Every finding on record at Amedisys Georgia, LLC

At the time of the survey, Central Home Health, an Amedisys Company, in Tucker, Georgia was in compliance with 42 CFR Part 484, Requirement for Home Health, as a result of an onsite complaint investigation conducted on July 6, 2022 for complaint number 18960. The complaint was unsubstantiated however, deficiencies were cited unrelated to the complaint. The agency census was 1631 at the time of the onsite visit.The following deficiencies were 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 failed to ensure the patients' individualized plans of care/treatment included all of the required elements to address the identified needs for one of four (# 2) sampled patients (P). 1. Review of the plan of care/treatment for Patient #2 (closed record) with a certification period of 2/16/21 to 4/15/21 revealed the patient had type 2, diabetes mellitus with hyperglycemia and long term use of insulin usage and long term usage of anticoagulant However, the plan of care/treatment lacked orders for blood glucose ranges/parameters to alert the physician of early diabetic complications, lacked interventions to assess and teaching on signs and symptoms of bleeding and prevention of bleeding caused by long term use of anticoagulants. The agency failed to ensure that the plan of care/treatment covered all pertinent interventions for the comprehensive care of the patient's multiple and specific disease entities. During an interview on 7/6/22 at 3:30 p.m. the Director of Operations and Area Vice President confirmed that the agency failed to ensure that the plan of care included patient-specific interventions for the comprehensive care of the patient.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined that the agency staff failed to document a discharge summary and inform the physician of the availability of a discharge summary for 2 of 4 (#1 and #2) sampled patients (P). Findings were: 2.Review of the clinical record for patient #2 with a certification period of 2/15/21 to 4/15/21 and a diagnosis of type 2 Diabetes mellitus with hyperglycemia, revealed the patient was discharged from home health services on 6/15/21. However, the clinical record lacked documentation of a discharge summary to close out the episode of care and also lacked documentation to indicate the physician was informed of the patient's discharge or the availability of a discharge summary. 1. Review of the clinical record for patient #1 with a recertification period of 7/1/21 to 8/29/21 and a diagnosis of intervertebral disc disorders with radiculopathy revealed the patient was discharged from home health services on 8/13/21. However, the clinical record lacked documentation of a discharge summary to close out the episode of care and also lacked documentation to indicate the physician was informed of the patient's discharge or the availability of a discharge summary. During an interview on 7/6/22 at 11:00 a.m. the Director of Nurses (DON) and the Area Vice President of Clinical Practice (AVPC) acknowledged the clinical record lacked evidence of an agency discharge summary as required and did not show evidence that the physician was notified of the agency discharge.

Central Home Health is in compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 for HHA, as a result of an onsite survey conducted on 2/3/22 by Surveyor.

A Recertification survey was conducted at Central Home Health, Georgia, on 2/3/22, by Surveyor. It was revealed that the agency is in compliance with Chapter 42 CFR Part 418, Rules and Requirements for Home Health and Hospice Agencies. The census was 1017.

