Every finding on record at Ahm Action Home Health, LP

On 01/29/2025 at 12:45 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 42 CFR Part 484 Conditions of Participation for Home Health Agencies. On 01/31/2025 at 10:30 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on Clinical Record Review and Agency Staff interview, the Agency staff failed to ensure the patients POC (Plan of Care) included the required elements of all patient specific interventions, education, measurable outcomes, goals, supplies and equipment specific to the individual patient in 2 (#1, #2) of 17 (#1-#17) clinical records reviewed. Findings: Review of Clinical Record #1 revealed the following: A. Home Health Certification and Plan of Care (POC) with dates from 12/28/24-02/25/25 revealed a pulse parameter of 50-100 (heartbeats per minute). B. Document titled Client Medication Report listed Digoxin 125 mcg (micrograms) tablet with instructions to take one tablet every PM. C. According to standard practice guidelines noted by Davis Drug Guide, "Teach patient to take pulse and to contact health care professional before taking medication if pulse rate is 100." (less than sixty heartbeats or more than one hundred heartbeats per minute). The patient's plan of care included a pulse parameter of 50 to 100. According to standard practice guidelines, a pulse of 50 would require a health care professional to be contacted before taking the medication. There was no evidence the agency educated the patient on contacting a health care professional before taking the medication. D. Agency Representative #1 reported on 01/31/2025 at 10:00 AM the agency did not use a standard of practice for medication administration. Review of Clinical Record #2 revealed: A. Home Health Certification and Plan of Care with certification dates of 01/01/2025-03/01/2025 B. An order for "Skilled Nurse (SN) for insertion of suprapubic catheter using # (omitted type/material of catheter), # (omitted size of catheter) cc (cubic centimeter) balloon inflated with (omitted fluid type- normal saline or sterile water). C. Agency Representative #1 on 01/31/25 at 10:00 AM was asked how the Skilled nurse was to carry out the above order per the POC, Agency Representative #1 said, "They (SN) cannot. The order isn't complete." Agency Representatives were asked to provide additional information. None was forthcoming.

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: 1. 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 3 (#5, #7,and #11) and in 4 (#8, #12, #13, and #16) of 17 (#1- #17) records reviewed the Physical Therapist (PT), not the SN completed the medication review. This failed practice by the SN posed a risk of potential harm for 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. Review of Clinical Records and Staff Interviews revealed the following: A. Clinical record #5 revealed a document titled "Visit Note Report" dated 4/6/2022. The SN documented on page 6 of the the narrative section, …and she was sent home with antibiotic pills too.” A review of a document titled "Client Medication Report" showed no evidence the antibiotic (a drug utilized to treat infections), was listed or checked for potential adverse effects, drug reactions, significant side effects and drug interactions of the antibiotic. B. Clinical record #7 revealed a document titled “Client Medication Record” which showed an active medication Levofloxacin (a medication used to treat an infection) 750 mg to be taken orally once daily. An interview with Representative #1 at 9:30 AM 4/29/22, confirmed the patient is no longer taking this medication by stating "the Patient is not taking it anymore." There was no evidence this medication was discontinued from the active Client Medication Record. C. Clinical Record #11 revealed a SN note dated 3/3/22. The SN documented the Patient was getting IV antibiotics administered at the Infectious Disease Clinic. Review of a document titled "Client Medication Record", showed no evidence the Antibiotics were listed or reviewed for potential adverse effects, drug reactions, significant side effects of significant drug interactions. An interview with Staff #1 confirmed the Antibiotic was not added to the Client's medication profile or checked for interactions. D. Clinical Record #8 revealed a document titled "Client Medication Record" that was signed by the Speech Therapist (ST) showing the Medications were reviewed by an ST. There was no evidence that the RN reviewed the medications for potential adverse effects, drug reactions, significant side effects of significant drug interactions. E. Clinical Records (#12, #13, and #16) revealed documents titled "Client Medication Record" were signed by a Physical Therapist as the Medications reviewer. There was no evidence a Registered Nurse (RN) reviewed the Medications for potential adverse effects, drug reactions, significant side effects or significant drug interactions. F. During an interview on 4/29/22 at 9:30 A M, Agency staff representative #1 confirmed that for Patients #8, #12, #13, and #16 there was no evidence an RN reviewed the clients' medications.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on Clinical Record Review and staff interview it was determined the Agency failed to alert the physician of relevant assessment findings which may have necessitated an alteration in the Plan of Care (POC) in 1 (#4) of 17 (#1-#17) Clinical Records Reviewed. This failed practice had the potential to affect all current patients on census in that Physicians may be unaware of new assessment findings resulting in missed opportunities for revision of patient goals/interventions and the prevention of hospitalizations. Review of Clinical Records and Staff interviews revealed the followed: A. Record #4 showed a primary diagnosis of Stage 4 and stage 3 Pressure Ulcers of both right and left buttocks. (Stage 3 pressure ulcer is a pressure injury to tissues that is an open wound and is characterized by an open wound that extends well into the dermis and begins to involve the hypodermis (also known as the subcutaneous layer). By this stage, the lesion will form a small crater. Fat may begin to show in the open sore but not muscle, tendon, or bone. In some cases, there may be visible pus and a foul smell. Stage 4 pressure wounds occur when the hypodermis and underlying fascia are breached, exposing muscle and bone. This is the most severe type of pressure ulcer and the most difficult to treat. Damage to deeper tissues, tendons, nerves, and joints may occur, usually with copious amounts of pus and drainage. Stage four pressure ulcers require aggressive treatment to avoid systemic infection and other potentially life-threatening complications. Review of a document titled “Visit Note Report” (a place where the nurse documents the findings from the visit) revealed nurse documentation of” Wound to Right buttock/hip noted to have dead ants in dressing. No live ants noted.” (Page 8 under Narrative section), Dated 4/27/2022 at 2:47 PM. B. During an interview 4/29/22 at 9:30 AM, Agency Representative #1 confirmed no communication to the treating physician by the nurse about the ants occurred.