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

An onsite unannounced Emergency Preparedness Survey and a survey for the Medicare COVID - 19 Staff Vaccination requirements were conducted at Amedisys Home Health of Clinton from 1/17/2023 to 1/19/2023. The Home Health Agency is in compliance with the Condition at 42 CFR 484.102 (Establishment of the Emergency Program). Amedisys Home Health of Clinton is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 98 staff members fully vaccinated, 29 religious exemptions, and 2 medical exemptions approved.

An onsite unannounced Recertification Survey was conducted from 1/17/2023 to 1/19/2023. The home health agency is in substantial compliance with the Medicare Conditions at 42 CFR PART 484. Standard level deficiencies were cited.

RN performs assessment CFR(s): 484.55(a)(1) A registered nurse must conduct an initial assessment visit to determine the immediate care and support needs of the patient; and, for Medicare patients, to determine eligibility for the Medicare home health benefit, including homebound status. The initial assessment visit must be held either within 48 hours of referral, or within 48 hours of the patient's return home, or on the physician or allowed practitioner - ordered start of care date. This ELEMENT is not met as evidenced by: Based on record reviews and staff interview, the home health agency staff failed to provide an initial patient visit within 48 hours of the physician's referral for one of 16 patient record reviewed. (Patient #16) The findings include: On 01/19/2023 at 11:00 AM, review of Patient #16's medical record revealed a physician referral to the home health agency for the patient dated 6/16/2022, but the patient was not admitted to service until 7/1/2022 which was 15 days after the physician's referral. On 1/19/2023 at 11:30 AM, Registered Nurse(RN) Manager #8 reported the patient was not released from the hospital, as expected, and had another surgery on 6/29/2022. There was no documentation in the patient's chart of the delay or documentation that another physician referral was obtained for the patient's delayed start of care.

Eligibility for Medicare home health benefit CFR(s): 484.55(b)(2) Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. This ELEMENT is not met as evidenced by: Based on record reviews and interview, the home health agency's Registered Nurse (RN) failed to perform the patient's the Start of Care (SOC) assessment when the patient's referral orders included orders for nursing interventions for 1 of 6 applicable patients. (Patient #8) The findings include: Patient #8 Chart review on 1/19/2023 at 11:04 AM reveals Patient #8 admitted on 12/15/2023 with diagnosis of Hypertensive chronic Kidney Disease W STG 1-4/Unsp CHR KDNY by Physical Therapist (PT) and assessed by Register Nurse (RN) on 12/16/2022. Interview on 1/19/2023 at 1:40 PM, RN #8 reports “can’t find the referral orders” to verify if only PT was ordered. No other orders post SOC for RN assessments or visits.

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 interviews and record reviews, the home health agency failed to ensure medication regimen accuracy when staff failed to communicate and clarify the physician's orders for medications with physicians for two of seven patients. (Patient 1 and 7) This failure had the potential to cause patients affected who did not receive medications as ordered by the physicians to achieve the expected level of wellness provided by the ordered medications. Patient #7 On January 19, 2023, Patient #7’s medical record was reviewed with the Registered Nurse Clinical Manager (RN CM). Patient #7’s record showed he/she was admitted to the home health agency on December 8, 2022 with diagnoses including Diverticulitis (intestinal disease with inflammation) with perforation (opening) and abscess (infected wound), Chronic Kidney Disease, and Diabetes Mellitus type II (disease causing high blood sugar levels and requiring insulin [medication to decrease blood sugar levels] injections). In a concurrent interview, the RN CM stated the hospital discharge planning document dated 12/08/2022, showed “...Discharge Medications…Amlodipine (decreases blood pressure)…Famotidine (decreases stomach acid)…Lopressor (decreases blood pressure)…Trazadone (for sleep)..” There was no list of ordered medications for Patient #7 at the time of admission on 12/08/2022 until December 21, 2022. During continued record review and interview with the RN CM the RN CM stated there was no list of ordered medications for Patient 7 at the time of admission until December 21, 2022. The RN CM confirmed the home health agency's admitting nurse should have called the patient’s physician at the time of admission on 12/08/2022 to ask the physician to clarify the medications that the patient was to take. The RN CM confirmed there was no documented evidence a home health agency nurse contacted the physician about the patient’s medications from the patient's admission on December 8, 2022 until December 21, 2022. Patient #1 On January 19, 2023, Patient #1’s medical record was reviewed with the Administrator and a concurrent interview was conducted. Patient #1's medical record revealed the patient was admitted to the home health agency on December 14, 2022 with diagnoses including Diabetes Mellitus type 2 (high blood sugars requiring insulin [medication that decreases blood sugar] injections). The “Client Medication Report,” showed, “…NOVOLIN 70/30 U-100 insulin…dose…12 UNIT…2 TIMES DAILY…” The “Client Coordination Note Report,” dated January 17, 2023, revealed Patient #1 takes “…30 UNITS AM (morning) AND 24 PM (evening)…”. The Administrator confirmed there was no documented evidence Patient 1’s insulin dose was clarified with the physician. The Administrator stated the home health nurse should have contacted the physician about the patient's insulin dose. On January 19, 2023, the home health agency policy, titled, “Plan of Care (POC)/Care Planning Process,” dated May 9, 2022, revealed, “….PURPOSE…to provide physician ordered care, treatment, and services…The plan of care will be established through the use of the admission evaluation assessment…The individualized plan…must include the following…All medication…Modifications to the POC will be based upon the patient’s individual condition, problems, needs, and reassessments. Modifications to the plan of care will be documented in a Verbal Oder as obtained from the Physician…”.

