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

Based on review of the agency Emergency Preparedness Plan and interview it was determined Amedisys Home Health of Brewton was in substantial compliance with 484.102 Conditions of Participation: Emergency Preparedness.

A recertification survey was conducted on 5/24/22 to 5/26/22 at Amedisys Home Health of Brewton, Standard Level deficiencies were cited and will require an acceptable 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 Medical Record (MR) review, Home Visit (HV) observations, agency policy and procedure, and interview, it was determined the agency failed to ensure the Client Medication Report (CMR) was updated with changes. This deficient practice affected 1 of 4 HV including HV # 1 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Drug Regimen Review Policy Number: MA-002 Date Revised: 01/2020 ...Procedure: 1. 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... 2. The clinician will question the patient and/or caregiver periodically regarding changes in medications including dosage changes... 1. HV # 1 was admitted to the agency on 12/14/2021 and recertified for home care on 4/13/22 with diagnoses including Primary Generalized Osteoarthritis, Dorsalgia, and Type 2 Diabetes Mellitus. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 4/13/22 revealed orders for Physical Therapy (PT) 1 visit per week x 8 weeks. A HV visit was conducted on 5/24/22 at 1:05 PM to observe care provided by Employee Identifier (EI) # 2, Physical Therapy Assistant (PTA). During the HV, a review of the medications in the home were compared to the CMR provided to the surveyor on 5/24/22. Metformin 1000 mg (milligram) tablet, take 2 times a day was on the CMR. HV # 1 stated he/she has been taking 500 mg 2 x a day for over a year. HV # 1 stated he/she breaks the 1000 mg tablet in half to take because his/her sugar was dropping. HV # 1 further stated his/her doctor never told her to take half of the tablet. In an interview conducted on 5/26/22 at 12:15 PM, EI # 1, Director, confirmed the CMR had not been updated per policy. EI # 1 further stated the physician was contacted on 5/24/22 and order was received to continue the Metformin 1000 mg 2 times a day.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on review of Medical Records (MR), Agency Policy and Procedure and interviews, it was determined the agency failed to ensure the physician was notified of changes in the patient condition and/or Plan of Care. This deficient practice affected 4 of 10 MRs reviewed, including Home Visit (HV) # 2, MR # 6, HV # 3, HV # 1, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Coordination of Care Policy Number: TX-002 Date revised: 04/2019 …Procedure: …4. Relevant physicians are notified promptly of any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. The Plan of Care is appropriately revised/updated to reflect current information concerning the patient’s measurable outcomes and goals… 3. HV # 3 was admitted to the agency on 4/5/22 with diagnoses including Acute Kidney Failure, Muscle Weakness, and Polyneuropathy. Review of the HHC and POC dated 4/5/22 revealed orders for SN 1 x week x 5 weeks, then 1 visit every 2 weeks x 4 weeks. Further review of the HHC and POC dated 4/5/22 revealed orders for "SN may perform O2 (oxygen) saturation level ... PRN (as needed) for SOB (Shortness of Breath) to assess patient, with notification to the physician if saturation is (less than) 90%..." Review of the VNR dated 4/18/22 revealed the nurse documented HV # 3 complained of SOB. There was no documentation of an O2 saturation and no documentation the nurse notified the physician of the complaint of SOB. In an interview conducted on 5/26/22 at 12:55 PM, EI # 1 confirmed the physician was not notified of the patient's complaint of SOB. 4. HV # 1 was admitted to the agency on 12/14/2021 and recertified for home care on 4/13/22 with diagnoses including Primary Generalized Osteoarthritis, Dorsalgia, and Type 2 Diabetes Mellitus. Review of the HHC