Every finding on record at Amedisys Louisiana, L.L.C

Amedisys Home Health is in compliance with federal emergency preparedness requirements.

Recertification Survey

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 record review and interview, the home health agency failed to ensure the patient's written individualized POC (Plan Of Care) was followed as evidenced by, the HHA (Home Health Aide) failing to make visits as ordered per the POC for patient (#4) and the SN (Skilled Nurse) failing to monitor blood glucose readings for patient (#8) for 2 out of 17 (#1-#17) sampled patients. 1. Patient #4. Review of the patient's electronic clinical record revealed the start of care date was 01/30/2025. The patient's diagnosis included Acute Kidney Failure. The certification period reviewed was 01/30/2025 to 03/30/2025. Review of the patient's POC for certification period 01/30/2025 to 03/30/2025 revealed an order for HHA effective 02/02/2025 2wk4 (home health aide visit effective the week of 02/02/2025 two times a week for four weeks). Review of the patient’s HHA visit notes revealed no evidence two HHA visits were made as ordered for the week of 02/02/2025. Further review of the patient’s clinical records revealed no evidence of a missed visit note for the week of 02/02/2025. On 02/10/2025 at 2:15 PM, an interview was conducted with S1DOO (Director of Operations). S1DOO reviewed the patient’s clinical record and confirmed there was no evidence that two HHA visits were made for the week of 02/02/2025 as ordered. S1DOO confirmed there was no evidence of a missed visit note at the time the interview was conducted. 2. Patient #8. Review of the patient’s electronic clinical record revealed the start of care date was 01/25/2025. The patient diagnoses included Diabetes Mellitus with Diabetic Chronic Kidney Disease. The certification period reviewed was 01/25/2024 to 03/25/2025. Review of the patient’s POC for certification period 01/25/2025 to 03/25/2025 revealed the following orders: SN 1wk10wk, (skilled nurse visit one time a week for ten weeks). Further review of the POC revealed orders for SN “…to observe and teach patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician… SN to report to physician blood glucose readings greater than 300 or less than 70…” blood sugar monitoring and results and to obtain weight. Review of the patient’s SN visit notes dated 01/25/2025, 01/30/2025, and 02/06/2025 revealed no evidence the SN obtained or monitored blood glucose readings. On 02/10/2025 at 2:55 PM, an interview was conducted with S1DOO. S1DOO reviewed the patient’s clinical record and confirmed there was no evidence the SN obtained or monitored the patient’s blood glucose readings and that the SN should have monitored them.

This entity is in compliance with federal emergency preparedness requirements.

Recertification Survey

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 observation, interview and record review, the agency's staff failed to review all medications that Patient #6 was currently using in order to identify any potential adverse effects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, and duplicate drug therapy as evidenced by an observation made on 3/15/2022 of S2OT (Occupational Therapy) failing to perform a medication reconciliation of Patient #6's medications for 1 (#6) out of 7 (#1-#7) patients in which home visits were conducted. Review of the agency’s Drug Regimen Review policy and procedure revealed, “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 any time there is a medication change including dose changes, new medications, and any medications discontinued… 6. Initially and ongoing: … Clinicians should assess and evaluate for drug contraindications, ineffectiveness, interactions and duplicative therapy to report to the physician…” Review of patient #6's electronic clinical record revealed the start of care date was 3/7/2022. The patient's diagnoses included Unilateral Primary Osteoarthritis of Right Hip and Rheumatoid Arthritis with Rheumatoid Factor. The certification period reviewed was 3/7/2022 to 5/5/2022. Review of the patient's POC (Plan of Care) for certification period 3/7/2022 to 5/5/2022 revealed the following order, OT 1wk4 (Occupational Therapy visit one time a week for four weeks) and PT 2wk4, 1wk3 (Physical Therapy visit two times a week for four weeks, one visit a week for three weeks). The patient had only the 2 disciplines. On 3/15/2022 at 9:30 am, a home visit was conducted with the patient and S2OT. During the home visit, S2OT instructed the patient on the therapeutic exercises. At the completion of the home visit, S2OT was not observed reviewing the patient’s medications. An interview was conducted with S2OT after walking out of the patient’s home. S2OT was asked about the patient’s medications and if someone reviews them. S2OT stated that PT conducted the initial assessment and that PT was responsible for reviewing the medications. On 3/15/2022 at 12:55 pm, an interview was conducted with S1DOO (Director of Operations). S1DOO stated that S2OT should have reviewed the patient's medications during the home visit.

