Every finding on record at Compassus Ohiohealth Columbus HHA LLC

Substantial Allegation Survey Extended Survey Substantial Allegation 96999 and 94731 An entrance conference was conducted on 04/24/23 with administrative staff, and an exit conference was conducted on 05/02/23 with administrative staff. The following deficiencies are based upon the substantial allegation 96999 completed on 05/02/23. OhioHealth Home Health, 367615, is not in compliance with the requirements found at 42 CFR Part 484, Subpart B, C. No deficiencies were cited related to substantial allegation 94731. OhioHealth Home Health 367615 is precluded from offering its own aide training and/or competency evaluation program for a period of two years from the exit date of this survey.

Skilled professional services CFR(s): 484.75 Condition of participation: Skilled professional services. Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in §409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in §409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care. This CONDITION is not met as evidenced by: Based on medical record review, staff interview and review of agency guidelines, the agency failed to ensure skilled professionals provided services that were ordered by the physician or where part of routine skilled assessments (G710) The cumulative effect of this systemic practice resulted in the agency's inability to ensure that the patients' skilled needs would be met.

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 medical record review, staff interview, review of the agency’s guidelines on wound care, and review of agency guidelines for clinical parameters, the agency failed to follow their guidelines to ensure wounds were assessed at each visit, failed to ensure patients were sufficiently trained in providing their own wound care when nurses were unavailable, failed to record vital signs, failed to address vital signs outside of parameters with the physician, failed to assess patient’s pain level, and failed to follow physician orders for skilled nursing visits. This affected nine (Patient #2, Patient #4, Patient #5, Patient #6, Patient #7, Patient #8, Patient #9, Patient #10, Patient #12) of 12 patients who were reviewed for wound care. Review of a document provided by the agency titled "Clinical Guideline Standard Clinical Parameters," last reviewed 05/22, revealed the following parameters would be followed by the agency unless the physician ordered patient specific parameters. The clinical parameters for vital signs were systolic low blood pressure (BP) of 100 millimeters of mercury (mmHg) and systolic high BP of 150 mmHg. The clinical parameters for diastolic BP were low of 60 mmHg and a high of 90 mmHg. The clinical parameters to report for heart rate was a heart rate less than 50 beats per minute or higher than 115 beats per minute. The clinical parameter for temperature was for high temperature of 101 degrees Fahrenheit (F) or temperature of 95 F or lower. The guideline further revealed it was mandatory for a pain scale to be used for home health patients. Review of a document provided by the agency titled "Clinical Guideline Standards for Wound Management," last reviewed 02/22, revealed the agency’s standard for teaching wound care to caregiver/patient was the caregiver/patient ability to learn and demonstrate wound care should be investigated and documented at the start of care (SOC) and at every visit until the caregiver/patient has learned the wound procedure. A minimum of two education sessions were recommended before caregiver/patient were deemed “independent” with wound care. One session for the Skilled Nurse (SN) to demonstrate the wound care and the second session to allow the clinician to observe a return demonstration by the caregiver/patient to assess their competence in providing wound care. Once the caregiver/patient demonstrated competence with wound care SN visits may decrease to one time per week for skill observation and teaching. The guideline further revealed all wounds should be photographed and measured weekly, ideally the first visit of the week, or per physician order, and at the SOC, resumption of care (ROC), recertification and a change in wound status. 