and POC dated 4/13/22 revealed orders for Physical Therapy (PT) 1 visit a week x 8 weeks. Further review of the HHC and POC revealed orders to report any pain above 7/10 to physician and clinical manager. Review of the VNR dated 4/21/22 revealed the Physical Therapy Assistant (PTA) documented "patient reports (his/her) right knee has really hurt the lat 2 days and is swollen...also reports (he/she) did something to (his/her) left hand and it is hurting...pain level is 7-8/10..." There was no documentation the PTA notified the physician or the clinical manager of the increased pain or changes in patient condition on 4/21/22. Review of the VNR dated 4/28/22 revealed the PTA documented "...reports (his/her) left shoulder is hurting today, throbbing. (He/She doesn't know what (he/she) did to it..." There was no documentation the physician was notified of the change in condition and pain in the shoulder on 4/28/22. In an interview conducted on 5/26/22 at 12:15 PM, EI # 1 confirmed the physician was not notified of the increased pain on 4/21/22 or changes in condition on 4/21/22 and 4/28/22. 1. HV # 2 was admitted to the agency on 5/3/22 with diagnoses including Varicose Veins of Left Lower Extremity with Both Ulcer of Calf and Inflammation, Non-Pressure Chronic Ulcer of Left Calf with Fat Layer Exposed and Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 5/3/22 to 7/1/22 revealed a nursing frequency of three times a week for 1 week, twice a week for 2 weeks then once a week for 6 weeks and orders for "Skilled Nurse (SN) to observe, assess and provide education on pain management techniques." Review of the SN Visit Note Reports (VNR) dated 5/3/22 and 5/5/22 revealed the patient reported a pain level of 4 on a 1-10 scale on 5/3/22 and a pain level of 5 on 5/5/22. Review of the SN VNR dated 5/7/22 revealed the patient reported pain in the lower back at a 7 on a 1-10 scale. There was no documentation the SN reported the patient's increased pain to the physician. Review of the SN VNR dated 5/13/22 revealed documentation the patient reported pain in the mid back and abdominal region at a 7 on a 1-10 scale and "...I just don't feel good I'm hurting especially in my stomach and back. I had that surgery on yesterday. I can hardly move today... Patient has dressing in place (to) Mid Back not (no) active bleeding. Patient can change this dressing in 42 hours..." There was no documentation the physician was notified of the patient's increased pain, new incision to Mid Back nor the SN attempted to obtain wound care orders for new incision. An interview was conducted on 5/26/22 at 12:42 PM with Employee Identifier (EI) # 1, Director, who confirmed there was no documentation the physician was notified of the patient's increased pain on 5/7/22 and 5/13/22, new incision to Mid Back on 5/13/22, nor the SN attempted to obtain wound care orders for the new incision. The surveyor asked EI # 1, if he/she would expect the physician to be notified of a patient reported pain level of 7. EI # 1 stated, "yes." 2. MR # 6 was admitted to the agency on 4/19/22 with diagnoses including Hypertensive Heart and Chronic Kidney Disease without Heart Failure, with Stage 1 through Stage 4 Chronic Kidney Disease, or Unspecified Chronic Kidney Disease and Acute on Chronic Systolic (Congestive) Heart Failure. Review of the HHC and POC dated 4/19/22 to 6/17/22 revealed a Physical Therapy (PT) frequency of once a week for 1 week, twice a week for 2 weeks and once a week for 4 week and orders for "PT will monitor for effective pain management...and report any pain above 7/10 (above a 7 on a 1-10 scale) to physician..." Review of the PT Assistant VNR dated 5/5/22 revealed the patient reported Lumbar Paraspinal pain at 8 on a 1-10 scale. There was no documentation the PT Assistant notified the physician of the patient reported pain level of 8. An interview was conducted on 5/26/22 at 1:09 PM with EI # 1, who confirmed there was no documentation the PT Assistant notified the physician of the patient reported pain level of 8.

