Every finding on record at Amedisys Home Health of Nebraska, L.L.C.

Amedisys Home Health of the Midlands is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure the patient's medication orders on the Plan of Care and the medication profile (a real-time document used by the agency that lists the patient’s medications) were accurate for 8 of 17 patient records reviewed (Patient 1, 3, 5, 7, 8, 9, 10, 11). The total sample size was 17. The census was 177. Findings are: A. Review of the agency’s policy and procedure titled Drug Regimen Review (Home Health Only), MA-002, reviewed 12/9/24, revealed: 1.The clinician was to perform a medication reconciliation by reviewing the discharge paperwork for patients being admitted/resumed from acute or post-acute facilities on admission, recertification, resumption of care and with any major change in condition. 2.The clinician was to contact the patient's physician to verify, receive/write subsequent orders, and amend the medication profile as indicated, when problems/concerns were noted. 3. During the review of the discharge paperwork from the facility, the clinician was to assure all medications were included with correct dosages. 4. Visualized medications in the home were to be compared to the current medication profile to ensure accuracy of the medication profile. Any discrepancies were to be clarified with the patient’s physician and documented in the clinical record. 5. Medication changes or additions were to be received from the physician verbally, and a supplemental order was to be completed. B. Review of Patient 1’s clinical record revealed: 1.Discharge documents from Methodist Health System, dated 12/12/24, included orders for Saliva substitute (used to relieve dry mouth), Loperamide (used to treat loose stools), and Docusate Sodium (stool softener). 2. The Home Health Certification and Plan of Care (POC) for the certification period 11/28/24 through 1/26/25, and the medication profile, dated 12/30/24, failed to include Saliva substitute, Loperamide, or Docusate Sodium. 3. There was no documentation in the clinical record, that the physician was notified of the medication discrepancies. C. Review of Patient 3’s clinical record revealed: 1.Discharge orders from Life Care Centers of America, dated 11/27/24, included orders for Bisacodyl suppository (used for constipation), Colace (stool softener), Deep Sea Nasal Spray (used for dry nasal passage), Docusate Rectal Enema (used for constipation), Fleet Enema (used for constipation), Glucagon (used for low blood sugar), Glucose Tabs (used for low blood sugar), Lidocaine External Gel (used to numb and relieve pain), Liquacel oral liquid (protein supplement), Lomotil (used for loose stools), Milk of Magnesia (used for constipation), and Multivitamin (supplement). 2. The POC for the certification period 12/1/24 through 1/29/25, and the medication profile, dated 12/31/24, failed to include Bisacodyl suppository, Colace , Deep Sea Nasal Spray, Docusate Rectal Enema, Fleet Enema, Glucagon, Glucose Tabs, Lidocaine External Gel, Liquacel oral liquid, Lomotil, Milk of Magnesia, and Multivitamin. 3. There was no documentation in the clinical record, that the physician was notified of the medication discrepancies. D. Review of Patient 5’s clinical record revealed: 1.The Order Summary Report from Old Mill Rehabilitation, dated 11/22/24, included order for MiraLAX (used for constipation), Senna tab (used for constipation), and Systane Ointment (used for dry eyes). 2. The POC for the certification period 11/28/24 through 1/26/25, and the medication profile, dated 1/8/25, failed to include MiraLAX, Senna, and Systane. 3. There was no documentation in the clinical record that the physician was notified of the medication discrepancies. E. Review of Patient 7’s clinical record revealed: 1.The agency received an order on 12/13/24, from the patient’s physician, to hold Statin (used to lower cholesterol), while patient was on IV (intravenous) Daptomycin (used to treat infection) therapy. 2. The agency failed to discontinue the Statin on the medication profile. F. Review of Patient 8’s clinical record revealed: 1.Orders from VA Nebraska-Western Iowa Health Care System, Home and Community Based Services, dated 10/23/24, included orders for Albuterol inhaler (used for shortness of breath), Nitroglycerin (used for chest pain), Olodaterol/Tiotrop inhaler (used for shortness of breath), and Trospium (used for urine incontinence), 20 milligrams (mg), 1 tablet, 2 times daily. 2.The POC for the certification period 12/23/24 through 2/20/25, and the medication profile dated 12/31/24, failed to include Albuterol inhaler, Nitroglycerin, and Olodaterol/Tioptrop inhaler. 3. The POC and the medication profile included Trospium 20mg, 1 tablet, daily, and Wellbutrin XL (used to treat depression). 