Every finding on record at Amedisys Home Health of Alabama, LLC

A recertification survey was conducted on 4/14/22 at Amedisys Home Health of Citronelle and the agency was found to be in compliance with the federal regulations for Emergency Preparedness.

A recertification survey was conducted on 4/12/22 to 4/14/22 at Amedisys Home Health Citronelle, standard level deficiencies were cited and will require a Plan of Correction.

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 Home Visit (HV) observations, Medical Record (MR) review, agency policy and procedure, and interviews with the staff it was determined the agency failed to ensure staff updated the Client Medication Report (CMR) per agency policy. This deficient practice affected 4 of 5 Home Visit (HV) patients including HV # 1, HV # 2, HV # 3, HV # 4 and 1 of 8 MR reviewed including MR # 4 and had the potential to negatively affect all patients served by the agency. Findings include: Agency Policy: Drug Regimen Review. Policy #: MA-002. Date Revised: 01/2020 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 anytime there is a medication change including dose changes, new medications, and any medications discontinued. ...Procedure: 1. 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, recertification, resumption of care and with any major change in condition... 2. The clinician will question the patient and/or caregiver periodically regarding changes in medications, including dosage changes, any new medications added, or any medications discontinued...The visualized medications are compared to the current medication profile to ensure accuracy of the medication profile... 3. HV # 3 was admitted to the agency on 1/25/22 an recertified on 3/26/22 with admitting diagnoses of Heart Failure and Hypertensive Heart Disease with Heart Failure. Review of the Home Health Certification and Plan of Care dated 3/26/22 the Occupational Therapist (OT) was to visit 1wk3 (1 time a week for 3 weeks) and 1 every 2 wk 6 (1 time a week every 2 weeks for 6 weeks) A HV was conducted on 4/13/22 at 10:10 AM to observe care. During the HV the patient's medications were reviewed with the patient using the medication bottles and the CMR provided to the surveyor by the agency on 4/13/22. The following medications were on the CMR and the patient stated he/she was no longer taking: Alive Women's Gummy Vitamin 200 mg (milligram) 1 tablet daily. Patient stated he/she stopped taking about 2 months ago. Calcium 600 mg 1 tablet daily. The patient stated he/she stopped the Calcium about 2 weeks ago. Lasix 20 mg 1 tablet as directed. Patient is not taking and not sure how long ago he/she stopped taking. Nystatin 100,000 units/ml (milliter) 5 ml 3 times a day. Patient stated stopped taking once mouth got better unsure of time frame. Tylenol Extra Strength 500 mg 1-2 tablets at bedtime as needed. HV # 3 stated he/she was no longer taking and unsure of the date he/she stopped taking the medication and is now taking Tylenol Extended Release tablets. Uribel 118mg 1 capsule 4 times daily. HV # 3 stated he/she topped taking medication about 2 months ago. Zyrtec 10 mg capsule 1 capsule daily. HV # 3 stated stopped taking the medication months ago. The following medications were not on the CMR and HV # 3 confirmed is taking: Tylenol Extended Release tablets 2 tablets at bedtime. HV # 3 stated started taking months ago. Cinnamon 1000 mg 1 tablet daily. HV # 3 stated has been taking for about 4 months. Fexofenadine 180 mg tablet 1 tablet daily as needed. HV # 3 stated started taking instead of the Zyrtec months ago. Ginseng 100 mg daily HV # 3 stated started taking months ago and not sure of the date. Vitamin B 12 1 tablet daily. HV # 3 stated started taking about 4 months ago. An interview was conducted on 4/14/22 at 12:15 PM with EI # 1 who stated the CMR is to be reviewed and corrected in the system on each visit. 4. HV # 4 was admitted to the agency on 9/28/21 and recertified on 3/27/22 and an admitting diagnosis of Malignant Neoplasm of Left Female Breast. Review of the Home Health Certification and Plan of Care dated 3/27/22 the Physical Therapist is to visit 1wk4 (1 time a week for 4 weeks), then 1QOWk2 (1 time every other week for 2 weeks). A HV was conducted on 4/12/22 at 1:00 PM to observe care provided by the agency. During the HV the medications were reviewed with the patient using the medication bottles and the CMR given to the surveyor by the agency. The following medications were on the CMR and the patient is no longer taking: Gabapentin 100 mg 2 times daily. HV # 4 stated he/she has not taken this medication in 15 years. Iron 325 mg 1 tablet daily. HV # 4 stated he/she stopped awhile back and unsure of how long ago. Probiotic 250 million cell chewable tablet. HV # 4 stated is no longer taking but could not give a time frame of when it was stopped. Zolpidem 5 mg tablet