1. Medical record review revealed Patient #2 was admitted to the agency on 03/08/23 with diagnosis of acute respiratory failure. Patient #2 was started at the agency for Physical Therapy (PT) and Home Health Aide only. On 03/08/23, PT did the SOC assessment and noted Patient #2 had one stage one pressure ulcer on the left/right buttock, open to air with barrier cream. No photo of the pressure ulcer was taken at admission. On 03/08/23 Patient #2 was seen by the PT. Patient #2 expressed pain as a 10/10 from a new pressure sore. The pressure sore was unable to be assessed as Patient #2 could not tolerate side lying. Patient #2 was assessed by an in-home urgent care after the SOC and this clinician ordered home SN. Review of a physician’s order dated 03/15/23 revealed Patient #2 had a new intervention ordered for the wound to consist of removal of dressing, cleanse wound with soap and water, apply triad cream, and cover with bordered foam dressing. Additionally, SN visits were added to be done two visits every week for five weeks from 03/15/23 to 04/15/23. The wound care orders were to be done daily and as needed by the SN or patient/caregiver. Patient #2 was seen by the SN on 03/15/23. The SN documented the wound was a pressure injury located on the left/right buttock measuring 0.5 centimeters (cm) by 0.5 cm by 0.1 cm with drainage described as fresh blood. This note also revealed the wound was originally assessed on 03/08/23, however on that date the PT had noted she could not assess the wound. The SN noted Patient #2 had also developed a yeast infection from the middle of her back to her abdomen and had developed a pressure ulcer on the left and right side of her buttocks. Patient #2’s family had purchased foam border and triad cream was provided. Upon assessment the areas were red. The left area was scabbed and the right area was red and painful to touch. The SN noted Patient #2’s daughter changed the dressing perfectly and supplies were ordered. The family was using anti-fungal medication and nystatin cream. On 03/17/23 there was a SN missed visit noted. The family stated they preferred morning visits and the SN was unable to come at that time. The SN noted the family told her Patient #2 was not feeling well and was not up to a visit on this date. On 03/21/23, Patient #2 was seen for a SN visit. The wound was noted to the left/ right buttock. The wound measurements were recorded as 0.4 cm by 0.4 cm by 0.0 cm with the wound bed noted to be pink. Triad and bordered foam were applied. There was no documented evidence the family/caregiver was instructed/assessed on providing wound care. Patient #2 was seen by the SN on 03/23/23. The wound was documented as a pressure injury to the left/ right buttock. Measurements were recorded as 1.0 cm by 0.3 cm by 0.1 cm. The wound care was documented as cleanse with soap and water and apply tried cream. The SN noted Patient #2’s daughter stated she had requested a wound care nurse since the start of care. Both daughters reported not being taught wound care or having performed a teach back of wound care for their mother since the start of care. They also stated the missed visit in the computer was inaccurate and she never received a call. The patient’s daughter also complained she had not received enough supplies. The SN apologized to Patient #2’s daughter. The patient's daughter stated she was not willing to perform daily wound care. Review of a physician order dated 03/23/23 revealed the SN service was increased to daily visit from 03/24/23 to 04/06/23. Interview on 04/25/25 at 9:10 AM, Staff X and Staff O both confirmed there was no documented evidence the family/patient was taught/assessed for their ability to perform wound care. Additional review of the medical record revealed Patient #2 was seen by the SN on 03/24/23. The wound was not documented to have been assessed at this visit, there was no documentation of wound care performed, or no documentation of any assessment/instruction to the patient/caregiver on their ability to provide wound care. Interview on 04/25/23 at 9:20 AM, Staff X and Staff O confirmed on 03/24/23 the wound was not documented as assessed by the SN and that was why the SN was in the home. The medical record revealed Patient #2 was seen by the SN on 03/25/23. The wound was documented as a pressure injury to the left/right buttock. No measurements were recorded and the wound was described as a Stage 2 with soft pink granulated tissue. Triad and foam boarder was applied. There was no documented evidence the patient/caregiver was instructed/assessed on providing wound care. Patient #2’s temperature was recorded at 93.9 degrees Fahrenheit (F) with no evidence of any follow up temperature or notification to the physician of the temperature being outside the set parameters. Patient #2 had a SN visit on 03/26/23 with no temperature documented at this visit. Interview on 04/25/23 at 9:35 AM, Staff X and Staff O verified the temperature on 03/25/23 should have been retaken and was outside of the reportable parameters. They also verified there