Every finding on record at Amedisys Tennessee, LLC

An Emergency Preparedness Survey was conducted on 5/13/2025-5/15/2025 at Amedisys Home Care Winchester. No deficiencies were cited under 42 CFR 484.102.

A recertification and complaint #94752 survey was conducted on 5/13/2025-5/15/2025 at Amedisys Home Care-Winchester. Deficiencies were cited under 42 CFR Part 484, Requirements for Home Health Agencies.

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 agency policy review, medical record review, Assisted Living Facility (ACLF) record review, and interview the agency failed to reconcile the medication profile for 3 patients (#2, #3 and #4) of 7 patients reviewed with home visits. The findings include: Review of the agency's policy titled, "Monitoring Medications," revised 11/21/2017, revealed "...To provide a process to ensure continuous monitoring of medications in patient’s home...A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments...all nurses will participate in medication review and reconciliation..." Medical record review revealed Patient #2 was admitted to the agency on 4/24/2025 with diagnoses including Osteoporosis, Multiple Rib fractures, and Wedge Compression Fracture T5-T-6. Review of Patient #2’s ACLF Order Summary Report dated 5/14/2025, revealed “...Acetaminophen Tab 325mg (medication for pain or fever) 2 tabs as needed every 6 hours...Docusate Sodium Cap 100mg (medication for constipation) 1 cap every 4-6 hours as needed...Lidocaine 4% topical patch (medication for pain) 1 patch to be applied topically to lower back once daily as needed for pain..." Review of Patient #2’s agency Physician Orders revealed no documentation for the ordered medications. Medical record review revealed Patient #3 was admitted to the agency on 3/10/2025 with diagnoses including Hypertensive Chronic Kidney Disease Stage 3, Weakness, and Age Related Osteoporosis. Review of Patient #3’s ACLF Order Summary Report dated 5/14/2025, revealed "...Acetaminophen Tab 325mg 2 tabs as needed every 6 hours...Docusate Sodium Cap 100mg 1 cap every 4-6 hours as needed...Geri-Lanta (medication for heartburn or indigestion) 30ml every 6 hours as needed..." Review of Patient #3’s agency Physician Orders revealed no documentation for the ordered medications. Medical record review revealed Patient #4 was admitted to the agency on 4/30/2025 with diagnoses including Displaced Fracture of the Base of Neck of Left Femur, Essential Hypertension, and Unspecified Severe Protein-Calorie Malnutrition. Review of Patient #4’s ACLF Order Summary Report dated 5/14/2025, revealed "...Acetaminophen Tab 325mg 2 tabs as needed every 6 hours... Docusate Sodium Cap 100mg 1 cap every 4-6 hours as needed... Hydrocortisone Cream 1% (topical medication for itching) to be applied as needed for itching. Review of Patient #4’s agency Physician Orders revealed no documentation for the ordered medications. During an interview on 5/14/2025 at 1;15PM, the Director of Operations confirmed Patients #2, #3, and #4’s medication profile had not been reconciled with the ACLF medication profile.

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 medical record review and interview, the agency failed to follow physician's orders for 1 patient (#13) of 17 patients reviewed. The findings include: Review of the agency's policy titled, "Physician Orders and Medical Supervision of the Plan of Care," revised 11/4/2024, revealed "...Each patient receives the home health services that are written in an individualized plan of care...” Review of the agency's policy titled, "Management of Diabetic," revised 3/5/2024, revealed "...Perform blood glucose monitoring according to Physician orders...instruct the patient/caregiver to: follow ordered diet, medication, and activity plans...” Medical record review revealed Patient #13 was admitted to the agency on 1/24/2025 with diagnoses including Type 2 Diabetes Mellitus, Chronic Kidney Disease, and Congestive Heart Failure. Medical record review of the Home Health Certification and Plan of Care dated 1/24/2025-3/24/2025 revealed the physician had ordered the skilled nurse to provide instructions and reinforcement for diabetic care to include monitor blood sugar logs for blood sugar readings that are being checked by the patient daily. Blood sugar parameters are 60-350 and should be reported to the physician when out of range. Nurse to perform finger stick blood glucose as needed. Medical record review of skilled nurse's notes dated 1/24/2025, 1/27/2025, 1/31/2025 revealed the skilled nurse had not assessed, provided instruction/reinforcement to Patient #13 regarding blood glucose monitoring. During an interview on 5/15/2025 at 1:15 PM, the Director of Operations confirmed the skilled nurse had not monitored Patient #13’s blood glucose 1/24/2025, 1/27/2025, 1/31/2025 as ordered by the physician. Further interview confirmed the agency failed to follow physician orders.

An Emergency Preparedness survey was conducted from 2/22/2022 to 2/24/2022 at Amedisys Homecare. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

A Recertification survey was conducted on 2/22/2022 to 2/24/2022 at Amedisys Home Care. Deficiencies were cited under CFR Part 484, Requirements for Homecare Organizations Providing Home Health Care.

Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to provide education regarding injections for 1 patient (#12) of 1 patient who received injections. The findings include: Medical record review revealed Patient #12 was admitted to the agency on 1/28/2022 with diagnoses including Malignant Neoplasm of Prostate and Acute Embolism and Thrombosis of Deep Veins of Left Lower Extremity. Medical record review of the Home Health Certification and Plan of Care dated 1/28/2022 to 3/28/2022 revealed a physician's order for Lovenox (used to prevent blood clots) 40 milligrams (mg)/0.4 milliliter (ml) subcutaneous (Sub Q) injection daily. Further review revealed "...Skilled nurse for administration of Lovenox via Sub Q injection as directed by prescription if pt (patient) is unable to inject self and requests help..." Medical record review of a skilled nurse's note dated 1/28/2022 revealed "...Management of Injectable Medications...Unable to take injectable medication unless administered by another person..." Further review revealed "...Skilled nurse administered Lovenox injection for pt due to him not feeling very comfortable administering it himself..." Medical record review of a skilled nurse note revealed the skilled nurse attempted a visit on 2/4/2022 and was unable to provide the visit. Medical record review of a skilled nurse note dated 2/9/2022 revealed the Lovenox was discontinued on 2/8/2022. No documentation the patient was able to administer the Lovenox from 1/29/2022 to 2/8/2022. Medical record review of a physician's order dated 2/9/2022 revealed the Lovenox was discontinued on 2/8/2022. Interview with the Director of Operations on 2/23/2022 at 2:30 PM confirmed no documentation the patient or caregiver was instructed on Lovenox injection.