Every finding on record at Amedisys Home Care

An Emergency Preparedness recertification and re-licensure survey was conducted on 2/24/2025-2/26/2025. The facility meets all of the requirements for Emergency Preparedness. There were no deficiencies identified.

A recertification survey was conducted on 2/24/2025-2/26/2025. An entrance conference was held on 2/24/2025 at 9:30 AM, with the Director of Operations. The current census was 218. An exit conference was held on 2/26/2025 at 12:30 PM, with the Area Vice President - Operations, Area Vice President - Clinical, Director of Operations, Clinical Manager #1, Office Manager, Vice President - Clinical, Clinical Manager #2, and Patient Service Coordinator.

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 policy review, medical record review, and interview, the agency failed to update the medication profile for 5 of 7 (Patient #1, #2, #3, #4, and #6) patients reviewed. The findings included: 1. Review of the agencies "Drug Regimen Review," policy last revised 12/9/2024, revealed "...Purpose: To identify appropriateness, inconsistencies, and/or significant drug interactions in the patient’s current medication regimen, as well as ensure the comprehensive list of medications are updated any time there is a medication change including dose changes, new medications, and any medications discontinued…” 2. Review of the medical record revealed Patient #1 was admitted to the agency Start of Care (SOC) on 2/11/2025, with diagnoses of Pulmonary Fibrosis, Chronic Kidney Disease, Atrial Fibrillation, and History of Falling. Observations in Patient #2’s home 2/24/2025 amlodipine (treats high blood pressure) 5 mg (milligram) by mouth daily, alprazolam (treats anxiety) 1 mg 2 times a day as needed for anxiety/sleep, levocetirizine (treats allergy symptoms) 5 mg by mouth at bedtime, over the counter (OTC) acetaminophen extra strength 500 mg by mouth every 4- 6 hours as needed, and OTC Nasacort (treats nasal allergies) nasal spray, 55 micrograms (mcg)/ spray, 2 sprays in each nostril twice daily. During an interview on 2/24/2025 at 1:45 PM, Patient #1 stated he didn’t take amlodipine because it caused swelling, and he used 1 spray of Nasacort at bedtime. During an interview on 2/24/2025 at 2:15 PM, Clinical Manager #1 confirmed Patient #1’s medications needed to be reconciled. 3. Review of the medical record revealed Patient #2 was admitted to the agency SOC on 10/18/2024, with diagnoses including Pressure Ulcers to right and left heel, Hypertensive Chronic Kidney Disease, and Emphysema. Review of the Home Health Certification and Plan of Care dated 2/15/2025 to 4/15/2025, revealed there were no orders for loperamide (treats diarrhea) 2 mg, twice daily and trazadone (treats insomnia) 50 mg. 0.5 tablet at bedtime. Observations in Patient #2’s home on 2/24/2025 at 1:32 PM, revealed trazadone (treats insomnia) 50 mg. 0.5 tablet at bedtime and loperamide hcl (hydrochloride) 2 mg, twice daily. Loperamide was not listed on the medication profile. During an interview on 2/24/2025 at 2:45 PM, Patient #2’s son stated that his father had been taking loperamide hcl for about 3 or 4 months, and his father stopped taking trazadone about 2 or 3 months ago. 4. Review of the medical record revealed Patient #3 was admitted to the agency SOC on 11/18/2023, with diagnoses of Pressure Ulcer of Sacral Region, Hypertension, and Alzheimer’s Disease. Review of the Home Health Certification and Plan of Care dated 1/11/2025 to 3/11/2025, revealed “…memantine [helps with cognition] 5 mg…2 times daily; Nystatin [treats fungal infections] 100,000 unit/gram topical cream…as directed…” During an interview on 2/25/2025 at 11:42 PM, Patient #3’s wife stated the memantine was increased from 5 mg to 10 mg several months ago and Nystatin had not been used since June 2024. During an interview on 2/24/2025 at 11:43 PM, Clinical Manager #2 confirmed Patient #3’s medications needed to be reconciled. 