was no assessment of patient/caregiver’s ability to provide wound care. Staff X and Staff O there was no temperature recorded on 03/26/23. On 03/27/23 Patient #2 had a SN visit. The wound was documented as a pressure injury to the left/right buttock. Measurements were recorded as 0.9 cm by 0.5 cm by 0.1 cm with granulated tissue. The wound care was provided as ordered. There was no documented evidence the family/caregiver was instructed/assessed on providing wound care. Interview on 04/25/23 at 9:49 AM, Staff X and Staff O confirmed there was no documented assessment of patient/caregiver’s ability to provide wound care. Patient #2 was seen by the SN on 03/28/23. The wound was documented as a Stage 2 pressure injury to the left/right buttocks. Wound care was documented as ordered. The SN noted she completed instructions to patient/caregiver on wound regimen and sign and symptoms of infection. On 03/29/23 Patient #2 was seen by the SN on 03/29/23 and the wound was documented as a Stage 2 pressure injury to the left/right buttock. The wound measurements were recorded as 0.0 cm by 0.0 cm by 0.0 cm with the wound healed. The SN discussed SN discharge with Patient #2’s daughter and the daughter requested one visit for two more weeks. The record does not have any documented evidence the physician was notified to obtain have the order was obtained to decrease the frequency of SN visits. The record revealed no SN visits occurred on 03/30/23, 03/31/23, 04/01/23, 04/03/23, and 04/05/23. A SN missed visit was documented on 04/02/23. Interview on 04/25/23 at 10:21 AM, Staff X confirmed the SN missed visits should have been documented on 03/30/23, 03/31/23, 04/01/23, 04/03/23 and 04/05/23 as no order had been received to decrease the nursing visit frequency from daily. 2. Medical record review revealed Patient #4 was admitted to the agency on 10/22/22 with diagnosis of aftercare following surgery for wound care. For the certification period of 10/22/22 to 12/20/22 Patient #4 was to receive SN once a week for one week, two visits every week for eight weeks, and two as needed visits. Patient #4 had wounds located of the right back and left abdomen. Wound care was to consist of cleaning the incision site with soap and water, pat dry and leave open to air, and may cover with dry sterile dressing. Patient #4 was had a SN visit for start of care on 10/22/22. It was noted Patient #4 had a new urostomy. Patient #4 had two wounds noted on the abdomen and one on the back. One of the abdominal wounds was the urostomy site. All were surgical wounds were covered with Exofin (mesh strips). No temperature was recorded at this visit. The pulse was recorded as 119. There was no documentation of physician notification when the pulse was outside the parameters identified in the guidelines. Interview on 04/25/25 at 1:36 PM Staff X and Staff O confirmed that the pulse was outside of agency parameters and no temperature was recorded. Patient #4 was seen by the SN for a scheduled nursing visit on 10/25/22 there was no documented evidence of patient teaching on independent urostomy care. Patient #4 was seen by the SN for scheduled nursing on 11/01/22 there was no documented evidence of patient teaching on independent urostomy care. The agency completed a transfer assessment on 11/08/22 for Patient #4’s hospitalization that began on 11/04/22. A resumption of care assessment was done on 11/17/22. Diagnoses listed included encounter for attention to artificial opening of urinary tract (urostomy). The urostomy was assessed as beefy red, round, clean, and intact with a one-piece appliance. The appliance was changed. The plan was for the next visit to teach and assess the urostomy. The SN documented Patient #4 was willing to attempt the next urostomy change and was able to teach back 60% of instruction. The SN frequency was one week one, then two week four, and one week one. On 11/25/22 Patient #4 had a SN visit. There were no vitals listed on this date. There was no documented evidence the urostomy appliance was changed or patient/caregiver was taught/instructed on independently doing urostomy care. Interviews on 04/25/23 between 1:55 PM and 2:57 PM, Staff X and Staff O confirmed no urostomy patient teaching was documented on the SN visits of 10/25/22, 11/01/22, and 11/25/22. Additionally the 11/25/22 visit had no evidence of any vital signs being obtained. 