Every finding on record at Amedisys Missouri, LLC

The Emergency Preparedness regulations were reviewed as part of the Medicare recertification survey completed on 06/11/2024.During the survey it was determined the home health provider is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Providers.

A partial extended survey for Medicare recertification for the home health provider was completed on 06/11/2024. The provider had 140 current patients.

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 policy review, record review, and interview, the home health provider failed to ensure an accurate and updated medication profile was included in the patient record in one of five full records reviewed (Record/Patient #2). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider's policy titled, "Drug Regimen Review," dated 12/01/2023, showed 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. RECORD/PATIENT #2: Review of the clinical record showed the patient admitted to home health services on 05/12/2024 with a primary diagnosis of Parkinson's disease (a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves). Observation and interview on 06/10/2024 beginning at 1:15 PM, during the patient’s home visit, showed the following medication discrepancies: -The medication profile showed an order for Acetaminophen (used to treat mild pain) 500 milligram (mg) tablet, take two tablets three times daily as needed. The patient stated that he/she took two tablets four times daily as needed; -The medication profile showed an order for Acidophilus (a probiotic) chewable tablet, take one tablet three times daily. The patient stated that he/she took one tablet once daily; -The medication profile showed an order for Baclofen (used to treat muscle spasms) 10 mg tablet, take 0.5 tablets twice daily and 1 tablet at night. The patient stated that he/she took one tablet three times daily; -The medication profile showed an order for Carbidopa 25 mg- Levodopa 100 mg tablet (used to treat Parkinson's disease), take one tablet three times daily. The patient stated that he/she took 1.5 tablets three times daily; -The medication profile showed an order for Cholecalciferol (Vitamin D3) 125 microgram (mcg) tablet, take one tablet daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Ciprofloxacin (used to treat infection) 500 mg tablet, take one tablet every 12 hours. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Colestipol (used to treat high cholesterol) 1 gram tablet, take one tablet two times daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Cyanocobalamin (Vitamin B-12) 1000 mcg tablet, take one tablet daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Ergocalciferol (Vitamin D2) 1250 mcg capsule, take one capsule weekly. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Ferrous Sulfate (iron) 325 mg tablet, take one tablet daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Leflunomide (used to treat arthritis) 20 mg tablet, take one tablet daily. The patient stated that he/she took 10 mg once daily; -The medication profile showed an order for Lidocaine (used to treat pain) pain relief 4% topical patches as needed daily. The patient stated that he/she no longer used this medication; -The medication profile showed an order for Propranolol (used to treat high blood pressure) 20 mg tablet three times daily. The patient stated that he/she took 80 mg once daily; -The medication profile showed an order for Saccharomyces Bouldardii (probiotic) 250 mg capsule, take one capsule daily. The patient stated that he/she no longer took this medication; -The medication profile showed an order for Sucralfate (used to treat acid reflux) 100mg/milliliter (mL) oral suspension, take 10 mL every 6 hours. The patient stated that he/she took 1 gram tablets three times daily; -The medication profile showed an order for Sulfamethoxazole 800 mg- Trimethoprim 160 mg tablet (used for urinary tract infection prevention), take one tablet at bedtime. The patient stated that he/she no longer took this medication; and -The medication profile showed an order for Vancocin (used to treat infections) 125 mg capsule, take one capsule four times daily for eight days, take one capsule twice daily for seven days, take one capsule daily for seven days, then discontinue. The patient stated that he/she no longer took this medication. Additionally, the patient stated during the home visit he/she was currently taking the following medications which were in the home but were not listed on the current mediation list supplied by the provider; -The medication Azathioprine (an immuno-suppressant) 50 mg tablet once daily; -The medication Famotidine (used to treat stomach and throat problems) 40 mg tablet once daily; -The medication Fludrocortisone (a corticosteroid) 0.1 mg tablet once daily; -The medication Macrobid (used to treat infections) 100 mg tablet twice daily for 10 days; and -The medication Potassium (a vitamin) 10 milliequivalents (mEq) tablet once daily. During an interview on 06/11/2024 at 2:05 PM, the administrator stated that he/she would expect the medications to be reconciled and match what the patient is currently taking.