Every finding on record at Amedisys Georgia, L.L.C.

At the time of the survey , Tugaloo Home Health in Lavonia GA was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a recertification survey conducted on March 9, 2022. A Focus Infection control survey was completed at the time of the survey. Current census 793. No deficiencies cited.

At the time of the survey, Tugaloo Home Health in Lavonia, GA was in compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of a recertification survey conducted on March 9, 2022. A Focus Infection control survey was completed at the time of the survey. Current census 793. Following deficiencies cited:

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 reviews and staff interviews, it was determined the agency staff failed to include orders to cover all pertinent diagnoses and ensure the patients' needs were addressed to include disease specific interventions/treatments were included on the plans of care for seven of seventeen (#8, #9, #10,#11,#12, #14and #16) sampled patients (P). Findings include: 1. Review of the plan of care/treatment for P#8 with a certification period of 2/2/22 to 4/2/22 revealed that patient has a diagnosis of heart failure and long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked teaching and assessment of bleeding complications. The plan of care/treatment does not specify interventions for monitoring for heart failure exacerbation (i.e., edema assessments , weight assessments or abdominal girth measurements) to evaluate the patient for complications and to alert the physician of potential complications. The agency failed to ensure the patient's plan of care/treatment addressed all of the pertinent interventions for the comprehensive care of the patient. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy, heart failure and its complications. 2. Review of the plan of care/treatment for P#9 with a certification period of 1/11/22 to 3/11/22 revealed that patient has a diagnosis of congestive heart failure with long-term use anticoagulant ; Eliquis 2.5 mg (blood thinner) twice daily. The plan of care also revealed that patient has an automatic implantable cardiac defibrillator. The plan of care lacked specific teaching and assessments of anticoagulation therapy and its complications. The plan of care/treatment does not specify interventions for monitoring the complications of the implanted cardiac defibrillator and heart failure exacerbation (i.e., edema assessments , weight assessments or abdominal girth measurements) to alert the physician of potential complications. The agency failed to ensure the patient's plan of care/treatment addressed all of the pertinent interventions for the comprehensive care of the patient. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy, heart failure and its complications. 3. Review of the plan of care/treatment for P#10 with a certification period of 2/9/22 to 4/9/22 revealed that patient has a diagnosis of essential hypertension , long term use anticoagulant ; Eliquis 5 mg (blood thinner) twice daily and has a diagnosis of diabetes mellitus. The plan of care lacked specific teaching and assessments of diabetes mellitus; frequency to check the blood sugar, teaching on diabetic complications, such as hyper and/or hypoglycemia and other diabetic complications to be reported to the nurse and to the physician. The plan of care lacked teaching and assessment of bleeding complications and the management of anticoagulant(Eliquis) therapy. The agency failed to ensure the plan of care was complete and consistent to include the specific teaching and assessments of diabetes and anticoagulant therapy and its complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of diabetes complications and anticoagulation therapy and its complications. 4. Review of the plan of care/treatment for P#11 with a recertification period of 2/13/22 to 4/13/22 revealed that patient has a diagnosis of interstitial pulmonary disease with long term use of anticoagulant therapy ; warfarin 3 mg (blood thinner)once daily . The plan of care lacked teaching and assessment of bleeding complications and the management of prothrombin time (PT) and International Normalized Ratio INR (PT/INR) levels to manage anticoagulant(warfarin) therapy. The agency failed to ensure the plan of care was complete and consistent to include the specific teaching and assessments of anticoagulant therapy and its complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. 5. Review of the plan of care/treatment for P#12 with a certification period of 1/10/22 to 3/10/22 revealed that patient has a diagnosis of Type 2 diabetes mellitus with long term use of hypoglycemic drug Metformin 850 milligrams twice daily and long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked specific teaching and assessments of diabetes mellitus; frequency to check the blood sugar, teaching on diabetic complications, such as hyper and/or hypoglycemia and other diabetic complications to be reported to the nurse and to the physician. The plan of care also lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of diabetic management and anticoagulation therapy and its complications. 6. Review of the plan of care/treatment for P#14 with a certification period of 2/15/22 to 4/15/22 revealed that patient has a diagnosis of heart failure with long-term use of anticoagulant Eliquis 2.5 mg (blood thinner) once daily. The plan of care lacked specific teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. During an interview on 3/9/22 at 4:15 p.m., the Administrator verbalized that plan of care/treatment did not cover all pertinent interventions for the comprehensive care of the patient's diabetic status, cardiac status and anticoagulant therapy. 