3. Medical record review revealed Patient #5 was admitted to the agency on 12/04/22. Diagnoses including encounter for attention to colostomy, encounter for surgical aftercare following surgery on the digestive system. Review of the certification period of 12/04/22 to 02/01/23 revealed Patient #5 was to have SN visits four times a week for one week, two visits every week for six weeks, and three as needed SN visits. The plan of care also revealed the SN was to instruct on colostomy care, appearance, trouble shooting and pouch change. One wound was noted as a drain to the left abdomen and the other was surgical wound to the abdominal. The drain wound care wound orders were clean drain site with normal saline, cover with split sponge, secure with tape and the change daily or as needed. The abdominal wound order was to remove the dressing, cleanse with normal saline, pack open area with ¼ inch packing, strips, cover with a dry sterile dressing, and secure with tape. Patient #5 was seen by the SN on 12/04/22 for the start of care. The colostomy was documented as beefy red, round, and intact. A pouch change was done with a one-piece appliance. The abdominal wound was documented as a surgical wound to mid-abdomen. The wound was noted to be 20 cm in length, width was noted as two areas with the first area measuring 2.5 cm by 2.8 cm by 0.4 cm and the distal area measuring 1.2 cm by 1.1 cm by 3.4 cm with tunneling noted of 3.4 cm at 11 o’clock. The wound was noted as pink with staples. The area was cleansed with soap and water and packing strips were the primary dressing. The closed section drain wound was documented as intact and the dressing was changed. Patient #4 was educated on drain care. It was noted non-agency caregivers needed education for care. The SN also noted the pouch was changed and Patient #5 indicated he planned to learn how to do it on his own. A communication note revealed the nurse attempted to contact Patient #5 on 12/04/22 and 12/05/22 and left messages and his spouse’s number was not in service. A missed visit was documented on 12/06/22. A communication note dated 12/06/22 revealed the nurse left two more messages to set up an appointment for 12/07/22 unsuccessfully. A missed visit was documented on 12/07/22. A communication note dated 12/08/22 revealed the nurse attempted to contact Patient #5 to set up a visit. Patient #5 was seen by the nurse on 12/09/22 for a scheduled SN visit. The colostomy was documented as beefy red, round, and intact. A pouch change was done with a one-piece appliance. The abdominal wound was documented as surgical wound mid abdomen. The dressing status was noted to be intact. The wound measurements were documented as 19 cm by undocumented cm by 2 cm with tunneling at 11 o’clock. There was no photo on record this date. Wound care was provided as ordered. There was no documented evidence of wound care teaching or patient’s ability to do wound care on his own. Interview on 04/26/23 at 9:18 AM, Staff X and Staff O verified there was no documented teaching to Patient #5 on completing his wound care. Patient #5 was not seen by the SN after the start of care on 12/04/22 until 12/09/22. The plan of care was for daily wound care/dressing changes, and it was not documented Patient #5 was proficient in daily wound care. Patient #5 was not seen again until 12/12/22 for a SN visit. At this time the SN documented Patient #5 jumped right into ostomy education and changed the pouch with minimal coaching from the SN. Patient #5 was noted to be involved in every step of wound and ostomy care. Patient #5 and the SN agreed Patient #5 would replace the ostomy on his own prior to her visit. Patient #5 was seen by the SN on 12/16/22 with no documented evidence of wound care teaching/assessment of patient independence. Patient #5 was seen by the SN on 12/19/22 with no documented evidence of wound care teaching/assessment of patient independence. Patient #5 was seen by the SN on 12/22/22 with no documented evidence of wound care teaching/assessment of patient independence. Interview on 04/26/23 between 9:45 AM and10:08 AM, Staff X and Staff O verified there was no documented evidence of wound care teaching on 12/16/22, 12/19/22 and 12/22/22. Patient #5 was seen by the SN on 12/26/22. The wound care regimen was instructed/taught however there was no documented indication of how self-proficient Patient #5 was in wound care. Interview on 04/26/23 at 10:17 AM, Staff X and Staff O verified there was no documented evidence of how proficient Patient #5 was in his own wound care. 4. Medical record review revealed Patient #6 was admitted to the agency on 02/10/23. Diagnoses included cellulitis of back and diabetes. For the certification period of 02/10/23 to 04/10/23 Patient #6 was to receive SN one visit every day for five days, two visits every week for four weeks, and two visits as needed for four weeks starting 02/19/23. Patient #6 was also to have physical therapy two visits every week for three weeks. The wound goal was to show evidence of healing and no signs and symptoms of infection by 4/10/2023. Patient/caregiver would be able to teach back self-management of the wound and healing process by 04/10/23. Patient #6 was seen on 02/10/23 for the SN start of care. The SN documented Patient #6 had a primary caregiver available seven days a week 24 hours a day and they would be able to assist the patient. The SN documented patient/caregiver was able to teach back/demonstrate given instruction including 100% teach back. Patient #6’s wife was doing wound care two days prior to the start of care. Patient #6’s wife was comfortable with doing evening dressing changes when no SN was available. On 02/12/23 Patient #6 was seen by the SN. Patient #6 had no temperature or respirations recorded on this date. Interview on 04/26/23 at 11:38 AM, Staff X confirmed there were missing vital signs on 02/12/23. Patient #6 was seen by the SN on 02/14/23. The SN documented Patient #6’s wife was re-educated on how to change the dressing properly. Patient #6 stated they did not have scissors. Patient #6 was advised to buy some scissors and to make sure she/he cleaned them off before and after using them. Patient #6’s wife stated she was currently using a knife. A case communication note dated 02/15/23 revealed Patient #6’s wife had called regarding daily visits and supplies. She was advised daily visits ended on 02/14/23 and the spouse should be independent. Patient #6 stated they had short term supply term supply but would need to get scissors. Patient #6 was advised to call back with additional concerns. Review of a case communication note dated 02/21/23 revealed Patient #6 called and stated he had uncontrolled pain in the last three to four days. Patient #6 reported he had been taking his ibuprofen and Tylenol. Patient #6 stated he has been using a heating pad. The agency instructed Patient #6 to try an ice pack alternating between heat and cold. Patient #6 stated he had been on antibiotics but had finished them. Patient #6 was instructed to contact his physician if he feels a need for pain medications. Patient #6 stated his inflammation had improved, no foul odor was present, there was no fever and no signs or symptoms of infection. Patient #6 was informed he had a SN visit on 02/23/23. Patient #6 was seen by PT on 02/22/23 for a scheduled visit. Patient #6’s care plan was followed as ordered. Patient #6 reported drinking at 5:00 AM due to severe pain. Patient #6 stated his pain level was a four but was relieved with current interventions and alcohol. The PT and nurse were both made aware of the alcohol use. Patient #6 was seen by SN on 02/23/23 1:04 PM for a scheduled visit. Patient #6 was noted to have acute cellulitis to his thoracic spine right upper area. Measurements were not recorded and the wound was noted to be painful, warm, with a foul odor, and swollen. An additional wound was noted on his right back. Measurements were not recorded and the wound was noted to be painful, warm, foul odor, and swollen. Pain was noted to be 7/10 at the wound sites. Patient #6’s family stated Patient #6 was struggling to get food and a social work consult would be requested. The SN noted Patient #6’s wife could not do the wound care. The SN documented upon arrival Patient #6 was tearful due to pain in his back. Upon assessment of wound sites the writer noted induration, erythema, warmth, and odor. The most recent wound care flowsheets documented by nursing staff show no wound odor, induration, or warmth. Patient #6 stated he experienced chills yesterday but none today. Patient #6 stated he did not have a thermometer to monitor his temperature. Patient #6 reported calling the office regarding uncontrolled pain and concern about wounds on 02/21/23. The SN discussed wound care treatment with Patient #6 and his wife. Patient #6’s wife denied she had been taught by the agency to do the wound care and she stated she had not performed a 'teach back' session with a SN. Patient #6’s wife stated she watched the first nurse perform wound care and tried to perform the same. The SN requested Patient #6’s wife demonstrate care with clinician's feedback. Patient #6’s wife did not wash hands, removed old outer dressing not using gloves, put old and saturated pads on nearby table, cut packing strips using writer's scissors because she didn't have any stating she was using a knife to cut packing strips, and then laid packing strips to be applied in patient's back on her cell-phone. The wife did not sanitize her hands during this process. The SN stopped