Every finding on record at Ambercare Home Health

A Recertification survey was conducted by Healthcare Management Solutions, LLC on behalf of the New Mexico Department of Health. An unannounced on-site Recertification survey at the above-named Home Health Agency (HHA) from 08/14/23 to 08/16/23 resulted in a finding of no deficiency citations respective to the Emergency Preparedness Program Condition of Participation under 42 CRF 484.102.

A Recertification survey was conducted by Healthcare Management Solutions, LLC on behalf of the New Mexico Department of Health. An unannounced on-site Recertification survey conducted at the above-named Home Health Agency (HHA) from 08/14/23 to 08/16/23 resulted in noncompliance with the Condition(s) of Participation Home Health Aide Services respective to applicable CoP under 42 CFR 484 Subparts A through C and the following standard-level deficiencies listed below.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on observation, staff interview and the Home Health Agency's (HHA's) policy review, the HHA failed to educate (Patient (P)1) on the medication parameters of when to take a take a medication that raises blood pressure (BP). This deficient practice had the potential to affect patients receiving care from the HHA needing medication education. Review of P1's medical record revealed that the patient started on Midodrine (medication to increase blood pressure) on 08/11/23; however, there was no documentation in the patient's medical record of the parameters ordered by the physician to not take the medication if the blood pressure was greater than 140/90, and there was no documentation that teaching had occurred regarding the parameters for holding the medication. Observation of P1 on 08/14/23 at 9:00 AM revealed that when Physical Therapist (PT)1 took the patient's BP the reading was 182/106. The patient stated that he/she checked his/her blood pressure immediately before taking the Midodrine and it was 154/82 at approximately 6:00 AM. The PT then looked at the hospital discharge instructions and realized that the medication should have not been taken if the patient's systolic (the top number) BP was greater than 140 or if the patient's diastolic (the bottom number) BP was greater than 90. During an interview on 08/17/23 at 10:00 AM, the PT confirmed that the parameters were not reviewed with the patient prior to the visit performed on 08/17/23 and that he/she didn't realize there were parameters ordered by the physician to hold the medication if the patient's BP was greater than 140/90. Review of undated policy number 3-024.1 titled "Medication Profile" indicated " … Each patient will receive appropriate written material for specific medications he/she is receiving. The material will contain information on actions of the medication, potential side effects, contraindications the patient should be aware of, and any special instructions when taking the specific medication. …"

Home health aide services CFR(s): 484.80 Condition of participation: Home health aide services. All home health aide services must be provided by individuals who meet the personnel requirements specified in paragraph (a) of this section. This CONDITION is not met as evidenced by: Based on medical record review, Home Health Agency (HHA) policy review, and staff interview, the HHA failed to perform Home Health Aide supervisory visits at least every 14 days by a licensed professional for five (Patient (P) 7, P8, P9, P10, and P11) of six active patient records reviewed and one of two discharged (P5) records reviewed receiving HHA services. This deficient practice has the potential to affect all patients receiving HHA services. The HHA failed to perform Home Health Aide supervisory visits at least every 14 days by a licensed professional for five patients, P7, P8, P9, P10, and P11 of six active patient records reviewed and for one (P5) of two discharged patient records reviewed receiving HHA services. (See findings in tag in G808) During an interview on 08/16/23 at 2:10 PM, the Clinical Services Manager confirmed that Home Health Aide supervisory visits were not being performed every 14 days by a licensed healthcare provider.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on medical record review, Home Health Agency (HHA) policy review, and staff interview, the HHA failed to perform Home Health Aide supervisory visits at least every 14 days by a licensed professional for five (Patient (P) 7, P8, P9, P10, and P11) of six active patient records reviewed and one (P5) of two discharged patient records reviewed receiving HHA services. This deficient practice had the potential to affect all patients receiving HHA services. Review of medical records revealed the following: 1. P5's start of care was on 04/10/23 and the patient was discharged on 08/02/23. A supervisory Home Health Aide visit was made by the Occupational Therapist (OT) on 04/17/23. There were no other supervisory visits made. 2. P7's start of care was on 05/12/23. There were no supervisory visits performed by a licensed professional. 3. P8's start of care was on 06/17/23. There were no supervisory visits performed by a licensed professional. 4. P9's start of the second episode began on 07/16/23. There were no supervisory visits performed by a licensed professional. 5. P10's start of care was on 06/22/23. Home Health Aide supervisory visits were performed by the OT on 08/01/23 and 08/10/23 only. 6. P11's start of care was on 06/13/23. There were no supervisory visits performed by a licensed professional. During an interview on 08/16/23 at 2:10 PM, the Clinical Services Manager confirmed that Home Health Aide supervisory visits were not being performed every 14 days by a licensed healthcare provider. Review of undated agency Policy Number 3-006.1 titled "Health Aide Plan of Care" indicated on page 2 " … The Case Manager or other appropriate clinician will supervise the home health aide at least every 14 days to ensure care is provided according to plan. …"