Every finding on record at Central La Home Health Care, LLC

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

Recertification Survey Abbreviations: mcg-microgram mg-milligram SQ-Subcutaneous QD-daily mls-milliliters PRN-as needed MD-Medical Doctor gm-gram meq-milliequivalent RN-Registered Nurse HCl-Hydrochloride ER-Extended Release LPN-Licensed Practical Nurse PT-Physical Therapy MVI-Multivitamin

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 record review and interview the agency failed to ensure the Patient's Individualized Plan of Care included all medications and treatments for 3 (Patient #1, Patient #7 and Patient #8) of 17 sampled Patients. #1 Review of Patient #1’s Plan of Care dated 01/04/2023 – 03/04/2023 revealed the primary diagnosis was Non-Pressure Chronic Ulcer of Left lower leg and secondary diagnosis of Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. Review of the Plan of Care and Medication List during a home visit on 02/28/2023 revealed the patient received the following medications: Belbuca Buccal 600 mcg 1 film to inside of cheek twice daily. Quetiapine Fumarate 25 mg 1 tab twice daily. Levemir FlexTouch inject 40 units SQ QD. Duloxetine HCL 30 mg 1 twice daily. Generlac 30 mls three times a day. Zinc Oxide External 20%, apply topically to affected are PRN redness. Thiamine HCL 100 mg 1 daily. Metformin HCL 500 mg 1 twice daily. Lasix 20 mg 1 every morning. Gabapentin 300 mg 1 four times daily. Cyanocobalamin Inj. 1000 mcg/ml, 1 ml monthly (receives at MD office). Vitamin D3 1.25 mg 1 daily. Levothyroxine Sodium 150 mcg 1 daily. Escitalopram Oxalate 10 mg 1 daily. Fluconazole 150 mg 1 daily as needed. Nystatin External 100,00 unit/gm use as needed. Januvia 100 mg 1 daily Ergocalciferol 1.25 mg 1 weekly. Multivitamin 1 daily Lactulose 20 gm 1 twice daily. Hydrochlorothiazide 25 mg 1 daily. Klor-Con/EF 20 meq 1 daily. Slow-Mag 71.5 – 119 mg 2 by mouth daily. Humalog SQ 20 units three times a day. Observation during a home visit on 02/28/2023 at 9:30 a.m. accompanied by S6 RN revealed Patient #1 was also taking Acyclovir 800 mg twice daily. Continued review of the medications revealed Patient #1 had stopped taking MVI, Hydrochlorothiazide, Klor-Con/EF, Slow-Mag, and Valacyclovir HCL 1 gm 1 daily. Patient #1 was taking Humalog SQ per sliding scale 200 – 250 = 5 units, 251 – 300 = 10 units, 301 – 350 = 15 units, 351 – 400 units = 20, 401 – 450 = 25 units and greater than 451 = 30 units. Patient #1’s Lisinopril 10 mg 1 daily had been decreased to Lisinopril 5 mg 1 daily, but was not taking. Interview with Patient #1 at the time of observation revealed she had started taking Acyclovir on 02/10/2023 and stopped taking MVI, Hydrochlorothiazide, Klor-Con/EF and Slow-Mag for at least a few months. Patient #1 also stated she had stopped taking her Lisinopril weeks prior and had been placed on a Humalog Insulin per sliding scale for several months now. Interview on 02/28/2023 at 8:51 a.m. with S6 RN revealed Patient #1’s medication list should have been updated to reflect Patient #1 was taking Acyclovir 800 mg 1 twice daily and Humalog Insulin per sliding scale. S6 RN also confirmed Patient #1’s medication list should have been updated to reflect she was no longer taking MVI, Hydrochlorothiazide, Klor-Con/EF, Slow-Mag and Lisinopril but had not been. #7 Review of the record revealed Patient #7 admitted to the agency on 09/06/2021 with diagnoses that included Venous Insufficiency, Lymphedema, Essential Hypertension, Hyperlipidemia, Epilepsy and Allergic Rhinitis. Review of the Plan of Care and Medication List during a home visit on 02/28/2023 revealed the patient received the following medications: Plavix 75mg 1 tablet daily. Aspirin 81mg 1 tablet daily. Phenytoin Sodium Extended oral 300mg 1 capsule daily. Metoprolol Succinate ER 50mg 1 tablet daily. Lisinopril-Hydrochlorothiazide 20-25mg 1 tablet daily. Levothyroxine Sodium 50mcg 1 tablet by mouth every morning. Levocetirizine Dihydrochloride 5mg 1 tablet daily. Fluticasone Propionate Nasal 50mcg shake liquid and use 2 sprays in each nostril every day. Atorvastatin Calcium 20mg 1 tablet at bedtime. Observation during a home visit on 02/28/2023 at 11:30 a.m. accompanied by S3 RN revealed Patient #7 had no Levocetirizine in the home. Interview on 02/28/2023 at 11:32 a.m. with Patient #7 revealed he had not taken Levoceterizine in over two weeks. Patient #7 also stated he took Tylenol 500mg 2 tablets every 8 hours as needed for pain. Interview on 02/28/2023 at 11:40 a.m. with S3 RN revealed Patient #7’s medication list should have been updated to reflect Patient #7 was no longer taking Levoceterizine. S3 RN also confirmed the Tylenol 500mg should have been added to Patient #7’s medication list and had not been. #8 Review of the record revealed Patient #8 admitted to the agency on 11/08/2022 with diagnoses that included Cellulitis of Left Lower Limb, Cellulitis of Right Lower Limb, Essential Hypertension, Localized Edema, Hypothyroidism, Long term (current) use of aspirin, Long term (current) use of anticoagulants, Personal history of Pulmonary Embolism and Anxiety. Review of the Plan of Care and Medication List during a home visit on 02/28/2023 revealed the patient received the following medications: Buspirone HCl 10mg 1 tablet twice a day as needed. Aspirin 81mg 1 tablet daily. Celecoxib 200mg 1 capsule daily. Dicyclomine HCL 20mg 1 tablet twice a day as needed. Eliquis 2.5mg 1 tablet twice a day. Folic Acid 1mg 1 tablet daily. Furosemide 40mg 1 tablet daily as needed. Tylenol extra strength 500mg 2 tablets every 6 hours as needed for pain. Hydralazine HCL 10mg 1 tablet four times a day. Euthyrox 100mcg 1 tablet daily. Potassium Chloride ER 20meq 1 tablet twice a day. Pramipexole Dihydrochloride 0.5mg 1 tablet twice a day. Sildenafil Citrate 20mg 1 tablet three times a day. Simvastatin 40mg 1 tablet at bedtime. Sulfasalazine 500mg 1 tablet twice a day. Tramadol HCL 50mg 1 tablet daily as needed for pain. Lisinopril 10mg 1 tablet daily. Observation during a home visit on 02/28/2023 at 11:30 a.m. accompanied by S5 LPN revealed Patient #8 was also taking Plavix 75mg 1 tablet daily and Omeprazole 20mg 1 capsule daily. Interview with Patient #8 at the time of observation revealed she had started taking Plavix on 01/06/2023 and had been taking Omeprazole daily for about 10 years. Patient #8 also stated she had stopped taking Aspirin in January when her doctor put her on Plavix. Interview on 02/28/2023 at 8:51 a.m. with S5 LPN revealed Patient #8’s medication list should have been updated to reflect Patient #8 was taking Plavix and Omeprazole and had not been. S5 LPN also confirmed Patient #8’s medication list should have been updated to reflect Patient #8 was no longer taking Aspirin and had not been.