7. Review of the plan of care for P#16 with a certification period of 1/19/22 to 3/19/22 revealed a pertinent diagnosis of Type 2 diabetes mellitus with diabetic chronic kidney disease. The patient currently takes insulin therapy to control diabetes however, the plan of care lacks interventions such as blood glucose parameters or frequency for monitoring blood glucose levels which would prompt the staff to notify the physician for early intervention and treatment of diabetic exacerbation. The agency failed to ensure the plan of care/treatment was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 3/9/22 at 4:15 p.m. the Administrator and Clinical Manager provided no evidence the plan of care included patient specific interventions to monitor the patient's diabetic status.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency failed to ensure the care and services were provided in conformance with the patients' plans of care/treatment as ordered by physicians for nine of seventeen (#1, #3, #4, #6, #7, #8,#9, #14 and #17) sampled patients (P). Findings include : 1. Review of the plan of care/treatment for patient #17 with a recertification period of 1/13/22 to 3/13/22 with diagnosis of Type 2 diabetes mellitus with foot ulcer required the skilled nurse (SN) to report blood sugar less than 60 or above 350 . The SN visited the patient on 2/14/22, and the PT visited the patient on 2/16, 2/18, 2/21 and 2/23/22 . However, the blood sugar was not assessed. The agency failed to ensure the plan of care/treatment for monitoring blood sugar was assessed as ordered. 2. Review of the plan of care/treatment for patient #6 with a recertification period of 1/6/22 to 3/6/22 with diagnosis of Type 2 diabetes mellitus required the SN to report blood sugar less than 60 or above 350 . The SN visited the patient on 1/26/22 . However, the blood sugar was not assessed. The agency failed to ensure the plan of care/treatment for monitoring blood sugar was assessed as ordered. 3. Review of the plan of care/treatment for patient #7 with a recertification period of 1/14/22 to 3/14/22 with a diagnosis of Type 2 diabetes mellitus with diabetic chronic kidney disease required the SN to report blood sugar less than 60 or above 350. The SN visited the patient on 2/14, 2/16, 2/22 and 2/25. However, the blood sugar was not assessed. The agency failed to ensure the plan of care/treatment for monitoring blood sugar was assessed as ordered. 4.Review of the plan of care/treatment for patient #8 with a certification period of 2/2/22 to 4/2/22 with diagnosis of Type 2 diabetes mellitus with diabetic chronic kidney disease required the SN and PT to report blood sugar less than 60 or above 350. The PT visited the patient on 2/16, 2/18, 2/22 and 2/23/22 .However, the blood sugar was not assessed. The agency failed to ensure the plan of care/treatment for monitoring blood sugar was assessed as ordered. 5. Review of the plan of care/treatment for patient # 9 with a certification period of 1/10/22 to 3/10/22 with diagnosis Type 2 diabetes mellitus with polyneuropathy required the skilled nurse (SN )to report blood sugar less than 60 or above 350 . The SN visited the patient on 2/14/22 however, the blood sugar was not assessed. The agency failed to ensure the plan of care/treatment for monitoring blood sugar was assessed as ordered. 6. Review of the plan of care/treatment for patient #14 with a certification period of 2/15/22 to 4/15/22 with diagnosis of congestive heart failure required the skilled nurse (SN) to observe/assess and report weight gain of greater than 2 pounds in one day or greater than 5 pounds in1 week or 5 pounds over target weight. The SN visited the patient on 2/23 and 2/28/22 however, the weight was not assessed. The agency failed to ensure the plan of care/treatment for monitoring weights was assessed as ordered. During an interview on 3/9/22 at 4:15 p.m., the Administrator and the clinical manager acknowledged the SN failed to monitor blood sugar and weights as ordered. 7. Review of the plan of care/treatment for P#1 with a certification period of 1/18/21 to 3/18/21 (closed record) revealed a primary diagnosis of Type 2 diabetes mellitus with ketoacidosis with coma. The patient is on insulin therapy to control diabetes and the SN is required to notify the physician of blood glucose levels less than 60 or greater than 350. The SN visited the patient on 2/3/21 however, the SN failed to assess the patient’s blood glucose to ensure the patient’s blood glucose levels were within the parameters specified. During an interview on 3/9/22 at 4:15 p.m., the Administrator and Clinical Manager acknowledged that the SN failed to assess the patient’s blood glucose on 2/18/22 as ordered. 8. Review of the plan of care for P#3 with a certification period of 2/8/21 to 4/8/21 (closed record) revealed the patient has pertinent diagnosis of type 2 diabetes mellitus with diabetic peripheral angiopath without gangrene. The SN is required to notify the physician of blood glucose levels less than 60 or greater than 350. The SN visited the patient on 3/19/21 however, the SN failed to assess the patient’s blood glucose levels to ensure the patient’s blood glucose level was within the parameters specified. During an interview on 3/9/22 at 4:15 p.m., the Administrator and Clinical Manager did acknowledge that the SN failed to assess the patient’s blood glucose on 2/11 and 2/16/22 as ordered. 