Every finding on record at Americare Home Health Agency, Inc.

A recertification and Emergency Preparedness survey was conducted on 5/2/2022 – 5/4/2022. No deficiencies were cited during the Emergency Preparedness survey.

A recertification and Emergency Preparedness survey was conducted on 5/2/2022 - 5/4/2022. An entrance conference was held with the Vice-President of Clinical Services. An exit conference was held with the Vice-President of Clinical Services on 5/4/2022, and an opportunity to answer questions was provided. The facility was cited under 484.60 Standard for Plan of Care. No deficiencies were cited during the Emergency Preparedness survey. The facility was also assessed for compliance with the federal vaccine requirements for home health agencies at 484.70(d) Covid 19 Vaccination of Home Health Agency Staff. No deficiencies were cited.

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 policy review, medical record review, observation, and interview, the facility failed to ensure the individualized plan of care was updated to include all current medications for 2 of 3 (Patient #1 and 2) sampled patients with home visits. The findings included: 1. Review of the facility policy, “MEDICATION ADMINISTRATION,” revealed, “…The nurse shall routinely monitor all medications to determine their action, indications, special precautions, and client’s response to therapy, side effects, allergies and contraindications…A medication profile, completed for each client at the time of admission, will be updated as indicated…The profile will include the name of the drug, date ordered, dose, route, frequency, duration of therapy if appropriate, action or effect, side effects, and contraindications…” 2. Medical record review for Patient #1 revealed a start of care date of 1/27/2022 with diagnoses which included Polyosteoarthritis. The plan of care signed on 4/28/2022 for the certification period from 3/28/2022 to 5/26/2022 revealed Patient #1 was to receive occupational therapy services once a week for 9 weeks starting on 3/28/2022. Observations during the home visit for Patient #1 on 5/3/2022 at 9:50 AM revealed the following medication: quetiapine (antipsychotic medication) 25 milligrams (mg) 1 tablet by mouth at bedtime. The medication bottle was dated 9/1/2021. This medication was not listed on the facility’s medication profile for Patient #1. During an interview on 5/3/2022 at 10:25 AM, Family Member #1 stated she gave Patient #1 one tablet of quetiapine 25 mg at bedtime to help her sleep. 3. Medical record review for Patient #2 revealed a start of care date of 2/24/2021 with diagnoses which included Lymphadema. The plan of care signed on 3/25/2022 for the certification period from 2/19/2022 to 4/19/2022 revealed Patient #2 was to receive skilled nursing services once a week for 9 weeks starting on 2/20/2022. The plan of care for the certification period from 4/20/2022 to 6/18/2022 (not signed by the physician) revealed Patient #2 was to receive skilled nursing services once a week for 10 weeks starting on 4/20/2022. The medication profile for Patient #2 listed Jardiance (antidiabetic medication) 25 mg by mouth daily and metoprolol tartrate (antihypertensive medication) 25 mg by mouth twice daily. Observations during the home visit on 5/3/2022 at 12:00 PM revealed the following medications: lisinopril (antihypertensive medication) 2.5 mg 1 tablet daily, dexamethasone (steroid) 4 mg 5 tablets every week, and pomalidomide (medication for multiple myeloma) 4 mg 1 capsule 21 days out of 28. The lisinopril medication bottle was dated 3/28/2022, the dexamethasone medication bottle was dated 4/18/2022, and the pomalidomide medication bottle was dated 3/22/2022. These medications were not listed on the facility’s medication profile for Patient #2. The medications, Jardiance and metoprolol tartrate were not observed during the home visit. During an interview on 5/3/2022 at 12:20 PM, Patient #2 stated her physician stopped the Jardiance and metoprolol tartrate on 3/29/2022. Patient #2 stated she started taking the dexamethasone and pomalidomide on 3/23/2022 and started taking the lisinopril sometime in April 2022. 4. During an interview on 5/4/2022 at 9:00 AM, the Vice President of Clinical Services stated staff should reconcile a patient’s medication with the medication profile on every home visit.