Responsibilities of skilled professionals CFR(s): 484.75(b) Standard: Responsibilities of skilled professionals. Skilled professionals must assume responsibility for, but not be restricted to, the following: This STANDARD is not met as evidenced by: Based on interview and record review the agency failed to ensure the RN re-assessed a Patient’s wounds weekly for 1 (Patient #1) out of a total of 17 sampled patients: Findings: Review of Patient #1’s Plan of Care for certification period 01/04/2023 – 03/04/2023 revealed the primary diagnosis was Non-Pressure Chronic Ulcer of Left lower leg and secondary diagnosis of Type 2 Diabetes Mellitus with Diabetic Polyneuropathy. Review of the OASIS recertification Nurses’ note dated 12/30/2022 revealed Patient #1 had an open wound to her left middle shin. Patient #1 had attended the wound care clinic on 12/29/2022 with wound care needing to be performed QOD, therefore, SN did not perform wound care this SNV. Review of Patient #1’s Nurses’ notes dated 01/04/2023, 01/11/2023 and 01/18/2023 revealed the Patient had not been seen by an RN to re-assess the wound. Interview with S1 Administrator on 02/28/2023 at 1:50 p.m. revealed she did not have a policy on the re-assessment of wounds but best practice and what they require is for the Patient’s wounds to be assessed by an RN weekly.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on interview and record review the agency failed to provide service that were ordered by the physician as indicated in the Plan of Care for 1 (Patient #9) of 17 sampled Patients. The agency failed to provide Physical Therapy as ordered by the physician. Findings: Review of the agency policy titled: Physical Therapist, revealed in part……Provides physical therapy services to patients in accordance to a written physician’s plan of care. Review of the record revealed Patient #9 was admitted to the agency on 01/27/2023 with diagnoses that included Aftercare following surgery for neoplasm, Injury of femoral nerve at hip and thigh level; right leg, Type II Diabetes Mellitus, Essential Hypertension, Hyperlipidemia and Anemia. Review of Patient #9’s Plan of Care for certification period 01/27/2023-03/27/2023 revealed in part……PT: 1W1, 3W4. Review of Patient #9’s Physical Therapy visit calendar revealed a missed PT visit on Monday, 02/13/2023. Review of a Missed Visit Form dated 02/13/2023 revealed the reason for the missed PT visit documented as “Other”. Review of the comments for the missed PT visit revealed: PT off and patient had appointments and busy other days. Interview on 03/02/2023 at 12:10 p.m. with S1 Administrator revealed there was no backup PT for the contracted provider servicing Patient #9. S1 Administrator confirmed Patient #9 did not receive PT services in accordance with his Plan of Care for the week of 02/13/2023 and should have.