Every finding on record at Amedisys Home Health Inc of Sc

An onsite unannounced Emergency Preparedness Survey was conducted at Amedisys Home Health of Charleston from 03/25/2024 to 03/28/2024. The home health agency is in substantial compliance with the Medicare Conditions at 42 CFR 484.102 (Establishment of the Emergency Program).

An unannounced onsite Recertification Survey was conducted at Amedisys Home Health of Charleston from 03/25/2024 to 03/28/2024. The facility is in substantial compliance with the Medicare Conditions at 42 CFR PART 484. Standard level 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 observation, interview and record review, the Home Health Agency (HHA) failed to ensure that the facility Medication Administration Records (MAR) was reflective of the medications for 4 of 6 home observations. (Patient #8, #9, #15 and #17). Observation in Patient #15’s home on 03/26/2024 from 10:30 AM to 11:20 AM showed Carbidopa ER 50 mg-Levodopa 200 mg tablet 1 tablet by mouth daily, caregiver reports this medication is given four times a day; Gabapentin 100 mg 1 capsule daily, caregiver reports this medicine is given every 12 hours. During an interview on 03/27/2024 at 12:47 PM, Clinical Manager stated medications should have been updated and verified the findings. Findings included: Observation and record review during a home visit on 03/25/2024 at 2:30 PM showed Patient #17 is not taking Gabapentin 100 milligrams three times daily, Santyl 250 grams topical ointment or Sodium Bicarbonate 650 milligrams twice daily, all of which are listed on the patient’s MAR. The patient is taking Spirolactone 25 milligrams daily, Trospium Chloride 20 milligrams 1 hour before meals, Lorsartan 100 milligrams daily, Chlorthalidone 25 milligrams daily and Aquacell & Proform for wound care. This information was confirmed on 03/25/2024 at 3:13 PM in an interview with the caregiver and Nurse #1. Observation and record review during a home visit on 03/26/2024 at 10:05 AM showed Patient #9 is not taking Atorvastatin 20 milligrams daily, Baclofen 10 milligrams twice daily, Lactulose 20 grams/30 milliliters twice daily or SennaLax 8.6 milligrams daily, all of which are listed on the patient’s MAR. The patient is taking Atorvastatin 40 milligrams daily, Baclofen 5 milligrams twice daily, Lactulose 20 milligrams/30 milliliters as needed, Benazepril 40 milligrams daily and saline nasal spray, none of which are listed on the MAR. This information was confirmed on 03/26/2024 at 10:37 AM in an interview with the caregiver and the Home Health Aide. Observation and record review during a home visit on 03/26/2024 at 12:04 PM showed Patient #8 is not taking Albuterol Sulfate 2.3 milligrams per 3 milliliters solution for nebulization, Aspirin 81 milligrams daily, Doxycycline Hyclate 100 milligrams twice a day, Ezetimibe 10 milligrams daily, Metformin 500 milligrams daily or Pioglitazone 30 milligrams daily, all of which are listed on the patient’s MAR. The patient is taking 3.5 liters of oxygen via nasal cannula continuously, Prednisone 20 milligrams daily, Folic Acid 1 milligram daily, Fantotidine 20 milligrams daily, Eliquis 5 milligrams twice daily, Topiramate 25 milligrams twice daily, Omprazole 40 milligrams daily, Vitamin D3 2000 units daily and Finasteride 5 milligrams twice daily, none of which are listed on the MAR. This information was confirmed on 03/26/2024 at 12:31 PM in an interview with the caregiver and the Speech Therapist.

A survey of the Home Health Agency's (HHA) Emergency Preparedness Program (EPP) was conducted from 09/20/2021 to 09/23/2021. Based on observations, record reviews, interviews, and review of the HHA's EPP and policies and procedures, it was determined the HHA is in compliance with the Condition at 42 CFR 484.102 (Establishment of the Emergency Program).

