Every finding on record at Amedisys Home Health, Inc of South Carolina

An onsite unannounced Emergency Preparedness Program Survey was conducted at Amedisys Conway Home Health from 07/10/2023 to 07/13/2023. The Home Health Agency is in compliance with the Medicare Conditions at 42 CFR 484.102 (Establishment of the Emergency Program).

An onsite unannounced Recertification Survey and a COVID - 19 Staff Vaccination Survey were conducted at Amedisys Conway Home Health from 07/10/2023 to 07/13/2023. The Home Health Agency is in substantial compliance with the Medicare Conditions at 42 CFR PART 484 with standard level deficiencies cited. The home health agency is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 34 staff members fully vaccinated and 12 approved religious exemptions

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 and patient record review, the home health agency failed to ensure nursing updated the patient's agency medication profile with the patient's home medications for 3 of 7 applicable patients. (Patient #1, #2 and #3) The findings include: Observations during a home visit with Patient #1 on 07/11/2023 from 9:02 AM to 9:42 AM revealed the following discrepancies on the patient's agency medication profile and the actual medications that the patient takes: 1. Caregiver reported the patient takes Cyclobenzaprine 5 mg(milligrams) by mouth 1.5 tablets daily. The home health agency's profile showed Cyclobenzaprine 5 mg by mouth 1 tablet once a day. 2. Caregiver reported the patient takes Namenda 10 mg tablet by mouth twice a day. The home health agency's profile showed Namenda 10 mg by mouth once a day. 3. Caregiver reported the patient takes Protonix 40 mg delayed release 1 tablet by mouth twice a day. The home health agency's profile showed Protonix 40 mg delayed release 1 tablet by mouth once a day. 4 Caregiver reports Tramadol ER 200 mg 1 tablet by mouth every day; agency lists Tramadol 50 mg 1 tablet by mouth 3 times a day. Interview on 07/12/2023 at 1:24 PM, Clinical Manager #1 verifies the findings. Observation during a home visit with Patient #2 on 07/11/2023 from 10:24 AM to 11:10 AM revealed the following discrepancies between what medications the patient actually takes and the medications listed in the patient home health agency medication profile: 1. Patient takes Vitamin D3 25 mcg (micrograms) 1 tablet by mouth once a day. Vitamin D3 25 mcg was not listed on the home health agency's medication profile. 2. Patient takes Vitamin B12 500 meq (milliequivalents) 1 tablet by mouth once a day. Vitamin B12 500 meq was not listed on the home health agency's medication profile. 3. The patient reported taking Tumeric Curcumin 1 tablet by mouth once a day. Tumeric Curcumin was not listed on the home health agency's medication profile for the patient. 4. Patient reported taking Melatonin 5 mg 1 tablet by mouth at bedtime. Melatonin 5 mg 1 tablet by mouth at bedtime was not listed on the home health agency's medication profile. 5. Patient reported taking Advair Diskus 250 mcg-50 mcg 1 puff morning and night. Advair Diskus 250 mcg-50 mcg 1 puff morning and night was listed as discontinued on the home health agency's medication profile.. On 07/12/2023 at 1:12 PM, Clinical Manager #2 verified the findings. Patient #3 During an observation visit with Patient #3 on 07/11/2023 from 12:10 PM to 12:52 PM, the following medication discrepancies between what the patient actually takes and the home health agency's medication profile:: 1. Patient reported taking Vitamin C 1000 mg 1 tablet by mouth once a day. Vitamin C 1000 mg 1 tablet by mouth once a day was not on the home health agency's medication profile. 2. Patient reported taking Miralax capsule 1capsule by mouth every other day. Miralax capsule 1capsule by mouth every other day was not listed on the home health agency's medication profile. On 07/12/2023 at 2:03 PM, Clinical Manager #1 verified the findings

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 observations, record reviews, and interview, the home health agency failed to ensure that wounds were measured for two (2) of three (3) patients receiving wound care. (Patient #1 and #14) The findings are: A home visit with Patient #14 on 7/12/23 at 10:00 AM concerns the care of a stage IV pressure wound to the left lower leg. The patient's Start of Care (2/24/2023) diagnosis also includes Osteomyelitis with antibiotic infusions, and a Colostomy. There is no measurement tool utilized during the admission process or subsequent visits, initially managed by the Registered Nurse (RN). Inspection of the medical record reveals no measurement of the wound occurred until the Licensed Practical Nurse (LPN) visits on 4/6/23. This information is confirmed in an interview with the Clinical Manager #3 on 7/12/23 at 1:15 PM who stated "I can't make the measurements appear". Patient #13 Review of patient chart on 07/12/2023 at 11 AM reveals, patient admitted to service on 03/09/2023 with Stage II pressure ulcer to median and plantar surface left heel. SN visit note on 03/14/2023 reveals no documentation of wound measurements. Interview on 07/12/2023 at 1:35 PM with Clinical Manager #3 reports, ”don’t see any” and verifies the finding.