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 observations, Agency Policies and Procedures and interviews, it was determined the agency failed to ensure infection control practices were observed. This deficient practice did affect 2 of 4 Home Visits (HV) observation including, HV # 2, HV # 4, and had the potential to affect all patients admitted to this agency. Agency Policy: Bag Technique Policy Number: PCP-002 Revised Date: 9/8/21 Purpose: To provide guidelines for the adherence of the principles of infection prevention in relationship to practitioner equipment and supply bag usage. ...Guidelines: ...Nothing inside the bag should ever be "dirty" or soiled... Staff should not re-enter the bag with used gloves. Always perform hand hygiene before entering bag. Procedure: ...3. The field staff member cleanses hands prior to accessing materials from the supply bag... 4. Equipment and supplies to be used...are removed and placed on a clean field... Agency Policy: Decontamination of Re-usable Equipment Policy Number: PCP-003 Revised Date: 6/24/21 Purpose: To prevent and control the spread of infection by the provision of sound decontamination guidelines... 3. Non-critical items...should be cleaned with...agency approved, single-use disinfectant wipe after each use and before placing the equipment back in the supply bag... Agency Policy: Hand Hygenie Policy Number: PCP - 001 Review Date: 6/24/21 Purpose: To prevent the spread of infection by contaminated hands. ...Guidelines: ...4. Perform hand hygiene as follows: ...g. After contact with inanimate objects (e. g. medical equipment) in the immediate vicinity of the patient... 1. HV # 2 was admitted to the agency on 5/3/22 with diagnoses including Varicose Veins of Left Lower Extremity with Both Ulcer of Calf and Inflammation, Non-Pressure Chronic Ulcer of Left Calf with Fat Layer Exposed and Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene. A HV was conducted on 5/24/22 at 2:25 PM with Employee Identifier (EI) # 5, Licensed Practical Nurse, to observe wound care provided to HV # 2. EI # 5 performed hand hygiene, donned gloves, and obtained vital signs. After obtaining vital signs, EI # 5 reached onto clean barrier with contaminated gloved hand and grabbed the pile of clean gloves on the barrier then dropped the clean glove pile back onto the barrier x 2, which contaminated the clean glove supply. EI # 5 then obtained 1 single use alcohol pad and cleaned stethoscope, thermometer and blood pressure cuff, failing to cleanse each piece of equipment with separate alcohol pads. After the stethoscope, thermometer and blood pressure cuff were cleaned, EI # 5 returned each piece of equipment onto the dirty barrier, which re-contaminated each piece of equipment. After removing gloves and performing hand hygiene, EI # 5 removed the stethoscope, thermometer and blood pressure cuff from the dirty barrier and placed the equipment in agency bag. EI # 5 gathered wound care supplies to provide wound care at the visit. EI # 5 obtained several clean uncovered gauze and placed the gauze on the dirty barrier, contaminating the clean gauze to be used to provide wound care. Prior to the wound care, EI # 5 obtained scissors from bag then used the scissors to cut off old wound dressing and cut rolled gauze applied to the wound. EI # 5 failed to cleanse scissors prior and/or post use. Following wound care, EI # 5 obtained a Sani-Cloth disinfected wipe and cleaned the Electronic Medical Record (EMR) tablet 4 times, using the same single use wipe. EI # 5 then had HV # 2 sign the EMR tablet, cleaned the EMR tablet again with the same Sani-Cloth wipe, placed the EMR tablet on the dirty barrier, which re-contaminated the EMR tablet, then gathered trash including the dirty barrier to which EI # 5 then place the EMR tablet on HV # 2's coffee table without a barrier. An interview was conducted on 5/26/22 at 12:42 PM with EI # 1, Director, who confirmed EI # 5 failed to perform infection control practices per agency policy. 2. HV # 4 was admitted to the agency on 5/10/22 with diagnoses including Bilateral Post-Traumatic Osteooarthritis of Knee and Cerebral Infarction, Unspecified. A HV was conducted on 5/24/22 at 3:47 PM with EI # 3, Occupational Therapist, to observe care provided. EI # 3 performed hand hygiene, removed sani- cloth disinfected wipes, alcohol pad, stethoscope, thermometer and blood pressure cuff from agency bag and placed supplies on a clean barrier. EI # 3 donned gloves cleaned EMR tablet with sani-cloth, documented on EMR tablet and placed on clean barrier. EI # 3 then obtained HV # 4's temperature and blood pressure without removing gloves and performing hand hygiene. EI # 3 continued to obtain vital signs then obtained and cleaned the stethoscope, thermometer and blood pressure cuff with alcohol pads, failing to remove gloves and perform hand hygiene prior to cleaning equipment. EI # 3 then removed gloves, performed hand hygiene, obtained HV # 4's medication bottles and compared medication bottles to agency medication list. EI # 3 then obtained disinfect wipe from agency bag without removing gloves and performing hand hygiene prior to entering bag. An interview was conducted on 5/26/22 at 12:34 PM with EI # 1, who confirmed EI # 3 failed to perform infection control practices per agency policy.