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 record review and interview, the agency failed to ensure the patient's written individualized PoC (plan of care) was followed as evidenced by: 1a. not collecting lab work as ordered for Patient #4; 1b. HHA (home health aide) visits not conducted as ordered for Patient #4; 2. weight not measured during skilled nurse visit for Patient #8; and 3. failing to make 2 visits for the week of 2/20/2022 for Patient #11 for 3 (#4, #8, #11) our of 17 sampled patients. 1. Patient #4: Review of the patient’s electronic clinical record revealed the start of care date was 2/25/2022. The patient’s admitting diagnoses included Fracture of the Left Femur, Fracture of the Upper End of Left Humerus and Atrial fibrillation. The certification period reviewed was 2/25/2022 to 4/25/2022. a. Review of the patient’s POC for the certification period 2/25/2022 to 4/25/2022 revealed the skilled nurse was to perform PT/INR (lab to determine therapeutic range of Warfarin) every week. Review of the patient’s medication listed on the POC revealed Warfarin (anticoagulant medication) 2 mg as directed. Review of Patient #4’s physician order dated 3/2/2022 revealed and order to recheck the patient’s PT/INR on Friday (3/4/2022). Patient was to hold Coumadin for 2 days. Review of the skilled nurse notes for the week of 2/27/2022 revealed that there was no visit conducted after 3/2/2022 to re-check the patient’s PT/INR. Review of skilled nurse note dated 3/9/22 revealed the following: PT/INR fingerstick results called into to Dr.…Coumadin (Warfarin) had been on hold 7 days…Take Coumadin 5 mg today… b. Review of the patient’s POC for the certification period 2/25/2022 to 4/25/2022 revealed an order for HHA Effective 2/27/2022 2WK4 (home health aide two times a week for 4 weeks). Review of the patient’s electronic clinical record revealed that only 1 HHA visit was made the week of 3/6/2022. Further review revealed that that patient’s physician had not been notified of the missed visit. During an interview on 3/15/22 at 1:55 pm, S1DOO confirmed that the there was a missed HHA visit for the week of 3/6/22 and that the patient’s physician had not been notified of the missed visit. He also confirmed that there was no SNV 2 days later to collect PT/INR. 2. Patient 8: Review of the patient’s electronic clinical record revealed the start of care date was 2/23/2022. The patient’s admitting diagnoses included Type 2 Diabetes Mellitus with Diabetic Polyneuropathy, Low Back Pain, Atherosclerotic Heart Disease and Hypertensive Heart Disease with Heart Failure. The certification period reviewed was 2/23/2022 to 4/23/2022. Review of the patient’s POC for the certification period 2/23/2022 to 4/23/2022 revealed an order for SN 1WK9 (skilled nurse one time a week for nine weeks). Further review revealed that the skilled nurse was to record patient reported weight or weight patient as needed. Review of Patient #8’s skilled nurse visit note dated 2/28/22 revealed no documented weight for the visit. During an interview on 3/15/22 at 2:00 pm, S1DOO confirmed that the patient was not weighed during the skilled nurse visit on 2/28/2022 as ordered. 3. Patient #11. Review of the patient’s electronic clinical records revealed the start of care date was 2/11/2022. The patient’s diagnoses included Acute Kidney Failure With Tubular Necrosis, Hypertensive Chronic Kidney Disease, Stage 3 Unspecified, Morbid Obesity Due To Excess Calories and Personal History Of Pulmonary Embolism and Malignant Neoplasm Of Breast. The certification period reviewed was 2/11/2022 to 4/11/2022. Review of the patient’s physician order dated 2/16/2022 for the certification period 2/11/2022 to 4/11/2022 revealed an order for “HHA 2wk1, 1wk3 (home health aide visit two times a week for one week, one visit a week for three weeks).” Effective date 2/20/22. Review of the patient’s HHA visit note for the week of 2/20/2022 revealed that a visit was made on 2/24/2022. There was no evidence that a second visit was made for the week of 2/20/2022. On 3/16/2022 at 12:30 pm, an interview was conducted with S1DOO (Director of Operations). S1DOO confirmed that 2 visits were not made as ordered for the week of 2/20/2022.

