Every finding on record at Amedisys New Jersey LLC

The facility is in compliance with Appendix Z-Emergency Preparedness for All Provider and Supplier Types, Interpretive Guidance 484.22, Conditions of Participation for Home Health Agencies for this survey.

This was a Federal Recertification and State Re-licensure survey conducted at Amedisys Home Health on 9/26-28/2023, to determine compliance with 42 CFR Part 484 - Conditions of Participation for Home Health Agencies; and State requirements under Title 8, Chapter 42 - Home Health Agency Licensing Standards. Standard-level deficiencies were cited.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on observation during one of three home visits (Patient (P) 2), medical record review, and review of facility policy and procedure, it was determined that the facility failed to ensure all patients participate in their pain assessment through the self-rating of pain in accordance with facility policy. Findings include: Facility policy titled, "Pain Assessment and Management" (last review date 3/7/23) states, "...Pain Management and Quality Indicators 1. On a scale of one to ten or other measurable scale, record the patient's rating of their pain. …Document in the clinical record: General status of patient including...self-rating of the pain. …" On 9/26/23 at 2:57 PM, during a home visit for P2, Staff (S)9 (Occupational Therapist) was observed instructing the patient to perform exercises. P2 reported left shoulder pain and stated, "Ouch." P2 continued to perform the exercises in the presence of S9, and S9 asked questions regarding P2's medications. While moving his/her arm, P2 stated, "It's cracking here. And the pain is going down to the elbows." S9 stated that he/she would inquire into the patient's recent orthopedic visit. S9 did not assess the patient's pain P2 to provide a self-rating of pain at the time of the visit, or the minimum or maximum amount of pain in the last five days, during the visit. On 9/28/23 at 9:15 AM, during a review of P2's medical record, the "Visit Note Report" documented by S9 revealed the following: "Vital Signs...Pain 0...Assessment...Pain...Indicate pain scale for patient ratings: Scale: 0-10 Indicate minimum amount of pain the patient has had in the last 5 days: 2 Indicate maximum amount of pain the patient has had in the last 5 days: 3...." The above findings were confirmed with S1 (Executive Director of Operations) at 12:20 PM. N.J.A.C. 8:43E-6.4(b)

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on the review of three out of 17 medical records (Patient (P) 5, 8, and 9), and staff interview it was determined the facility failed to ensure that all services ordered by the physician are provided in accordance with the plan of care. A review pf P8’s Plan of Care, for the Certification Period 9/6/23 through 11/4/23, indicated the following orders for social worker visits: “MSW [Medical Social Worker] Effective 09/10/2023 1WK1 [one visit each week for one week]” P8’s medical record lacked evidence that a social worker visit was conducted. P8’s medical record lacked evidence of communication to the physician, or of an explanation of the missed visit. This missed visit was confirmed by Staff (S)1 on 9/28/23 at 1:58 PM. Findings include: Facility document titled, "Section 7 - Scheduling", revised date 9/13/23, states, "...Missed Visits All missed visits must be communicated to the physician...Visits - Touchpoints. Standard of Practice for Missed Visits. Touchpoints Missed - Any touchpoint missed must be explained in the patient record. [Facility name] standard of practice is that missed touchpoints should be rare, for patient related reasons only, and must be explained in the patient record. …" On 9/28/23, a review of Patient (P)5’s Plan of Care, for the Certification Period 8/25/2023 through 10/23/2023, indicated the following orders for home health aide visits: “HHA [Home Health Aide] Effective 8/27/23 1WK3 [one visit each week for three weeks]." For the week of 9/10/23, P5’s medical record lacked evidence that a home health aide visit was conducted. P5’s medical record lacked evidence of communication to the physician, or of an explanation of the missed visit. A review of P9’s Plan of Care, for the Certification Period 8/15/2023 through 10/13/2023, indicated the following orders for skilled nursing visits: “SN [Skilled Nurse] 2WK1 [two visits each week for one week], 1WK2 [one visit each week for two weeks] 8/28/23 - SN [Skilled Nurse] 2WK1 [two visits each week for one week], 1WK4 [one visit each week for four weeks.]" For the week of 9/17/23, P9’s medical record lacked evidence that a skilled nursing visit was conducted. P9’s medical record lacked evidence of communication to the physician, or of an explanation of the missed visit. The above findings were confirmed by S1 at 12:20 PM. N.J.A.C. 8:42-6.2(a)(6)

