Every finding on record at Amedisys Arkansas, LLC

On 04/28/2025 at 12:30 PM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a complaint investigation as well as a recertification survey for compliance with the conditions of Participation for Home Health. On 05/02/2025 at 9:00 AM, an exit conference was conducted with Agency Representatives. The preliminary findings for the recertification survey and the Complaint were discussed.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on clinical record review and staff interview, it was determined the agency staff failed to follow out the plan of care for assessing patients with Congestive Heart Failure (CHF) in 3 (#5, #7, #9) of 18, (#1-#18) medical records reviewed. If left uncorrected, this failed practice has the potential to place all patients with CHF at risk for complications, exacerbation of condition, hospitalization and death. Clinical record #5 showed: A) Start of care on 04/10/2025 showed an order for "Heart failure; RN (Registered Nurse) to assess/teach LPN (Licensed Practical Nurse) to observe/teach cardiopulmonary system to identify signs of decompensation and intervene to minimize the severity of fluid overload. Observe patient ability to monitor and record daily weights and vital signs, including pulse and blood pressure; record patient reported weight or weigh patient as needed, report increased edema or weight gain of >2 LBS (greater than two pounds) in 1 day or >5 LBS in 1 week or more over target weight. B) A Vital Sign Report with visit entries for 4/10/25, 4/16/25, 4/16/25 (therapy visit), 4/22/25, 4/24/25, 4/24/25 (therapy visit), 4/29/25. c) Only one weight recorded on 4/10/25. Clinical record #7 showed: A) A Plan of Care with certification dates of 03/03/2025-05/01/2025 B) Practitioners order to "Report increased edema or weight gain on >2 LBS in 1 day or >5 LBS in 1 week or 5LBS or more over target weight. May measure abdominal girth if unable to weigh. Scales and BP (blood pressure) monitor to be provided if needed. C) Vital sign report showing patient visits for 03/03/25, 03/08/25,03/12/25,03/13/25,03/19/25, 03/19/25 (therapy), 03/26/25,03/31/25,04/01/25,04/08/25,04/09/25,04/16/25,04/23/25,04/24/25,04/29/25. D) Weights were recorded only for 03/03/25, 03/12/25, 04/01/25, 04/09/25, 04/24/25, 04/29/25 E) There was no abdominal girth recorded for any visit date in lieu of weight. Clinical Record #9 revealed: A) A Plan of Care Certification Period of 04/06/25-06/04/25 B) Practitioners orders PT (physical therapist)/ PTA (physical therapy assistant) to monitor for Heart Failure exacerbation and record patient reported weight and notify the physician and/or the RN (registered nurse) clinical manager for physician notification of HF (heart failure) exacerbation (2 LBS weight gain in 1 day, 5 LBS in a week or 5 LBS over baseline; increased SOB (shortness of breath), edema (swelling), needing more pillows at night, crackles in basis of the lungs or PMI shift) (a difference in where one can hear the heart beat on a persons chest the loudest) C) Visit Entries for vital signs on 04/11/2025, 04/11/2025 (therapy visit), 04/14/25,04/16/25, 04/22/25, 04/23/25 D) Weights for the patient were only recorded on 04/11/25, 04/11/25 (therapy), 04/14/25 & 4/16/25. On 05/01/2025 3:00 PM, the Agency Administrator was asked to provide any further information. None was forthcoming.

Goals in the patient's plans of care CFR(s): 484.110(a)(3) Goals in the patient's plans of care and the patient's progress toward achieving them; This ELEMENT is not met as evidenced by: Based on clinical record review and personnel interview, it was determined the Agency failed to ensure there were assessments and measurements of wounds to demonstrate progress toward healing in3 (#4, #6, & #8) of 18, (#1-#18) clinical records reviewed that have wounds being treated by the agency. If left uncorrected, this has the potential to affect all patients on census with wounds in that frequent assessment of wounds is necessary to avoid prolonged presence of wound, possible infection, complications, increase in size of wound and rehospitalization. Findings follow: Clinical Record #4 revealed the following A) Plan of care with certification dates from 04/08/25-06/06/2025 B) Diagnosis of Pressure Ulcer of Sacral Region Stage 2 C) A Wound Record Report showing no wound measurement during the current certification period. Clinical Record #6 Showed: A) Plan of Care with certification dates from 03/28/25-05/26/25 B) Diagnosis of Encounter for orthopedic aftercare following surgical amputation. (of great toe) C) A wound record report without wound measurements for visits dates 04/02/25, 04/07/25, 04/09/25, 04/14/25, 04/16/25, 04/23/25, 04/28/25. Clinical Record #8 Revealed: A) Plan of Care Certification period from 04/12/25-06/10/25 B) A Diagnosis of Pressure Ulcer Sacrum, Stage 2, and DTI (deep Tissue Injury) on the left buttock, a wound to right hand, wound to right buttock and venous ulcers on both right and left leg. C) Wound Record Report did not have an assessment for the wounds on the right hand and the right buttock. D) The Wound Record Report did not have an updated and routine assessment, including measurement, for the remainder listed wound areas. On 05/01/2025 at 3:00 PM, the Administrator was asked to provide further information. None was forthcoming.

