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

A complaint survey to investigate # 96534 was conducted at Amedisys Home Health, Macon, on April 18, 2023, and concluded on April 20, 2023. At the time of the survey, the agency was not in compliance with Chapter 42 CFR Part 418, Rules and Requirements for Home Health and Hospice Agencies. The census was 556. The following deficiencies were cited.

HHA can no longer meet the patient's needs CFR(s): 484.50(d)(1) The transfer or discharge is necessary for the patient's welfare because the HHA and the physician or allowed practitioner, who is responsible for the home health plan of care agree that the HHA can no longer meet the patient's needs, based on the patient's acuity. The HHA must arrange a safe and appropriate transfer to other care entities when the needs of the patient exceed the HHA's capabilities; This ELEMENT is not met as evidenced by: Based on clinical record reviews, staff interviews, and review of policy, it was determined that the Home Health Agency failed to meet one patient's (P#1) needs; and also failed to find placement for (P#1) of three sampled patients. Findings include: The patient was accepted by Amedisys Home Health from Northside Hospital Rehabilitation Unit. He was discharged on 02/21/2023. The patient was discharged home with supervision and assistance from his brother and other family members. According to the family of P#1, Amedisys Home Health Agency (HHA) refused to accept P#1 after his discharge from Northside Hospital or to find another placement for P#1. The complaint was substantiated with deficiencies. On 04/18/2023 at 11:48 a.m., an interview was conducted with Registered Nurse (RN) AA, who stated that she spoke with the Case Manager (CM) from Northside Rehabilitation about the patient’s referral. According to RN AA, the CM was upset and stated that the Home Health Agency had accepted the patient. RN AA further stated the HHA backed out when the family of P#1 called and informed the HHA that there would not be a caregiver at the patient’s home. She stated the family of P#1 reported they were looking for placement for the patient. On 04/18/2023 at 12:23 p.m., an interview was conducted with RN BB, Admission Coordinator (AC), she stated the family of P#1 called and stated that there was no one to stay with P#1 because the family of P#1 lives at Alabama whereas P#1 lives in Georgia. RN BB, said that he called the office and spoke with RN AA, to follow up with the P#1 and the family of P#1. RN BB said he believed that RN CC followed up with the family of P#1. On 04/18/2023 at 1:10 p.m., an interview was conducted with RN CC, who stated that she thought that RN AA or RN BB had contacted the family of P#1. On 04/18/2023 at 2:00 p.m., an interview was conducted with the family of P#1, who stated that the HHA refused to accept P#1 after discharge from Northside Hospital and failed to find placement for P#1. The family of P#1was upset and called the CM at Northside Hospital ,who sent the patient back to the hospital, to find another agency that would accept P#1. The family of P#1 stated they live in Alabama but the patient lives in Georgia, which is why they were thinking that placement would be better in Georgia for P#1. The family of P#1 further stated the HHA continued to report that P#1 was not their patient. Review of the agency's policy titled, 'AA-002’, “Initial Referral/Admission Process”, dated 4/20, revised on 8/26/2021, page 2 of 35, number 12: stated “If the agency cannot provide services as ordered, the physician referral source will be notified, and the patient will be referred to another agency of his/her choice with appropriate referral information forwarded to the receiving agency.” The agency failed to follow their referral/admission policy.

At the time of the survey, Amedisys Home Health in Macon, 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 June 16, 2022. A Focus Infection Control Survey was completed at the time of the survey. No deficiencies were cited.

At the time of the Recertification survey, Amedisys Home Health of Macon, Georgia was in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of the survey conducted on June 16, 2022. A Focus Infection Control Survey was completed at the time of the survey. Current census 1066. The follow deficiencies were cited.

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 home visit observations and staff interviews, it was determined the agency failed to ensure that patients' medication profiles were updated to reflect current medications for 2 of 7 (#2 and #5) sampled patients (P). Findings were: 1. During a home visit observation on 6/13/22 at approximately 4:00 p.m., for patient (P)#1 with a certification period of 5/31/22 to 7/29/22 and diagnosis of chronic obstructive pulmonary disease, this surveyor observed the occupational therapist assistant (OTA) compare the medications found in the home, to agency's the medication profile. The medication profile did not reflect the patient's current medications. The patient had a bottle of Metformin 500mg, Iron 65 mg, and Aspirin 81mg in the home that were not listed on the medication profile. The agency staff failed to update the patient's medication profile during each skilled visit per agency protocol. During an interview on 6/14/22 at approximately 10:00 a.m., the Director of Operations (DOO) did verbalize that the clinicians are required to reconcile medications at each visit. It was also confirmed that the medication profile was not up to date and the clinician was sent out to patient’s home on 6/14/22 to update and clarify with the patient the current medication regime. 2. During a home visit observation on 6/14/22 at approximately 2:45 p.m., for P#4 with a certification period of 5/27/22 to 7/25/22 and diagnosis of Gout unspecified, this surveyor observed the occupational therapist (OT) compare the medications found in the home, to agency's the medication profile. The medication profile did not reflect the patient's current medications. The patient had a bottle of Fish Oil 1000mg, Centrum multivitamin, B12 vitamin, and Ezetimbe 10mg tab every day. The patient and caregiver report that the patient does take these medications daily however, these medications were not listed on the medication profile. The agency staff failed to update the patient's medication profile during each skilled visit per agency protocol. During an interview on 6/14/22 at approximately 10:00 a.m., the Director of Operations (DOO) did verbalize that the clinicians are required to reconcile medications at each visit. It was also confirmed that the medication profile was not up to date.

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 that appropriate care and services were provided in conformance with the patients' plans of care as ordered by physician for 2 of 17 (#6 and #11) sampled patients (P). Findings were: 1.Review of the plan of care for patient (P)#6 with a recertification period of 5/19/22 to 7/17/22 and diagnosis of encounter for other fitting and adjustment of urinary device required the skilled nurse (SN) to perform insertion of 16french indwelling catheter and instill 10cc of normal saline into the balloon. Secure tubing with appropriate securement device. Change every month and as needed. The SN visited the patient on 5/23/22 and documented an indwelling catheter change using a 18french/30cc balloon. The agency failed to ensure the plan of care for Foley catheter changes were performed as ordered. During an interview on 6/16/22 at approximately 10:00 a.m., the Director of Operations (DOO) did provide a physician’s order dated 6/15/22 for the SN to use an 18fr/30cc balloon however, this order was not available at the time of the catheter change done on 5/23/22 which required a 16fr indwelling catheter. 2.Review of the plan of care for P #11 with a certification period of 4/21/22 to 6/19/22 and diagnosis of acute and chronic respiratory failure revealed resumption of care orders dated 5/12/22 which required the skilled nurse (SN) to assess the patient’s ability to monitor daily weights and vital signs including pulse and blood pressure and record the patient reported weight or weigh patient as needed and report increased edema or weight gain of greater than 2 pounds in 1 day or 5 pounds or more over target weight. The SN visited the patient on 5/24 and 6/7/22 however, and the weight and edema assessment were not done as ordered on these dates. During an interview on 6/16/22 at approximately 10:00 a.m., the Director of Operations (DOO) did not provide evidence that the weight and edema assessment was completed as ordered on 5/24 and 6/7/22.