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to send a transfer/discharge summary to the receiving provider in one of two discharge records reviewed (Record/Patient #6). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider's policy titled, "Discharge of Patient," dated 05/23/2024, showed the home health provider must send all necessary medical information pertaining to the patient's current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility to ensure the safe and effective transfer of care. RECORD/PATIENT #6: Review of the clinical record showed the patient was admitted to home health services on 04/25/2024 with a primary diagnosis of protein-calorie malnutrition. Review of the communication note dated 05/07/2024 showed the patient's spouse planned to take the patient to the hospital related to pain level and low oxygen saturation. Review of the communication note dated 05/09/2024 showed the patient was admitted to [named hospital] on 05/07/2024 for end stage renal disease and hypertension. During an interview on 06/11/2024 at 2:05 PM, the administrator stated that he/she did not have a discharge summary for the patient. The administrator also stated he/she spoke with the staff regarding the need for discharge summaries and will be doing agency training regarding the need for the discharge summaries.

The Emergency Preparedness regulations were reviewed as part of the Medicare certification survey completed on 11/09/2021. During the survey it was determined Amedisys Home Health of Missouri is in compliance with the requirements of 42 CFR 484.102 Condition of Participation: Emergency Preparedness for Home Health Agencies.

A partial extended survey for Medicare certification for Amedisys Home Health of Missouri was completed on 11/09/2021. The agency had 119 current patients. A COVID-19 Focused Infection Control Survey was completed in conjunction with the survey and no deficiencies were identified related to the Focused Infection Control Survey. A complaint investigation, #43791, was completed on 11/09/2021. The complaint was not substantiated. None of the allegations were verified and no deficiencies are cited.

Contact info Federal/State-funded entities CFR(s): 484.50(c)(10)(i,ii,iii,iv,v) Be advised of the names, addresses, and telephone numbers of the following Federally-funded and state-funded entities that serve the area where the patient resides: (i) Agency on Aging (ii) Center for Independent Living (iii) Protection and Advocacy Agency, (iv) Aging and Disability Resource Center; and (v) Quality Improvement Organization. This ELEMENT is not met as evidenced by: Based on review of the agency's current patient rights information, and interview, the agency failed to update the written notice of patient rights to ensure that the patient and representative (if any) were advised of the name, addresses, and telephone numbers of Federally funded and state funded entities that serve the area where the patient resides to include the current the Protection and Advocacy agency and the Aging and Disability Resource Center. This deficient practice has the potential to affect the knowledge and comprehension of the rights and responsibilities of all agency patients. Findings included: The administrator provided an admission packet for review on 11/08/2021. The agency notice of patient rights and community resources given to a patient during the initial visit showed the Protection and Advocacy Agency listed was an entity in Jefferson City. The Aging and Disability Resource Center was listed for an entity in Albany, Mo and an entity in the Cameron area. The findings were reviewed with the administrator on 11/08/2021 at 4:30 PM. He/she was not aware the Protection and Advocacy Agency and the Aging and Disability Resource Center was not listed to serve the area in which the patient resides. The administrator agreed to update the patients rights information to include local entities.

