Every finding on record at Amedisys Georgia, LLC

A Recertification Survey was Coosa Valley Home Health, An Amedisys on December 2, 2024, and concluded on December 4, 2024. At the time of the survey, the agency was in compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 infection control.

A Recertification Survey was conducted at Coosa Valley Home Health, An Amedisys on December 2, 2024, and concluded on December 4, 2024. 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 580. The following deficiencies were cited.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on the Centers for Medicare & Medicaid Services (CMS) Home Health Agency (HHA) Error Summary by agency report, agency policy “OASIS Outcome and Information Set,” and staff interview, it was determined that the agency failed to electronically transmit monthly Outcome and Assessment Information Set (OASIS) data collected to the CMS system every 30 days. Findings include: Review of the policy titled “OASIS Outcome and Information set,” last revised 6/26/23, revealed the following: 10. OASIS data will be accurate, completed, encoded, and routinely transmitted to CMS in accordance with the required submission timelines. Review of CMS report titled “HHA Error Summary by Agency,” with a run date of 11/13/2024, revealed the agency failed to transmit OASIS data to the CMS system within 30 days. On 12/14/2024 at 11:00 am, during an in-office interview, the Assistant Vice President of Operations (AVPO) confirmed awareness of the 30-day OASIS submission timeframe requirements not met during the time frame of 10/01/2023 through 11/01/2024. The AVPO explained the agency OASIS reviewing and submission process was completed by the clinical managers and clinical directors. The AVPO acknowledged the agency did not have a designated person reviewing or submitting OASIS transmittal and felt the agency staff needed further education on the process of reviewing and submitting OASIS transmittals.

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 record review and staff interview, the agency failed to send a discharge summary within five business days to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge for five patients (P) (P#6, P#7, P#8, P#9 and P#10) of 17 sampled patients. Findings include: Review of policy titled “Discharge of Patients,” revised 10/10/24 revealed that the agency must develop and implement an effective discharge planning process. Further review revealed “A completed discharge summary is sent to the primary care physician/allowed practitioner, receiving facility 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.” Review of the clinical records for P#6, P#7, P#8, P#9, and P#10 revealed an absence of the discharge summary. An interview on 12/3/2024 at 2:30 p.m., conducted at the Home Health agency with the Area Vice President of Operations confirmed that the discharge summaries had not been completed and sent to the primary care practitioner or other health care responsible for providing care and services to the patient after discharge from the home health agency for five of 17 sampled patients. P#6, P#7, P#8, P#9 and P#10.

Coosa Valley 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 12/2/21.

A Recertification survey was conducted at Coosa Valley Home Health Rome, Georgia, on 12/2/21. As a result of the recertification survey, 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 627.

Treatment or care CFR(s): 484.50(e)(1)(i)(A) (i)(A) Treatment or care that is (or fails to be) furnished, is furnished inconsistently, or is furnished inappropriately; and 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 obtain physician’s order for one (1) of thirteen (13) patient's (P) #1, observed for wound care. The Findings include: On 11/30/21 at 8:15 a.m., observed Licensed Practical Nurse (LPN) AA, performed wound care on P#1’s right foot open wound. Left foot with blister was wrapped with kerlix, secured with paper tape. This surveyor asked (LPN) AA, why the Registered Nurse (RN) DD wrapped P#1’s left foot without physician’s order. (LPN) AA replied that she had no idea why (RN) DD wrapped the left foot without physician’s order for the left foot blister dressing. On 11/30/21 at 2:00 p.m., an interview was conducted with (RN) DD, who stated that she forgot to obtain physician’s order for the left foot blister dressing.