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 record review and interview, the agency failed to notify the physician of: 1. abnormal urinary findings for Patient #4; 2. no CBG (capillary blood glucose) monitoring being conducted by Patient #8 3. 5 pound weight gain in one day for patient #9 for 3 (#4, #8, #9) out of 17 sampled residents. 1. Patient 4: Review of the patient’s electronic clinical record revealed the start of care date was 2/25/2022. The patient’s admitting diagnoses included Fracture of the Left Femur, Fracture of the Upper End of Left Humerus and Atrial fibrillation. The certification period reviewed was 2/25/2022 to 4/25/2022. Review of the patient’s POC for the certification period 2/25/2022 to 4/25/2022 revealed an order for PT 1WK1, 2WK4, 1WK2 (Physical therapy once a week for one week, twice a week for four weeks, once a week for two weeks). Review of the patient’s visit note dated 3/1/2022 conducted by S5PTA revealed documented abnormal findings of urine odor and color. Further review of the patient’s electronic clinical record revealed no documentation that the abnormal findings had been reported to the agency nor the patient’s physician. During an interview on 3/15/22 at 1:55 pm, S1DOO stated that S5PTA had notified the physical therapist of the abnormal findings but had not reported it to the agency or the patient’s physician. 2. Patient #8: Review of the patient’s electronic clinical record revealed the start of care date was 2/23/2022. The patient’s admitting diagnoses included Type 2 Diabetes Mellitus with Diabetic Polyneuropathy, Low Back Pain, Atherosclerotic Heart Disease and Hypertensive Heart Disease with Heart Failure. The certification period reviewed was 2/23/2022 to 4/23/2022. Review of the patient’s POC for the certification period 2/23/2022 to 4/23/2022 revealed an order for SN 1WK9 (skilled nurse one time a week for nine weeks). Further review revealed blood glucose testing daily…SN to report to physician blood glucose readings greater than 300 or less than 70… Review of skilled nurse visit dated 2/28/2022 revealed that the patient does not check blood sugar unless he feels ill. Review of the patient’s electronic record failed to reveal that the patient’s physician had been notified that the patient was not checking his blood sugars. During an interview on 3/15/22 at 2:00 pm, S1DOO confirmed that the patient’s physician had not been notified that the patient was not checking his blood sugars and should have been notified. Patient #9. Review of the patient's electronic clinical record revealed the start of care date was 2/5/2022. The patient's diagnoses included Hypertensive Heart Disease with Heart Failure. The certification period reviewed was 2/5/2022 to 4/5/2022. Review of the patient's POC (Plan of Care) for certification period 2/5/2022 to 4/5/2022 revealed the following order, SN 1wk10 (skilled nurse visit one time a week for ten weeks). Also, the POC revealed an order for ST effective week of 2/6/2022 1wk6 (Speech Therapy visits one time a week for six weeks beginning week of 2/6/2022). Further review of the POC revealed, “… Report increased edema or weight gain of > (greater than) 2 lbs (pounds) in 1 day or > 5 lbs in 1 week…” Review of the patient's SN Visit Note dated 3/7/2022 revealed that the patient’s weight was 266.2 pounds. Review of the patient’s ST Visit Note dated 3/8/2022 revealed that the patient’s weight was 271 pounds, which was a 5 pound weight gain in one day. There was no evidence that the ST notified the physician or the DOO (Director of Operations) of the patient’s 5 pound weight gain in one day. On 3/15/2022 at 1:20 pm, an interview was conducted with S1DOO. S1DOO reviewed the patient's clinical record and verified that there was no evidence that the physician was notified of the patient’s five pound weight gain in one day. Also, S1DOO stated that the five pound weight gain should have been reported to the physician.