Every finding on record at Alabama Homecare of Coosa Valley

A recertification survey was performed on 11/18/25 to 11/20/25 at Alabama HomeCare of Coosa Valley. The agency was found to be in substantial compliance with the Conditions of Participation for Emergency Preparedness.

A recertification survey was performed on 11/18/25 to 11/20/25 at Alabama HomeCare of Coosa Valley. Standard level deficiencies were sited that will require an acceptable plan of correction.

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 observations, medical record (MR) review, agency policy and procedure, and interviews with staff, it was determined the agency failed to ensure medications were reconciled each Skilled Nurse (SN) visit per agency policy. This deficient practice affected five of seven home visit (HV) patients including HV # 1, HV # 4, HV # 6, HV # 3, and HV # 2, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Medication Management Policy Number: 10.008 Revised: 7/1/24 Purpose: To provide a process to ensure continuous monitoring of medications in the patient's home. Policy: A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode. Procedure: ...2. All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care. During the patient's episode of care the following will occur: ...i. Compare medications patient is currently taking with medications ordered for the patient in order to identify and resolve discrepancies. 5. HV # 2 was admitted to the agency on 9/22/25 with a primary diagnosis of Nondisplaced Fracture of the Proximal Phalanx of Right Index Finger. A HV was conducted on 11/18/25 at 1:30 PM to observe care provided by EI # 3, Physical Therapist. During the HV, EI # 3 reviewed the medications with HV # 2's caregiver and compared the medications with the agency ML dated 11/18/25. The following is a list of the discrepancies: Glipizide 5mg by mouth daily was discontinued on 6/4/25 per the caregiver report. Glipizide was documented as an active medication on the agency ML. MiraLAX 17 gram daily as needed for constipation was not listed on the agency ML. A resumption of care was performed on 10/21/25 with an order for MiraLAX 17 gram as needed for constipation, and a recertification visit was performed by the SN on 11/17/25 and the medication was not added to the agency ML. An interview was conducted on 11/20/25 at 10:52 AM with EI # 1, who confirmed the staff failed to reconcile the patient medications per the agency policy. 4. HV # 3 was admitted to the agency on 7/12/25 with a primary diagnosis of Paroxysmal Atrial Fibrillation. A HV was conducted on 11/18/25 at 3:10 PM to observe the care provided by EI # 9, Licensed Practical Nurse. During the HV, EI # 9 reviewed the medications with HV # 3 and compared the medication with the agency ML dated 11/18/25. The following is a list of the discrepancies: Cefuroxime Axetil 500 milligrams (MG) one oral tablet every twelve hours for seven days for urinary tract infection (UTI) prescribed 10/8/25 is on the agency ML. HV # 3 stated he/she has not taken this medication since October. Hydrocodone 5 mg- Acetaminophen 325 mg one oral tablet every six hours as needed for pain above 5 on a 1-10 scale prescribed 2/3/25 is listed on the agency ML. HV # 3 stated he/she has not taken this medication in a long time. HV # 3 stated the medication was ordered only short term for pain control. Zinc 50 mg one oral tablet daily was found in home and was not listed on the agency ML. HV # 3 stated the medication was started in September to help with his/her immune system. Vitamin C 500 mg one oral tablet daily was found in home and was not listed on the agency ML. HV # 3 stated the medication was started in September to help with his/her immune system. An interview was conducted on 11/20/25 at 10:47 AM with EI # 1, who confirmed the staff failed to reconcile the patient medications per the agency policy. 