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 review and interview, the home health agency failed to obtain physician orders for Registered Nurse (RN) visits and wound care for 3 of 17 patient charts reviewed for care and services. (Patient #2, #3 and #13) The findings include: Review of Patient #2's chart on 07/11/2023 at 2:22 PM revealed referral orders from the physician for Physical Therapy (PT). Patient #2 was admitted on 05/22/2023 by a RN. There was no documentation in the patient's chart for physician orders for RN visits. On 07/12/2023 at 1:12 PM, Clinical Manager #2 reported “I can’t find an order either” and verified the finding. Review of Patient #3's chart on 07/11/2023 at 3:01 PM revealed the physician orders read for “SKILLED NURSE to teach/perform the following wound care to #1 left buttock: skilled nurse may change outer dressing only. Careful to leave mesh with steri strips in place. Wound care to be performed twice weekly, once by skilled nurse and once by NP (Nurse Practitioner). May change dressing PRN (as needed) for soiled or dislodged”. Patient and RN #2 reported during observation visit on 07/11/2023 that wound care had been “deactivated”. There was no documentation in the patient's chart of physician orders to discontinue wound care. Review of Patient 13's chart on 07/12/2023 at 11:00 AM revealed, “SKILLED NURSE (SN) to perform/teach patient/caregiver wound care pressure ulcer to left heel (area): cleanse with wound cleanser, pat dry with 4x4 gauze, apply foam dressing, cover with elastic bandage. SN to change dressing daily and PRN if soiled or dislodged. Caregiver to change dressing in absence of SN. SN to DC (Discontinue) when healed”. SN visit note dated 03/22/2023 reported wound care “Inactivated 03/22/2023…applied foam dressings back to left heel for protection. Secure with ace bandage”. SN note dated 03/29/2023 reads “SN assessed left heel. No open areas or signs of infection noted. Foam dressing applied for prevention. Secure with ace bandage”. SN noted dated 04/12/2023 reported “…assessed left heel. No open areas noted. Foam dressing applied for prevention. Secure with ace bandage”. SN noted dated 04/20/2023 reported “…SN removed dressing to left foot…Left heel was painted with Betadine and covered with foam dressing and secured with ace wrap”. There were no physician orders documented for continued wound care after the wound care healed/inactivated. There were no physician orders documented for Betadine to the wound. On 07/12/2023 at 1:35 PM, Clinical Manager #3 revealed "can’t see any orders” and verified the finding.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to ensure its nursing staff provided an accurate, individualized, updated Plan of Care (POC) for the Home Health Aide's (HHA) care for 1 of 2 applicable patients. (Patient #3) The finding includes: Review of Patient #3's chart on 07/11/2023 at 3:01 PM revealed Patient #3 was admitted to services with a PICC line for intravenous administration of medications on 01/28/2023. The intravenous antibiotics and PICC line were discontinued during the patient's second episode. Review of the patient's POC (Plan Of Care) dated 05/28/2023 revealed "instructs SPECIAL EQUIPMENT, IV (intravenous), every visit". ELIMINATION, provide perineal care, Pro Re Nata (PRN) PERSONAL CARE, shampoo, as requested INFO/SPECIAL PRECAUTIONS, report any VS (vital signs) outside of parameters to RN/CM (Registered Nurse/Clinical Manager). Parameter for PAIN is “above 9”. There was no documentation in the HHA visit notes of documentation of PAIN level. On 07/12/2023 at 2:03 PM, Clinical Manager #1 reported “not a spot to write it in” and verified the finding.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to ensure its nursing staff documented supervisory visits for the Home Health Aide (HHA) every 14 days for 1 of 2 applicable patients. (Patient #3) The finding includes: Review of Patient #3 chart on 07/11/2023 at 3:01 PM revealed the RN documented supervisory visits on 05/26/2023 and 06/12/2023 with 17 days between the supervisory visits. On 07/12/2023 at 3 :00 PM, Clinical Manager #1 reported “Computer not rescheduling the supp(supervisory) visits” and verified the finding.