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, clinical record reviews, and staff interviews, it was determined that the agency failed to ensure that patient's medication profile and plan of care was updated to reflect current medications at the time of the comprehensive assessment for five (5) of nineteen (19) Patients (P) (P#14, #15, #16, #18 and #19) sampled. The Findings include: During a home observation on 2/2/22, at approximately 10:52 a.m., with Physical Therapist (PT) AA, for P#14 who was admitted to agency on 12/14/21 with a diagnosis of hemiplegia right side, atrial fibrillation, major depression, hyperlipidemia, heart valve, coronary heart disease, this surveyor compared the patient's current medication list at home, to the home health agency's medication profile. P#14 was taking Lasix 20 milligrams (MG) one tablet oral daily for fluids retention, started on 1/5/22; Oxybutynin Chloride 10mg take one tablet oral daily for overactive bladder, started on 9/20/21; Vitamin C 500mg one tablet oral daily for supplement dated 2/2/21; Benadryl 25mg take one capsule oral as needed for sleep, started on six months ago; and Salmeterol inhaler bronchodilator 50 microgram (MCG) two times daily. But this medication profile was not listed in the agency’s medication profile and plan of care. During an interview on 2/2/22 at 11:20 a.m., with (PT) AA, he stated that he was not aware that P#14 was taking the above medications. On 2/2/22 at 11:38a.m., an interview was conducted with P#14; he was alert and oriented to person, place, and time. P#14 stated that he has been taking the above medications for long time. 2. On 2/2/22 at 12:09 p.m., during a home observation with P#15 with Licensed Practical Nurse (LPN) BB, it was revealed that P#15 was admitted to the agency on 12/22/21, with a diagnosis of neoplasm of colon, colostomy, hypertension, chronic kidney disease, dementia, and dysphagia. The agency medication profile did not correspond with the patient’s home medications. It was revealed that cholestyramine light 4gram (GM), powder oral twice daily for cardiovascular therapy was discontinued in December 2021; pantoprazole 40mg tablet delayed release, take one tablet oral twice daily for gastrointestinal, was discontinued on December 2021; and Tylenol 325mg take one tablet oral daily as needed for pain. Patient’s daughter stated that her mother never took Tylenol, but the three medications were listed in agency’s medication profile. During an interview on 2/2/22 at 12:27 p.m., with (LPN) BB, she stated that she was not the assigned nurse to P#15. (LPN) BB stated that she was transferred from South Carolina to Georgia and was new to the patient. 3. On 2/2/22 at 1:30 p.m., during a home observation with P#16 with (LPN) CC, it was revealed that P#16 was admitted to the agency with a diagnosis of left lower limb cellulitis, right ankle blister, chronic pain, hypertension, irritable bowel syndrome, hypothyroidism, and history of malignant neoplasm of breast. The agency medication profile did not correspond with patient medications, and one medication has expired since 2019. P#16 confirmed that she took the medication that day (2/2/22) at 10:00 a.m. Patient #16 was taking gabapentin 100mg one capsule oral daily for nerve pain, it was listed in agency medication profile for three times daily. Lasix 40mg one tablet oral as needed for fluid retention, the medication was dated filled on 9/5/18 and should be discarded by 9/5/19, but the medication was not discarded, and patient said she took the medication (Lasix 40mg half tablet oral today (2/2/22) at 10:00 a.m. Benadryl 25mg one tablet oral for sleep, Aspirin 81mg one tablet oral for anticoagulant, B12 2500microgram (MCG) one tablet oral for supplement, and D3 125mcg one gel caplet oral daily for supplement. During an interview on 2/2/22 at 1:49 p.m., with (LPN) CC, she stated that she was not aware that the above listed medications were being taken by P#16. (LPN) CC confirmed that she neither updated nor reviewed P#16 medications. 4. On 2/3/22 at 10:10 a.m., during a home observation to P#18 with a Registered Nurse (RN) DD, it was revealed that P#18 was admitted on 11/30/21, with a diagnose of vascular implants grafts, pulmonary embolism, acute respiratory failure with hypoxia, pneumonia, kidney failure, gastrointestinal hemorrhage, iron deficiency, insomnia, hypothyroidism and obesity. Patient #18 was taking iron 65mg with 325mg ferrous sulfate one tablet oral every other day started on 11/30/21; omeprazole delayed release 20mg one capsule oral before meal started on 11/30/21; sucralfate 1gram (GM) one tablet oral four times daily, started on 11/30/21; and hydrocodone 5mg one tablet oral daily, was discontinued on 12/5/21, but it was not updated in agency’s medication profile. On 2/3/22 at 10:40 a.m., an interview was conducted with (RN) DD, stated that he was not aware that P#18 was taking the above listed medications. 5. On 2/3/22 at 11:10 a.m., during a home observation with P#19 with (RN) EE, it was revealed that P#19 was admitted to the agency with a diagnosis of type 2 diabetes, anemia, encounter for change or removal of surgical wound dressing, renal dialysis, occlusion and stenosis of bilateral carotid arteries, and obesity. Patient #19 was taking Novolog Flex pen 100 units insulin, Aspart 100unit/milliliters (ML) (3ml), give 4ml subcutaneous as needed per sliding scale, give 3units for blood glucose less than 100. But the agency’s medication profile revealed give insulin 4units three times daily. On 2/3/22 at 11:53 a.m., an interview was conducted with (RN) EE, who confirmed that she was not aware of the insulin discrepancies.