5. Review of the medical record revealed Patient #4 was admitted to the agency SOC on 2/13/2025, with a diagnosis of Nonrheumatic Aortic (Valve) Stenosis. Review of the Home Health Certification and Plan of Care dated 2/13/2025- 4/13/2025, revealed no order for lidocaine patches. Observations in Patient #4’s home on 1/7/2025 at 12:27 PM, revealed a box of over the counter (OTC) lidocaine 4% patches (treats pain), apply 1 patch to affected area for 12 hours and remove after 12 hours, was not listed on the medication profile. During an interview on 2/25/2025 at 11:35 AM, Patient #4’s wife reported that Patient #4 was using the patches once a week, and he had been using them prior to receiving home health services on 2/13/2025. During an interview on 2/24/2025 at 2:46 PM, Clinical Manager (CM) #2 confirmed that all medications were to be listed in the patient’s chart. CM #2 stated nursing was to contact the patient’s physician to review the medication list. 6. Review of the medical record revealed Patient #6 was admitted to the agency SOC on 2/1/2025, with diagnoses of Displaced Oblique Fracture of Right Femur, Pressure Ulcer of Right Heel, Hypertension, Diabetes Mellitus, and Prostate Cancer. Review of the Home Health Certification and Plan of Care dated 2/1/2025 to 4/1/2025, revealed “…baclofen [muscle relaxer] 5 mg …oral…3 times daily/prn [as needed]; folic acid [supplement] 1 mg…oral…daily; lidocaine [treats pain] 5% topical Patch daily; melatonin [helps with sleep]…1 tablet…oral…bedtime; Miralax [helps with constipation] 17 gram/ dose oral powder…prn…” Observations in Patient #6’s home on 2/26/2025 at 9:15 PM, revealed Humalog insulin (treats high blood sugar) 3 units twice daily for glucose greater than 150. During an interview on 2/26/2025 at 9:20 AM, Patient #6’s wife stated “…A nurse came out last Tuesday to change his [Patient #6] dressing on his foot…He has been checking his blood sugars and taking his insulin since he was diagnosed with Cancer…” Patient #6’s wife confirmed he was no longer taking Baclofen, folic acid, melatonin, Miralax, or using the lidocaine patch. During an interview on 2/26/2025 at 9:40 AM, the Registered Nurse (RN) confirmed that Patient #6’s medications were not updated. The RN explained to Patient #6 that he would receive an updated medication list in the mail, and she had deleted the medications that he was no longer taking.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on policy review, observation, and interview, the facility failed to follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases when 1 of 7 (Patient #2) employee failed to change gloves and perform hand hygiene after removing a soiled dressing. The findings included: Review of the agency’s policy “Application of a Wound Care Dressing," dated 4/30/2024, revealed “…Hold soiled dressing in hand and remove glove to wrap inside out around dressing. Repeat with second glove and discard in disposable bag…Perform hand hygiene. Don non-sterile gloves…” Review of the agency’s policy “Hand Hygiene," dated 6/26/2024, revealed “…Perform hand hygiene as follows: ...After contact with…wound dressings…” Review of the medical record revealed Patient #2’s was admitted to the agency Start of Care (SOC) on 10/18/2024 with diagnoses including Pressure Ulcers to right and left heel, Hypertensive Chronic Kidney Disease, and Emphysema. Review of the Home Health Certification and Plan of Care dated 2/15/2025 to 4/15/2025, revealed “…RN [Registered Nurse]/LPN [Licensed Practical Nurse]/ LVN [Licensed Vocational Nurse] to perform/ teach patient/ caregiver wound care pressure injury to…[both heels]…cleanse with wound cleanser[,] apply…[Named petroleum gauze] with foam dressing wrap with [Named gauze wrap]…[Named adhesive wrap] Change dressing 2 X [twice] a week and PRN [as needed] for dislodgement…” Observation in Patient #2’s home on 2/24/2025 at 2:00 PM, revealed that after removing the soiled dressing from Patient #2’s left heel, the LPN threw the soiled dressing in the trash. Patient #2 requested to see the soiled dressing. The LPN reached into the trash with both hands to retrieve the soiled dressing and showed it to Patient #2. The LPN returned the soiled dressing to the trash, grabbed a bag of gauze pads, and removed the scissors from the clean drape to cut the bag. The LPN then applied a clean dressing to Patient #2’s left heel. The LPN did not change her soiled gloves and did not perform hand hygiene prior to applying a clean dressing. During an interview on 2/24/2025 at 2:46 PM, Clinical Manager #2 confirmed that the LPN should have removed the soiled gloves, performed hand hygiene, and donned a pair of clean gloves before returning to Patient #2’s dressing change.

