Every finding on record at Adoration Home Health Care West Tennessee

A Health Emergency Preparedness survey was conducted on 1/12/2026 through 1/14/2026 with the recertification survey. The facility meets all requirements reviewed for Emergency Preparedness.

A recertification and complaint #2676889 survey was conducted on 1/12/2026 - 1/142026. An entrance conference was held on 1/12/2026 at 9:15 AM, with the Administrator and Area Vice President of Operations. An exit conference was held on 1/14/2026 at 2:00 PM, with the agencies administration.

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 policy review, medical record review, observation, and interview, the agency failed to update the medication profile for 2 of 7 (Patient #3 and #5) sampled patients observed during home visits. The findings included: 1. Review of the agency’s policy “Home Health Clinical Practice Expectations,” revised 10/24/2025, revealed “…A comprehensive review of medications requires seeing the medications…Medication reconciliation and medication teaching will be completed, and documented by every clinician, on every visit…” 2. Medical record review for Patient #3 revealed a start of care date of 9/24/2025 with diagnoses including Diabetes Mellitus with Diabetic Chronic Kidney Disease, Lymphedema and Venous Insufficiency. Review of the “Home Health Certification and Plan of Care” for the certification period from11/23/2025-1/21/2026, revealed the following medication orders: Aspirin (anticoagulant) 81 mg (milligrams) over the counter (OTC) Cetirizine (antihistamine) 10 mg (OTC) Ciprofloxacin (antibiotic) 250 mg with an initial prescription date of 10/31/2025 1 tablet every 12 hours Gabapentin (used to treat neuropathy) 100 mg capsule 3 times daily Pantoprazole (used to treat heartburn and reduce the amount of acid in the stomach) 40 mg with an initial prescription date of 9/24/2025 1 capsule daily Rosuvastatin (used to treat high cholesterol) 5 mg 1 tablet daily Vitamin C (used to boost immune system) 500 mg (OTC) Observations in Patient #3’s home on 1/13/2026 at 11:10 AM, revealed the following medications: Aspirin (anticoagulant) 81 mg over the counter (OTC) Cetirizine (antihistamine) 10 mg (OTC) Gabapentin (used to treat neuropathy) 100 mg capsules 3 times daily Rosuvastatin (used to treat high cholesterol) 5 mg 1 tablet daily Vitamin C (used to boost immune system) 500 mg (OTC) (Vitamin) with Iron (vitamin with extra iron) (OTC) Colace (stool softener) 100 mg 1 capsule daily Fluticasone (used to treat allergies) 50 microgram 1spray daily as needed During an interview on 1/13/2026 at 11:25 AM, Patient #3 confirmed she completed ciprofloxacin three months ago and she stopped pantoprazole four months ago. She confirmed she had been taking (vitamin with iron) and colace for a few weeks. 3. Medical record review for Patient #5 revealed a start of care date of 1/4/2026 with diagnoses including Type 2 Diabetes Mellitus with Hyperglycemia and Acute Embolism and Thrombosis of Left Internal Jugular Vein. Review of the “Home Health Certification and Plan of Care” for the certification period from 1/4/2026-3/4/2026, revealed the following medication orders: Atorvastatin (used to treat high cholesterol) 40 mg 1 tablet daily Bisacodyl (used to treat constipation) 5 mg 1 daily Carvedilol (used to treat heart disease) 25 mg 1 tablet 2 times daily Clonidine (used to treat high blood pressure) 0.1 mg tablet 2 times daily Diazepam (used to treat anxiety) 5 mg tablet daily/as needed Eliquis (used to treat blood clots) 5 mg 2 tablets daily Gabapentin (used to treat nerve pain) 100 mg capsule 3 times daily Levothyroxine (used to treat hypothyroidism) 50 micrograms 1 tablet daily Observations in Patient #5’s home on 1/14/2026 at 11:10 AM, revealed the following medications: Atorvastatin (used to treat high cholesterol) 40 mg 1 tablet daily Carvedilol (used to treat heart disease) 25 mg 1 tablet 2 times daily Clonidine (used to treat high blood pressure) 0.1 mg tablet 2 times daily Diazepam (used to treat anxiety) 5 mg tablet daily/as needed Eliquis (used to treat blood clots) 5 mg 2 tablets daily Gabapentin (used to treat nerve pain) 100 mg capsule 3 times daily Levothyroxine (used to treat hypothyroidism) 50 micrograms 1 tablet daily Triamterene/Hydrochlorothiazide (used to treat high blood pressure and fluid) 37.5/25 mg 1 every AM as needed for lower extremity edema Losartan (used to treat high blood pressure) 100 mg 1 tablet daily Amlodipine (used to treat high blood pressure) 10 mg 1 tablet daily During an interview on 1/14/2026 at 11:10 AM, Patient #5 stated she had been on triamterene/hydrochlorothiazide, losartan, and amlodipine for a while. 4. During an interview on 1/14/2026 at 1:55 PM, the Administrator stated, all medications should be reconciled at every visit and the nurses should put their hands on the medication bottles and use best practice.

