Every finding on record at Amedisys Sc, LLC

An onsite unannounced Emergency Preparedness Survey and a survey for the Medicare COVID - 19 Staff Vaccination requirements were conducted at Amedisys Home Health of Lexington from 01/30/23 to 02/02/23. The Home Health Agency is in compliance with the Condition at 42 CFR 484.102 (Establishment of the Emergency Program). Amedisys Home Health of Lexington is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 82 staff members fully vaccinated, 63 religious exemptions, and 2 medical exemptions approved.

An onsite unannounced Recertification Survey was conducted at Amedysis Home Health of Lexington from 01/30/23 to 02/02/23. The facility is in substantial compliance with the Conditions for Coverage (CFC) at 42 CFR PART 484. Current census is 2,115. Amedysis Home Health of Lexington had standard level deficiencies.

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 patient chart reviews and interview, the home health agency's staff failed to ensure accurate data was documented when updating the patients Plan of Care (POC) for 2 of 17 patient charts. (Patient #1 and Patient #4) The findings include: On 2/01/2023 at 1:53 PM, review of Patient #1's chart showed the patient was admitted on 10/21/2022. Review of the documentation for the Episode starting 12/20/2022 revealed physician orders for a “suprapubic catheter size 18 French indwelling catheter, instill 10 cc (cubic centimeters) of saline into balloon…change monthly and as needed”. Review of the Skilled Nursing (SN) note dated 12/30/2022 revealed Patient #1 had a size 22 French suprapubic catheter in place. Review of the SN note dated 1/06/2023 revealed documentation that the patient's suprapubic catheter was changed on 01/06/2023 with a “22 French 10 bulb”. Review of the SN note dated 1/12/2023 revealed the patient had a 16 French suprapubic catheter in place. On 2/01/2023 at 2:45 PM, Skilled Nurse (SN) #5 reported the documentation was “inconsistent and verified the finding. On 1/31/2023 at 2:38 PM review of Patient #4's chart revealed the patient was admitted on 11/30/2022 with physician orders for "Aftercare Following Surgery For Neoplasm. Orders for Skilled Nurse To Perform/Teach Incision Care To Right Lateral Chest Wall Keep Clean And Dry Leave Ota (open to air) Unless Drainage Appears and DME (Durable Medical Equipment" and Supplies: Dressing Antimicrobial And Silver; Dressing Gauze; General Supply; Skin Care; Wound Cleanser. Review of the documentation for the patient's episode starting 1/29/2023 revealed "Orders for DME and Supplies: Dressing Antimicrobial And Silver; Dressing Gauze; General Supply; Skin Care; Wound Cleanser." Patient’s surgical incisions are closed." On 2/02/2023 at 8:58 AM, the Director/Administrator reported “Orders for silver dressings must be a mistake, put in the wrong place…should have been updated with new POC (plan of care)”, and verified the finding.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on patient chart reviews and interview, the home health staff failed to perform a cognitive and psychosocial assessment at the patient's Start of Care (SOC) for 1 of 17 patient charts reviewed. (Patient #1) The finding includes: On 2/01/2023 at 1:53 PM, review of Patient #1's chart revealed the patient was admitted on 10/21/2022, but there was no documentation of a cognitive/psychosocial assessment completed. On 2/01/2023 at 2:45 PM, Registered Nurse (RN) #5 verified the finding and reported, “Should have been done”.