take 0.5 tablet at bedtime. HV # 4 stated he/she stopped taking the medication back in late February. The following medications were found in the home and not on the CMR: Zofran 8 mg ODT (orally disintegrating tablet) every 8 hours as needed. Start date 4/5/22 Prochlorperazine10 mg every 6 hours as needed. Start date 4/5/22. Microbid 1000 mg 1tablet, 2 times a day. Start date 4/8/22 The following medication was on the CMR but with a different frequency: Sucralfate 1 gram take 1 tablet 4 times a day was on the CMR and HV # 4 states he/she takes it 2 times a day 1 tablet. The following medication was on the CMR and was a duplicate: Eszopiclone 3 mg take 1 tablet at bedtime. One medication was entered on 3/14/22 and the other was entered on 3/15/22. An interview was conducted on 4/14/22 at 12:10 PM with EI # 1 who confirmed the medications are to be reviewed each visit and corrections are to be made in the system by the discipline who reviews the medications. 5. MR # 4 was admitted to the agency on 4/6/21 with admitting diagnoses of Acute Post Hemorrhagic Anemia and Displaced Intertrochanter Fracture of Left Femur. Review of the Home Health Certification and Plan of Care dated 4/6/22 revealed the SN was to visit 2wk1 (2 times a week for 1 week), 1wk4 (1 time a week for 4 weeks) then 1 every 2wk4 (1 time a week every 2 weeks for 4 weeks.) Review of the Home Health Certification and Plan of Care dated 4/6/21 revealed an order for Oxygen 2 L/Min (Liters per min) via nasal cannula. Review of the CMR dated 4/6/21 revealed the Oxygen humidified 2 liters continuous. Review of the physician order dated 4/23/21 revealed an order for the administration of Oxygen at 3 L/Min via nasal cannula. Review of the SNV (skilled nurse visit) dated 4/23/21 revealed the nurse documented under the Respiratory section of the note the patient was on O2 by nasal cannula at 3L (liters). Review of the CMR dated 4/6/21 revealed no documentation of a CMR update on 4/23/22 of O2 increased to 3 L/M. An interview was conducted on 4/14/22 at 11:55 AM with EI # 1 who confirmed the CMR should be updated each time a medication is added or changed and the Oxygen was not updated to indicate the patient was on 3 liters of Oxygen. 1. HV # 1 was admitted to the agency on 2/19/22 with diagnoses including Infection/Inflamation Reaction Due to Internal Right Hip Prosthesis and Type 2 Diabetes with Foot Ulcer. Review of the Home Health Care and Plan of Care (HHC and POC) dated 2/19/22 revealed orders for Skilled Nurse (SN) 1 x week (wk) x 1, 2 x wk x 1, then 1 x wk x 2. A HV conducted on 4/12/22 to observe care provided by Employee Identifier (EI) # 5, Licensed Practical Nurse (LPN). A review of the medications was conducted and compared to the CMR provided to the surveyor on 4/12/22. The following is a list of the medication discrepancies: a. Furosemide 40 milligrams (mg) take 1 tablet 2 times a day was listed on the CMR and on the medication bottle in the home dated 12/30/2021. HV # 1 stated he/she has been taking the Furosemide only as needed for shortness of breath and swelling "for years". b. Potassium Chloride Extented Release 10 MEQ (milliequivalents) take 1 tablet daily was listed on the CMR and on the prescription bottle in the home dated 12/30/2021. HV # 1 stated he/she only takes the Potassium when taking the Furosemide and "has been doing it that way for years". EI # 5 confirmed the medication discrepancies during the HV. During an interview conducted on 4/14/22 at 12:20 PM, EI # 1, Director of Operations, confirmed the EMR had not been updated with the changes in medications per agency policy. 2. HV # 2 was admitted to the agency on 1/30/2021 and recertified for home care from 3/26/22 to 5/24/22 with diagnoses including Encounter for Fitting and Adjustment of Urinary Device, Flaccid Neuropathic Bladder, and Type 2 Diabetes. Review of the HHC and POC dated 3/26/22 revealed SN frequency of 1 x wk x 1 then 1 x every other week x 2. A HV was conducted on 4/13/22 to observe care provided by EI # 6, Registered Nurse (RN). During the HV a review of the medications in the home was conducted with EI # 6 and HV # 2 and compared to the CMR provided to the surveyor on 4/12/22. Levothyroxine 75 mcg (micrograms) take one tablet daily dated 4/4/22 was listed on the CMR. Levothyroxine 25 mcg take one daily dated 6/19/2020 and Levothyroxine 50 mcg take one daily dated 1/10/22 were in the home. The caregiver of HV # 2 stated the prescription was changed last month and he/she has been giving HV # 2 the Levothyroxine 25 mcg daily and will start the 50 mcg daily once the 25 mcg tablets are gone. During the home visit EI # 6 verified the medication discrepancy and notified HV # 2's physician while in the home. During an interview conducted on 4/14/22 at 12:20 PM, EI # 1 confirmed the CMR had not been updated with the medication changes per agency policy.

