Every finding on record at Amedisys Home Health of Virginia LLC

An unannounced Medicare/Medicaid home health recertification survey was conducted at the above noted agency 07/11/2022 to 07/13/2022 by two (2) Medical Facilities Inspectors from the Virginia Department of Health Office of Licensure and Certification. In conjunction with this survey, the agency's emergency preparedness plan was reviewed. The agency was found to be in compliance with 42 CFR 484.102 the Conditions of Participation: Emergency Preparedness for Home Health Agencies.

An unannounced Medicare/Medicaid home health recertification survey was conducted at the above noted agency 07/11/2022 to 07/13/2022 by two (2) Medical Facilities Inspectors from the Virginia Department of Health, Office of Licensure and Certification. The agency reported 1,069 unduplicated admissions during the last 12 months. In conjunction with the survey, the following were reviewed: seventeen (17) clinical records, ten (10) personnel files, COVID-19 vaccination requirement, agency admission packet, complaint log, organizational chart, and CLIA (Certified Laboratory Improvement Amendments) waiver. Seven (7) home visits and multiple staff interviews were conducted. The facility was found not to be in compliance with the Federal requirements of 42 CFR 484, the Medicare/Medicaid Conditions for Certification of Home Health Agencies. Standard level deficiencies were identified and cited in this report.

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 clinical record review and staff interview, it was determined the agency failed to ensure each patient received home health services as ordered by the physician in the patient's individualized plan of care for five (5) of seventeen (17) clinical records in the survey sample (Clinical records #6, #7, #10, #13, and #17) Findings: Seventeen (17) clinical records were reviewed in the agency on 07/12/2022 and 07/13/2022 with the following findings: 1. The clinical record of patient #6 was reviewed for the certification period 06/18/2022 to 08/16/2022. According to patient #6's plan of care (POC), the physician ordered Skilled Nurse (SN) frequency was one (1) time a week for ten (10) weeks. The POC contained a physician's order for nephrostomy management: Skilled Nurse to instruct patient/caregiver on nephrostomy management including changing dressing by cleansing area with DWC (Dermal Wound Cleanser) and 4x4 gauze, apply 2x2 split gauze and Tegaderm. SN to change one (1) time a week and SN to educate caregiver to perform on non-skilled days. The clinical record failed to contain documentation nephrostomy care was provided as ordered above during the weekly SN visits conducted on 06/18/2022, 06/22/2022 and 07/06/2022 or an explanation as to why nephrostomy care was not performed as ordered. Medical Facilities Inspector's findings were confirmed by the Administrator during the clinical record reviews on 07/13/2022. 2. The clinical record of patient #7 was reviewed for the certification period 06/18/2022 to 08/16/2022. According to patient #7's plan of care (POC), the physician ordered Skilled Nurse (SN) frequency was two (2) times a week for nine (9) weeks. The POC contained a physician's order for SN to report weight gain greater than two (2) pounds in one (1) day or greater than five (5) pounds in one (1) week or five (5) pounds or more over target weight. The clinical record contained SN documentation the patient's weight on 06/29/2022 was 278 pounds. On 07/01/2022 patient's weight was reported as 298 pounds. The clinical record failed to contain documentation SN notified physician of the above noted findings. The Administrator confirmed the Medical Facilities Inspector's (MFI) findings during the clinical record reviews on 07/13/2022 and stated she notified the physician as soon as the MFI notified her of the MFI's findings but clinician should have reported the patients weight the same day. 3. The clinical record of patient #10 was reviewed for the certification period 06/07/2022 to 08/05/2022. According to patient #10's plan of care (POC) the patient was to receive speech therapy effective 06/12/2022 one (1) time a week for one (1) week then once every three (3) weeks for three (3) weeks. The clinical record failed to contain documentation of any speech therapy visits or an explanation as to why visits were not conducted as ordered. The Administrator confirmed the Medical Facilities Inspector's (MFI) findings during the clinical record reviews conducted on 07/13/2022. 4. The clinical record of patient #13 was reviewed for the certification period 06/14/2022 to 08/12/2022. According to patient #13's plan of care (POC), the physician ordered Skilled Nurse (SN) frequency was one (1) time a week for nine (9) weeks. The POC contained physician orders for SN to draw lab BMP, Mag, and PO4 on Thursday 06/16/2022. The clinical record failed to contain documentation a SN visit was made on 06/16/2022 to collect labs as ordered above. Also the POC contained a physician's order for SN to draw labs CBC with Diff, Magnesium, Phosphorus, and Triglycerides every Monday. The clinical record contained documentation labs ordered for 07/04/2022 were not collected till Tuesday 07/05/2022 and no explanation as to why. The Administrator confirmed the Medical Facilities Inspector's (MFI) findings during the clinical record reviews on 07/13/2022 and stated the prior Director of Nursing (DON) who no longer is with the company didn't sync the order for the 06/16/2022 lab until after it was due and the labs due on the 07/04/2022 were probably not collected till 07/05/2022 due to the 4th of July holiday. In addition the plan of care contained orders for observation and assessment of patient's dual lumen PICC access site. The order failed to contain location of the PICC catheter. 5. The clinical record of patient #17 was reviewed for the certification period 07/01/2022 to 08/29/2022. According to patient #17's plan of care (POC), the physician ordered Physical Therapy (PT) frequency was one (1) times a week for one (1) week then three (3) times a week for three (3) weeks then two (2) times a week for one (1) week. The POC contained a physician's order for PT to report pulse less than 60. The clinical record contained documentation patients pulse was 53 on 07/05/2022. The clinical record failed to contain documentation patient's pulse was reported to physician as ordered. The Administrator confirmed the Medical Facilities Inspector's (MFI) findings during the clinical record reviews on 07/13/2022 and stated she notified the physician as soon as the MFI notified her of the MFI's findings but clinician should have reported the patient's pulse the same day. The above noted findings were acknowledged by the Administrator during the clinical record reviews and again during the exit conference conducted in the agency on 07/13/2022.