Every finding on record at Attentive Care Service Agency, Inc.

Based on the findings of an onsite unannounced Initial Home Health Agency Medicare certification survey conducted June 5, 2023, through June 6, 2023, Attentive Care Service Agency Inc., was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies - Emergency Preparedness.

Based on the findings of an onsite unannounced Initial Home Health Agency Medicare certification survey conducted June 5, 2023, through June 6, 2023, Attentive Care Service Agency Inc., was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: 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 a review of clinical record (CR) reviews, and an interview with the administrator, the agency failed to reconcile the Medication Record with the current Home Health Certification and Plan of Care/physician orders allowing the potential for medication errors for seven (7) of seven (7) CR's reviewed, (CR #1, 2, 3, 4, 5 6 and 7). Findings include: Interview with the administrator on June 5, 2023, approximately 1:15 pm. Administer stated "She was unaware of the reconcile of the Medication Record with the current Home Health Certification and Plan of Care/physician orders allowing the potential for medication errors". No medication reconciliation policy available. A review of CR's was conducted on June 5, 2023, from approximately 11:15 am to 2:00 pm revealed the following: CR #1, Start of Care: 3/16/2023, Home Health Certification and Plan of Care period reviewed 5/15/2023 through 7/13/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Amlodipine Besylate, Oral 5 mg, take one tablet every day at the same time. Quinapril HCL Oral, 40 mg take one tablet each day the same time each day. CR #2, Start of Care: 3/16/2023. Home Health Certification and Plan of Care period reviewed 5/15/2023 through 7/13/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Acetaminophen, oral 500 mg one tablet Q 6 hours for pain PRN. Ventolin HFA inhalation108 (90Base) MCG/ACT 2 inhale 2 puffs Q 4 hours as needed for shortness of breath. Atorvastatin Calcium, oral 40 mg take one tab Q Day PO at bedtime. Incruse Ellipta Inhalation 62.5mcg/Inh 1 inhale one puff daily. Famotidine oral 20 mg take one tab PO Q 12 hours. Fluticasone-Salmeterol Inhalation 500-50mcg/act 1 diskus Inhale 1puff Q 12 hours PO. Ammonia lactate external 12% 1 ml apply one application topically to affected areas Q 8 hours. Diclofenac Sodium External 3%. Apply 1 grams topically(external) Q 8 hours as needed for pain. Furosemide Oral 20 mg, take 1-tab PO Q other day. Polyethylene Glycol 3350 Oral 17-gram one packet, take one packet PO Q 12 hours as needed for constipation. CR #3, Start of Care: 3/8/2023. Home Health Certification and Plan of Care period reviewed 5/12/2023 through 7/10/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Amlodipine Besylate Oral 5 mg, take one tablet PO 2 times day. Orlistat Oral 120 mg, take 2 capsules PO daily. Metoprolol tartrate oral 100 mg take one tab BID for heart. Amlodipine Besylate Oral 10 mg, take one tablet PO Q Day for blood pressure. Oxycodone HCL Oral 30 mg take one tab PRN Q 6 hours for pain management. CR #4, Start of Care: 3/6/2023. Home Health Certification and Plan of Care period reviewed 3/6/2023 through 5/4/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Albuterol Sulfate inhalation 108 (90 Base) mcg/act 2 puffs Q4 hours for shortness of breath. Aspirin Oral 81 mg, chew1 tab Q Day for heart. Atorvastatin Calcium Oral 40 mg take one-tab Q Day for cholesterol. Metformin HCL Oral 500 mg take one tab BID for diabetes. Mirtazapine Oral 7.5 mg take one tab BID for mood/ anxiety. Multivitamin Oral take one-tab Q Day Naltrexone Intramuscular 380 mg administered monthly by his doctor. Nifedipine ER oral 60 mg take one tab BID for blood pressure CR #5, Start of Care: 3/8/2023, Home Health Certification and Plan of Care period reviewed 3/8/2023 through 5/6/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Amlodipine-Atorvastatin Oral 10 mg take one tablet by mouth daily. Fluticasone-Propionate Nasal 50 mcg/act .50 ml spray into each nostril every day. Tylenol Extra Strength Oral 500 mg take 2 tablets as needed for pain. Atorvastatin Calcium Oral 20 mg take one tab by mouth 2 x daily. Pantoprazole sodium Oral 40 mg take 1 X daily by mouth. Loratadine Oral 10 mg take one tablet by mouth daily. Citalopram Hydrobromide Oral 10 mg take 1 tablet by mouth every day. Senna Oral 8.6 mg take 1 tab by mouth daily as needed. CR #6, Start of Care: 5/22/2023, Home Health Certification and Plan of Care period reviewed 5/12/2023 through 7/10/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Albuterol Sulfate HFA inhalation 108 (90 Base) mcg/act 1 puff inhale by mouth every 6 hours as needed. Atorvastatin Calcium Oral 40 mg take one tab by mouth 1 x day. Dulcolax rectal 10 mg 1 suppository. Insert 1 suppository rectally every 48 hours as needed. Milk of Magnesia Oral 1200 mg/15 ml 30 ml, take 30 ml as needed every 48 hours. Carboxymethylcellulose Sodium ophthalmologic 0.5% instill 1 drop in both eyes 4 times a day. Spiriva Respimat Inhalation 2.5 mcg/act 2 puffs Inhale 2 puffs by mouth 1 x day. Benzocaine Menthol mouth/ throat 15-4 mg take 1 lozenge by mouth every 2 hours as needed. Oxybutynin Chloride Oral 5 mg take 1 tab by mouth twice a day. Fluticasone-Salmeterol Inhalation 500-50mcg/act inhale 1 puff by mouth 2 x day. CR #7, Start of Care: 4/26/2023, Home Health Certification and Plan of Care period reviewed 4/26/2023 through 6/24/2023 did not contain any documentation of a completed medication reconciliation for the following medications. Acetaminophen Oral 325 mg take 2 tablets Q 6 hours as needed for mild or moderate pain. Eliquis Oral 2.5 mg take one tablet PO 2 x day to lower the risk of stroke or blood clot. Hydroxyzine HCL Oral 25 mg take one tablet PO 3 x day as needed for itching. Senna Oral 8.6 mg take1 tablet PO as needed for constipation. Alka-Aid oral 180 -360 mg take 1 tablet PO daily. Linaclotide Oral 290 mcg take one capsule Q Day PO for chronic constipation. Creon Oral 24000-76000 unit 2 caps, take 2 capsules PO 3 x day with meals for enzyme replacement therapy Cholecalciferol Oral 25mcg take one tablet PO Q Day for vitamin D deficiency. Citalopram Hydrobromide Oral 10 mg take 1 tablet PO Q Day for anti-depressant. An interview with the administrator on June 6, 2023, at approximately 1:30 pm confirmed the above findings. .