An Emergency Preparedness recertification and re-licensure survey was conducted on 9/11/2023-9-13/2023. The facility meets all of the requirements for Emergency Preparedness. There were no deficiencies identified.

A recertification survey was conducted on 9/11/2023. An entrance conference was held on 9/11/2023 at 8:40 with the Administrator. An exit conference was held on 9/13/2023 at 2:00 PM, with the agencies administration.

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on policy review, medical record review, and interview, the agency failed to receive proper written notice of discharge for 1 of 5 (Patient #17) discharge patients reviewed. The findings included: Review of the agency's "Medicare Notice of Non-Coverage," revealed "...The agency will issue the "Notice of Medicare Non-Coverage" to all Medicare beneficiaries...no later than 2 days before the end of covered services or the second to the last day of service if care is not provided daily..." Review of the medical record revealed Patient #17 was admitted to the agency on 5/19/2023 with diagnoses of Osteoarthritis, Tarsal Tunnel Syndrome, Spondyls, and Radiculopathy of Thoracic Region. Review of the Visit Note Report dated 7/14/2023 revealed "PT [Physical Therapy] discharge from agency." Review of the Notice of Medicare Non-Coverage revealed Patient #17 signed the form on 8/28/2023. During an interview on 9/12/2023 at 1:37 PM, the Vice President of Operations confirmed, if an issue getting it signed usually, we tell them 48 hours. If they have refused, we will call them, and they will go over it them...Better late than never..."

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 policy review, medical record review, and interview, the agency failed to update the medication profile for 5 of 7 (Patient #2, #3, #5, #6 and #7) patients reviewed. The findings included: Review of the agencies "Drug Regimen Review,” policy dated 1/2020, revealed “…The clinician completing the OASIS Assessment must complete a comprehensive drug regimen review of all medications the patient is currently taking at the time of admission, recertification, resumption of care and with any major change in condition. The medication profile is completed by documenting – All of the patient’s medications which includes: Medications on written prescriptions and medication bottles; over-the-counter medications; herbal products; Vitamins and Supplements and Oxygen…The clinician will also ask the patient to periodically allow them to visualize all the medications the patient is currently taking…The visualized medications are compared to the current medication profile to ensure accuracy of the medication profile. Any discrepancies should be clarified with the patient’s Physician and documented in the clinical record…” 2. Medical record review revealed Patient #2 was admitted to the agency on 8/25/2023 with diagnoses of Hemiplegia, Aphasia, Dysphagia, Hypertension, Atrial Fibrillation, and Hyperlipidemia. Review of the Home Health Certification and Plan of Care revealed “…6/1/2023…Atorvastatin…40 mg…oral…bedtime...6/1/2023…Eliquis [Anti-coagulant] 2.5 mg…oral…two times a day…7/19/2023…Lisinopril [Anti-hypertensive] 72 mcg…oral…daily…8/9/2023…Amoxicillin [Antibiotic] 500 mg-Potassium Clavulanate 125 mg…oral…daily…7/19/2023…Levothyroxine 88 mcg…oral…2 times daily…7/27/2023…Loratadine [Anti-histamine] 10 mg…oral…bedtime…” Review of Patient #2’s home medications revealed the following: Xarelto (anticoagulant) 15 mg one daily. Nebivolol (anti-hypertensive) 5 mg daily. Levothyroxine (hypo-thyroidism) 75 mcg one daily. Torsemide (diuretic) 20 mg one twice daily. Interview on 