Graft, Hypertension, and Type 2 Diabetes. The certification period reviewed was 10/07/2024 to 12/05/2024. Review of the patient's POC for certification period 10/07/2024 to 12/05/2024 revealed an order for skilled nurse 3wk1, 1wk8 (skilled nurse visit three times a week for one week, skill nurse visit one time a week for eight weeks). Further review of the patient's POC revealed an order for "…Skilled nurse to instruct patient on blood glucose testing. Frequency for blood glucose testing QSNV (Every Skilled Nurse Visit) patient’s therapeutic CBG (Capillary Blood Glucose) range is 70 mg/dl (milligrams per deciliter) to 200 mg/dl…” Review of the patient's SN visit notes dated 10/07/2024, 10/08/2024, 10/11/2024, 10/17/2024, and 10/28/2024 revealed there was no evidence the SN performed and recorded blood glucose readings. On 10/29/2024 at 1:35 p.m., a telephone interview was conducted with S2RN (Registered Nurse). S2RN confirmed that she did not perform blood glucose testing on the patient for every SN visit. On 10/29/2024 at 2:45 p.m., an interview and review of the patient’s electronic clinical record was conducted with S1ED (Executive Director). S1ED confirmed there was no evidence the SN performed and recorded the patient’s blood glucose readings. S1ED stated the SN should have performed the patient’s blood glucose testing and documented the results in the patient’s clinical record.

This entity is in compliance with federal emergency preparedness requirements.

Recertification survey.