Within 48 hours of the patient's return CFR(s): 484.55(d)(2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner - ordered resumption date; This ELEMENT is not met as evidenced by: Based on clinical referral record reviews and staff interviews, it was determined that the agency staff failed to conduct an assessment after Patient (P) #2 was discharged from the hospital within 48 hours of referral or on the physician order for resumption of care date for one(1) of nineteen (19) sampled patients. The Findings include: 1. Review of the plan of care and treatment for P#2 with a certification period of 1/28/22 to 3/28/22, revealed that P#2 was discharged from the hospital on 12/26/21. However, the patient did not receive services until 1/14/22. The clinical record lacked justification for the resumption of care delay and documentation that the physician was notified and authorized the resumption of care later than 48 hours from the referral, resulting in an unauthorized delay for resumption of care. During an interview on 2/2/22 at 2:36 p.m., the clinical manager (CM) did confirm a resumption of care delay without physician notification. The Director of operations also confirmed the start of care delay, and further stated that the process is as follows: once the agency receives a referral, the staff will reach out to the patient to welcome the patient and set of an appointment for the initial assessment within 48 hours. However, the agency staff did admit that during this time, the staff failed to reach out to the patient within 48 hours to complete the initial assessment.

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 observations, clinical record reviews, and staff interviews, it was determined that the agency failed to ensure that patient's plan of care was updated to reflect current medications at the time of the comprehensive assessment for five (5) of nineteen (19) Patients (P) (P#14, #15, #16, #18 and #19) sampled. The Findings include: During a home observation on 2/2/22, at approximately 10:52 a.m., with Physical Therapist (PT) AA, for P#14 who was admitted to agency on 12/14/21 with a diagnosis of hemiplegia right side, atrial fibrillation, major depression, hyperlipidemia, heart valve, coronary heart disease, this surveyor compared the patient's current medication list at home, to the home health agency's medication profile. P#14 was taking Lasix 20 milligrams (MG) one tablet oral daily for fluids retention, started on 1/5/22; Oxybutynin Chloride 10mg take one tablet oral daily for overactive bladder, started on 9/20/21; Vitamin C 500mg one tablet oral daily for supplement dated 2/2/21; Benadryl 25mg take one capsule oral as needed for sleep, started on six months ago; and Salmeterol inhaler bronchodilator 50 microgram (MCG) two times daily. But this medication profile was not listed in the agency’s medication profile and plan of care. During an interview on 2/2/22 at 11:20 a.m., with (PT) AA, he stated that he was not aware that P#14 was taking the above medications. On 2/2/22 at 11:38a.m., an interview was conducted with P#14; he was alert and oriented to person, place, and time. P#14 stated that he has been taking the above medications for long time. 2. On 2/2/22 at 12:09 p.m., during a home observation with P#15 with Licensed Practical Nurse (LPN) BB, it was revealed that P#15 was admitted to the agency on 12/22/21, with a diagnosis of neoplasm of colon, colostomy, hypertension, chronic kidney disease, dementia, and dysphagia. The agency medication profile did not correspond with the patient’s home medications. It was revealed that cholestyramine light 4gram (GM), powder oral twice daily for cardiovascular therapy was discontinued in December 2021; pantoprazole 40mg tablet delayed release, take one tablet oral twice daily for gastrointestinal, was discontinued on December 2021; and Tylenol 325mg take one tablet oral daily as needed for pain. Patient’s daughter stated that her mother never took Tylenol, but the three medications were listed in agency’s medication profile. During an interview on 2/2/22 at 12:27 p.m., with (LPN) BB, she stated that she was not the assigned nurse to P#15. (LPN) BB stated that she was transferred from South Carolina to Georgia and was new to the patient. 