9/11/2023 at 2:08 PM, Patient #2 confirmed she took her own medications and kept her bottles in the kitchen cabinet. Interview with Physical Therapist Assistant (PTA) #1 on 9/11/2023 at 2:15 PM, confirmed she checks her medication and she last saw the patient on Friday and the daughter had her medication. Confirmed the patient’s daughter and grandson fills her weekly pill planner. During an interview with Patient #2 on 9/11/2023 at 2:20 PM, stated “I don’t take Eliquis, lisinopril, Atorvastatin, Antibiotics and had given her grandson her Loratadine. Patient #2 stated she is talking One A Day Multivitamin once a day. 3. Medical record review revealed Patient #3 was admitted to the agency on 6/8/2023 with diagnoses of Depression, Hypertension, Hyperlipidemia, Atrial Fibrillation, and Chronic Ischemic Heart Disease. Review of Patient #3’s Medication Administration Record (MAR) from the Assisted Living Facility (ALF) was reviewed and the following medications were not listed on the Patient #3’s facility's medication list: Atorvastatin [treats high cholesterol] 20 mg [milligram] one tablet daily. Levothyroxine [treats Hypothyroidism] 100 mcg [microgram] tablet once daily. Potassium CL ER 10 [supplement] MEQ [milliequivalents] two tablets once daily Eye Itch Relief 0.025% 1 drop into both eyes twice daily as needed. Loperamine 2 mg Capsule 1 tablet as needed for Diarrhea. Loperamine 2 mg Capsule 2 tablet as needed for Diarrhea. During an interview on 9/11/2023 at 1:30 PM, Patient #3 confirmed the staff of the Assisted Living Facility give her medication and she does not keep any pills in her room. During an interview with Physical Therapist (PT) #1 on 9/11/2023 at 1:35 PM, confirmed everyone checks meds once a week, every visit. The ALF list is reviewed, and the medication list is updated. 4. Medical record review revealed Patient #5 was admitted to the agency on 9/1/2023 with diagnoses of Renal and Perinephric Abscess, Pyonephrosis, Hypertension, Diabetes Mellitus, and Adult Failure to Thrive. Review of the Medicine List revealed, “…Lansoprazole 30 MG Delayed Release Tablet, 1 tablet, 2 times daily for Gerd [Gastroesophageal Reflux Disease]…” Review of Patient #5’s Home Medications revealed Over the Counter (OTC) Omeprazole 20 mg. During an interview on 9/12/2023 at 11:25 AM, Patient #5’s wife confirmed patient has not been on Lansoprazole since his last hospital discharge on August 18, 2023, and confirmed the insurance nurse had told her to start Omeprazole 20 mg over the counter. 5. Medical record review revealed Patient #6 was admitted to the agency on 2/6/2020 with diagnoses of Retention of Urine, Hypertension, and Hypothyroidism. Review of the Medicine List revealed, “…INDOMETHACIN 25 MG…1 capsule…DAILY [Pain] was not in the home. Review of the home medication bottles revealed Nitrofurantoin Mac Cap 100 mg 1 tablet once daily [Antibiotic] filled on 8/1/2023…was not on the facility’s medication list. During an interview on 9/13/2023 at 11:55 AM, with Registered Nurse (RN) #1 confirmed the Indomethacin should have been removed from the facility’s medication profile and Nitrofurantoin added. During an interview on 9/13/2023 at 1:40 PM, the Vice President of Clinical confirmed the medication list should be confirmed on each visit. 