1. HV # 1 was admitted on 10/25/25 with a primary diagnosis of Encephalopathy, unspecified. A HV was conducted on 11/18/25 at 12:06 PM to observe care provided by Employee Identifier (EI) # 4, Occupational Therapist. During the HV, EI # 4 reviewed the medications with HV # 1 and compared the medications with the agency Medicine List (ML) dated 11/18/25. The following is a list of the discrepancies: Entresto 24-26 mg tablet take 1 daily was on the ML, but Entresto 24-26 mg take 1/2 tablet twice a day was in the home and prescription was dated 8/25/25. HV # 2 stated he/she was currently taking Entresto 24-26 mg 1/2 tablet twice a day. Guaifenesin Extended Release 600 mg once daily was in the home and was not on the agency ML. HV # 1 said he/she had been taking about ten years. Mirtazapine 15 mg tablet at bedtime was on the agency ML and was not in the home. HV # 1 stated, "I don't remember even taking it." Amitriptyline 75 mg tablet at bedtime was on the agency ML and was not in the home. HV # 1 stated, "I haven't taken it for three to four months." Hydrocodone 5 mg-Acetaminophen 325 mg tablet, one tablet every six hours-take only as needed for severe pain was on the agency ML. Hydrocodone 5 mg-Acetaminophen 325 mg tablet, one tablet three times daily was in the home and the prescription was dated 8/4/25. HV # 1 stated he/she was currently taking Hydrocodone 5 mg-Acetaminophen 325 mg tablet three times daily. Ipratropium 0.5 mg-Albuterol 3 mg (2.5 mg base) 3 milliliters (ml) Nebulization Solution-Inhalation 3 ml three times a day was on the agency ML. HV # 1 stated, "I haven't used that in three years." Zaleplon 5 mg one capsule at bedtime as needed was in the home, and was not on the agency ML. HV # 1 said he/she was taking, but couldn't remember when she had started and date on the prescription bottle was unreadable. An interview was conducted on 11/20/25 at 10:25 AM with EI # 1, Executive Director who confirmed the staff failed to reconcile the patient medications per the agency policy. 2. HV # 4 was admitted on 8/12/25 and recertified for continued care on 10/11/25 to 12/9/25 with a primary diagnosis of Encounter for Orthopedic Aftercare following Surgical Amputation. A HV was conducted on 11/19/25 at 8:37 AM to observe care provided by EI # 6, SN. During the HV, EI # 6 reviewed the medications with HV # 4 and compared the medications with the agency ML dated 11/18/25. The following is a list of the discrepancies: Aspirin 81 mg tablet, delayed release one tablet daily was on the agency ML and was not in the home. HV # 4 said he/she had not taken in about two months. Biotin10,000 micrograms (mcg) capsule once daily was on the agency ML and was not in the home. HV # 4 stated, "I have not taken that since last year." Calcitrol 6.25 mg one capsule three times a week was on the agency ML and was not in the home. HV # 4 said he/she had not taken for approximately one month. Losartan 50 mg one tablet daily was on the agency ML. Losartan 100 mg one tablet daily was found in the home dated 11/14/25 on the prescription bottle. HV # 4 stated he/she was currently taking Losartan 100 mg one tablet daily. Metformin 500 mg one tablet daily was on the ML. Metformin 500 mg one tablet twice a day was in the home and prescription was dated 11/14/25. HV # 4 stated he/she was taking Metformin 500 mg one tablet twice daily. There were two nursing visits which were made on 11/15/25 and 11/17/25 prior to HV on 11/19/25. Proair Respiclick 90 mcg/Actuation Breath Activated-Inhalation was on the agency ML and was not in the home. HV # 4 stated he/she had not taken for years and years. Sulfamethoxazole 800 mg-Trimethoprim 160 mg tablet two times daily was on the agency ML and was not in home. HV # 4 stated this medication was discontinued on 11/14/25. There were two nursing visits which were made on 11/15/25 and 11/17/25 prior to HV on 11/19/25. Clopidogrel 75 mg one tablet daily was found in the home, dated 10/15/25 on the prescription bottle. There was no documentation of Clopidogrel on the agency ML. HV # 4 stated he/she was taking Clopidogrel 75 mg one tablet daily. An interview was conducted on 11/20/25 at 10:30 AM with EI # 1, who confirmed the staff failed to reconcile the patient medications per the agency policy. 3. HV # 6 was admitted on 1/7/25 and recertified for continued care on 11/3/15 to 1/1/26 with a primary diagnosis of Pressure Ulcer of Sacral Region, Stage 4. A HV was conducted on 11/20/25 at 8:03 AM to observe care provided by EI # 7, SN. During the HV, EI # 7 reviewed the medications with HV # 6 and compared the medications with the agency ML dated 11/19/25. The following is a list of discrepancies: Triad Wound Dressing Paste apply one centimeter around wound edges with wound care at least daily. May use twice a day if dressing requires changing twice due to urine saturation. Triad Wound Dressing Paste, dated 10/21/25 was on the agency ML, and was not in the home. An interview was conducted on 11/20/25 at 10:30 AM with EI # 1, who confirmed the staff failed to reconcile the patient medications per the agency policy.