3. On 2/2/22 at 1:30 p.m., during a home observation with P#16 with (LPN) CC, it was revealed that P#16 was admitted to the agency with a diagnosis of left lower limb cellulitis, right ankle blister, chronic pain, hypertension, irritable bowel syndrome, hypothyroidism, and history of malignant neoplasm of breast. The agency medication profile did not correspond with patient medications, and one medication has expired since 2019. P#16 confirmed that she took the medication that day (2/2/22) at 10:00 a.m. Patient #16 was taking gabapentin 100mg one capsule oral daily for nerve pain, it was listed in agency medication profile for three times daily. Lasix 40mg one tablet oral as needed for fluid retention, the medication was dated filled on 9/5/18 and should be discarded by 9/5/19, but the medication was not discarded, and patient said she took the medication (Lasix 40mg half tablet oral today (2/2/22) at 10:00 a.m. Benadryl 25mg one tablet oral for sleep, Aspirin 81mg one tablet oral for anticoagulant, B12 2500microgram (MCG) one tablet oral for supplement, and D3 125mcg one gel caplet oral daily for supplement. During an interview on 2/2/22 at 1:49 p.m., with (LPN) CC, she stated that she was not aware that the above listed medications were being taken by P#16. (LPN) CC confirmed that she neither updated nor reviewed P#16 medications. 4. On 2/3/22 at 10:10 a.m., during a home observation to P#18 with a Registered Nurse (RN) DD, it was revealed that P#18 was admitted on 11/30/21, with a diagnose of vascular implants grafts, pulmonary embolism, acute respiratory failure with hypoxia, pneumonia, kidney failure, gastrointestinal hemorrhage, iron deficiency, insomnia, hypothyroidism and obesity. Patient #18 was taking iron 65mg with 325mg ferrous sulfate one tablet oral every other day started on 11/30/21; omeprazole delayed release 20mg one capsule oral before meal started on 11/30/21; sucralfate 1gram (GM) one tablet oral four times daily, started on 11/30/21; and hydrocodone 5mg one tablet oral daily, was discontinued on 12/5/21, but it was not updated in agency’s medication profile. On 2/3/22 at 10:40 a.m., an interview was conducted with (RN) DD, stated that he was not aware that P#18 was taking the above listed medications. 5. On 2/3/22 at 11:10 a.m., during a home observation with P#19 with (RN) EE, it was revealed that P#19 was admitted to the agency with a diagnosis of type 2 diabetes, anemia, encounter for change or removal of surgical wound dressing, renal dialysis, occlusion and stenosis of bilateral carotid arteries, and obesity. Patient #19 was taking Novolog Flex pen 100 units insulin, Aspart 100unit/milliliters (ML) (3ml), give 4ml subcutaneous as needed per sliding scale, give 3units for blood glucose less than 100. But the agency’s medication profile revealed give insulin 4units three times daily. On 2/3/22 at 11:53 a.m., an interview was conducted with (RN) EE, who confirmed that she was not aware of the insulin discrepancies.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on clinical record reviews, observations, and staff interviews, it was determined that the agency failed to follow physician’s order to weigh P#3 daily if unable to weigh patient may measure abdominal girth during home visit, and agency failed to follow wound care dressing order for P#19, two (2) of thirteen (19) patients (P) sampled. The Findings include: 1. Patient #3 was admitted to agency on 12/29/21, with a diagnosis of hypertensive heart disease with heart failure, anxiety, chronic obstruction pulmonary disease, type 2 diabetes, and osteoarthritis. Physician ordered dated 1/11/22, skilled nurse to assess, monitor and record daily weight, if unable to weigh patient may measure abdominal girth and to notify physician if P#3 gained two pounds in one day or five pounds in one week. Licensed Practical Nurse (LPN) FF weighed P#3 three times only (on 12/29/22 weight was 157, and 1/21/22 weight was 152 lbs). There was no record showing that (LPN) FF notified physician for not obtaining the weight for three weeks. On 2/3/22, at 10:00 a.m., an interview was conducted with (LPN) FF, who stated that P#3’s scale was damaged, and she did not have a scale in her car to weigh P#3. Also (LPN) FF confirmed that she did not measure abdominal girth nor notify the physician. 2. On 2/3/22, at 11:10 a.m., observed (RN) EE, perform wound care to P#19. Physician’s order dated 11/17/21, was for skilled nurse to cleanse wound with wound cleanser filled with Dakin’s moistened gauze, may apply skin barrier to peri wound as needed to prevent maceration and protect peri wound cover with dry gauze or abdominal pad, secured with kerlix and ace tolerated with no complain of pain. Order was discontinued on 1/15/22. (RN) EE visited P#19 on 1/21/22 and again on 1/29/22, but did not follow physician’s order, and she continued to use previous discontinued order and document it in the nurse’s visit notes. During the interview with (RN) EE, on 2/3/22 at 11:55 a.m., she confirmed that she was not aware that the wound order has changed. P#19 was alert and oriented to time, person, place or things, P#19 said that she notified (RN) EE when she came back from physician’s appointment that the wound order was discontinued.