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 Home Visit (HV) observations, agency policy and procedure and interviews it was determined the agency failed to ensure staff performed hand hygiene per agency policy. This deficient practice affected 2 of 5 HV including HV # 4, and HV # 3, and had the potential to negatively affect all patients served by the agency. Agency Policy: Hand Hygiene Policy Number: PCP-001 Revised Date: 6/24/21 Purpose: To prevent the spread of infection by contaminated hands. Regulatory Guidance: The agency must follow accepted standards of practice, including the use of standard precautions (including hand hygiene), to prevent the transmission of infections and communicable diseases. Guidelines: 1. The term hand hygiene includes both hand washing with soap and water and use of alcohol-based products that do not require the use of water. Alcohol-based hand sanitizers are the most effective products for reducing the number of germs on the hands of healthcare providers. 4. Perform hand hygiene as follows: a. Before having direct contact with patients. b. Before donning gloves. d. After contact with a patient's intact skin. f. when moving from a contaminated body site to a clean body site during patient care. h. After glove removal. 11. Change gloves during patient care if moving from a contaminated body site to a clean body site. Procedure: Use of Alcohol-based hand rubs: Apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers. Continue ribbing the product over hands and finger surfaces until the solution dries completely. (usually this takes about 20 seconds or more). 1. HV # 4 was admitted to the facility on 9/28/21 with a recertification date of 3/27/22 and an admitting diagnosis of Malignant Neoplasm of Unspecified Site of Left Female Breast. A HV was conducted on 4/12/22 at 1:00 PM with EI # 7, Physical Therapist, to observe care provided. After sanitizing hands EI # 7 placed barriers on the table and placed tablet and bag on the barriers. EI # 7 removed equipment from the bag and placed on the barrier. EI # 7 then donned gloves and failed to sanitize hands prior to donning gloves. EI # 7 wore the same gloves while taking vital signs, assessing the patient's skin and having patient perform leg lifts. EI # 7 then documented on the tablet and failed to remove gloves and sanitize hands prior to using the tablet. EI # 7 then documented in the patient's Home Health folder using his/her pen and wearing the same pair of gloves since arrival in patient's home. EI # 7 then reviewed all the medications using the medication bottles and continued to wear the same gloves. After checking the patient's medication EI # 7 with the same gloves documented again on the tablet. EI # 7 then assisted the patent with ambulation outside the home wearing the same gloves. An interview was conducted on 4/14/22 at 12:10 PM with EI # 1, Director of Operations, who confirmed EI # 7 should not have worn the same gloves for the entire visit. EI # 7 should have changed gloves and sanitized hands prior to the medication check and before documenting on the tablet each time. 2. HV # 3 was admitted to the agency on 1/25/22 with admitting diagnoses of Hypertensive Heart Disease with Heart Failure and Heart Failure Unspecified. A HV was conducted on 4/13/22 at 10:10 AM with EI # 8, Occupational Therapist, to observe care provided to the patient. During the HV EI # 8 placed barriers on the kitchen table and placed bag on the barriers. EI # 8 sanitized hands and began documenting on the tablet. EI # 8 cleaned the tablet and stylet and removed equipment from the bag. EI # 8 then donned clean gloves and failed to sanitize hands prior to donning gloves. EI # 8 then assessed the patient and took vital signs. EI # 8 removed gloves once the assessment was complete and sanitized hands. EI # 8 then removed a pair of gloves from scrub top pocket and donned the gloves. EI # 8 place a belt on the patient and assisted the patient to the bathroom to be weighted. After completing the weight EI # 8 lifted patient's shirt and assessed the skin on the back and breast area. EI # 8 then assessed the patient's skin on the buttocks. EI # 8 assisted patient back to kitchen table and with the same gloves used to do a skin assessment cleaned the equipment and placed on a clean barrier. EI # 8 removed gloves, sanitized hands and placed the equipment back into the bag. The medications then were reviewed by EI # 8 after donning clean gloves but failed to sanitize hands prior to donning the gloves and began to review the patient's medications and update the medication on the tablet. Once the medication profile was updated on the tablet EI # 7 removed the barriers and placed in the trash. EI # 7 removed gloves, used a Sani wipe to clean the tablet and stylet and failed to sanitize hands after cleaning the tablet. An interview was conducted on 4/13/22 at 12:15 PM with EI # 1 who confirmed EI # 8 should have removed gloves and completed hand hygiene after assessing the skin, prior to cleaning the equipment and after removing gloves.