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on review of medical records (MR), agency policy, and interviews with staff it was determined the agency failed to ensure the patient/caregiver (pt/cg) were provided education and/or provided a return demonstration of the following: 1. Wound care per the physician's orders. 2. Levemir administration. 3. Altered Respiratory Status. This affected 2 of 10 MR's reviewed including Home Visit (HV) # 2, MR # 4 and had the potential to negatively affect all patients at this agency. Findings include: Agency Policy: Coordination of Care Policy #: TX-002 Date Revised: 04/2019 … Standard: Coordination of Care. The HHA (Home Health Agency) must: … 5. Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA (Home Health Agency), as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge… 1. HV # 2 was admitted to the agency on 5/3/22 with diagnoses including Varicose Veins of Left Lower Extremity with Both Ulcer of Calf and Inflammation, Non-Pressure Chronic Ulcer of Left Calf with Fat Layer Exposed and Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 5/3/22 to 7/1/22 revealed a nursing frequency of three times a week for 1 week, twice a week for 2 weeks then once a week for 6 weeks and orders for "Skilled Nurse (SN) to perform/teach patient/caregiver (pt/cg) wound care to wound # 2, Left Pretibial Distal Chronic Non-Pressure Ulcer and wound # 8, medical Distal Lower Leg Right Non-Pressure ulcer, 3 x (times) weekly...Cleanse with wound cleanser, pat dry with gauze, apply collagen to open wound bed, cover with calcium alginate, cover with gauze for drainage, wrap with rolled gauze and secure with tape. Pt/cg to perform in absence of SN." Further review of the HHC and POC dated 5/3/22 to 7/1/22 and the Medicine List (ML), printed by the agency on 5/23/22, revealed the patient was prescribed Levemir Flextouch Insulin 25 Units daily Subcutaneous (SQ) on 8/23/21. Review of the SN Visit Note Report (VNR) dated 5/3/22 revealed documentation the patient was educated on the wound care to wounds # 2 and # 8 and "...pt will perform return demonstration on next SNV (SN visit)..." Review of the SN VNR dated 5/5/22 and 5/7/22 revealed no documentation the patient performed a return demonstration of the wound care to wounds # 2 and # 8. Review of the On Call Coordination Note dated 5/9/22 revealed documentation the patient call the on call service requesting assistance with wound care because she/he was "...not able to do it... Patient stated she/he doesn't have anyone to help her/him do it and she/he can't bend over..." Review of the SN VNR dated 5/13/22 revealed documentation of "...Patient has dressing in place (to) Mid Back not active bleeding. Patient can change this dressing in 42 hours..." There was no documentation the SN provided education on changing the dressing to the Mid Back. Review of 8 of 8 SN VNR's dated 5/3/22 to 5/23/22 revealed no documentation the patient was provided education on Levemir and performed a return demonstration to ensure competency with Levemir administration. An interview was conducted on 5/26/22 at 12:42 PM with Employee Identifier (EI) # 1, Director, who confirmed there was no documentation of a return demonstration on 5/5/22 and 5/7/22 for wounds # 2 and # 8, the SN provided education to the patient on changing the Mid Back dressings on 5/13/22, and the patient received education and provided a return demonstration of Levemir. 2. MR # 4 was admitted to the agency on 4/11/22 with diagnoses including Other Specified Arthritis, Multiple Sites and Acute Upper Respiratory Infection, Unspecified. Review of the HHC and POC dated 4/11/22 to 6/9/22 revealed a SN frequency of twice a week for 1 week, once a week for 4 weeks then once every 2 weeks for 4 weeks and an order for "...SN to assess and teach related to Altered Respiratory status to minimize complications and reduce hospitalization." Review of 6 SN VNR dated from 4/11/22 to 5/10/22 revealed no documentation the SN educated the patient on Altered Respiratory status. An interview was conducted on 5/26/22 at 1:05 PM with EI # 1 who confirmed there was no documentation the SN educated the patient on Altered Respiratory status.