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 a review of the medical record (MR), agency policy and procedure, and staff interview, it was determined the agency failed to ensure the staff notified the physician of any significant changes in measurement of the length of the peripherally inserted central catheter (PICC) as this may indicate migration of catheter, per agency policy. This deficient practice affected 2 of 2 MRs with PICCs reviewed including HV # 7 and MR # 1, and has the potential to negatively affect all the patients with PICCs served by the agency. Findings include: Agency policy: Dressing Change Procedure for Central Venous, Midline, and Peripherally Inserted Central Catheters. Policy Number: 10.027 Date Revised: 10/01/2016 Procedure: 8. Inspect catheter, catheter exit site, and surrounding skin and patient’s arm, chest, and neck area …d. Measure external length of catheter from the insertion site to the catheter hub. Notify Physician of any significant findings in measurement as this may indicate migration of catheter… 2. MR # 1 was admitted to the agency on 6/5/25 with a primary diagnosis of Type Two Diabetes Mellitus with Foot Ulcer. A review of the SN Visit dated 10/13/25 revealed the staff documented a PICC in the right upper extremity with an external catheter measurement of 1 CM. A review of the SN Visit dated 10/15/25 revealed the staff documented the external catheter measurement of 11.5 CM. There was no documentation the physician was notified of the 10.5 CM increase in the external catheter measurement. An interview was conducted on 11/20/25 at 11:05 AM with EI # 1, who confirmed there was no documentation the SN notified the physician of the significant change to the PICC measurement per policy 1. HV # 7 was admitted to the agency on 4/30/25 with a primary diagnoses of Chronic Venous Hypertension with Ulcer and Inflammation of the Left Lower Extremity. Review of the Skilled Nurse (SN) Visit dated 10/29/25 revealed an external left upper arm PICC measurement of 1.5 centimeters (CM). Review of the SN Visit dated 11/8/25 revealed an external left upper arm PICC measurement of 0 cm. There was no documentation found in the medical record of the provider being notified of the change in the external PICC length by the SN. Review of the SN visit dated 11/12/25 revealed an external left upper arm PICC measurement of 5 cm. There was no documentation found in the medical record of the physician being notified of the change in the external PICC length by the SN. An interview was conducted on 11/20/25 at 10:40 am with the EI # 1, Executive Director, who confirmed there was no documentation the SN notified the physician of the significant change to the PICC measurement per policy.

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 observation, review of the agency policy and procedure, and staff interview it was determined the agency failed to ensure the staff followed the policy for Hand Hygiene, Dressing change for Peripherally Inserted Central Catheters (PICC), and Cleaning of Re-Useable Equipment. This affected three of seven home visits (HV) to include HV # 5, HV # 7 and HV # 4, and has the potential to affect all patients served by this agency. Findings include: Agency Policy: Hand Hygiene Policy number: 8.004 Revised date: 5/1/19 Purpose: to help prevent the spread of microorganisms and infection by cross-contamination and provide practice guidelines. Policy: The staff are required to perform hand hygiene prior to, and at specific time points during, and following patient contact... Procedure: 1. Staff performs hand hygiene by handwashing with soap and water or using alcohol-based hand sanitizer. a. before direct contact with patients... f. before and after removal of personal protectant equipment... Agency Policy: Dressing Change Procedure For Central Venous Midline, And Peripherally Inserted Central Catheters Policy Number: 10.027 Revised Date: 10/1/2016 Purpose: To keep insertion sites clean, stabilize catheters and minimize the risk of infection Policy: ...Sterility will be maintained throughout this procedure... Procedure: ... 7. Remove gloves, perform hand hygiene, and don sterile gloves... Agency Policy: Cleaning of Re-Useable Equipment Policy Number: 8.006 Revised Date: 6/1/25 Purpose: To assure equipment required for patient care is clean and sanitized to prevent the spread of infections. Policy: Equipment used for more than one patient is cleaned between each patient use. Procedure: ...8. Stethoscopes are cleaned with a low-level disinfectant wipe before being returned to the staff bag, 9. Thermometers: ...Digital thermometers will be cleaned, after disposing of the disposable cover, with a low-level disinfectant. 