4. Wellbutrin XL was not included on the orders from the VA Nebraska-Western Iowa Health Care System, Home and Community Based Services, dated 10/23/24. 5. There was no documentation in the clinical record that the physician was notified of the medication discrepancies. G. Review of Patient 9’s clinical record revealed: 1.CHI Lakeside Hospital discharge summary, dated 6/13/24, included orders for CBD Caramels (used for anxiety), and Herblax (used for constipation). 2. The POC for the certification period 10/12/24 through 12/10/24 and 12/11/24 through 2/8/25, and the medication profile, dated 12/31/24, failed to include CBD Caramels and Herblax. 3. There was no documentation in the clinical record that the physician was notified of the medication discrepancies. H. Review of Patient 10’s clinical record revealed: 1.Discharge orders and information from Nebraska Medicine, dated 11/22/24, included orders for Acetaminophen (used for mild to moderate pain). 2. The POC for the certification period 11/17/24 through 1/15/25, and the medication profile, dated 12/31/24 failed to include Acetaminophen. I. Review of Patient 11’s clinical record revealed: 1.An Encounter Summary from CHI Health Lakeside, from the encounter date 11/19/24 through 11/23/24, included orders for Potassium Chloride (supplement), start taking 11/23/24 and stop taking 12/23/24. 2. The POC for the certification period 11/25/24 through 1/23/25, and the medication profile, dated 12/23/24, failed to include the end date of the Potassium Chloride. J. During an interview on 1/15/25 at 12:00 PM, the Administrator confirmed the agency failed to follow their policy and procedures to ensure the patient's medication orders on the Plan of Care and the medication profile, were accurate for 8 of 17 patient records reviewed (Patient 1, 3, 5, 7, 8, 9, 10, 11).

Revisions communicated to patient and MDs CFR(s): 484.60(c)(3)(i) (i) Any revision to the plan of care due to a change in patient health status must be communicated to the patient, representative (if any), caregiver, and all physicians or allowed practitioner's issuing orders for the HHA plan of care. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, and staff interview, the agency failed to ensure staff notified the patient's physician when a change in wound status occurred for 1 of 10 patient records reviewed (Patient 5), who received wound care. The total sample size was 17. The census was 177. Findings are: A. Review of the agency’s policy and procedure titled Plan of Care/Care Planning Process, AA-014, reviewed 11/4/24, revealed: 1.Each patient was to have an individualized written plan of care, including any revisions or additions. 2. Revisions to the plan of care were to be communicated to the patient’s provider. 3. Modifications to the plan of care were to be documented in a verbal order obtained from the patient’s physician. B. Review of the agency’s policy and procedure titled Coordination of Care, TX-002, reviewed 5/22/24, revealed: 1.Any revisions to the plan of care, due to a change in the patient’s health status, were to be communicated to the patient’s physician. 2. The Clinical Manager was responsible for assuring the plan of care was updated. C. Review of the agency’s policy and procedure titled Assessment/Reassessment, AA-003, reviewed 10/10/24, revealed the patient’s physician was to be notified when the plan of care was to be altered. D. Review of Patient 5’s record revealed: 1.The Home Health Certification and Plan of Care (POC) for the certification period 11/28/24 through 1/26/25, included orders for Skilled Nurse (SN), to provide wound care daily and PRN (as needed) to the patient’s right lower distal leg: a . Cleanse with soap and water b. Apply Santyl (an ointment used to remove damaged tissue from a wound) to the wound. c. May apply skin barrier to the surrounding wound PRN to prevent maceration. d. Cover with a 4 X 4 gauze, and secure with Kerlix (rolled gauze dressing). 2. Nurse to perform/teach patient/caregiver wound care to the right lower distal leg. 3. SN to perform/teach patient/caregiver wound care, daily and PRN for soiled dressing, to right elbow, included orders to: a. Cleanse with soap and water b. Apply Mepilex (foam absorbent dressing). c. May apply skin barrier to peri wound (skin surrounding the wound), PRN to prevent maceration. 4. A Client Coordination Note Report, dated 12/5/24, revealed the right elbow wound and the right lower distal leg wound were healed and completely epithelialized. 5. There was no documentation in the clinical record the physician was notified that the right elbow and the right lower distal leg wounds were healed, or that the plan of care for these wounds needed to be revised. E. During at interview on 1/15/25 at 12:00 PM, the Administrator confirmed the agency failed to follow their policy and procedure of notifying the physician with a change in the patient’s condition, which required a POC revision.