On08/02/2022 at 9:40 AM, an entrance conference was conducted with Facility 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 08/05/2022 at 1:00 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 in the medication interaction check for 7 (#2, #3, #5, #6, #9, #11, #15) of 17 (#1-#17) 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. Findings: 1. A review of patient #2 Clinical record contained the following: A. Document titled "Home Health Certification and Plan of Care" (POC) dated 6/13/22 to 8/11/22 showed a pertinent diagnosis (dx) of "Dependence on supplemental Oxygen." B. Document titled "Client Medication Report" (a document used by the Agency to list all medications Patient #2 was currently taking), showed Oxygen (O2) listed and highlighted in blue. The blue highlighted medications were not included in the medications review related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. 2. A review of patient #3 Clinical record contained the following: A. Document titled "Home Health Certification and Plan of Care" (POC) dated 7/8/22 to 9/5/22 showed a pertinent dx of "Dependence on supplemental Oxygen." B. Document titled "Client Medication Report" listed all medications Patient #3 was currently taking and showed O2 listed and highlighted in blue. The blue highlighted medications were not included in the medications review related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. 3. A review of patient #5 Clinical record contained the following: A. Document titled "Home Health Certification and Plan of Care" (POC) dated 6/4/22 to 8/2/22 showed a pertinent dx of "Dependence on supplemental Oxygen." B. Document titled "Client Medication Report" listed all medications Patient #5 was currently taking and showed O2 listed and highlighted in blue. The blue highlighted medications were not included in the medications review related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. 4. A review of patient #6 Clinical record contained the following: A. Document titled "Home Health Certification and Plan of Care" (POC) dated 6/4/22 to 8/2/22 showed a pertinent dx of "Dependence on supplemental Oxygen." B. Document titled "Client Medication Report" listed all medications patient #6 was currently taking and showed O2 listed and highlighted in blue. The blue highlighted medications were not included in the medications review related to potential adverse effects, drug reactions, significant side effects or significant drug interactions. C. Further review of patient #6's Medical Record revealed that the Client Medication Report listed a drug "” Vitamin B 12 10% ( a vitamin supplement) in blue and therefore not checked by the SN for potential adverse effects, drug reaction, significant side effects or significant drug interactions. 5. Review of clinical record #9 revealed the following: A. Document titled Home Health Certification and Plan of Care dated 6/30/2022 through 8/28/2022 under "Orders of Disciplines and Treatments" showed an order for "Oxygen Management and teaching Pt oxygen flow rate 2-3 L/MIN (liters per minute). B. Document titled "Client Medication Report" has Oxygen listed but highlighted in blue. Medications highlighted in blue are not checked for interactions per the information from Electronic Medical Record (EMR) utilized by the Agency. 6. Review of clinical record #11 revealed the following: A. Document titled Home Health Certification and Plan of Care dated 7/10/22 through 9/07/2022 shows a diagnosis of "Dependence on Supplemental Oxygen" B. Document titled "Client Medication Report" has oxygen listed but highlighted in blue. Medications highlighted in blue are not checked for interactions per the information from the EMR utilized by the Agency. 7. Review of Clinical Record #15 revealed the following: A. Skilled Nurse visit note dated 6/28/2022 showed documentation Patient #15 was prescribed an antibiotic for a urinary tract infection. B. A review of the Medication Profile showed no evidence the antibiotic was added to or checked for interactions. 8. During an interview on 8/5/22 at 1:00 P.M, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 and #2 confirmed the Agency staff did not include all medications that patients #2, #3, #5, #6, #9, #11, #15, were currently taking during a review of medications. Agency Personnel #2 confirmed medications highlighted in blue on the Client Medication Report were not reviewed.