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 reviews, observations, and staff interviews, it was determined that the agency failed to ensure that patient's medication profile was updated to reflect current medications at the time of the comprehensive assessment for three (3) of thirteen (13) Patients (P) observed. P#1, P#2, and P#3. The Findings include: 1. During a home visit observation on 11/30/21 at approximately 8:00 a.m., with License Practical Nurse (LPN) AA, for P#1, who was admitted to the agency on 5/28/20. P#1 was admitted with a diagnosis of heart failure, pressure induced deep tissue damage of other site, venous insufficiency chronic peripheral disease, chronic respiratory failure with hypoxia, hyperlipidemia, anemia, anxiety, chronic obstruction pulmonary disease, and oxygen dependence. The patient's current medication was then compared to the home health agency's medication profile. P#1 was taking Benadryl 25milligram (MG) oral at bedtime as needed for itching, and Dulcolax 25mg oral as needed for constipation. This medication was not listed in agency medication profile and plan of care. During an interview on 11/30/21 at 8:38 a.m., with (LPN) AA, she stated that she was not aware that P#1 was taking Benadryl 25milligram (MG) oral at bedtime as needed for itching, and Dulcolax 25mg oral as needed for constipation. 2. On 11/30/21 at 9:15 a.m., during home visit to P#2 with Registered Nurse (RN) BB, it was revealed that P#2 was admitted to the agency on 7/27/21, with a diagnose of open wound to left lower leg, hypertensive chronic kidney disease stage 3, type 2 diabetes mellitus, bilateral osteoarthritis of knee, dementia, gout, history of falling, localized edema and urinary tract infection. The agency medication profile did not correspond with Assisted Living Facility (ALF) Medication Administration Record (MAR). Patient #2 was taking Potassium Chloride Extended Release (ER), 10 milliequivalent (MEQ), instruction was to take three tablets by mouth daily for electrolyte balance and supplement, order dated 2/25/21. Novolin R Flex pen 100 Unit/ML (Milliliters), insulin instruction was to follow in sliding scale order; if blood glucose is 200 or less, give none insulin; for blood glucose of 201-250, give two units; for blood glucose of 251-300, give four units; for blood glucose of 301-350, give five units; for blood glucose of 350-400, give seven units; and for blood glucose of 401-500, give eight units of insulin, dated on 10/11/21, and Novolog mix 70/30 flex pen 100 unit/ML suspension, administer 40 units subcutaneous injection before morning meal and 40 units before evening meal; if the blood glucose is less than 130 reduce to 20 units, subcutaneous hold for blood glucose 100, and notify doctor for blood glucose less than 60 or more than 350, order dated 9/24/20. The home health agency medication profile and plan of care listed medications has Klor-con 10meq extended release, give one tablet oral daily, order dated 7/27/21, and Novolog flex pen U-100 insulin Aspart 100unit/ml, give 3ml subcutaneous before meal and bedtime, order dated on 7/27/21. During an interview on 11/30/21 at 9:54 a.m., with (RN) BB, she stated that she was the assigned nurse and worked as a part-time, but she was not aware that P#2 was taking three tablets of potassium, and she was also not aware of the discrepancy in insulin order. (RN) BB also said that she was not aware that she has to list the insulin sliding scale number in agency medication profile and care plan. 3. On 12/1/21 at 10:00 a.m., during home visit to P#3 with agency (RN) CC., it was revealed that P#3 was admitted to the agency on 9/2/21, with a diagnose of necrotizing fasciitis, Escherichia coli, removal of surgical wound dressing, repeated falls, muscle weakness, malnutrition, anemia, osteoarthritis, and nicotine dependence cigarettes. Again, the agency medication profile did not correspond with P#3 home medications. Patient #3 was taking Integra vitamin supplement one capsule oral daily, order dated 10/6/21, and Tamsulosin 0.4mg take one capsule oral daily for prostate muscle relaxation, order dated 9/2/21. But as stated by P#3, Tamsulosin 0.4mg has been discontinued three months ago by P#3’s primary physician. The home health agency medication profile and plan of care revealed that Tamsulosin 0.4mg was active in their medication list, and Integra vitamin supplement was not listed. During an interview on 12/1/21 at 10:27 a.m., with (RN) CC, she stated that she was not aware that Tamsulosin 0.4mg was discontinued, and Integra vitamin was still being taken by P#3. (RN) CC confirmed that she did not update P#3 agency medication profile to match his home medication.

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, observations, 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 three (3) of thirteen (13) Patients (P) observed. P#1, P#2, and P#3. The Findings include: 1. During a home visit observation on 11/30/21 at approximately 8:00 a.m., with License Practical Nurse (LPN) AA, for P#1, who was admitted to the agency on 5/28/20. P#1 was admitted with a diagnosis of heart failure, pressure induced deep tissue damage of other site, venous insufficiency chronic peripheral disease, chronic respiratory failure with hypoxia, hyperlipidemia, anemia, anxiety, chronic obstruction pulmonary disease, and oxygen dependence. The patient's current medication was then compared to the home health agency's medication profile. P#1 was taking Benadryl 25milligram (MG) oral at bedtime as needed for itching, and Dulcolax 25mg oral as needed for constipation. This medication was not listed in agency plan of care. During an interview on 11/30/21 at 8:38 a.m., with (LPN) AA, she stated that she was not aware that P#1 was taking Benadryl 25milligram (MG) oral at bedtime as needed for itching, and Dulcolax 25mg oral as needed for constipation. 2. On 11/30/21 at 9:15 a.m., during home visit to P#2 with Registered Nurse (RN) BB, it was revealed that P#2 was admitted to the agency on 7/27/21, with a diagnose of open wound to left lower leg, hypertensive chronic kidney disease stage 3, type 2 diabetes mellitus, bilateral osteoarthritis of knee, dementia, gout, history of falling, localized edema and urinary tract infection. The agency medication profile did not correspond with Assisted Living Facility (ALF) Medication Administration Record (MAR). Patient #2 was taking Potassium Chloride Extended Release (ER), 10 milliequivalent (MEQ), instruction was to take three tablets by mouth daily for electrolyte balance and supplement, order dated 2/25/21. Novolin R Flex pen 100 Unit/ML (Milliliters), insulin instruction was to follow in sliding scale order; if blood glucose is 200 or less, give none insulin; for blood glucose of 201-250, give two units; for blood glucose of 251-300, give four units; for blood glucose of 301-350, give five units; for blood glucose of 350-400, give seven units; and for blood glucose of 401-500, give eight units of insulin, dated on 10/11/21, and Novolog mix 70/30 flex pen 100 unit/ML suspension, administer 40 units subcutaneous injection before morning meal and 40 units before evening meal; if the blood glucose is less than 130 reduce to 20 units, subcutaneous hold for blood glucose 100, and notify doctor for blood glucose less than 60 or more than 350, order dated 9/24/20. The home health agency plan of care listed medications has Klor-con 10meq extended release, give one tablet oral daily, order dated 7/27/21, and Novolog flex pen U-100 insulin Aspart 100unit/ml, give 3ml subcutaneous before meal and bedtime, order dated on 7/27/21. During an interview on 11/30/21 at 9:54 a.m., with (RN) BB, she stated that she was the assigned nurse and worked as a part-time, but she was not aware that P#2 was taking three tablets of potassium, and she was also not aware of the discrepancy in insulin order. (RN) BB also said that she was not aware that she has to list the insulin sliding scale number in agency care plan. 3. On 12/1/21 at 10:00 a.m., during home visit to P#3 with agency (RN) CC., it was revealed that P#3 was admitted to the agency on 9/2/21, with a diagnose of necrotizing fasciitis, Escherichia coli, removal of surgical wound dressing, repeated falls, muscle weakness, malnutrition, anemia, osteoarthritis, and nicotine dependence cigarettes. Again, the agency medication profile did not correspond with P#3 home medications. Patient #3 was taking Integra vitamin supplement one capsule oral daily, order dated 10/6/21, and Tamsulosin 0.4mg take one capsule oral daily for prostate muscle relaxation, order dated 9/2/21. But as stated by P#3, Tamsulosin 0.4mg has been discontinued three months ago by P#3’s primary physician. The home health agency medication profile and plan of care revealed that Tamsulosin 0.4mg was active in their medication list, and Integra vitamin supplement was not listed. During an interview on 12/1/21 at 10:27 a.m., with (RN) CC, she stated that she was not aware that Tamsulosin 0.4mg was discontinued, and Integra vitamin was still being taken by P#3. (RN) CC confirmed that she did not update P#3 agency care plan to match his home medication.