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 record review, policy and procedure review, observation of the provision of care, and staff interview, the agency failed to ensure 4 of 7 staff (Staff F, G, H, and I ), observed during the provision of care for 4 of 7 patients (Patient 4, 5, 6, and 7 ), performed proper hand hygiene, bag technique and cleaning of equipment, according to the agency's policies and procedures. The total sample size was 17. The census was 177. Findings are: A. Review of the agency’s policy and procedure titled Hand Hygiene, PCP-001, reviewed 6/26/24, revealed: 1.Staff were to perform hand hygiene before and after having direct contact with patients. 2. Before applying gloves. 3. After contact with a patient’s intact skin. 4. After removing gloves. 5. Gloves were to be changed during patient care. B. Review of the agency’s policy and procedure titled Bag Technique, PCP-002, reviewed 6/26/24, revealed hands were to be sanitized prior to entering the nursing bag. C. Review of the agency’s policy and procedure titled Bath Shower, PC-002, reviewed 3/26/24, revealed: 1.Gloves are to be worn during the shower. 2. A separate washcloth was to be used for the perineum. 3. Gloves were to be removed, and hand hygiene was to be performed after patient care. D. Review of the agency’s policy and procedure titled Decontamination of Re-usable Equipment, PCP-003, reviewed 6/26/24, revealed: 1.Blood pressure cuffs, pulse oximeters, stethoscopes, and scales, were to be cleaned with an 70% isopropyl alcohol or an agency approved, single use disinfectant wipe, after each use. 2. Scales were to be cleaned prior to use, and all external surfaces were to be cleaned after use prior to being removed from the home, with an agency approved disinfectant. E. Review of clinical records revealed: 1.Patient 4’s Home Health Certification and Plan of Care (POC), for the certification period 12/23/24 through 2/20/25, included orders for a Home Health Aide, 2 times weekly, to assist with personal care, hygiene and activities of daily living. 2. Patient 5’s POC, for the certification period 11/28/24/through 1/26/25, included orders for Skilled Nursing (SN), 1 time weekly, to provide wound care. 3. Patient 6’s POC for the certification period 11/13/24 through 1/11/25, included orders for Physical Therapy (PT), 1 time weekly, for gait training and therapeutic exercises. 4. Patient 7’s POC for the certification period 12/7/24 through 2/4/25, included orders for SN, 1 time a week, to obtain intravenous (IV) access via implanted port, IV port cares, and draw lab via IV implanted port F. During the observation of the provision care for Patient 4 on 1/2/25 at 2:30 PM, Staff F failed to: 1.Sanitize hands before having direct contact with the patient. 2. Sanitize hands prior to entering the nursing bag on 2 separate occasions. 3. Wear gloves while providing a shower and washing the perineum. 4. Use a separate washcloth for washing the perineum. 5. Sanitize hands after completing patient care. 6. Sanitize the electronic tablet after documenting cares and having the patient electronically sign on the tablet. G. During the observation of the provision of care for Patient 5 on 1/6/25 at 11:00 AM, Staff G failed to: 1.Sanitize hands prior to putting on gloves, prior to performing wound care. 2. Sanitize hands prior to entering the nursing bag to return clean equipment. 3. Sanitize the electronic tablet after documenting cares and having the patient electronically sign on the tablet, prior to returning the tablet into the nursing bag. H. During the observation of the provision of care for Patient 6 on 1/6/25 at 9:00 AM, Staff H failed to clean reusable equipment, with a single use disinfectant wipe, after using the equipment and prior to returning the equipment into the nursing bag. I. During the observation of the provision of care for Patient 7 on 1/6/25 at 1:25 PM, Staff I failed to: 1.Sanitize hands, on 1 occasion, prior to entering the nursing bag. 2. Clean the scale, prior to placing it on the patient’s floor. 3. Failed to sanitize all external surfaces of the scale after use. J. During an interview on 1/15/25 at 12:00 PM, the Administrator confirmed Staff F, G, H, and I failed to follow the agency’s policies and procedures for proper hand hygiene, bag technique, and cleaning of equipment, during the provision of care for Patient 4, 5, 6, and 7.