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 patient chart reviews, interview, and review of the home health agency's policies, the home health agency staff failed to follow physician orders regarding weights, urinary catheter size, discipline schedules, and wound measurements for 8 of 17 patient charts. (Patient #1, #3, #6, #7, #8, #13, #14 and #17) On 1/31/2023 at 4:15 PM a record review was conducted on Patient # 13. Physician verbal orders dated 12/16/2022 10:36 PM called for a Speech Therapist (ST) to visit the patient twice in weeks 1-5. The agency Start of Care (SOC) documents the SOC as 12/19/2022. As the agency begins the week on Sunday, the ST did not visit the patient until week 2. On 2/1/2023 at 4:00 PM during an interview the Director, he/she confirmed that the patient was not seen until week 2. On 1/31/2023 at 12:15 PM a record review on Patient # 14. Physician orders for Physical Therapy (PT) dated 12/28/2022 1:44PM read "PT effective 1/1/2023 2Wk1, 1Wk5", then a second over riding order dated 12/30/2022 4:31 PM for "PT effective 1/1/2023 1Wk1" The PT visited patient # 14 on 1/5/2023 per orders, but also visited on 1/12/2023, 1/18/2023 and 1/27/2023. On 2/1/2023 at 2:28 PM Manager #14 confirmed that the orders should have been clarified. Patient #3 On 02/01/23, Patient #3’s record was reviewed with Skilled Nurse #7 (SN #7). Patient #3 was admitted to the home health agency on 12/02/22 with diagnoses including stage III (three) pressure ulcer (a wound with full thickness skin loss involving damage or death of the tissue under the skin that may extend down to, but not through, underlying connective tissue). The physician’s orders dated 12/02/22 indicated, “…PT (patient) GOAL…WOUND STATUS WILL IMPROVE AS EVIDENCED BY A DECREASE IN SIZE…” In a concurrent interview with SN #7, he/she confirmed there was no documented evidence of wound measurements for nursing visits on 01/01/23, 01/08/23, 01/15/23, and 01/22/23. When asked how often the nurse should have measured Patient #3’s wounds, he/she stated, "every time" wound care was provided. Patient #8 On 02/01/23, Patient #8’s record was reviewed with the Administrator. Patient #8’s record indicated she/he was admitted to the home health agency on 09/30/22 with diagnoses including congestive heart failure (a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues). The physicians orders dated 12/22/22 indicated, “…HEART FAILURE…SKILLED NURSE TO ASSESS CARDIOPULMONARY SYSTEM TO IDENTIFY SIGNS OF DCOMPENSATION AND INTERVENE TO MINIMIZE THE SEVERITY OF FLUID OVERLOAD…RECORD PATIENT REPORTED WEIGHT, OR WEIGH AS NEEDED…REPORT INCREASED EDEMA (swelling) OR WEIGHT GAIN OF > (greater than) 2 LBS (pounds) IN ONE DAY OR > 5 LBS IN 1 WEEK OR 5 LBS OR MORE OVER TARGET WEIGHT…” Patient #8’s record revealed there were no weights recorded for nursing visits on 10/04/22, 10/10/22, 10/27/22 and 11/03/22. In a concurrent interview with the Administrator, she/he confirmed there was no documented evidence the nurse monitored Patient #8’s weight during nursing visits on 10/04/22, 10/10/22, 10/27/22 and 11/03/22. The Administrator confirmed Patient #8’s weight should have been monitored and recorded on every nursing visit. The Findings include: Patient #1 Chart review on 2/01/2023 at 1:53PM reveals Patient #1 admitted 10/21/2022. Episode starting 12/20/2022 reveals orders for “suprapubic catheter size 18 French indwelling catheter, instill 10 cc of saline into balloon…change monthly and as needed”. Skilled Nursing (SN) note on 12/30/2022 reports patient has a 22 French suprapubic catheter in place. SN note on 1/06/2023 reports reinserted on this date with a “22 French 10 bulb”. SN note on 1/12/2023 reports patient has a 16 French suprapubic catheter in place. Episode starting 12/20/2022 indicates orders for Physical Therapy (PT) 1 visit every week for 6 weeks starting 12/25/2022 and Occupational Therapy (OT) visits 1 visit every week for 9 weeks starting 12/20/2022. There are no documented visits by PT or OT the week on 12/25/2022. Interview on 2/01/2023 at 2:45 PM, Skilled Nurse (SN) #5 reports “staff not paying attention” and verifies the finding. Patient #6 Chart review on 1/31/2023 at 1:30 PM reveals Patient #6 admitted 12/15/2022 with orders RECORD PATIENT REPORTED WEIGHT, OR WEIGH PATIENT AS NEEDED. REPORT INCREASED EDEMA OR WEIGHT GAIN OF >2 LBS IN 1 DAY OR >5 LBS IN 1 WEEK OR 5 LBS OR MORE OVER TARGET WEIGHT”. SN visits on 12/19/2022 and 1/12/2023 have no documentation for weight. SN visit note on 1/15/2023 report weight of 189.5 pounds. SN visit note on 1/24/2023 reports weight of 195.5 pounds, a weight gain of 6 pounds in 6 days. SN visit note for 1/24/2023 reports “Patient has had a 4 lb gain since last week” and no documentation that the physician was notified as ordered. Patient #7 Chart review on 2/01/2023 at 1:35 PM reveals Patient #7 admitted on 10/06/2022. Consent is not signed by the patient or any of the caregivers on file. Consent also documents “IS SOMEONE OTHER THAN THE PATIENT SIGNING CONSENT FOR PATIENT, “NO”. Interview on 2/01/2023 at 2:55 PM with SN #7 reports “I don’t know who that is either” and verifies the finding. When this surveyor asked SN #7 about policy concerning consents, SN #7 did not have an answer. Patient #17 Chart review on 2/01/2023 at 2:35 PM reveals, Patient #17 admitted 10/20/2022 with orders “RECORD PATIENT REPORTED WEIGHT, OR WEIGH PATIENT AS NEEDED. REPORT INCREASED EDEMA OR WEIGHT GAIN OF >2 LBS IN 1 DAY OR >5 LBS IN 1 WEEK OR 5 LBS OR MORE OVER TARGET WEIGHT”. SN visits were documented on 10/27/2022, 11/01/2022, 11/09/2022, 11/17/2022, 11/22/2022, 12/02/2022 and 12/13/2022. There are no weights documented in these notes. Interview on 2/02/2023 at 3:01 PM, SN #6 reports “weren’t done” and verifies the findings.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on record reviews and interview, the home health agency failed to ensure services were provided based on physician orders for one of seventeen patient records reviewed for care and services. (Patient #3) The findings are: On 02/01/23 at 2:00 PM, review of Patient #3’s record with Skilled Nurse #7 (SN #7) revealed the patient was admitted to the home health agency on 12/02/22 with diagnoses including right sided hemiplegia (paralysis of one side of the body) following cerebral infarction (a stroke in which the blood supply to the brain is impaired). Documentation showed a Speech Therapist (ST) evaluated the patient on 12/22/22 with four additional ST visits on 12/29/22, 01/05/23, 01/11/23 and 01/16/23. There was no documented evidence of physician orders for the four additional ST visits. In a concurrent interview with SN #7, when asked if there were physician orders for the four additional ST visits, SN #7 stated, "No." SN #7 confirmed there should have been orders for the four additional ST visits.