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 policy review, medical record review, and interview, the agency failed to follow the plan of care and notify the physician responsible for missed visits for 4 of 12 (Patient #3, #6, #9, and #10) sampled records reviewed. The findings included: 1.Review of the agency's "SCHEDULING PATIENT CARE," policy dated 8/6/2025, revealed, "...Patient care staff are assigned to provide care for patients, in accordance with each patient’s plan of care, under the direction of the clinical manager…all missed visits are documented in the clinical record and communicated to the physician…practitioner...If a visit is missed and unable to be rescheduled within the same week, the physician …practitioner issuing the orders must be notified.” 2. Record review for Patient #3 revealed a Start of Care (SOC) of 9/24/2025 with diagnoses of Heart Failure, Diabetes Mellitus, and Anemia. Review of the Home Health Certification and Plan of Care dated 11/23/2025 to 1/21/2026 revealed, "...OT [Occupational Therapy] effective 1/23/2025 1WK[Week]9 [1 time a week for 9 weeks]..." Review of the medical record for the week of 11/23/2025 revealed there was no documentation of an OT visit and no physician notification documentation. Review of the medical record for the week of 11/30/2025 revealed there was no documentation of an OT visit. During an interview on 1/14/2026 at 10:45 AM, the Regional Vice President of Operations (RVPO) stated the two OT visits were missed and the facility failed to notify the physician of the missed visit for the week of 11/23/2026. 3. Record review for Patient #6 revealed a SOC of 12/16/2025 with diagnoses of Heart Failure. Review of the Home Health Certification and Plan of Care dated 12/16/2025 to 2/13/2026 revealed, "...SN [Skilled Nurse] effective 12/16/2025 1WK[Week]7[1 time a week for 7 weeks]..." Review of the Coordination Note dated 12/24/2025 revealed, "...SN...MISSED VISIT....NO ANSWER TO…PHONE...” During an interview on 1/14/2026 at 10:56 AM, the RVPO stated, "... the OT visit was missed, and the physician was not notified of the missed visit..." 4. Record review for Patient #9 revealed a SOC of 9/10/2025 with diagnoses of Femur Fracture, Heart Failure, Diabetes Mellitus, and End Stage Renal Disease. Review of the Home Health Certification and Plan of Care dated 1/8/2026 to 3/8/2026 revealed, "...SN effective 1/11/2026 1WK[Week]1[1 time]..." Review of the Coordination Note dated 1/8/2026 revealed, "...SN...MISSED VISIT....SN WAS OFF…” During an interview on 1/14/2026 at 11:07 AM, the RVPO stated, "... the SN visit was missed, and the physician was not notified of the missed visit..."

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on facility policy, medical record review, observation, and interview, the agency failed to ensure measures were utilized to prevent exposure of potential infectious bacteria for 1 of 7 (Patient #3) home visit observations. The findings included: 1. Review of the agency's “Hand Hygiene,” policy revised 9/2021, revealed, “...Hand Hygiene: …Before donning and immediately after removing gloves…After touching…contaminated items, even when wearing gloves…” 2. Review of the medical record revealed Patient #3 was admitted with a start of care date of 9/24/2025 with diagnoses of Type 2 Diabetes Mellitus with Diabetic Chronic Kidney Disease, Lymphedema, and Venous Insufficiency. Review of the physician order dated 1/5/2026, revealed, “…SKILLED NURSE...”TO PERFORM WOUND CARE TO BILATERAL LOWER EXTREMITIES EVERY OTHER DAY OR AS NEEDED. CLEANSE AREA WITH WOUND WASH AND 4 X 4 GAUZE. PAT DRY WITH 4X4 GAUZE. PLACE ALGINATE (Highly absorbent, bandage that forms a soft moist gel when they contact wound fluid) TO OPEN AREAS. COVER WITH BANDAGE GAUZE AND SECURE WITH ACE WRAP…” 3. Observations in Patient #3's home on 1/13/2026 at 11:00 AM, revealed Registered Nurse (RN) #1 performed a dressing change to Patient # 3’s right lower extremity, RN #1 failed to perform hand hygiene between glove changes after the removal of the soiled dressing and applying the new dressing. RN #1 proceeded to the left lower extremity and failed to perform hand hygiene between glove changes after the removal of the soiled dressing and applying the new dressing. 4. During an interview on 1/14/2026 at 1:50 PM, Administrator confirmed staff were to perform hand hygiene between glove changes and use best practice.