Amedisys Home Health of the Midlands is in compliance with the requirements of 42 CFR 484.102 Condition of Participation for Home Health Agencies,

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, policy and procedure review, and staff interview, the agency failed to follow the agency policy and procedure to ensure the home health aide (HHA) plan of care (POC) was individualized to meet the patient’s specific care needs for 3 of 6 patients records reviewed who received HHA services (Patient- 1, 4, and 7). The total sample size was 17. The census was 191. A. Review of the agency policy and procedure titled, Home Health Aide Care Plan/Assignment, revised 2/25/21, revealed the HHA Assignment was to outline specific instructions that are incorporated into the POC for each patient receiving home health aide services. The HHA POC was to avoid terms such as "as needed", and "per patient request" and instead include the specific frequency for the task developed. B. Review of Patient-1's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 12/7/21 through 2/4/22, included orders for HHA services for assistance with personal care, hygiene, and activities of daily living, it did not include the frequency and duration of the HHA services. 2. A physicians order dated 1/24/22 requesting HHA visits return to 2 times per week to assist with showering safely and progressing patient towards independence. 3. The Aide Care Plan Report (a document used as the HHA POC/assignment sheet) did not include the frequency for HHA visits. C. Review of Patient-4's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 11/15/21 through 1/13/22 and 1/14/22 through 3/14/22 revealed the patient had a diagnosis of a stage 4 pressure ulcer (a sore caused by unrelieved pressure that can extend into muscle, and may have exposed bone and/or tendons) of the right lower limb. It also included orders for wound dressings (items such as gauze, covers, and /or negative pressure devices to protect and improve healing of a wound), and a shower chair for equipment. 2. An physicians order dated 12/2/21 for HHA services 2 times a week for 5 weeks to assist with hygiene. 3. The Home Health Certification and Plan of Care for the certification period of 1/14/22 through 3/14/22 included orders for HHA 1 time a week for 8 weeks. 4. The HHA POC for the period of 12/5/21 through 1/13/22 and 1/14/22 through 3/14/22 included directions to shower the patient every visit, it did not include instructions to the HHA to use a shower chair during showers and did not include instructions to the HHA for how to protect or remove the pressure ulcer dressing to the right limb during a shower. The 12/5/21 through 1/13/22 HHA POC did not include the frequency for HHA visits. D. Review of Patient-7's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 12/21/21 through 2/18/22 included orders for HHA services 2 times a week for 7 weeks for personal cares including showering, hygiene, and activities of daily living. It also included orders for Eliquis (an anticoagulant (blood thinner) that can cause a patient to bruise or bleed easily). 2. The HHA POC for the certification period of 12/21/21 through 2/18/22 did not include instructions to the HHA for bleeding precautions due to the patient's use of Eliquis. E. During an interview on 2/1/22 at 1:30 PM, the Administrator confirmed agency staff developing the HHA POC failed to follow the agency policy and procedure to include patient specific interventions on the HHA POC for Patient's 1, 4m and 7.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review, policy and procedure review, observation of the provision of cares, and staff interview, the agency failed to ensure the Skilled Nurse (SN) follow the agency policy and procedure perform wound measurements weekly and when a new wound is identified for 1 of 4 patient's reviewed who receive wound care (Patient- 3). The total sample size was 17. The census was 191. A. Review of the agency policy and procedure titled, The Provision of Wound and Skin Care, revised 1/20/22 revealed wounds were to be measured a minimum of one time a week, preferably on the first visit of the week, by the same nurse, utilizing the same tool and measurement terminology in accordance with best practice and standards of care. B. Review of Patient-3's clinical record revealed: 1. The Home Health Certification and Plan of Care for the certification period of 12/3/21 through 1/31/22 included a diagnosis of Pressure Ulcer of Left Hip, Stage 4 (a sore caused by unrelieved pressure that can extend into muscle, and may have exposed bone and/or tendons). It also include orders for SN services 1 time for 1 week, 3 times for 1 week, 2 times for 2 weeks, 3 times a week for 5 weeks, then 1 time a week for 1 week for wound treatment and assessments. 2. A Visit Note Report by the SN on 12/27/21, included documentation that a new area of breakdown (a pressure ulcer) was identified on the patients sacrum (the large triangular bone at the base of the spine). No measurements were included in the documentation of this wound. 3. There was no documentation in the clinical record of sacral wound measurements the week of 12/26/21 through 1/1/22 (SN visit notes for 12/27/21, 12/28/21, and 12/31/21). 4. There was no documentation in the clinical record of measurements of the Stage 4 pressure ulcer of the left hip the week of 1/23/22 through 1/29/22 (SN visit notes for 1/24/22, 1/26/22, and 1/28/22). C. During the observation of the provision of wound cares on 1/26/22 at 9:00 AM, the SN was not observed to obtain measurements of the left hip or the sacral wounds during the observation visit. D. During an interview on 2/1/22 at 1:30, the Administrator confirmed the agency staff did not follow the policy and procedure for measuring wounds weekly and for newly identified wounds.