10. Blood pressure cuffs are cleaned with a low-level disinfectant wipe before being returned to staff bag. 3. HV # 4 was admitted on 8/12/25 and recertified for continued care on 10/11/25 to 12/9/25 with a primary diagnosis of Encounter for Orthopedic Aftercare following Surgical Amputation. A HV was conducted on 11/19/25 at 8:37 AM to observe care provided by Employee Identifier (EI) # 6, SN. EI # 6 obtained blood pressure, temperature, pulse oximetry, and used stethoscope to listen to HV # 4's heart and lungs. EI # 6 then placed equipment on barrier with clean equipment. EI # 6 then cleaned equipment with low-level disinfectant wipe, placed on barrier with dirty equipment, and returned equipment to staff bag. An interview was conducted on 11/20/25 at 10:30 AM with EI # 1, who confirmed staff failed to follow the agency policy and procedure for cleaning of re-usable equipment. 2. HV # 7 was admitted to the agency on 4/30/25 with a primary diagnoses of Chronic Venous Hypertension with Ulcer and Inflammation of Left Lower Extremity. Review of the plan of care (POC) dated 10/27/25 to 12/25/25 revealed an order for the left upper arm PICC line dressing change to be conducted weekly using sterile technique. A HV was conducted on 11/19/25 at 8:45 AM to observe the care provided by EI # 8, Registered Nurse. EI # 8 was observed using his/her sterile gloved left hand to reposition the patient’s extension tubing connected to the PICC line during the sterile PICC line dressing change. EI # 8 was also observed using their left hand to stabilize the PICC line while cleaning with his/her right hand. An interview was conducted on 11/20/25 at 10:40 AM with EI # 1, who confirmed the staff failed to follow the agency policy regarding dressing change procedure for peripherally inserted central catheters. 1. HV # 5 was admitted to the agency on 10/14/25 with a primary diagnosis of Hemiplegia following a Cerebral Infarction affecting Right Dominate Side. An observation was performed on 11/19/25 with Employee Identifier (EI) # 5, Certified Occupational Therapy Assistant to observe care provided. During the visit EI # 5, removed their gloves after cleaning vital sign equipment and continued to perform patient care without performing hand hygiene. An interview was conducted on 11/20/25 at 10:58 AM with EI # 1, Executive Director, who confirmed the staff failed to follow the agency policy regarding hand hygiene.

A recertification survey was conducted at Coosa Valley Homecare on 12/6/22 through 12/8/22, standard level deficiencies were cited and will require a plan of correction.

EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, OPO, "Organizations" under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE's emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI's emergency plan, as needed. This STANDARD is not met as evidenced by: Based on review of the agency Emergency Preparedness program, Emergency Preparedness Operations Plan Policy and interview with the staff it was determined the agency failed to perform an exercise of choice as required every two years opposite the year of the actual emergency event which occurred in 2020, 2021 or 2022. This had the potential to affect all persons served by the agency. Findings include: Agency Policy: Emergency Preparedness/Operations Plan Policy Number: 9.001 Revised Date: 8/1/22 Purpose: To provide protocol and processes for prompt actions to be taken to assist the agency's patients before, during and following man-made and natural emergencies and/or disasters. Policy: The Executive Director (ED), Alternate ED, Clinical Director, or their designee will activate and coordinate the procedures in the plan...needs resulting from the emergency or disaster. Procedure: ...A. Before the Emergency: (Mitigation) The agency will continually update the emergency plan... B. Preparation for Emergencies and Disasters: (Preparation) ...9. The agency shall test their emergency operations plan annually. The agency must do one of the following: a. Participate in a full-scale exercise that is community based,... c. Mock disaster drill or tabletop exercise, but this method is only allowed every other year. Review of the agency's Emergency Preparedness Program revealed actual events in years 2020, 2021 and 2022. Further review of the Emergency Preparedness Program revealed no documentation of a testing exercise of choice as required every two years opposite the year of a full-scale exercise or activation of the agency's emergency plan. In an interview conducted on 12/8/22 at 9:45 AM with Employee Identifier (EI) # 1, Executive Director (ED) it was confirmed the agency failed to complete a testing exercise every two years.