The Home Health Agency's (HHA) Recertification Survey was conducted in conjunction with the COVID-19 focused Infection Control requirements from 09/20/2021 to 09/23/2021. Based on observations, record reviews, interviews, review of the COVID -19 requirements, and review of the HHA's policies and procedures, it was determined the HHA is in compliance with the COVID - 19 focused Infection Control requirements, and determined that standard level deficiencies resulted from the HHA's Recertification Survey.

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 record reviews, interviews, and review of the Home Health Agency's (HHA) policies and procedure, the HHA failed to provide measurable outcomes for all identified problems listed in the patient’s Plan of Care (POC) for fifteen(15) of sixteen (16) patient records reviewed. (Patient #1, #2, #3, #4, #5, #6, #7, #9, #10, #11, #12, #14, #15, #16, and #17) The findings are: Patient #9 On 9/20/2021 at 2:47 PM, a review of Patient #9’s chart reveals the plan of care does not have measurable goals for all goals (strategies to minimize fall risk, plan of care will be established, risk for rehospitalizations, and changes in skin integrity). The finding is verified by the Administrator on 9/23/2021 at 2:43 PM. Patient #8 On 9/20/2021 at 3:28 PM, a review of Patient #8’s chart reveals the plan of care does not have measurable goals for all goals (safe management of medication, identify fall risk factors, and plan of care will be established). The finding is verified by the Administrator on 9/23/2021 at 2:38 PM. Patient #4 On 9/22/2021 at 8:40 AM, a review of Patient #1’s chart reveals the plan of care does not have measurable goals for all goals (plan of care will be established, changes to co-morbid conditions, safe medication management, risk for rehospitalization, demonstrate the ability to perform wound care, and implement strategies to minimize fall risk). The finding is verified by the Administrator on 9/23/2021 at 2:37 PM. Patient #2 On 9/22/2021 at 9:44 AM, a review of Patient #2’s chart reveals the plan of care does not have measurable goals for all goals (signs for rehospitalization and additional orders will be received in a timely manner). The finding is verified by the Administrator on 9/23/2021 at 2:33 PM. Patient #3 On 9/22/2021 at 10:03 AM, a review of Patient #3’s chart reveals the plan of care does not have measurable goals for all goals (plan of care will be established, changes in co-morbid conditions, safe management of medications, signs for rehospitalization, and demonstrate ability to perform wound care). The finding is verified by the Administrator on 9/23/2021 at 2:35 PM. Patient #1 On 9/22/2021 at 10:24 AM, a review of Patient #1’s chart reveals the plan of care does not have measurable goals for all goals (plan of care that meets the patient’s needs, demonstrate oxygen saturation, effective safe management of medication, ineffective anticoagulation therapy will be identified, and verbalize signs for rehospitalization). The finding is verified by the Administrator on 9/23/2021 at 2:29 PM. Patient #14 On 9/22/2021 at 10:40 AM, a review of Patient #14’s chart reveals the plan of care does not have measurable goals for all goals (plan of care will be established, changes in co-morbid conditions, safe management of medications, risk for rehospitalization, and strategies for minimize fall risk). The finding is verified by the Administrator on 9/23/2021 at 2:46 PM. Patient #15 On 9/22/2021 at 11:03 AM, a review of Patient #15’s chart reveals the plan of care does not have measurable goals for all goals (plan of care will be established, effective safe management of medications, and strategies to minimize fall risks). The finding is verified by the Administrator on 9/23/2021 at 2:53 PM. Patient 5 On 9/21/2021 at 12:05 PM, a review of Patient #5’s chart revealed the plan of care does not have measurable goals for all goals (safe management of medication, plan of care will be established, risk for re-hospitalizations). The finding is verified by the Administrator on 9/22/2021 at 1:55 PM. Patient 6 On 9/22/2021 at 9:05 AM, a review of Patient #6’s chart revealed the plan of care does not have measurable goals for all goals (safe management of medication, plan of care will be established, risk for re-hospitalizations). The finding is verified by the Administrator on 9/22/2021 at 2:13 PM. Patient 7 On 9/22/2021 at 10:10 AM, a review of Patient #7’s chart revealed the plan of care does not have measurable goals for all goals (safe management of medication, plan of care will be established, risk for re-hospitalizations). The finding is verified by the Administrator on 9/22/2021 at 2:20 PM. Patient 11 On 9/22/2021 at 11:10 AM, a review of Patient #11’s chart revealed the plan of care does not have measurable goals for all goals (plan of care will be established, risk for re-hospitalizations). The finding is verified by the Administrator on 9/22/2021 at 2:15 PM. Patient 12 On 9/22/2021 at 9:45 AM, a review of Patient #12’s chart revealed the plan of care does not have measurable goals for all goals (safe management of medication, plan of care will be established). The finding is verified by the Administrator on 9/22/2021 at 2:30 PM. Patient 16 On 9/22/2021 at 1:05 PM, a review of Patient #7’s chart revealed the plan of care does not have measurable goals for all goals (safe management of medication, risk for re-hospitalizations). The finding is verified by the Administrator on 9/22/2021 at 2:40 PM. Patient 17 On 9/2/2021 at 10:10 AM, a review of Patient #17’s chart revealed the plan of care does not have measurable goals for all goals (plan of care will be established, risk for re-hospitalizations). The finding is verified by the Administrator on 9/22/2021 at 2:45 PM. The facility's policy and procedure titled "Plan of Care" reads "o. Patient-specific interventions and education: measurable outcomes and goals identified by the HHA and the patient....".