Content of the comprehensive assessment CFR(s): 484.55(c) Standard: Content of the comprehensive assessment. The comprehensive assessment must accurately reflect the patient's status, and must include, at a minimum, the following information: This STANDARD is not met as evidenced by: Based on policy review, record review, and interview, the agency failed to ensure a complete comprehensive assessment was completed in one (Record/Patient #4) of five full records reviewed. This deficient practice has the potential to affect the full assessment of problem areas is completed for all the agency's patients. Findings included: Review of the agency's policy titled, "Patient Assessment/Reassessment," last review date of 09/13/2021, showed, in part, the following: - The adult assessment is appropriate to the type of care and services provided and will include physical finding/impairments; and - LPNs (Licensed Practical Nurses) may monitor the patient status (including collecting some of the above data and findings during on-going patient visits only) and gather pertinent information for the registered nurse (RN) to interpret. RECORD/PATIENT #4: Review of the clinical record showed the patient was admitted on 10/09/2021 with the admitting diagnoses of COVID 19 and pneumonia (lung infection). Co-morbidities included, but not limited to, urinary tract infection (UTI) and alcohol abuse. The patient lived in the home of his/her sister. The sister was also his/her caregiver. Review of the start of care comprehensive assessment completed by the RN, dated 10/09/2021, showed the respiratory assessment as follows: - Lungs clear to auscultation (use of a stethoscope to hear lung sounds); and - Shortness of breath when walking more than 20 feet or climbing stairs. Review of the clinical record showed the LPN nurse visit notes on 10/12/2021, 10/20/2021, and 10/25/2021 failed to include a complete respiratory assessment. The documentation on these visits showed in the respiratory section, "no problems were identified" and no new symptoms. During an interview with the acting administrator on 11/09/2021 at 2:00 PM, he/she stated that the respiratory assessment should be documented completely on a patient with COVID 19 and pneumonia.

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 policy review, record review, home visit observation, and interviews, the agency failed to ensure the patient's medications were reconciled during the start of care comprehensive assessment and that the medication profile was updated with medication changes in, two (Records/Patients #2 and #3) of five full records reviewed. This deficient practice has the potential to adversely affect the accuracy and safety of medication administration for all the agency's patients. Review of the agency's policy titled, "Plan of Care (POC)/Care Planning Process," dated 0/13/2021 showed, in part, the following: - Documentation of the Care Planning Process includes, but is not limited to: * Medication profile; and * Medication/treatment administration. Review of the agency's policy titled, "Patient assessment/Reassessment," dated 06/24/2021 showed, in part, the following: - Review of all medications the patient is currently using in order to identify any potential adverse affects and drug reactions, including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug therapy, and non-compliance with drug therapy. RECORD/PATIENT #3: Review of the plan of care dated 10/21/2021 through 12/19/2021 showed: - Benadryl 25mg (milligram) 1 capsule as needed at night for sleep; - Furosemide 20mg 1 tablet daily to reduce fluid retention; and - Nitroglycerine 0.3mg as needed for chest pain. Review of the referral medication list dated 10/20/2021 showed: - Benadryl not listed as a medication being taken; - Furosemide 40mg 1 tablet by mouth two times daily; and - Nitroglycerine 0.4 mg sublingual (dissolve under tongue) as needed for chest pain: if no improvement after first dose call 9-1-1. May take 2 additional doses. During a home visit on 11/09/2021 at 10:40 AM, the following medication discrepancies were identified: - The patient reported taking 2 Benadryl each night for a total of 50mg to assist with sleeping; - Patient had two bottles of furosemide with 1 bottle of 20mg tablets and another bottle of 40mg tablets; - Patient reported taking a sliding scale for furosemide; and - Patient’s nitroglycerine tablets were confirmed to be 0.4mg tablets to be administered for chest pain as needed. During a home visit on 11/09/2021 at 12:45 PM, review of the medication discrepancies were discussed with the administrator. No additional documentation provided. On 11/09/2021 at 2:30 PM, the clinical manager reports notifying physician’s office regarding medication discrepancies and counseling provided to staff that medication clarification needed to be provided at time of discovery. