Every finding on record at Amedisys Home Health

An Emergency Preparedness survey was conducted along with a recertification survey beginning 3/24/2025. The facility was found to be in compliance with the regulations reviewed related to Emergency Preparedness.

A recertification survey was conducted beginning 3/24/2025 and concluded on 3/26/2025. An exit conference was held on 3/26/2025 and the facility was informed of the survey findings.

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 facility policy review, medical record review, observation, and interview, the facility failed to ensure an updated and accurate medication profile for 2 of 7 (Patient #1 and #7) sampled patients with home visits. The findings included: 1. Review of the facility's "Drug Regimen Review" policy reviewed on 12/9/2024 revealed, "Purpose: To ensure the comprehensive list of medications are updated any time there is a medication change including dose changes, new medications, and any medications discontinued...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 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..." 2. Review of the Client Medication Report for Patient #1 revealed the alprazolam 1 mg, 3 tablets at bedtime was "Discontinued By: Process Readmission" on 2/23/2025. Observations in Patient #1's home on 3/26/2025 at 9:47 AM, revealed alprazolam (used to treat anxiety) 0.5 milligrams (mg), 3 tablets at bedtime. The medication dosage did not match the Client Medication Report. During an interview on 3/26/2025 at 9:47 AM, Patient #1 stated she was still taking the alprazolam 0.5 mg, 3 tablets every night and she had never stopped taking the medication. 3. Review of the Client Medication Report for Patient #7 revealed the following medications were "Discontinued By: Process Readmission" on 2/23/2025 ": a. Meloxicam (used to treat inflammation and pain) 15 mg once a day b. Trazodone (used to treat depression) 100 mg 2 tablets at bedtime c. Nitrofurantoin (used to treat and prevent urinary tract infections) 50 mg at bedtime d. Meclizine (used to prevent and control nausea, vomiting and dizziness caused by motion sickness) 12.5 mg three times a day as needed e. Dulcolax (laxative used to treat constipation) 100 mg as needed f. Loratadine (used to treat allergy symptoms) 10 mg once a day as needed Observations in Patient #7's home on 3/25/2025 at 2:20 PM, revealed Patient #7 was still taking all of the above listed medications. During an interview on 3/25/2025 at 2:20 PM, Patient #7's daughter confirmed the Patient was still taking the above medications and they had not been discontinued. 4. During an interview on 3/26/2025 at 10:40 AM, the Regional Director of Operations verified the Client Medication Report should match the medications the patients were taking.

An Emergency Preparedness Survey was conducted on 1/24/2022-1/26/2022 at Amedisys Home Health Murfreesboro. No Deficiencies were cited under 42 CFR 484.102.

A Recertification Survey was conducted on 1/24/2022-1/26/2022 at Amedisys Home Health. Deficiencies were cited under 42 CFR Part 484, Requirements for Home Health Agencies.

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 facility policy review, medical record review, and interview, the facility failed to notify the Physician after a Skilled Nurse (SN) missed a home health visit for 2 patients (#3 and #7) of 17 records reviewed. The findings include: Review of the facility policy titled, "Coordination of Care," dated 4/2019, showed "...To ensure consistent documentation, communication...Assure communication with all physicians involved in the plan of care...A missed visit communication note is completed when a home care visit is unable to be completed as scheduled...The physician will be notified...this communication will be noted on the Missed Visit Communication Note...There are no exceptions, in which the physician does not have to be notified of a missed visit..." Medical record review showed Patient #3 was admitted to the agency on 10/26/2021 with diagnoses including Essential Hypertension, Syncope and Collapse, and Depression. Review of Patient #3's Home Health Certification and Plan of Care dated 12/25/2021-2/22/2022, showed the SN was to visit the Patient 1 time every week. Review of Patient #3's Client Coordination Note Report dated 1/7/2022, showed the SN had missed a visit and the physician had not been notified. Medical record review showed Patient #7 was admitted to the agency on 4/21/2021 with diagnoses including Complication of Breast Prosthesis and Implant, Lymphedema, and Osteoarthritis. Review of Patient #7's Home Health Certification and Plan of Care dated 12/17/2021-2/14/2022, showed the SN was to visit the Patient 2 times every week. Review of Patient #7's Client Coordination Note Report dated 1/7/2022, showed the SN had missed a visit and the physician had not been notified. During an interview on 1/26/2022 at 9:20 AM, the Area Vice President of Operations (AVPO) confirmed the physician had not been notified of the SN missed visits on 1/7/2022 for Patient #3 and Patient #7.

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 facility policy review, observation, and interview the agency failed to develop an accurate Plan of Care (POC) to include all Physician ordered medications for 1 patient (#2) of 7 patients reviewed. The findings include: Review of the agency policy titled, "Coordination of Care," revised 4/2019, showed "...Coordination of care...The HHA [Home Health Agency] must...Integrate orders...in the plan of care to assure the coordination of all services...provided to the patient...to assure the identification of patient needs...that could affect patient safety and treatment effectiveness...Coordinate care delivery to meet the patient's needs...The HHA must provide...A list of Patient medication schedule...including...medication name, dosage and frequency..." Review of the agency policy titled, "Drug Regimen Review," revised 1/2020, showed "...Purpose...To identify appropriateness, inconsistencies...in the patient's current medication regimen...The clinician completing the OASIS [Outcome and Assessment Information Set] Assessment must complete a comprehensive drug regimen review of all medications the patient is currently taking at the time of admission...The medication profile is completed by documenting...All the patient's medications...medications are compared to the current medication profile to ensure accuracy of the medication profile..." Medical record review showed Patient #2 was admitted to the agency on 1/18/2022 with diagnoses to include Open Wound, Right Lower Leg, and Coronary Artery Disease. Further review showed the patient resided in an Assisted Living Facility (ALF). Medical record review of an admission assessment dated 1/18/2022, showed "...86 YEAR OLD MALE WHO LIVES IN ASSISTED LIVING FACILITY...MEDICATIONS WERE RECONCILED WITH NO PROBLEMS IDENTIFIED..." Medical record review of Patient #2's Resident Information Sheet from the ALF showed Patient #2 received the following medications: Miralax (medication used for constipation) 17 Grams by mouth daily as needed with a start date of 12/1/2021.Mucus Relief Tablet 600 MG (Milligram) Extended Release 1 tablet every morning as needed with a start date of 10/19/2021.Nystatin Powder (medication used for infections of the skin), apply to the affected areas twice daily with a start date of 12/29/2021. Medical record review of a Home Health Certification and POC with a start of care date of 1/18/2022 and a certification period of 1/18/2022-3/18/2022, showed Patient #2 did not have Miralax or Nystatin Powder listed on the medication profile. Further review showed Mucus Relief Tablet 400 MG tablet (assisted living facility order was 600 MG extended release every morning as needed) as needed and Pantoprazole (medication used for acid reflux) 40 MG delayed release tablet daily. Medical record review of the Resident Information Sheet from the ALF showed Patient #2 did not have a current order for Pantoprazole. During an interview on 1/26/2022 at 9:50 AM, the Area Vice President/Clinical confirmed Patient #2's medication list on his POC had not been reconciled on admission with the ALF medication list.