Every finding on record at Central Home Health, LLC

The entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey

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 observation, record review, and interview, the agency failed to ensure the patient had an accurate medication reconciliation for 1 (Patient #4) of 4 (Patient #1, Patient #2, Patient #3, and Patient #4) sampled patients observed during home visits for accurate medication reconciliation. Findings: Review of Patient #4’s Medication Profile revealed, in part, Atorvastatin Calcium (medication used to treat high cholesterol) 40 milligrams (mg) one tablet by mouth daily with a start date of 08/03/2023. Review of Patient #4’s Referral dated 09/13/2023 revealed medication of in part, Atorvastatin Calcium 80 mg one tablet by mouth daily. Observation on 10/18/2023 at 9:00 a.m. during Patient #4’s home visit revealed, in part, Atorvastatin Calcium 80 mg one tablet by mouth daily. Observation of the medication bottle revealed a note for the new dose of 80 mg to replace the 40 mg tablets. Further review revealed the filled date on the bottle was 08/25/2023. In an interview on 10/18/2023 at 3:30 p.m., S1Administrator/Director of Nursing (DON) stated the agency had no further documentation to present regarding the above named medication. S1Administrator/DON further stated the field staff should have be reviewed the medication list against physician orders, and the bottle in the home every visit and reconciled when medications changed.

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 record review and interview the agency failed to indiviaulize a plan of care to ensure: 1. Patients without a diagnosis which required blood glucose monitoring had individualized care plans for 4 (Patient #1, Patient #3, Patient #4, and Patient #6) of 10 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, and Patient #10) sampled patients reviewed for comprehensive plans of care; and, 2. Patients without a diagnosis of congestive heart failure (CHF) or a diagnosis which required monitoring for weight gain had individualized care plans for 2 (Patient #1 and Patient #6) of 10 (Patient #1, Patient #2, Patient #3, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, and Patient #10) sampled patients reviewed for comprehensive plans of care. Findings: Patient #1 Review of Patient #1’s Home Health Certification and Plan of Care dated 08/03/2023 to 10/01/2023 revealed, in part, the skilled nurse was to report: fasting blood glucose greater than 250 or less than 60; random blood glucose greater than 200 or less than 60; and weight greater than 181 pounds or less than 171 pounds. Review of Patient #1’s Home Health Certification and Plan of Care dated 10/02/2023 to 11/20/2023 revealed, in part, the skilled nurse was to report: fasting blood glucose greater than 250 or less than 60; random blood glucose greater than 200 or less than 60; and weight greater than 195 pounds or less than 185 pounds. Review of Patient #1’s record revealed no documented evidence and the provider presented no documented evidence of Patient #1’s blood glucose nor weight having been assessed by the nurse. Further review of Patient #1’s record revealed no documented evidence of any diagnoses of medication which would warrant a need for Patient #1’s blood glucose or weight to be monitored. Patient #3 Review of Patient #3’s Home Health Certification and Plan of Care dated 09/01/2023 to 10/30/2023 revealed, in part, the skilled nurse was to report: fasting blood glucose greater than 200 or less than 60; random blood glucose greater than 250 or less than 60. Review of Patient #3’s record revealed no documented evidence and the provider presented no documented evidence of Patient #3’s blood glucose having been assessed by the nurse. Further review of Patient #3’s record revealed no documented evidence of any diagnoses of medication which would warrant a need for Patient #3’s blood glucose to be monitored. Patient #4 Review of Patient #4’s Home Health Certification and Plan of Care dated 09/14/2023 to 11/12/2023 revealed, in part, the skilled nurse was to report: fasting blood glucose greater than 200 or less than 60; random blood glucose greater than 250 or less than 60. Review of Patient #4’s record revealed no documented evidence and the provider presented no documented evidence of Patient #4’s blood glucose having been assessed by the nurse. Further review of Patient #4’s record revealed no documented evidence of any diagnoses of medication which would warrant a need for Patient #4’s blood glucose to be monitored. Patient #6 Review of Patient #6’s Home Health Certification and Plan of Care dated 09/08/2023 to 11/06/2023 revealed, in part, the skilled nurse was to report: fasting blood glucose greater than 200 or less than 60; random blood glucose greater than 250 or less than 60; and weight greater than 115 pounds or less than 100 pounds. Review of Patient #6’s record revealed no documented evidence and the provider presented no documented evidence of Patient #6’s blood glucose having been assessed by the nurse nor consistent assessment of Patient #6’s weight. Further review of Patient #1’s record revealed no documented evidence of any diagnoses of medication which would warrant a need for Patient #1’s blood glucose or weight to be monitored. In an interview on 10/19/2023 at 3:40 p.m., S1Administrator/Director of Nursing (DON) stated the above mentioned patients Home Health Certifications and Plans of Cares should have been individualized for each patient and should not have included regular monitoring of blood glucose levels for non-diabetics nor should routine weight assessment be included for patients without heart issues.