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted on 10/26/2021 for dislocation of right hip prosthesis. During a home visit observation on 11/8/2021 beginning at 4:00 PM, the agency medication list showed: - Ipratropium bromide 42 microgram (mcg) (0.06%) nasal spray one spray daily; caregiver (cg) stated that the patient was no longer using this medication, and that the doctor had discontinued the medication on his/her home visit on 10/27/2021; - Lactulose 20 gram/30milliliter (ml) solution (laxative) two times a day, cg stated that the patient was no longer using this medication, and that the doctor had discontinued the medication on his/her home visit on 10/27/2021; - Bethanechol Chloride (urinary retention) 25 milligram (mg) take one tablet before meals; cg stated that the patient was no longer using the medication, and that the doctor had discontinued the medication on his/her home visit on 10/27/2021; - Omega-3-Acid Ethyl Esters (high cholesterol) 1 gram daily; cg stated that the patient was no longer using this medication, and that the doctor had discontinued the medication on his/her home visit on 10/27/2021; - Senna Plus 8.6 mg-50mg (laxative) one tablet two times a day; cg stated that the patient was no longer using this medication, and that the doctor had discontinued on his/her home visit on 10/27/2021; and - Vesicare (inflammation urinary tract) one tablet daily; cg stated that the patient was no longer using this medication, and that the doctor had discontinued on his/her home visit on 10/27/2021. Record showed that the agency physical therapist (PT) had conducted a home visit three times with no change in medication list since the physician visit. and that the agency's registered nurse (RN) had conducted a home visit twice, since the physician visit. and had documented no medication changes, documentation showed "no medication discrepancies found." During the home visit observation the PT aide concurred with the findings and stated that he/she would ask the clinical manager to clarify the medications for the patient.

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 agency policy review, clinical record review, and interview, the agency failed to ensure the plan of care was followed in one (Record/Patient #1) of five full records reviewed. This deficient practice has the potential to adversely affect the care provided to all the agency’s patients. Findings included: Review of the agency’s policy titled, “Plan of Care/Care Planning Process,” dated 06/24/2021, showed the following: - The individualized plan of care must specify the care and services necessary to meet the patient- specific needs as identified in the comprehensive assessment, including identification of the responsible disciplines, and measurable outcomes that the home health agency (HHA) anticipates will occur as a result of implementing and coordinating the plan of care; and - Changes to the plan of care are communicated to the patient and/or caregiver prior to the initiation of the change. RECORD/PATIENT #1: Review of the clinical record showed the patient was admitted to the agency on 10/20/2021 with diagnoses of, but not limited to, congestive heart failure (CHF) ( a chronic condition in which the heart doesn’t pump blood properly), Type 2 Diabetes Mellitus (a chronic condition that affects the way the body processes blood sugar), and atrial fibrillation (an irregular, often rapid heart rate that commonly causes poor blood flow), and a recent left hip fracture (break) with surgical repair in June 2021. Review of the plan of care dated 10/20/2021 through 12/18/2021 showed: - Skilled nurse visits two times weekly for nine weeks; - Physical therapy visits one time weekly for one week, two times weekly for two weeks, and one time weekly for six weeks; and - Occupational therapy visits one time weekly for one week. Review of the clinical record showed: - On the week of 10/31/2021, no skilled nursing visits were completed; and - No communication notes or physician notification regarding the missed visits. During an interview on 11/09/2021, the administrator stated that there were no skilled nurse visit notes for the week of 10/31/2021.