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#1 during home visit, and agency failed to follow wound care dressing order for P#2 Two (2) of thirteen (13) patients (P) observed. P#1 and P#2. The Findings include: 1. On 11/30/21 at 8:35 a.m., surveyor observed Licensed Practical Nurse (LPN) AA during the home visit assessment. It revealed that Registered Nurse (RN) DD failed to weigh P#1 for three weeks (11/16/21, 11/19/21 and 11/26/21). According to record review, it revealed that (RN) DD visited P#1 on 11/16, 11/19, 11/23/21 and 11/26/26, (RN) DD recorded the weight only on 11/23/21 (155.4 pounds). Patient #1 was admitted to agency on 5/28/20, with a diagnosis of heart failure, pressure induced deep tissue damage of other site, venous insufficiency chronic peripheral disease, chronic respiratory failure with hypoxia, hyperlipidemia, anemia, anxiety, chronic obstruction pulmonary disease, and oxygen dependence. Physician’s ordered weekly weight and to notify physician if P#1 gain five pounds. On 11/30/21 weight was 159.8Ibs, within one week P#1 gained 4.4 pounds. There was no record that (RN) DD notified physician of not obtaining weight for three weeks. 11/30/21 at 3:00 p.m., an interview was conducted with (RN) DD, who stated that P#1’s scale was damaged, and she did not have a scale in her car to weigh P#1. Also (RN) DD confirmed that she did not notify the physician. 2. On 11/30/21 at 9:40 a.m., observed (RN) BB, perform wound care to P#2. Physician’s order was skilled nurse to cleanse wound with wound cleanser, pat dry, apply Opticell, cover with foam, secure with kerlix and tape as needed. (RN) BB did not follow physician’s order. She cleaned the wound with wound cleanser and applied Opti foam. (RN) BB did not secure with kerlix nor tape; also, she did not clarify what type of tape to be used for P#2’s dressing. During the interview with (RN) BB, on 11/30/21 at 10:05 a.m., she stated that P#2 did not need kerlix, and even if she needed to use kerlix, the stock had finished and was not available. (RN) BB said that she did not know that she had to clarify the type of tape that needed to be used for P#2’s dressing.

Documentation of inservice training CFR(s): 484.80(d)(2) The HHA must maintain documentation that demonstrates the requirements of this standard have been met. This ELEMENT is not met as evidenced by: Based on staff record reviews, and staff interviews, it was determined that the agency failed to keep a record of staff competency skill. The Findings include: A review of staff records revealed that agency failed to keep documentation record of a Registered Nurse (RN) DD competency skills. (RN) DD was hired on 6/24/19. On 12/1/21 at 2:50 p.m., an interview was conducted with office manager who confirmed that (RN) DD’s competency skills record was missing in the staff file. On 12/1/21 at 3:00 p.m., an interview was conducted with clinical manager who stated that she did not know what happened to (RN) DD’s competency skills document. On 12/1/21 at 3:15 p.m., an interview was conducted with Director of operation, who confirmed that the document was not found and (RN) DD’s record lacked competency skills form.