Every finding on record at Advanced Healthcare Services, LLC

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 10/24/24. The Agency was in compliance with the Condition, 42 CFR 484.102, Establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 10/24/24. The Agency was not in compliance with Standards for Home Health Agencies, 42 CFR 484 as evidenced by: Abbreviations: E- Employee Pt- Patient RN- Registered Nurse SOC- start of care

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 observation, document review, and interview, it was determined for 1 of 7 patients (Pt #1) home visits observed, the Agency failed to ensure medication reconciliation was complete and accurate. Findings include: 1. Pt #1 Start of Care (SOC): 6/15/2024 Diagnosis: Neuromuscular dysfunction of the bladder. A home visit was conducted on 10/22/2024 at approximately 11:45 AM with the Registered Nurse (RN, E #3). The Plan of Care and the Client Medication Report dated 10/14/2024 noted the following home medication discrepancies: a) lacked documentation of Cetirizine 10mg 1 cap once daily, Losartan 25mg 1 tab once daily, Tresiba inject 64 units subcutaneous at bedtime, and Pyrroloquinoline Quinone 40 mg once daily on the medication list; b) listed on the medication list was the wrong long-acting insulin. The medication list showed Lantus inject 64 units subcutaneous once a day at bedtime instead of Tresiba inject 64 units subcutaneous at bedtime. Pt #1 stated, “I’m taking Tresiba 64 units at bedtime.” Also listed on the medication list was Tamsulosin 0.4mg 1 tab once daily. Pt #1 stated, “I no longer take that." 2. Policy titled “Medication Reconciliation” (Revised February 2021) states, “… 2. Mediations ordered while the patient is receiving care will be compared to the medication list/profile. The mediation list/profile will be updated with each new or changed medication. The patient’s medication list in the home will also be updated.” 3. During an interview on 10/23/2024 at approximately 11:00 AM, the Agency supervisor (E#2) agreed the medications were incorrectly reconciled.

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 11/18/21. The Agency was in compliance with the Condition, 42 CFR 484.22, Establishment of the Emergency Program for this Survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 11/18/21. The Agency was not in compliance with Standards for Home Health Agencies, 42 CFR 484, as evidenced by: abbreviations: Pt- patient E- employee SOC- start of care

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 document review and staff interview, it was determined for 1 of 1 (Pt #15) patients requiring speech therapy, the Agency failed to ensure visits were conducted in accordance with the physician ordered plan of care (POC). This has the potential to affect all patients who receive care by the Agency with a current census of 160 patients. Findings include: 1. The policy "Missed Visit Policy" (revised March 2014) was reviewed 11/18/21 at approximately 10:00 AM. The policy noted, "If a scheduled visit is not met or not done on the scheduled date, a missed visit report will be filled out by each professional". 2. Pt #15 Start of Care: 7/28/21 Diagnosis: Type 2 diabetes with diabetic polyneuropathy The record was reviewed on 11/18/21 at approximately 9:00 AM. The plan of care dated 9/26/21 to 11/24/21 included Speech Therapy to see patient once per week for 8 weeks, starting the week of 9/26/21. The following missed visits were noted by the speech therapist: 9/28/21 missed visit (noted in record)10/8/21 missed visit (noted in record)10/15/21 missed visit (noted in record)Week of 10/17/21 through 10/23/21, no visit made, no missed visit report filed, and no notification made to the physician regarding the missed visit. No interdisciplinary notes made regarding the missed visit.Week of 10/24/21 through 10/30/21, no visit made, no missed visit report filed, and no notification made to the physician regarding the missed visit. No interdisciplinary notes made regarding the missed visit.3. An interview was conducted 11/18/21 at approximately 11:00 AM with the Agency Supervisor (E #2). E #2 verbally confirmed there were no Speech Therapy visits conducted and there should have been between 10/17/21 and 10/30/21