Infection control CFR(s): 484.70(b)(1)(2) Standard: Control. The HHA must maintain a coordinated agency-wide program for the surveillance, identification, prevention, control, and investigation of infectious and communicable diseases that is an integral part of the HHA's quality assessment and performance improvement (QAPI) program. The infection control program must include: (1) A method for identifying infectious and communicable disease problems; and (2) A plan for the appropriate actions that are expected to result in improvement and disease prevention. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to ensure all patient infections were included in the agency’s infection surveillance monitoring to identify trends of infections for 3 (Patient #1, Patient #5, and Patient #9) of 4 (Patient #1, Patient #5, Patient #9, and Patient #10) sampled patients which were identified as having infections while receiving care from the agency. Findings: Patient #1 Review of Patient #1’s record revealed Patient #1 was prescribed sulfamethoxazole-Trimethoprim (antibiotic/medication used to treat infections) 400/80 milligrams (mg) one tablet by mouth twice a day for 10 days with a start date of 09/22/2022 and discontinue date of 10/02/2022. Further review revealed Patient #1 was prescribed sulfamethoxazole-Trimethoprim 400/80 mg one tablet by mouth twice a day with a start date of 12/05/2022 and discontinue date of 05/30/2023. Review of the agency’s Infection Control Log for the 3rd quarter for the year of 2022 revealed no documented evidence and the agency presented no documented evidence that the agency had tracked and trended Patient #1’s above mentioned 09/22/2022 infection. Review of the agency’s Infection Control Log for the 4th quarter for the year of 2022 revealed no documented evidence and the agency presented no documented evidence of the agency had tracked and trended Patient #1’s above mentioned 12/05/2022 infection. Patient #5 Review of Patient #5’s record revealed Patient #5 was prescribed Ciprofloxacin (antibiotic/medication used to treat infections) Hydrochloride (HCL) 250 mg one tablet by mouth twice a day for three days with a start date of 04/01/2022 and to discontinue on 04/06/2022. Review of the agency’s Infection Control Log for the 3rd quarter for the year of 2022 revealed no documented evidence and the agency presented no documented evidence of the agency had tracked and trended Patient #5’s above mentioned 04/01/2022 infection. Patient #9 Review of Patient #9’s record revealed Patient #9 was prescribed Ciprofloxacin 500 mg one tablet by mouth twice a day for 7 days with a start date of 03/20/2023 and to discontinue on 03/27/2023. Review of the agency’s Infection Control Log for the 1st quarter for the year of 2023 revealed no documented evidence and the agency presented no documented evidence of the agency had tracked and trended Patient #9’s above mentioned 03/20/2023 infection. In an interview on 10/18/2023 at 4:34 p.m., S4Registered Nurse (RN) stated when a patient had a sign or symptom of infection or new antibiotics/infection was identified, the field staff were to report the infection to her and complete an infection control report. S4RN stated once she was notified she would include the information on the infection control log and review for trends and potential issues that would need to be addressed. S4RN confirmed the above mentioned patient infections were not captured on the infection control log, and the agency had an issue with field staff completing the infection control reports and notifying the agency.