Patient #6’s wife before she touched the wounds and initiated care for Patient #6 going step-by-step with Patient #6’s wife and educating on the importance of a clean set-up, washing hands/using hand sanitizer, washing scissors, wearing gloves, and performing each wound care separately to decrease cross contamination of bacteria. Step by step instructions were written out for Patient #6’s wife to follow in case issues arise with a nurse visiting twice daily. Patient #6’s wife requested a SN visit twice daily and the SN notified the physician’s office twice daily visits had not been performed as ordered per patient and his wife. The SN documented she notified scheduling Patient #6’s wife was not able to perform wound care correctly and due to the condition of the wounds and environment a twice daily SN visit was warranted. Review of physician’s order on 02/23/23 revealed the new order for wound care was to clean the patient’s back with normal saline or full-strength Dakin’s solution, dry well with gauze, pack wounds with full strength Dakin’s solution impregnated nu-gauze packing strip, cover with gauze/abd pad, and secure with tape changing dressing daily. An additional order on 02/23/23 for SN frequency of one every day for one day (02/23/23) and two SN visits every day for 20 days (02/24/23 to 03/15/23) was obtained. Orders were also received for the pain medication Tramadol 50 milligram (mg) every six hours for pain as needed and the antibiotic doxycycline 100 mg daily for seven days. An additional SN visit was done the evening of 02/23/23 at 6:48 PM. The pain was recorded as 7/10 mid-back and described as achy. The thoracic right spine wound had no measurements recorded. The skin was described as pink, temperature within normal limits, no swelling was documented, and a small amount of serous drainage was noted. The wound care was done as ordered. Interview on 04/27/23 at 8:00 AM, Staff X and Staff O stated the notes on 02/23/23 are confusing as the spouse had been independent with wound care more than once prior per SN documentation. Staff X stated the nurse who took the phone call on 02/21/23 felt she had sufficiently triaged the complaint and did not Patient #6 needed an additional nursing visit. Patient #6 was seen by SN on 02/26/23 at 10:33 AM there were no vital signs recorded at this visit. Patient #6 was seen by SN on 03/01/23 at 5:33 PM there were no vital signs were recorded. Interview on 04/27/23 at 8:54 AM, Staff O acknowledged no vital signs were recorded on 02/26/23 and 03/01/23. Patient #6 was seen by SN on 03/07/23 at 3:48 PM. The pain was recorded as 10/10 back and described as sharp. throbbing. The thoracic right spine wound measurements were not recorded. The skin was described as having serosanguineous drainage, pink with a normal temperature. The right back wound measurements were not recorded. The skin was described as having serosanguineous drainage, painful, swollen, red with a normal temperature and wound progress was noted as deteriorating. The wound care was done as ordered. No vital signs were recorded. The SN documented she encouraged the patient to notify the physician if his pain persists. Interview on 04/27/23 at 10:13 AM Staff O verified no vital signs were recorded on 03/07/23. Patient #6 was seen by SN on 03/12/23. No pain assessment was completed. The thoracic right spine wound measurements were not recorded. The skin was described as having serosanguineous drainage, red, with a normal temperature. The right back wound measurements were not recorded. The skin was described as having serosanguineous drainage, red, with a normal temperature. No BP was not recorded on this date. The wound care was done as ordered. The SN was to perform all wound care. Interview on 04/27/23 at 10:57 AM, Staff O confirmed no assessment for pain was done and no BP was recorded on 03/12/23. Patient #6 was seen by SN on 03/18/23. Patient #6’s BP was recorded to be elevated at 158/102 mmHg. The record had no documentation the physician was notified. Interview on 04/27/23 at 1:11 PM, Staff O confirmed the BP was outside of the guideline parameters on 03/18/23. 5. Medical record review Patient #7 was admitted to the agency on 04/10/23. Diagnoses included encounter after orthopedic aftercare following surgery for toe amputation and diabetes. For the certification period of 04/10/23 to 06/08/23 Patient #7 was to have SN three visits every week for six weeks and three visits as needed. Patient #7 was seen by the SN on 04/21/23 for a scheduled visit. No temperature or respirations were recorded. Interview on 04/27/23 at 3:22 PM, Staff O confirmed there was no temperature or respirations recorded on 04/21/23. 