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on record reviews and interview, the Home Health Agency(HHA) failed to ensure its staff followed physician orders for documenting missed visits for three (3) of 3 patient charts reviewed. (Patient #11, #13, and #17), and Skilled Nurses (SN) failed to follow the physician orders to document patient weights for one of one patient’s charts reviewed with physician orders for weights. (Patient #15) On 9/22/2021 at 11:03 AM, a review of Patient #15’s chart reveals a physician’s order to "report weight gain of greater than or equal to two pounds in one week or more over target weight. May measure abdominal girth if unable to weigh." The patient was seen by SN on 6/25/2021, 6/28/2021, 7/2/2021, 7/12/2021, 7/23/2021, 7/26/2021, 7/28/2021, 8/2/2021, 8/6/2021, 8/10/2021, and 8/20/2021. The chart shows no weights or abdominal girths documented on the SN visits listed above. This finding is verified by the Administrator at 2:53 PM on 9/23/2021. The findings are: Patient 11 On 9/22/2021 at 11:10 AM, a review of Patient #11’s chart revealed reveals an order for skilled nursing frequency as one time a week for nine weeks, On the week of 09/05/2021, the chart shows a missed visit but there is no documentation of the visit being rescheduled and there is no documentation the physician was notified. The finding is verified by the Administrator on 9/22/2021 at 2:15 PM. Patient 13 On 9/22/21 at 10:28 AM, a review of patient 13’s chart revealed an order for skilled nursing frequency as one time a week for one week, two times a week for two weeks and one time a week for six weeks. On the week of 05/23/2021, the chart shows a missed visit but there is no documentation of the visit being rescheduled and there is no documentation the physician was notified. The finding is verified by the Administrator on 9/22/2021 at 2:25 PM. Patient 17 On 9/22/2021 at 10:10 AM, a review of Patient #17’s chart revealed an order for skilled nursing frequency as one time a week for one week, one every two weeks for eight weeks. On the week of 06/20/2021, the chart shows a missed visit but there is no documentation of the visit being rescheduled and there is no documentation the physician was notified. The finding is verified by the Administrator on 9/22/2021 at 2:45 PM. The facility's policy and procedure titled "Coordination of Care" reads "....11. In the event an ordered service cannot be performed, the physician shall be notified and new orders obtained as indicated....".