Every finding on record at County of Calhoun

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 8/7/24. The Agency was in compliance with the 42 CFR 494.62, establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 8/7/24. The Agency was not compliance with 42 CFR 484.60 (a)(1), standards for Home Health Agencies, for this survey.

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, policy review, and interview, the facility failed to follow the physician’s orders and patient care plan for 1 of 7 patients (Pt #6). Findings include: 1. Per record review on 8/7/24 at 10:00 a.m., Pt #6 was admitted to the Home Health Agency (HHA) on 6/27/24. The physician’s order on the plan of care stated that Pt #6 was to receive occupational therapy two times a week for three weeks. It was noted that Pt #6 was seen on 07/01/24, 07/03/24, 07/09/24, 07/16/24, and 07/17/24. One occupational visit was missed the week of 07/07/24, and there was no documentation as to why the visit was missed. 2. An undated document titled “Missed Visit Policy” states that “Visits should be missed only for adequate reasons… The agency must promptly alert the relevant physician to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered.” This document also included, “... A missed visit that is rescheduled within the week, with ordered frequency being achieved, is not a ‘missed visit.’ A missed visit which cannot be rescheduled shall be documented and communicated to the physician.” 3. On 8/7/24 at 11:30 a.m., E#3 (Employee), Director of Nursing, verbally agreed the medical record lacked documentation explaining why the visit was missed and not rescheduled within the week.

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 08/04/2021. The Agency was in compliance with the Condition, 42 CFR 484.102, Establishment of the Emergency Program (EP), for this survey.

A recertification survey was conducted in conjunction with a Focused Infection Control (FIC) survey on 08/04/2021. The Agency was not in compliance with Standards for Home Health Agencies, 42 CFR 484, as evidenced by: Abbreviations #-number E-employee HHA-home health agency P-patient

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, document review, and interview, it was determined for 1 of 3 (Pt #3) patients, where home visits where conducted, the Home Health Agency (HHA) failed to ensure a review of the patient's medication included over the counter medications, thereby preventing potential adverse drug reactions, significant side effects, significant drug interaction, and duplicate drug therapy. This has the potential to affect all patients receiving care from the HHA with a current patient census of 9. Findings include: 1. On 08/02/2021 at approximately 11:30 AM, a home visit was conducted at Pt #3's home. A review of Pt #3's medication bottles, revealed the patient was taking the over the counter medication, Aspirin 81 milligram, by mouth, once a day, as a blood thinner. 2. On 08/02/2021 at approximately 1:00 PM, the medical record of Pt #3 was reviewed. Pt #3 was admitted on 07/29/2021 with the primary diagnoses of right heart failure. The "Medication List" from the patient's physician included the medication "Aspirin, 80 milligrams, by mouth, daily". "The Plan of Care for certification period 07/29/2021 thru 09/26/2021 did not include Aspirin. 3. On 08/02/2021 at approximately 11:40 AM, an interview with Pt #3's spouse was conducted. It was confirmed the patient was taking Aspirin 81 milligram, by mouth as an over the counter medication. The spouse was responsible for ensuring the patient took the correct medications. The spouse was not sure why the patient was taking the medication, but that the patient had been taking it for over a year. The spouse explained that Pt #3 was scheduled for a left, 2nd toe amputation on 08/05/2021 and was told by the patient's primary care physician to stop taking the Aspirin until after the operation. 4. On 08/02/2021 at approximately 12:00 PM, an interview with Nurse Supervisor (E #1) was conducted. E #1 confirmed the Plan of Care for Pt #3 did not include the medication Aspirin. E #1 was unable to provide an explanation why. 4. On 08/03/2021 at approximately 9:30 AM, the HHA policy "Medication Reconciliation" (no date) was reviewed. It reads "Review of medications will be conducted at the time of admission. The Patient's medication list and bottles will be reviewed and will be checked against the hospital's discharge medication list and/or ordering provider's medication list."