Plan of care CFR(s): 484.60(a)(1) 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. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient's written individualized POC (plan of care) was followed as evidenced by the SN (Skilled Nurse) failing to follow the physician’s orders for oxygen at the ordered rate for 1 (patient #9) out of 17 sampled patients. (#9) Patient #9. Review of the patient’s electronic clinical records revealed the start of care date was 8/13/2021. The patient’s diagnoses included Urinary Tract Infection, Hypertension, Pneumonia due to Corona Virus, and Acute Respiratory Failure with Hypoxia. The certification period reviewed was 10/12/2021 to 12/10/2021. Review of the patient’s POC for certification period 10/12/2021 to 12/10/2021 revealed an order for “SN 1wk7, 1 every2wk2 (skilled nurse visit one time a week for seven weeks, one visit every two weeks for two weeks).” Further review of the patient’s POC under the medication section revealed an order for oxygen 5 liters per nasal cannula continuous. Review of the patient’s skilled nurse visit notes dated 10/14/2021 and 10/19/2021 revealed that the SN documented the patient was on 2 liters of oxygen and not 5 liters of oxygen as ordered. Further review of the patient’s electronic clinical records revealed an order dated 10/28/2021 to change oxygen to 2 liters per nasal cannula continuous. Review of the patient’s skilled nurse visit notes dated 10/28/2021, 11/5/2021, and 11/9/2021 revealed that the SN documented the patient was on 1.5 liters of oxygen and not 2 liters of oxygen as ordered. On 11/17/2021 at 1:30 pm, S1ED (Executive Director) reviewed the patient’s electronic clinical record and confirmed that there were no orders to decrease the oxygen from 5 liters to 2 liters for the skilled nurse visits made on 10/14/2021 and 10/19/2021. Also, S1ED confirmed that there were no orders to decrease the oxygen to 1.5 liters for the skilled nurse visits made on 10/28/2021, 11/5/2021, and on 11/9/2021.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency’s staff failed to ensure the patient’s physician responded timely to communication of concerns identified during skilled nurse visits for 3 (#2, #11, #12) out of 17 sampled patients. Findings: Patient #2. Review of the patient’s electronic clinical record revealed a start of care date was 7/31/2021. The patient’s diagnoses included Malignant Neoplasm of Unspecified Part of Left Bronchus or Lung and Essential Hypertension. The certification period reviewed was from 9/29/21 to 11/27/2021. Review of the patient’s POC (Plan of Care) revealed that patient had an expressed goal of decrease pain. Review of client coordination note dated 10/13/21 revealed the note type was MD/SBAR (Medical Doctor Situation, Background, Assessment, Recommendation) Communication. The note revealed the following: Patient being seen for: pain management. Significant Event/Problem: Pain 6/10 daily and uncontrolled to bilateral lower extremities. Patient states Tramadol (pain medication) is ineffective. Patient has to lay in bed most hours of the day to get some relief. Request/Comment: Patient requests stronger pain medication to treat uncontrolled pain. Review of the patient’s visit note report dated 10/19/2021 revealed that the patient still complained of pain and that S2RN was following up on MDSBAR sent last week. Review of the patient’s visit note report dated 10/26/21 revealed the following: Rates right leg pain 5/10…S2RN trying to set up f/u (follow up) with NP (Nurse Practitioner) for pain management. Review of client coordination note dated 10/29/21 revealed pt (patient) needs refill on Gabapentin (treats nerve pain)…notified (oncologist) office spoke with nurse…called (nurse practitioner agency) when is the next NP visit, no visit set up he will find out more info and call back. Review of the patient’s visit note report dated 11/2/21 revealed the following: Patient c/o (complained of) pain located in the right and left knee and lower back. Uses OTC (over the counter) Tylenol and rest to help relieve pain. MDSBAR sent previously for clarification on Gabapentin (treats nerve pain) medications as it was not included in monthly prefilled box. Awaiting response… Review of client coordination note dated 11/2/21 revealed the note type was MD/SBAR Communication. The note revealed the following: Significant Event/Problem: Patient would like an appointment to have mediport flush. Patient states last time her port was flushed was last visit with (oncologist) in September 2021. Patient would like to know if Baclofen or Meloxicam would be beneficial to help relieve back spasms/pain? Request/Comment: Patient would like to be scheduled for an infusion appointment. Further review of the patient’s electronic clinical record revealed no evidence that the patient’s physician or NP agency responded to any of the above communication. Review of the patient’s visit note report dated 11/15/21 revealed the following: …Rates pain 7/10 in bil (bilateral) legs…no response to message from MD from last week…message left with (oncologist) regarding flushing mediport, pain management and Gabapentin refill… On 11/15/21 at 11:15 AM , a home visit was conducted with Patient #2 and S3LPN. During the visit, the patient stated that she was disappointed that no one had addressed her knee pain and that she still had not had her mediport flushed. She stated that the only way she could get some pain relief was to lay in bed most of the day and that being in bed all day was no way to live. During an interview at this same time with S3LPN, she stated that the resident had been having chronic pain that the prescribed Tramadol did not help. She had been having difficulty getting the doctor or NP to address the resident’s pain and mediport. On 11/16/21 at 10:30 AM, an interview with S2RN was conducted. She stated that the she had tried to get in touch with the patient’s doctor to get the patient’s medication refilled but the office was not responding to the SBARs. She also confirmed that she called to get an appointment with a nurse practitioner but none had been scheduled as of yet. On 11/16/21 at 10:45 AM, an interview with S1ED was conducted. She stated that they have a nurse practitioner agency that they are contracted with to see patients who don’t have a primary physician but had been unsuccessful with getting them to respond to requests for appointments. She confirmed that the patient’s pain and mediport had not been successfully addressed since they had received no communication responses from the patient’s doctor or nurse practitioner. Patient #11. Review of the patient's electronic clinical records revealed the start of care date was 4/29/2021. The patient's diagnoses included Diabetes and Chronic of Ulcer of Right and Left leg. The certification period reviewed was from 10/26/2021 to 12/24/2021. Review of the patient's plan of care (POC) for certification period 10/26/2021 to 12/24/2021 revealed the following order: SN 1wk9 change 10/31/2021 2wk8 (skilled nurse visit one time a week for nine weeks, change 10/31/2021 two times a week for eight weeks). Review of the patient's skilled nurse visit note dated 11/5/2021 revealed documentation that the patient's blood sugar was 311. The note next to the 310 reading revealed "See note Follow-up comment entered by ____ on 11/7/2021 Notify MD". There was no evidence that the physician was notified concerning the patient's 311 blood sugar reading. On 11/17/2021 at 2:15 pm, S1ED (Executive Director) reviewed the patient’s electronic clinical record and confirmed that she could not provide evidence that the physician was notified concerning the patient's 311 blood sugar reading. S1ED provided documentation that a fax was sent to the physician’s office concerning the patient's 311 blood sugar reading. Also, S1ED confirmed that she could not provide evidence that the physician responded to the fax. Patient #12: Review of the patient’s electronic clinical record revealed a start of care date was 10/23/21. The patient’s diagnoses included Type 2 Diabetes Mellitus with Hyperglycemia and Chronic Kidney Disease. The certification period reviewed was from 10/23/21 to 12/21/2021. Review of client coordination note dated 11/4/21 revealed the note type was MD/SBAR Communication. The note revealed the following: patient requires more assistance in the home and CG (caregiver) is requesting a social worker consult. Review of the patient’s electronic clinical record on 11/17/2021 did not reveal a response from the patient’s physician nor an order for a social worker consult. On 11/17/21 at 3:30 PM, an interview was conducted with S1ED. She stated that the MD/SBARs were faxed to the doctor by a registered nurse. The SBAR is then given to one of the office assistants to follow up on in a day or two. She stated that there was no policy or procedure for SBAR follow-up. She confirmed that no additional communication was made to the doctor when there had been no response to the request for the social worker consult.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure a registered nurse (RN) made an onsite supervisory visit for Patient #6 who was receiving home health aide (HHA) services no less frequently than every 14 days for 1 (#6) out of a total of 17 sampled patients. Patient #6. Review of the patient’s electronic clinical record revealed the start of care date was 10/14/2021. The patient’s diagnoses included Hemiplegia Following Cerebral Infarction. The certification period reviewed was 10/14/2021 to 12/12/2021. The patient's plan of care (POC) was reviewed and revealed the following orders: SN 1wk1, 2wk1, 1wk7 (skilled nurse visit one time a week for one week, two times a week for one week, one time a week for seven weeks). HHA effective 10/17/2021 2wk3, 1wk4 (home health aide visit effective week of 10/17/2021 two times a week for three weeks, one time a week for four weeks). The patient's HHA visit note report dated 10/18/2021 revealed that the HHA made the first visit for the certification period. Further review of the patient’s electronic clinical record revealed that the RN conducted a supervisory visit on 11/2/2021, which was not within 14 days. The HHA continued visits with the patient. Further review of the patient’s clinical record revealed that there was no evidence that the RN made a supervisory visit from 11/3/2021 to 11/17/2021, which was not within 14 days. On 11/17/2021 at 11:40 am, an interview was conducted with S1ED (Executive Director) and after a review of the patient's electronic clinical records, she verified that the RN did not make a supervisory visit for the HHA no less frequently than every 14 days.