A recertification survey was conducted at Coosa Valley Homecare on 12/6/22 to 12/8/22 and standard level deficiencies were cited and will require a plan of correction.

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 review of agency policy and procedure, observations, medical records (MR), and interviews with staff, it was determined the agency failed to maintain an accurate and updated Client Medication Report (CMR) per policy. This deficient practice affected two out of thirteen MR reviewed including Home Visit (HV) HV # 3 and HV # 5 and had the potential to affect all patients served by the agency. Findings include: Agency Policy Number: 10.008 Title: Monitoring Medications Revised Date: 05/01/19 Purpose: To provide a process to ensure continuous monitoring of medications in the patient's home. Policy: A drug regimen review will be performed on all patients... throughout the episode... Procedure: 1. The discipline responsible for the drug regimen review will: a. Compare medication list... to actual medications patient is taking. b. Review all medications... to identify issues... 2. All clinicians... are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care... 2. HV # 5 was admitted to the agency on 11/23/22 with admitting diagnoses of Dysarthria Following Cerebral Infarction and Type 2 Diabetes Mellitus with Hyperglycemia. Review of the HHC and POC dated 11/23/22 revealed the SN to visit 1 time a week for 9 weeks and the OT (Occupational Therapist) to visit 1 time a week for 1 week starting 11/27/22. Review of the Physician order dated 12/5/22 revealed OT to visit 2 times a week for 4 weeks and then 1 time a week for 1 week beginning 12/4/22. A HV was conducted on 12/8/22 at 1:00 PM with EI # 5, Occupational Therapist, to observe care provided. During the HV, the patient's medication bottles were reviewed with the CMR provided to the surveyor by the agency. The following medications were found in the home, confirmed as current medications, and were not listed on the CMR: Vitamin B Complex 1 tablet daily by mouth. start date 11/23/22. Myrbetriq 50 mg by mouth PRN (as needed). The caregiver stated the patient has been on the medication since sometime in July 2022. An interview was conducted on 12/8/22 at 1:00 PM with EI # 1 who confirmed the staff failed to maintain a current CMR. 1. HV # 3 was admitted to the agency on 12/3/2022 with diagnoses including Primary Generalized Osteoarthritis and Essential (Primary) Hypertension. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 12/3/22 revealed skilled nurse (SN) visits were ordered one time a week for one week, two times a week for one week, and one time a week for three weeks. A HV was conducted on 12/6/22 at 2:30 PM to observe care provided by Employee Identifier (EI # 8) Home Health Aide. A review of the patient's medications was conducted with the caregiver (cg) using the current CMR provided by the agency. Ondansetron four milligrams (mg) oral disintegrating tablets every six hours as needed for nausea and vomiting dated 5/26/22 was found in the home and not listed on the CMR. The cg confirmed the patient had been using the medication for "several months." An interview was conducted with EI # 1, Executive Director, on 12/8/22 at 12:44 PM, who confirmed the staff failed to maintain an accurate CMR.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of medical records (MR), agency policy and procedure, V.A.C. (Vacuum Assisted Closure) guidelines and interviews with the staff it was determined the agency failed to ensure: 1. All wound measurements were complete and assessed weekly and documented in the MR. 2. The nurse documented the number of foam pieces applied and removed from the wound during wound V. A. C. dressing changes. This deficient practice affected two of four patients with wounds and did affect Home Visit (HV) # 4, and MR # 7 and had the potential to negatively affect all patients served by the agency with wounds. Findings include: Agency Policy: Wound Assessment, Documentation, And Photography Policy Number: 2.2.001 Revised Date: 12/1/21 Policy: Upon initial visit and subsequently...all wounds will be assessed with