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 observation during home visits of four of four patients (Patient (P)2, P4, P6, and P7), staff interview, and facility policy and procedure, it was determined the facility failed to ensure that 1.) re-useable equipment is decontaminated after each use; 2.) re-usable equipment is cleaned in accordance with manufacturer’s instructions. Findings include: Facility policy "Decontamination of Re-usable Equipment", last review date 6/20/23, states, "...Procedure: …3. 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. …" On 9/26/23 at 2:33 AM, during a home visit of Patient (P)2, Staff (S)9 was observed entering the patient's home while carrying a tablet in his/her hands. At 3:10 PM, at the conclusion of the visit, S9 provided the tablet to P2, and the patient used his/her finger to sign the tablet. S9 tucked the tablet under his/her arm, provided hand sanitizer to P2, and then sanitized his/her own hands. S9 then placed the tablet inside his/her supply bag. The tablet was not cleaned following contact with the patient and before placing it back into the bag. N.J.A.C. 8:42-12.2(b)(6) Facility policy and procedure titled, “Hand Hygiene” (reviewed 6/20/23), stated “…GUIDELINES: …4. Perform hand hygiene as follows: a. Before having direct contact with patients. b. Before donning gloves. …d. After contact with a patient’s intact skin. …g. After contact with inanimate objects (e.g., medical equipment) in the immediate vicinity of the patient. …” On 9/26/23 at 2:11 PM, during a home visit of P4, S5 (Physical Therapist) was observed taking the tablet out of his/her bag and using it to document the patients’ vital signs throughout the visit. At 2:54 PM, at the conclusion of the visit, S5 provided P4 with hand sanitizer and then provided the tablet to P4, and the patient used his/her finger to sign the tablet. S5 then placed the tablet in his/her supply bag. The tablet was not cleaned following contact with the patient and before placing it back into the bag. On 9/27/23 at 12:20 PM, during a home visit of P6, S6 (Registered Nurse) was observed taking the tablet out of his/her bag and using it to document during the patient’s treatment session. At 12:50 PM, at the conclusion of the visit, S6 provided the tablet to P6, and the patient used his/her finger to sign the tablet. S6 then carrier the tablet out of the patients home. The tablet was not cleaned following contact with the patient. On 9/28/23 at 10:20 AM, during a home visit of P7, S10 (Registered Nurse) was observed taking the tablet out of his/her bag and using it to document during the patient’s treatment session. At 10:37 AM, at the conclusion of the visit, S10 provided the tablet to P7, and the patient used his/her finger to sign the tablet. S10 then placed the tablet into a bag and proceeded to clean the outside of the bag. The tablet was not cleaned following contact with the patient. At 10:42 AM, S10 was asked how often the tablet should be cleaned and S10 stated “the tablet should be cleaned after every visit”. 2. On 9/26/23 at 2:11 PM, during a home visit of P4, S5 (Physical Therapist) was observed using a blood pressure cuff, thermometer, and pulse ox on P4 during the visit. When S5 was finished with the items, he/she cleaned them using a Sani cloth wipe and immediately placed the items back into his/her supply bag. S5 did not allow the items to dry prior to placing them back into his/her bag. At 3:00 PM during interview with S5, he/she indicated he/she was unsure of the appropriate dry time. On 9/27/23 at 12:20 PM, during a home visit of P6, S6 (Registered Nurse) was observed using a blood pressure cuff, thermometer, and pulse ox on P6 during the visit. When S6 was finished with the items, he/she cleaned them using a Sani cloth wipe and immediately placed the items back into his/her supply bag. S6 did not allow the items to dry prior to placing them back into his/her bag. 3. On 9/26/23 at 2:11 PM, during a home visit of P4, S5 (Physical Therapist) was observed donning gloves. S5 then proceeded to take P4’s vital signs and then clean the equipment that was used. S5 did not change his/her gloves after cleaning the equipment and then conducted P4’s physical therapy visit, at times touching P4 to assist with exercises. S5 then reviewed P4’s medications and went over discharge paperwork with P4, while still wearing the same gloves. At 2:54 PM, at the conclusion of the visit, S5 took out the tablet and P4 signed with his/her finger. S5 then removed his/her gloves and used hand sanitizer. S5 wore the same gloves throughout P4’s entire home visit.

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by:

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by:

This was a Federal Complaint Survey conducted on September 14, 2021. Amedisys Home Health is not in compliance with 42 CFR Part 484, Conditions of Participation for Home Health Agencies for this complaint (NJ00147454).

Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This ELEMENT is not met as evidenced by: Based on staff interview, review of three (3) of three (3) medical records (#1, #2, #3), and review of facility documents, it was determined the facility failed to ensure that patients participate in establishing their plan of care. Reference: Facility policy titled, Plan of Care (POC)/Care Planning Process states, “… The patient has the right to Participate in… establishing and revising the plan of care… .” 1. Upon review of Medical Record #1, Medical Record #2, and Medical Record #3 the following was indicated: a. There was no evidence that the Plan of Care was discussed with Patient #1, Patient #2, or Patient #3. 2. The above findings were confirmed with Staff #1 on 9/14/21 at 2:00 PM.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on staff interview, review of one (1) of three (3) medical records (#2), and review of facility documents, it was determined the facility failed to ensure that patient care services are provided in accordance with the plan of care. Findings include: Reference #1: Facility policy titled, Plan of Care (POC)/Care Planning Process states, “… Services are provided under a Plan of Care established and approved by a Physician… .” Reference #2: Facility document titled, Home Health Office Ops Manual (Section 7 – Scheduling) states, “… Missed Visit – Home Health Aide… The missed visit note is faxed to the MD (Medical Doctor)… .” 1. Upon review of Medical Record #2, the following was indicated: a. The Home Health Aide visit frequency orders beginning 7/18/21 states, “1wk1 (one visit a week for one week), 2wk1 (two visits a week for one week).” i. For the week of 7/18/21 to 7/24/21, there was no evidence of a home health aide visit. There was no evidence that the physician was notified of the missed visit. ii. For the week of 7/25/21 to 7/31/21, one (1) home health aide visit was made. There was no evidence that an additional home health aide visit was made. There was no evidence the physician was notified of the missed visit. 2. The above findings were confirmed with Staff #1 on 9/14/21 at 2:00 PM.