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 review of the agency's policy, observation, and interview, the agency failed to ensure that staff followed infection control standards of practice in two (Records/Patients #1, and #2) of three home visit observations. This deficient practice has the potential to affect the health and safety of all patients served by the agency. Findings included: Review of the agency's policy titled, "Decontamination of Re-usable Equipment," dated 06/24/21 showed that to prevent and control the spread of infection staff need to follow sound decontamination guidelines. Adequate disinfection in the home setting is necessary to provide a safe patient environment. Non-critical items (i.e., blood pressure cuffs, pulse oximeters, stethoscopes, flashlights and scales etc.) should be cleaned with 70% isopropyl alcohol or an agency approved, single-use disinfectant wipe after each use and before placing the equipment back in the supply bag. RECORD/PATIENT #2: Observation on 11/08/2021 at 4:30 PM, showed physical therapy assistant (PTA) provided patient with a pen to sign PTA's tablet (computer, used to document staff visit). PTA placed pen in his/her uniform pocket without cleaning pen after patient use. During an interview immediately after patient visit, the PTA stated that he/she should have cleaned the pen prior to removing from the home. The PTA concurred that the pen should not have been placed in his/her uniform pocket. During an interview on 11/09/2021 at 12:30 PM, the administrator stated that the PTA should have cleaned the pen before taking out of the patient's home. Review of the agency policy titled “Bag Technique”, dated 09/08/2021 showed: -The purpose is to provide guidelines for the adherence of the principles of infection prevention in relationship to practitioner equipment and supply bag usage; -Bags are placed on a barrier in the patient’s home. Bags should not be placed on padded furniture, such as sofas or beds without a barrier. Bags should not be placed on the floor in the patient’s home; and -Equipment and supplies to be used, such as blood pressure cuffs and thermometers, are removed and placed on a clean field. RECORD/PATIENT #1: A home visit observation on 11/08/2021 at 5:05pm showed: -The licensed practical nurse (LPN) entered the patient’s home and placed his/her bag on the floor without placing a barrier; and -The LPN placed his/her tablet (used for computer charting) on the patient’s home health binder lying on the patient’s ottoman. No barrier was placed between the patient’s binder and staff tablet. During an interview on 11/09/2021, the administrator stated that the LPN should have placed a barrier under his/her bag and tablet.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on agency policy review, clinical record review, home visit observation, and interview, the agency failed to ensure that the patient received initial and ongoing education regarding medications and failed to ensure that the registered nurse (RN) developed a plan of care that included all information identified during the comprehensive assessment to include patient and caregiver education in one (Patient/Record #1) of five full records reviewed. This deficient practice has the potential to affect all patients served by the agency. Findings included: Review of the agency’s policy titled, “High Risk/High Alert Medication,” (undated), showed in part, the agency recognized five medication categories of significant risk which included narcotic/opiates-synthetics. Review of the agency’s policy titled, “Plan of Care/Care Planning Process,” dated 06/24/2021, showed: - A plan of care will be developed through a care planning process, which is designed to provide care, treatment, and services that are appropriate to the patient's individual needs, as well as the patient’s choice; - The individualized plan of care must also specify the patient and caregiver education and training; and - The individualized plan of care must include patient-specific interventions and education. RECORD/PATIENT #1: Review of the OASIS (outcome assessment information set) comprehensive assessment, performed by a RN, dated 10/20/2021, showed the following: - The patient reported a pain level of 5 on a scale of 0 (lowest pain level) to 10 (highest pain level); and - The patient takes hydrocodone (Norco) (a narcotic pain reliever combined with acetaminophen-a non-narcotic pain reliever) and Tylenol (acetaminophen) for pain relief. Review of the plan of care dated 10/20/2021 through 12/18/2021 showed: - A physician order for hydrocodone 5 mg (milligrams)/acetaminophen 325 mg (milligrams) one tablet by mouth every six hours as needed for pain; - A physician order for acetaminophen (Tylenol) extra strength 500 mg two tablets every six hours as needed for pain; and - The agency failed to include education warning the patient to not exceed the Food and Drug Administration’s (FDA) maximum acetaminophen daily dose of 4000 mg in a twenty-four hour time period. Review of the interdisciplinary team (IDT) note dated 10/22/2021 failed to show education regarding the FDA recommended maximum daily