6. Medical record review revealed Patient #7 was admitted to the agency on 9/9/2023 with diagnoses of Fall, Injury to Left Knee, and Wound infection. Review of the facility's Medicine List revealed, “…KLOR-CON M20 MEQ TABLET EXTENDED RELEASE, 1 tablet daily for hypokalemia [Low Potassium]…Meclizine 25 MG, 1 tablet 2 TIMES A WEEK…DIZZINESS..." During an interview on 9/13/2023 at 10:30 AM, with Resident # 7 confirmed her medications Meclizine 25 mg, was one tablet daily. Resident #7 stated she was on Juice Festiv Daily Vggie 2 tablets daily [supplement], Juice Festiv Daily Fruit 2 tablets daily [supplement], Tylenol 500 mg as needed, [pain]. During an interview on 9/13/2023 at 10:35 AM, the Licensed Practical Nurse (LPN) #2 confirmed the facility's medication profile was not complete.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on policy review, medical record review, observation, and interview, the facility failed to ensure practices to prevent the potential spread of infection were maintained when wounds were re-contaminated during cleansing and no glove changes were made during a dressing change for 2 of 3 (Patient #1 and 4) patients reviewed for wounds. The findings included: 1. Review of the agency's "Hand Hygiene," policy dated 6/20/2023, revealed "...To prevent the spread of infection by contaminated hands...Perform hand hygiene as follows...change gloves during patient care if moving from a contaminated body site to a clean body site..." Review of the agency's "The Provision of Wound and Skin Care," policy dated 3/8/2023, revealed "...Infection Control Basics: To maintain proper infection control protection, wounds should be treated individually...wounds should be cleansed, treated and dressed at a time with proper hand hygiene and glove changes..." 2. Medical record revealed Patient #1 was admitted to the agency on 7/7/2023 with diagnoses of Hemorrhage Due to Vascular Prosthetic Device/Graft, Stage 5 Kidney Disease, Dependence on Renal Dialysis, and Atherosclerotic Heart Disease. Review of the Physician Order dated 9/1/2023, revealed "...Cleanse area with Vashe and pat dry with 4 x 4 gauze. May apply skin barrier to peri wound prn [as needed] to prevent maceration...Pack lightly with iodoform packing strips, cover with border gauze and secure with tape..." Observation on 9/11/2023 at 3:03 PM, during Patient #1's dressing change to left upper arm graft Licensed Practical Nurse (LPN) used hand sanitizer and donned gloves, removed the dressing, cleansed wound and applied new dressing without changing gloves or performing hand hygiene during procedure. 3. Medical record review revealed Patient #4 was admitted to the agency on 7/12/2023 with diagnoses of Stage 4 Sacral Pressure Ulcer, Unstageable Right Heel Pressure Ulcer, Multiple Sclerosis, Hypertension, and Osteoarthritis. Review of the Physician Order dated 9/6/2023, revealed "...Irrigate/Cleanse with wound cleanser. Apply fiber or alginate...May apply skin barrier to peri wound as needed to prevent maceration...Cover with foam. Secure with tape or transparent dressing...To heel irrigate/cleanse with wound cleanser. Apply betadine..." Observations during Patient #4's dressing change on 9/11/2023 at 12:45 PM, revealed Registered Nurse (RN) #1 cleansed and applied betadine with a swab, going over the same area the same swab, re-contaminating the heel wound. Observations during Patient #4's dressing change on 9/11/2023 at 1:00 PM, revealed RN #1 cleansed Patient #4's sacral wound with wound cleanser and 4 x 4 gauze, cleansed the wound with the same gauze, cleansing different areas of the wound, re-contaminating the sacral wound. During an interview with Vice President of Clinical on 9/13/2023 at 1:40 PM, she stated they [staff] should be changing gloves before each step of a dressing change..." She was asked while cleansing or dressing the wound is it appropriate to clean over the same area." She stated, "you should clean and discard...when using swabs, apply from center outward... you should not go over the same spot..."