An unannounced complaint investigation for intake #95634 was initiated on 1/30/2023. An exit interview was conducted on 2/6/2023 and the facility was informed of the investigation findings.

Authentication CFR(s): 484.110(b) Standard: Authentication. All entries must be legible, clear, complete, and appropriately authenticated, dated, and timed. Authentication must include a signature and a title (occupation), or a secured computer entry by a unique identifier, of a primary author who has reviewed and approved the entry. This STANDARD is not met as evidenced by: Based on policy review, record review and interview, the facility failed to ensure clinical notes were appropriately signed and dated for 3 of 7 (Patient #2,5 and 6) private duty patients reviewed. The findings included: 1 Review of the facility's "CLINICAL RECORDS" policy (revised 10/20/22) revealed, "...All entries in the clinical record must be legible, clear, complete, and appropriately authenticated, dated, and timed...Documentation shall be written on the day the service is delivered..." 2 Medical record review for Patient #2 revealed a Start of Care (SOC) date of 5/10/2022 with diagnoses that included Chronic Heart Failure and Pneumonia. The most recent Plan of Care (POC) dated 1/5/2023 through 3/5/2023 revealed a physician's order for Aide services 35 hours a week. Review of Aide notes beginning 1/16/2023 through 1/29/2023 revealed the following: There were no patient/caregiver signatures for 1/16/2023, 1/17/2023, 1/19/2023, 1/20/2023, 1/24/2023, 1/26/2023, 1/27/2023, 1/28/2023. An Aide note for 1/29/2023 had a patient/caregiver signature dated 1/30/2023. Further review of Aide notes revealed a 1/26/2023 note was signed and dated by the Aide on 1/27/2023. A 1/28/2023 note was signed and dated by the Aide on 1/30/2023. A 1/29/2023 note was signed and dated by the Aide on 1/30/2023. 3 Medical record review for Patient #5 revealed a SOC date of 9/23/2014 with diagnoses that included Cerebral Palsy and Convulsions. The most recent POC dated 12/10/2022 through 2/7/2023 revealed a physician order for Skilled Nurse 30 hours weekly and Aide services 10 hours weekly. Review of Skilled Nurse and Aide notes beginning 1/16/2023 through 1/29/2023 revealed the following: A 1/20/2023 Aide note was signed by the patient/caregiver on 1/22/2023. A 1/21/2023 Aide note was signed by the patient/caregiver on 1/22/2023. A 1/28/2023 Aide note was signed by the patient/caregiver on 1/29/2023. 4 Medical record review for Patient #6 revealed a SOC date of 6/13/22 with diagnoses that included Cerebral Palsy and Dysphagia. The most recent POC dated 12/10/2022 through 2/7/2023 revealed a physician order for Skilled Nurse 30 hours weekly. Review of Skilled Nurse notes beginning 1/16/2023 through 1/29/2023 revealed the following: A 1/18/2023 note was not signed by the patient/caregiver. A 1/20/2023 note was not signed by the patient/caregiver. A 1/23/2023 note was signed by the Skilled Nurse and patient/caregiver on 1/24/2023. A 1/25/2023 note was signed by the Skilled Nurse and patient/caregiver on 1/26/2023. In an interview on 2/2/2023 at 10:00 AM, the facility's Administrator and Private Duty Director stated there were issues with some of the IPAD's in the patient homes, and this caused interference with documentation being done timely. The Administrator verified there was no documentation to verify issues with the IPADS.