appropriate documentation within the medical record. Unless otherwise ordered by the physician, the Registered Nurse or Physical Therapist will assess wounds at least: Weekly for patient receiving negative pressure wound therapy, receiving daily wound care... The assessment includes measurement of the length, width, and depth, undermining and tunneling, wound bed description, wound edges, exposed tissue type, drainage and the condition of the peri wound... Procedure: 3. Document the following in the medical record: c. Wound size: Length, Width, and Depth measured in centimeters (cm)... Policy: V.A.C (Vacuum-Assisted Closure) Therapy Clinical Guidelines Revised Date: 3/2011 Points to Remember When Using V.A.C. Wound Therapy: Accurately record the number of foam pieces used in the patient's chart and on a readily visualized place on the drape... When dressing is removed, count the number of foam pieces removed, correlate the count with the number of pieces previously placed in the wound... 1. HV # 4 was admitted to the agency on 6/14/22 with admitting diagnoses of Non-Pressure Chronic Ulcer Other Part Right Foot With Muscle Involvement Without Evidence of Necrosis and Non-Pressure Chronic Ulcer Other Part Left Foot With Muscle Involvement Without Evidence of Necrosis. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 6/14/22 revealed the skilled nurse (SN) was to visit one time a week for two weeks and then two times a week for seven weeks. Review of the Physician Order dated 11/16/22 revealed the following orders for wound care: SN to perform/instruct/reinforce patient/caregiver on procedure for wound care...Wound # 1 Right plantar non pressure ulcer: cleanse with betadine, air dry use Pedi pad around wound. Apply Hydrofera Blue to wound bed. Cover with dry gauze and secure with tape... Wound # 2 Left Plantar non pressure ulcer: SN cleanse with betadine, air dry. Use Pedi pad around wound, apply Hydrofera Blue. Cover with dry gauze, secure with tape. SN to perform wound care on Wednesdays and Fridays. Wound # 4 Right dorsal non pressure ulcer: SN to cleanse with wound cleanser , pat dry, cover with Drawtex and dry gauze and secure with tape. SN to perform wound care on Wednesdays and Fridays. Review of the SN visit notes dated 11/23/22 and 11/28/22 revealed no weekly wound measurements documented for wound # 4. An interview was conducted on 12/8/22 at 12:33 PM with Employee Identifier # 1, Executive Director, who confirmed the SN failed to assess and document wound measurements weekly as directed per policy. 2. MR # 7 was admitted to the agency on 1/20/22 and recertified for care 7/19/22 to 9/16/22 with diagnoses of Infection/Inflammation Reaction Due to Other Internal Prosthetic Devices, Implants and Grafts, Initial Encounter Pressure Ulcer of Right Buttock Stage 4. Review of the HHC and POC dated 7/19/22 revealed the SN was to visit one time a week for one week then two times a week for eight weeks. Further review of the HHC and POC dated 7/19/22 was the following wound care order: SN to perform/instruct/reinforce patient/caregiver regarding wound care to wound # 4, Unstageable Pressure Ulcer to right buttocks... Cleanse wound with Vashe, Pat dry, apply no sting barrier wipe, window pane wound, lightly moisten V.A.C. foam with wound cleanser then dust it with Collagen powder. Pack black foam into wound bed being careful not to overlap the wound edge, cover with drape, bridge to right hip and place another layer of drape, cut opening in V.A.C. drape and place V.A.C. head over opening to foam. Secure with drape and turn V.A.C. on to suction at 125 mm/hg (millimeters per mercury) continuous... SN to perform two times a week. Review of the SN visit note dated 7/25/22 revealed the SN failed to document how many pieces of black foam was removed from wound # 4. Review of the SN visit notes dated 8/1/22, 8/8/22, 8/15/22 and 8/22/22 revealed the SN failed to document how many pieces of black foam was applied to the wound during wound care. An interview was conducted o 12/8/22 at 1:00 PM with EI # 1 who confirmed the SN failed to document the number of black foam placed in the wound and removed from the wound.