dose of acetaminophen. Observation during a home visit on 11/08/2021 showed: - The Licensed Practical Nurse (LPN) reviewed a patient provided medication list that contained hydrocodone/APAP (acetaminophen) and acetaminophen; - The LPN asked the patient to rate his/her pain on a scale of 0 to 10 and the patient rated his/her pain at a “6”; - The patient told the LPN that he/she gets approximately four hours of pain relief from the hydrocodone/APAP; - The patient told the LPN he/she takes his/her Tylenol in between the hydrocodone/APAP for breakthrough pain; and - The LPN failed to provide education warning the patient to avoid exceeding the maximum daily limit of acetaminophen. During an interview with Patient #1 on 11/08/2021, he/she stated that: -He/she was taking hydrocodone/APAP around the clock for left knee pain and extra strength acetaminophen for breakthrough pain; and -He/she was not aware of the acetaminophen maximum daily dose of 4000 mg. During an interview on 11/09/2021, the administrator stated that he/she would expect education, warning the patient not to exceed 4000 mg a day, to be on the individualized plan of care and he/she would expect the agency’s clinicians to educate the patient during each home visit.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on policy review, record review, and interview, the agency failed to ensure communication with all physicians involved in the plan of care (POC) when there were changes in the current POC in one (Record/Patient #4) of five full record reviews completed. This deficient practice has the potential to affect physician involvement for changes in condition for all the agency's patients. Findings included: Review of the agency's policy titled, "Patient Assessment/Reassessment," last review date of 09/13/2021, showed the patient's physician/allowed practitioner will be notified of changes/updates in the patient's condition included, in part, any changes in the patient's condition or needs indicating outcomes are not being achieved and/or that the plan of care should be altered. RECORD/PATIENT #4: Review of the plan of care dated 10/09/2021 showed the patient was admitted on 10/09/2021 with the admitting diagnoses of COVID 19 and pneumonia (lung infection). Co-morbidities included, but not limited to, urinary tract infection (UTI) and alcohol abuse. Review of the start of care comprehensive assessment dated 10/09/2021, showed the patient lived in the home of his/her sister. The sister was also his/her caregiver. Review of the POC dated 10/09/2021 to 12/07/2021 showed, in part, the following: - Urinary tract infection management: Skilled nurse to provide skilled teaching and self-care management related to UTI to minimize complications and reduce the risk of hospitalization; - Urine specimen test, skilled nurse to collect urine via clean catch for UA/C&S (urine analysis and culture with sensitivity) on 10/12/2021; and - Goals included: patient and caregiver will verbalize/demonstrate understanding of measures to manage altered genitourinary status and care and management of UTI by end of episode, 12/07/2021. Review of the skilled nursing visit notes showed the following: - On the 10/12/2021 visit notes, the LPN documented that the nurse obtained the urine specimen as ordered; - On the 10/20/2021 visit notes, the LPN documented that no problems were identified on the genitourinary assessment and the patient stated that he/she had no burning or frequency with urine. The physician office was called to obtain results of UA taken at last visit (8 days ago). A message was left for the patient to be called with the results; - On the 10/25/2021 (13 days after the UA was obtained) visit note, the LPN documented that no problems were identified on the genitourinary assessment. The patient heard back from the doctor on the UA results. A script was called in for antibiotics and will be picked up that day. The patient was instructed to make sure and complete the antibiotics and the sister reports that the patient starts feeling better and then stops taking the antibiotic. The medication will be added to the medication list on the next nursing visit; and - On the 11/02/2021 visit note, the RN documented that the patient was complaining of burning and pain with urination. The physician office was called to inform them of the urinary complaints and increased alcohol consumption. An order was obtained for a UA/C&S. The specimen was obtained during the visit. The patient's sister informed the RN that the patient was previously prescribed an antibiotic for the UTI but the patient did not pick the medication up from the pharmacy; - The documentation and communication notes failed to show notification to the physician regarding the patient not taking the prescribed antibiotic. During an interview on 11/09/2021 at 2:00 PM, the alternate administrator stated that he/she was unable to find: - An order for the antibiotics called to the pharmacy on 10/25/2021; - Communication showing the physician was contacted regarding the patient not taking the antibiotics; and - He/she would expect follow up when a UA result was obtained sooner than 13 days.