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 observations, record reviews, and interviews, the home health agency failed to ensure the patient's home health medication profile was accurate for two of seventeen patients reviewed for medication reconciliation. (Patient #2 and #5). This failure had the potential to interfere with Patient #2 and #5 achieving quality levels of wellness within the goals of the medication administration. The findings are: On January 18, 2023, during a home visit with Registered Nurse (RN) to Patient #2 home revealed during medication reconciliation (comparing the physicians orders with the medications the patient is taking in the home), the following discrepancies: 1. Rosuvastatin (medication to decrease Cholesterol) 10 mg (milligrams), one tablet daily, was on the home health agency's medication profile with a start date of January 2, 2023, but the medication was not in the patient's home. 2. Folic Acid 1 (one) mg daily was in the patient's home, but was not on the home health agency's medication profile. The date the medication was filled by the pharmacy was December 30, 2022. In a concurrent interview with Patient #2 and RN #2, the patient reported he/she did not take Rosuvastatin and did not know what Rosuvastatin was, and had never taken Rosuvastatin. Patient #2 confirmed he/she takes Folic acid daily. On January 18, 2023, RN #2 confirmed the patient's home health medication profile was not accurate. On January 19, 2023, Patient #2’s home health medication profile was reviewed with the Administrator and a concurrent interview was conducted. The Administrator verified medications are to be reconciled by every discipline every visit, and Patient #2’s medications should have been clarified with the physician. On January 19, 2023, review of the home heath agency's policy, titled, “Medication Administration,” dated April 29, 2021, revealed, “…Medication management is assessed at start of care and ongoing. This assessment includes a drug regimen review with follow-up as indicated…".

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 staff failed to follow the physician's orders for visit schedules, reporting patient weights and management of glucose levels for 5 of 16 patient charts. (Patient #1, #6, #9, #12 and #13) The findings include: Patient #9 has a number of co-morbidities including hypertensive heart disease with heart failure. The plan of care signed by the physician reads: “Record patient reported weight, or weigh patient if needed. Report increased edema or weight gain of >2lbs in 1 day or >5lbs in one week or more over target weight. May measure abdominal girth if unable to weigh. There is no evidence in the record that this order is done. Staff interview on 1/19/2023 with the RN manager #8 confirmed that the patient had no record of weights or abdominal girths in the patient record. Patient #13 with a diagnosis of amyotrophic lateral sclerosis is ordered a speech therapist visit effective 10/17/2022, yet there is no evidence in the patient record that this visit ever took place. Staff interview on 1/19/2023 with the RN manager #8 confirmed that the patient did not receive a visit from the speech therapist. Patient #6 On 1/18/2023 at 10:01 AM chart review reveals Patient #6 admitted on 12/16/2022 with visit schedule for Skilled Nurse (SN) effective 12/18/2022 1 visit every week for 4 weeks, 1 visit every 2 weeks for 4 weeks. SN visits are documented on 12/19/2022, 12/29/2022 and a missed SN visit on 1/12/2022. There is no documentation for a SN visit the week of 1/01/2023. Interview on 1/19/2023 at 1:31 PM with Registered Nurse (RN) #8 reports “can’t find any orders if the schedule changed”. On January 19, 2023, Patient 1’s record was reviewed with the Administrator (Adm). Patient 1 was admitted to the agency on December 14, 2022, with diagnoses including diabetes mellitus type 2 (a disease causing high blood sugar and requiring insulin [medication that lowers blood sugar levels] injections). The nursing visit note dated January 3, 2023 indicated Patient 1’s fasting blood sugar was 331. In a concurrent interview, the Adm confirmed the physician orders indicated for the physician to be notified if Patient 1’s FBS was greater than 300. The Adm confirmed there was no documented evidence the nurse notified the physician Patient 1’s FBS was 331 on January 3, 2023.