6. Medical record review revealed Patient #8 was admitted to the agency on 02/16/23. Diagnoses included non-pressure chronic ulcer of back and diabetes. For the certification period of 02/16/23 to 04/16/23 Patient #8 was to receive one SN visit a week for one week, two visits every week for four weeks, and two visits as needed. Wound care orders were to remove dressing, cleanse wound with mild soap and water, apply dry dressing and secure with tape. The dressing was to be changed daily by the SN, patient/caregiver. Patient #8 was seen by the SN for the start of care visit on 02/16/23. Patient #8 had a sacral wound documented with measurements of 3.0 cm by 1.0 cm by 0.1 cm. The wound was excoriated, fragile and scabbed. Wound care orders were followed as ordered. Patient #8 was noted to have a wife as a caregiver. The SN documented the patient/caregiver were educated on wound regime and signs and symptoms of infection. There was no evidence patient/caregiver were assessed for their ability to perform wound care independently. Interview on 05/01/23 at 9:24 AM, Staff O confirmed there was no documented evidence the patient/caregiver were taught independent wound care for the daily wound care order. On 02/20/23 a SN visit revealed there were no wound measurements recorded. There was no description of the wound. There was no evidence patient/caregiver was assessed for their ability to change the dressing independently. Interview on 05/01/23 at 9:28 AM, Staff O confirmed there was no documented evidence patient/caregiver taught independent wound care for the daily wound care order. Staff O also verified there was no documented assessment of the patient’s wound. 7. Medical record review revealed Patient #9 was admitted to the agency on 03/11/23. Diagnosis included cellulitis of right lower limb. For the certification period of 03/11/23 to 05/09/23 Patient #9 was to receive SN visits one a week for one week, three visits every week for eight weeks and four as needed visits. Wound care orders were for daily and as needed wound care to be performed by the SN or patient/caregiver. Review of the start of care SN note, dated 03/11/23, revealed there were no vital signs recorded. Patient #9 had a wound to the venous ulcer of the lower leg measuring 18.9 cm by 20.2 cm by 0.1 cm described as non-healing, with serous drainage, yellow scab, peri-wound red, and scaly. There was no documentation that patient/caregiver was taught how to perform his own wound care independently. Interview on 05/01/23 at 10:43 AM, Staff O confirmed no vital signs were recorded and no teach back/demonstration was documented for wound care. Review of SN note dated 03/14/23 revealed Patient #9 had a wound to the venous ulcer of the lower leg no measurements were recorded and it was described as having serous tan drainage, pink, scabbed, and yellow granulated tissue. The SN documented patient/caregiver was able to demonstrate/teach back given instruction including 100% wound care instructions and the wife’s ability to perform wound care when SN not available. Interview on 05/01/23 at 10:50 AM, Staff O confirmed no teaching was documented on independent wound care until 03/14/23. Review of SN visit note dated 03/15/23 revealed Patient #9’s BP was recorded as 158/88 mmHg. There was no documentation the physician was made aware of the BP reading. Interview on 05/01/23 at 10:59 AM Staff O, confirmed the BP outside of parameters was not addressed. Review of a SN visit note dated 04/09/23 revealed Patient #9 had a wound to the venous ulcer of the lower leg with no measurements or description recorded. No other wound was documented. There was no temperature or respirations recorded. Interview 05/01/23 at 11:57 AM, Staff O confirmed the wound was not measured and there was no documented assessment. Staff O also confirmed a full set of vitals was not recorded. Review of a SN visit note dated 04/12/23 revealed Patient #9 had no temperature recorded. Interview on 05/01/23 at 12:00 PM Staff O, confirmed no temperature was recorded on 04/12/23. 8. Medical record review revealed Patient #10 was admitted to the agency on 12/13/22 with diagnoses including diabetes, peripheral artery disease and non-pressure chronic ulcer and other part of foot. Review of the certification period of 04/12/23 to 06/10/23 revealed Patient #10 was to have SN services two visits weekly for six weeks and three visits as needed. Review of a SN visit note dated 04/25/23 revealed no vital signs were recorded. Review of a SN visit note dated 04/27/23 revealed the BP was recorded as 166/94 mmHg with no physician notification of the elevated parameters and no temperature was recorded. Interviews on 05/01/23 at 2:59 AM and 3:07 PM, Staff O confirmed no vital signs were recorded on the 04/25/23 visit. Staff O confirmed the BP outside of the guideline parameters were not addressed and no temperature was recorded on 04/27/23. 