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 Clinical Record review and staff interview, it was determined the Agency staff did not follow the Attending Physician orders contained in the Plan of Care (POC) for 4 (#7, #9, #15, #17) of 17 (#1 - #17) Clinical Records reviewed. This failed practice if not corrected had the potential of increased risk of rehospitalizations due to disease exacerbation for all patients on census. Findings: 1. Review of Clinical Record #7 revealed a document titled, "Home Health Certification and Plan of Care" dated 6/8/22 to 8/6/22 with a secondary diagnosis of "Chronic Combined Systolic and Diastolic Heart Failure” ( a disease of the heart that can cause fluid to accumulate on the lungs making it difficult to breath), and an order “to assess patient ability to monitor and record daily weights and vital signs including pulse and blood pressure, record patient reported weight or weigh patient as needed. Report increased edema or weight gain of >(greater) than 2 lbs. (pounds) in 1 day or > than 5 lbs. in 1 week or 5 lbs. or more over target weight. A. Review of skilled nurse (SN) visit notes dated 6/13/22, 6/14/22, 7/6/22, 7/12/22 and 7/18/22 showed no evidence weights or circumferences were completed by the SN and no documentation of recorded weights reported by Patient #7 2. Review of clinical record #9 revealed a document titled, "Home Health Certification And Plan of Care" dated 6/30/22 to 8/28/22 with a diagnosis of "Dependence on Supplemental Oxygen" and an order for "Oxygen management and teaching" by the Physical Therapist (PT). A. Review of clinical Physical Therapy notes (PT) on dates 6/30/22, 7/06/22, 7/19/22, 7/22/22, 7/26/22 shows no evidence of teaching documented. B. Review of a document titled "Discharge Summary" dated 7/26/2022 documentation showed oxygen teaching interventions "were not provided." . 3. Review of Clinical Record #15 revealed a document titled "Home Health Certification And Plan of Care" dated 6/16/22 to 8/14/22 with a primary diagnosis of "Hypertensive Heart Disease With Heart Failure" and secondary diagnosis of "Heart Failure, Unspecified" (a disease making it difficult to breath), and an order to "Assess patient ability to monitor and record daily weights and vital signs. Record patient reported weight, or weigh patient as needed. Report increased edema or weight gain of >2 LBS in 1 day or >5 LBS or more over target weight. May measure abdominal girth if unable to weigh, scales to be provided if needed." A. Review of a SN note dated 7/22/22 showed documentation of weight for Patient #15 of 170 pounds. There was no evidence of any further weights of the Patient completed. Review of all clinicians notes dated 6/21/22, 6/23/22, 6/27/22, 6/28/22, 7/05/22, 7/08/22, 7/11/22, 7/15/22, 7/29/22, and 8/02/22 showed no evidence weights were monitored or reviewed on the patient's weight log or documented in the chart. 4. Review of Clinical Record #17revealed a document titled "Home Health Certification And Plan of Care" dated 5/31/22 to 7/25/22 with an order for Physical Therapy (PT) visit frequency as One time weekly for one week, 2 visits weekly for two weeks, then one visit weekly for 5 weeks. A Review of PT visit notes for week of 7/3/22 through 7/9/22 showed no evidence any visits were made by the PT. 5. During an interview on 8/5/22 at 1:00 P.M, Agency Representatives were provided an opportunity to present additional documentation. With no additional documentation presented, Agency Personnel #1 and #2 confirmed the Agency staffs failure to provide interventions as ordered in the individualized POC for Patients #7, #9, #15, and #17.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on Clinical Record review and staff interview, it was determined the agency failed to educate or document patients response to education and teaching in one #9 of 17 (#1-#17) clinical records reviewed. This failed practice has the potential to affect all patients on census in that it may inhibit the patients understanding and self management of their individual health needs as well as the ability to obtain goals and prolong patients' need for home health service. Findings: 1. Clinical Record #9 revealed the following: A. Document titled "Home Health Certification And Plan of Care" (POC) contained orders for "Oxygen management and teaching." and goals of "Patient/Caregiver will demonstrate understanding of oxygen safety, care, and management by discharge" B. There was no evidence in the clinical record regarding oxygen teaching on any clinician visits dated 6/30/22, 7/06/22, 7/19/22, 7/22/22, 7/26/22. 2. During an interview 8/05/22 at 1:00PM Agency Staff #1 and #2 confirmed there was no evidence of teaching regarding oxygen during patient #9's episode.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on Record review and staff interview, the Skilled Nurse (SN) failed to ensure complete, plain language medication administration instructions were documented on 1 (#8) of 17 (#1-#17) of clinical record reviewed. This has the potential to effect all patients on census taking medications in that serious side effects and toxicity may occur. Findings: 1. Review of Patient #8 Clinical Record revealed the following: A. Document titled "Client Medication Report" lists Nitroglycerin 0.4mg sublingual (under the tongue) with instructions "as needed" B. According to Drugs.com, standard instructions for Nitroglycerin sublingual is "Use nitroglycerin at the first sign of chest pain. Use another dose every 5 minutes as needed, up to a total of 3 doses. Get emergency medical help if you still have chest pain after using a total of 3 doses in 15 minutes, or if your chest pain seems unusual. You may use nitroglycerin sublingual within 5 to 10 minutes before an activity that might cause chest pain." 2. During an interview on 8/05/22 at 1:00 PM, Agency Staff #1 confirmed the administration instructions for Nitroglycerin sublingual were incomplete.