Every finding on record at Advantage Home Health Services East, LLC

Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022 through November 10, 2022, Advantage Home Health and Hospice, was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation" Home Health Agencies-Emergency Preparedness.

Based upon an unannounced, onsite home health recertification and relicensure survey conducted November 7, 2022, through November 10, 2022, Advantage Home Health and Hospice, was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B & C, Conditions of Participation: Home Health Agencies.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on reviews of agency policy, clinical records (CRs), and interview with the vice president of compliance (EMP#1) and employee registered nurse # 2, it was determined agency failed to follow physician orders for one (1) of thirteen (13) clinical records reviewed. (CR# 8) Findings included: Review of agency policy 'Physician Orders-Verbal Orders' on November 10, 2022 at approximately 9:45 a.m. states, "POLICY: Drugs and treatments are administered by the Agency staff only as ordered by physician... " Review of CRs conducted on November 7, 2022 between approximately 12:30 p.m. to 3:00 p.m., November 8, 2022 between approximately 9:00 a.m. to 12:00 p.m. and November 10, 2022 between approximately 9:00 a.m. to 12:00 p.m. revealed the following: CR # 8, Start of Care (SOC), 6/3/2022; Plan of Treatment (POT) certification period reviewed 10/1/2022-11/29/2022 with diagnosis: acute myelomonocytic leukemia (rare type of acute myeloid leukemia (AML) in which there is an increased production of immature neutrophil white blood cells and immature monocyte white blood cells in the bone marrow) not having achieved remission and encounter for adjustment and management of VAD (ventricular assist device- a mechanical pump used to support heart function and blood flow in people with weak or failing hearts). POT for Skilled Nursing (SN) Orders: 1 wk 9 wk (one visit per week for 9 weeks). Medications listed included: "Normal Saline Flush (NSF) 0.9% injectable solution: Inject 5-10 milliliter(s) intravenously (IV) before and after medications; Flush IV with 5-10 mL NSF before and after medications and PRN (as needed) for IV patency" 'Skilled Nursing Visit Note' from 10/6/2022, section, 'Care Plan Documentation' contained documentation of "Flush Details: Flush Solution: Heparin 10 units/ml." No physician order for Heparin to be used as a flush solution. Interview with employee registered nurse # 2 that documented on the 'Skilled Nursing Visit Note' from 10/6/2022 was conducted on November 10, 2022 at approximately 9:30 a.m. Surveyor questioned the employee registered nurse # 2 to explain her documentation and she replied, "I didn't flush it with Heparin. I have several patients that get flushes, it was an error in documentation." Interview with EMP # 1 on November 10, 2022 at approximately 12:30 p.m. confirmed above findings.