Every finding on record at Ahm Action Home Health, LP

. On 6/19/2023 at 12:00 PM an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 6/22/2023 at 12:15 PM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. .

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 Clinical Record review and staff interviews, it was determined the Skilled Nurse (SN) failed to include all medications during the review of the patients' medications in 4 (#2, #4, #6, and #13) of 17 (#1 - #17) Clinical Records reviewed. This failed practice by the SN posed a risk of potential harm for all patients on census by inhibiting the Nurse and Physician's ability to make informed decisions regarding the patients medication regimen related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. A review of Patient #2 Clinical Record revealed the following: A. Document titled “Medication Report” lists medications salcubitril/valsartan (trade name Entresto) and biorutin and were highlited in the color blue which indicates these medications were not included in the medications review by the Agency's electronic medical record (EMR). There was no evidence these medications were reviewed by a SN by any other method. 2. A review of Patient #4 Clinical Record revealed the following: A. Document titled “Medication Report” lists medications Oxygen (O2) and Penicillin G Potassium and were highlited in the color blue which indicates these medications were not included in the medications review by the Agency's (EMR). There was no evidence these medications were reviewed by a SN by any other method. 3. A review of Patient #6 Clinical Record revealed the following: A. Document titled “Medication Report” lists medical marijuana as a medication prescribed for pain,and were highlited in the color blue which indicates these medications were not included in the medications review by the (EMR). There was no evidence these medications were reviewed by a SN by any other method. 4. A review of Patient #13 Clinical Record revealed the following: A. Document titled “Medication Report” listed Oxygen (O2) and were highlited in the color blue which indicates these medications were not included in the medications review by the Agency's (EMR). There was no evidence these medications were reviewed by a SN by any other method. 5. During an interview with Agency staff on 6/22/23 at 9:30 A.M. Agency staff were given an opportunity to present documentation to show medications highlighted in blue on the Medication Reports for Patients #2, #4, #6, and #13 were included in the medications review by the SN. With no additional documentation presented, Agency staff #1 verified the medications on the Medication Reports that were highlighted in blue were not included in the medications review for potential adverse effects, drug reactions, significant side effects or significant drug interactions.

Written instructions to patient include: CFR(s): 484.60(e) Standard: Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: This STANDARD is not met as evidenced by: Based on Home Visits and staff interviews it was determined the Agency failed to provide the Patients/Caregivers with a complete and current medication list and instructions in 3 (#2, #4, and #7) of 7 (#1-#7) home visits completed. This failed practice prohibits the Patients/Caregivers and Care Providers from making informed decisions about their current medications regimen. Home visit for Patient #2 on 6/21/23 at 9:50 AM revealed the following: A. Review of Agency provided home folder for Patient #2 showed a medication list that was dated in 2022. There was no evidence a recent medication list had been provided to the Patient/Caregiver. . 2. Home visit for Patient #4 on 6/21/23 at 1:34 PM revealed the following: A. Review of Agency provided home folder for Patient #4 showed there was no evidence a recent medication list had been provided to the Patient/Caregiver. 3. Home visit for Patient #7 on 6/21/23 at 10:10 AM revealed the following: A. Review of Agency provided home folder for Patient #7 showed a medication list dated in 2022. There was no evidence a recent medication list had been provided to the Patient/Caregiver. 4. During the home visits for Patients #2, #4, and #7, Agency staff were provided an opportunity to locate the current medication lists for each patient. None was presented verifying a complete and current medications list with instructions had failed to be provided by the Agency. NOTE: This is a Repeat deficiency from the previous survey dated 1/24/2020.