9. Medical record review revealed Patient #12 admitted to the agency on 11/12/22 with diagnoses including diabetes and chronic non-pressure ulcers. Review of the certification period of 03/12/23 to 05/10/23 revealed Patient #12 was to receive SN seven visits every day for two weeks and five visits as needed. Review of a hospital note dated 03/26/23 revealed Patient #12 went to the hospital for cast removal due to swelling and blisters. Patient #12 was admitted to the hospital and discharged on 03/31/23. Review of SN resumption of care dated 04/01/23 revealed the SN documented Patient #12 had at least one observable wound. There was no documentation of this wound. Review of a SN visit dated 04/21/23 revealed no vital signs were recorded on this date. Interview on 05/02/23 at 9:34 AM and 10:07 AM, Staff X stated she was uncertain of why there was no description or measurements of Patient #12’s wound at the resumption as care visit as the wound was marked as observable. Staff X also confirmed no vital signs were recorded on 04/21/23.

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 07/19/21, Ohiohealth Home Health., 367615 is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies excluding the Life Safety Code.

Partial Extended Recertification Survey COVID 19 Focus Infection Control Survey The following deficiencies are based on the partial extended recertification survey completed 07/19/21. OhioHealth Home Health Advanced Home Care Inc., 367615, is not in compliance with the requirements found at Home Health Agency 42 CFR Part 484, Subpart B, C. A COVID 19 Focused Infection Control Survey conducted concurrently revealed the facility is in compliance with the requirements at Home Health Agency 42 CFR Part 484.70 related to Infection Control and 42 CFR Part 484.102(b)(5) related to Emergency Preparedness.

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, patient and staff interview, and policy review, the agency failed to review and update the medication orders, medication profile, and the medications available in the home. This affected three ( #14, #15, and #16) of seven patients (Pt) who's medications were reviewed during a home visit. The census was 1900. Findings include: 1. On 07/13/21 at 10:25 A.M. a review of Pt #14's medication orders on the 485/Physician order sheet and the medication profile sheet, and the medications available in the home revealed an order for calcium oral one tablet by mouth every day, and an order for multivitamin one tablet by mouth daily. Observations at this time in the home revealed there was no calcium oral available in the home for Pt #14. An interview with Pt #14 at this time revealed he/she felt there was enough calcium in the multivitamin, so Pt #14 was not worried about the calcium oral. Further interview revealed Pt #14 does not remember the timeline concerning when he/she ran out of calcium oral. 2. On 07/14/21 at 9:23 A.M. a review Pt #15's medication orders on the 485/Physician order sheet and the medication profile sheet, and the medications available in the home for Pt #15 revealed an order was written for Klonopin 1 milligram (mg) tablet two times every day for anxiety. Observation at this time in the home revealed there was no Klonopin 1 mg available in the home of Pt #15. An interview with Pt #15 at this time revealed he/she has not been taking Klonopin 1 mg for over two years. An interview with Staff Q at the time of the medication observation confirmed the findings. 3. On 07/14/21 at 10:38 A.M. a review of Pt #16's medication orders on the 485/Physician order sheet and the medication profile sheet, and the medications available in the home of Pt #16 revealed an order was written for Lasix 20 mg one time every day as needed for edema. Observations at this time revealed there was no Lasix available in the home for Pt #16. An interview with Pt #16 at this time revealed he/she has not had Lasix since March of 2021. A review of the agency policy titled "Medication Reconciliation and Review" revealed at each patient visit staff should ask the patient if there has been any medication changes, or new medications added. If there has been medication changes they should be reconciled and the complete order information should be documented. Further policy review revealed the changes should be communicated and clarified with the physician.