9. Review of the plan of care for P#4 with a certification period of 4/15/21 to 6/13/21 (closed record) revealed the patient has pertinent diagnoses of acute on chronic diastolic congestive heart failure and type 2 diabetes mellitus with chronic kidney disease. The SN is required to notify the physician of blood glucose levels less than 60 or greater than 350 and weight gain greater than five pounds in one week or greater than two pounds in one day. The SN visited the patient on 5/12 and 5/25/21 however, the SN failed to assess the patient’s weight and blood glucose levels to ensure the patient’s blood glucose levels and weight were within the parameters specified. During an interview on 3/9/22 at 4:15 p.m., the Administrator and Clinical Manager did acknowledge that the SN failed to assess the patient’s weight and blood glucose on 5/12 and 5/25/22 as ordered.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined that the personnel furnishing services failed to maintain liaison to ensure their efforts were coordinated effectively and timely to support the objectives outlined in the plan of care for 1 of 17 (#2) sampled patients (P). Findings were: 1. Review of the plan of care for patient (P) #2 with a certification period of 2/10/21 to 4/10/21 required the speech therapist (ST) to evaluate the patient for communication deficits. According to a coordination note dated 2/19/21, the ST missed a visit on 2/18/21 however, the missed visit note did not indicate why the visit was missed. Further review of the clinical lacked revealed no additional attempts to complete the ST evaluation as ordered. There was documentation in the record to indicate the physician had been made aware of the missed visit. However, the clinical record lacked any communication or coordination efforts made with the physician or amongst the care team members to assist in completing the ST evaluation to meet the identified needs of the patient. The agency failed to communicate with the physician and team to effectively coordinate the patient's care for identified needs and services. During an interview on 3/9/21 at 4:15 p.m., the Administrator and Clinical Manager provided no evidence of coordination with the physician or team members regarding coordination of the patient's therapy services.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency failed to ensure the clinical records contained clear, complete, and accurate documentation in the clinical record for 3 of 17 (#3, #4 and #5) sampled patients (P). Findings were: 1. Review of the plan of care for P#3 with a certification period of 2/8/21 to 4/8/21 (closed record) required the SN to provide wound care to wound pressure ulcer on left heel as follows: irrigate/cleanse with wound cleanser, pat dry, apply silversorb, may apply skin barrier to periwound as needed, cover with 4X4 secure with kling. The SN visited the patient on 3/15, 3/19, 3/22, and 3/26/21 and documented wound care was done per physician orders. However, the SN failed to document the specific steps and supplies used during wound care as required. During an interview on 3/9/22 at 4:15 p.m., the Administrator and Clinical Manager did acknowledge that the SN failed to document the specific steps and supplies used during wound care. 2. Review of the plan of care for P#4 with a certification period of 4/15/21 to 6/13/21 (closed record) required the SN to provide wound care to a superficial trauma of left lower leg as follows: cleanser with wound cleanser, pat dry, cover with oil emulsion and gauze, secure with roll gauze and tape. The SN visited the patient on 5/12/21 and documented the patient tolerated the wound care well. However, the SN failed to document the specific steps and supplies used during wound care as required. During an interview on 3/9/22 at 4:15 p.m., the Administrator and Clinical Manager did acknowledge that the SN failed to document the specific steps and supplies used during wound care. 3. Review of the plan of care for P#5 with a certification period of 4/29/21 to 6/27/21 (closed record) required the SN to provide wound care to several wounds. Wound care to the left lateral knee and right medial elbow as follows: remove old dressing, cleanse wound and periwound with wound cleanser, use prisma to wound bed and secure with meilex border. Wound care to the right lower buttock and sacral/coccyx as follows: remove old dressing, cleanse wound and periwound with wound cleanser, use prisma to wound bed and allevyn sacral as the primary dressing. Wound care to the right ischium, remove old dressing, cleanse wound and periwound with wound cleanser, use santyl, moistened gauze to wound bed and allevyn as primary dressing, use aquacel plain as secondary dressing. Wound care to right hip cluster, remove old dressing, cleanse wound and periwound with wound cleanser, use aquacel plain to wound bed, secure with allevyn. Wound care to left hip as follows: remove old dressing, cleanse wound and periwound with wound cleanser, use santyl, black foam to wound bed and transparent dressing with suction to 125mmg. The SN visited the patient on 4/29/21 and copied and pasted the physician orders and documented the patient tolerated the wound care well. However, the SN failed to document the specific steps and supplies used during wound care as required. During an interview on 3/9/22 at 4:15 p.m., the Administrator and Clinical Manager did acknowledge that the SN failed to document the specific steps and supplies used during wound care.