Visit schedule CFR(s): 484.60(e)(1) Visit schedule, including frequency of visits by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on Home visits and Agency staff interviews it was determined that the Agency failed to provide the required information in writing of planned schedules for visits of all disciplines for 3 (#2, #4, and #7) of 7 (#1 - #7 home visits completed. This failed practice had the potential to affect all patients on census in that a lack of communication and information prohibits the patient and or caregiver from making informed decisions about care and potentially prohibits coordination of care. 1. A Home visit with Patient #2 on 6/21/23 at 9:50 A.M. revealed the following A. During a review of Patient #2 home folder provided by the Agency, there was no evidence Patient #2 was provided with a current visit schedule. The most recent schedule was dated 2022. 2. A Home visit with Patient #4 on 6/21/23 at 1:34 PM revealed the following: A. During a review of Patient #4 home folder provided by the Agency, there was no evidence Patient #4 was provided with a current visit schedule. . 3. A Home visit with Patient #7 on 6/21/23 at 10:10 AM revealed the following: A. During a review of Patient #7 home folder provided by the Agency, there was no evidence Patient #7 was provided with a current visit schedule. The most recent schedule was dated 2022. 4. Agency Staff accompanying surveyor was given an opporutnity to verify the planned visits were not in the home folders. For each instance, agency staff were unable to locate the required schedules, verifying the Agency failed to provide Patients #2, #4, and #7 with a written shedule of planned visits. NOTE: This is a repeat deficiency from previous survey dated 1/24/2020.

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 observations during home visits and review of the Agency's Policy and Procedure, the Skilled Nurse (SN) failed to follow accepted professional standards for infection control in 1 (#4) of 7 (#1- #7) home visits conducted. This deficient practice had the potential to place these patients with wound care at risk for adverse outcomes, wound infection and/or hospitalization. During a home visit 6/21/23 at 1:40 PM to observe care for client #4, surveyor observed SN (Skilled Nurse) have patient #4 remain seated on an office chair with arm out to remove PICC (Peripherally Inserted Central Catheter) dressing. Patient was asked and prompted twice to hold the sleeve of the shirt away from the PICC care and dressing change site. The SN made no effort to roll up or otherwise secure the sleeve prior to PICC care. A. Review of the Agency's Home Health and Hospice Policy and Procedure for PICC Dressing Change showed documentation that the patient needs to be positioned with arm extending away from the body to gain access to the insertion site. B. During the PICC dressing change, the Surveyor Observed that after the SN removed the PICC dressing that the PICC had nothing to secure the PICC catheter. The SN then asked patient #4 to reach over with the opposite arm to hold the distal end of the PICC line to keep it in place and prevent it from pulling out. The SN failed to apply sterile drapes during the PICC dressing change as per the Agency's policy and procedure. C. The Surveyor observed as Patient #4 struggled with positioning the arm for the PICC dressing change and rolled the arm to where the PICC insertion site was turned toward the inside of the Patient's body. (a natural disposition of the inner arm). D. The SN was observed as the PICC site was cleaned without visualizing the insertion site. The bio-patch (a small round felt like material that is used to cover where the PICC goes into the arm), was placed. SN then began attempting to hold both the bio-patch over the insertion site, as well as the distal end of the PICC. SN touched both the sterile area as well as the dirty end of the cath area, going from sterile to dirty area and then back. SN then placed the transparent dressing over the area. SN then proceeded to secure the PICC with a holder that was supplied in the dressing change kit. E. Review of web site for Nursing.com, showed that sterile technique must be maintained during PICC line dressing changes to prevent central line associated blood stream infections (CLABSI).

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on Clinical Record review and staff interviews, it was determined the Occupational Therapisit (OT) did not provide an accurate assessment in 1(#8) of 3 (#3, #8 and #11) Clinical Records reviewed with OT services ordered. This deficient practice had the potential to affect all patients receiving OT services currently on census in that, the assessents may not be accurate for those Patients on service.. Review of Clinical Record #8 revealed the following: A. Document titled "Visit Note Report" dated 6/7/23 showing documentation by the Registered Nurse (RN) for Integumentary (Skin) assessment of "No abnormal Integumentary findings." Skilled Nurse (SN) documented on 6/13/23 "Bruising" for integumentary status. B. Document titled "Visit Note Report dated 6/15/23 showed an assessment by an Occupational Therapist (OT) and documentation by the OT for Integumentary findings of "Abnormal integumentary findings." OT documentation continues "Stage II to buttock..." 2. During an interview on 6/22/23 @ 9:30 AM with Agency staff, Agency staff member #1 stated "I have spoken with the RN who did the assessment and she said there was no skin integrity issues other than brusing that the RN assessed." Agency staff member #1 continues to state, "We will educate the OT how the skin should be assessed."