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined that the agency failed to ensure the plans of care which contained verbal orders were signed by the physician within the required 30-day time frame for seven (7) of nineteen (19), Patients (P) (#2, #4, #5, #6, #7, #16, and #18) sampled patients. The Findings include: 1. Review of a verbal order dated 1/24/22 for P#2 with a certification period of 1/28/22 to 3/28/22, revealed the physician has not reviewed, signed, and approved the verbal order as of the record review date, 2/2/22. The agency failed to obtain the physician's signature on verbal orders within the 30-day timeframe as required. 2. Review of the plan of care for P#4 with a certification period of 1/16/22 to 3/16/22, revealed the physician has not reviewed, signed, and approved the plan of care as of the record review date, 2/2/22. The agency failed to obtain the physician's signature on verbal orders within the 30-day timeframe as required. 3. Review of the plan of care for P#5 with a certification period of 12/8/21 to 2/5/22, revealed the physician has not reviewed, signed, and approved the plan of care as of the record review date, 2/2/22. The agency failed to obtain the physician's signature on verbal orders within the 30-day timeframe as required. 4. Review of the plan of care for P#6 with a certification period of 1/12/22 to 3/12/22, revealed the physician did not review, sign, and approve the plan of care as of record review date, 2/2/22. The agency failed to obtain the physician's signature on verbal orders within the 30-day timeframe as required. 5. Review of the plan of care for P#7 with a certification period of 1/17/22 to 3/17/22, revealed the physician did not review, sign, and approve the plan of care as of record review date, 2/2/22. The agency failed to obtain the physician's signature on the plan of care within the 30-day timeframe as required. 6. Review of the plan of care for P#16 with a recertification period of 1/17/22 to 3/17/22, revealed the physician did not review, sign, and approve the plan of care as of record review date, 2/2/22. The agency failed to obtain the physician's signature on the plan of care within the 30-day timeframe as required. 7. Review of the plan of care for P#18 with a recertification period of 1/29/22 to 3/29/22, revealed the physician did not review, sign, and approve the plan of care as of record review date, 2/2/22. The agency failed to obtain the physician's signature on the plan of care within the 30-day timeframe as required. During an interview on 2/2/22 at 1:07 p.m., the clinical manager (CM) acknowledged the plan of care was not countersigned by the physician within 30 days of receipt of orders.

An Abbreviated/Partial Extended Survey investigating GA00212606 was initiated on 6/10/21 and concluded on 6/11/21. The complaint was substantiated and a deficiency was cited.

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 reviews and patient/staff interviews , the agency failed to ensure that the plan of care for visit frequency was followed as ordered by the physician for 1 of 3 sampled patients (P) #1. 1. Review of clinical record for P#1 with a certification period of 3/29/21 to 5/27/21 revealed a verbal order signed and dated 4/9/21 by the physician which required the skilled nurse (SN) to visit the patient two times a week for wound care to the right lower leg and right dorsal plantar foot. Review of the clinical record revealed the SN only visited the patient one time a week from 3/39-5/29/21. The SN failed to follow the required visit frequency. During an interview on 6/10/21 at 10:15 a.m., the Director of Operations (DOO) of the Winder office did confirm that the nursing staff was only seeing the patient one time per week and stated the wound center was seeing the patient one time a week which would ensure the patient was being seen two times per week. The DOO was unable to provide documentation to indicate the wound center would be seeing the patient weekly. Also, the DOO was unable to provide evidence that the SN frequency had been decreased to only one time per week. The SN failed to visit the patient 2 times per week as required.