Every finding on record at Dogwood Home Health Care LLC

Purpose of Visit: Recertification Entrance Conference Date: 5/7/22 at 8:50 a.m., with the Alternate Administrator/Supervising Nurse Agency Census: Parent (Palmview) Licensed and Certified (L&C) - 1 Licensed Home Health (LHH) - 0 Personal Assistance Services (PAS) - 113 Branch - San Antonio L&C - 0 LHH - 0 PAS - 214 An Exit Date was conducted on 5/11/22 at 4:00 p.m. with the Alternate Administrator/Supervising Nurse The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided or submitting a plan of correction within 10 days of receipt of the Statement of Deficiencies.

Purpose of Visit: Recertification Entrance Conference Date: 5/7/22 at 8:50 a.m., with the Alternate Administrator/Supervising Nurse Agency Census: Parent (Palmview) Licensed and Certified (L&C) - 1 Licensed Home Health (LHH) - 0 Personal Assistance Services (PAS) - 113 Branch - San Antonio L&C - 0 LHH - 0 PAS - 214 An Exit Date was conducted on 5/11/22 at 4:00 p.m. with the Alternate Administrator/Supervising Nurse The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided or submitting a plan of correction within 10 days of receipt of the Statement of Deficiencies. Alternate Admin - Alternate Administrator SOC - Start of Care POC - Plan of Care Rt - right Lt - Left prn - when needed po - by mouth mg - milligram cap - capsule LVN - Licensed Vocational Nurse tab - tablet q - every qd - every day Pot - Potassium Clav - Clavulanate

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, interview, and record review, the agency failed to have a current medication list in each clinical record for one of one active L&C patients (Patient #1) whose records were reviewed, in that: Patient #1's medication list did not include Amoxicillin-Potassium Clavulanate (antibiotic) (kills bacteria and used for prevention of infection) and did not include Pro-Renal with Vitamin D (multivitamin). This deficient practice places Patient #1 at risk for medication errors and decline in health when medications are not taken as prescribed. The findings included: 1. Review of Patient #1's clinical record revealed a POC with a SOC date of 8/11/18 for a certification period from 3/23/22 through 5/21/22 with a diagnosis of Non-Pressure Chronic Ulcer (skin sores) on the Rt. and Lt foot, Diabetes (high blood sugar) and ESRD (the kidneys no longer work to sustain life and requires dependence on a dialysis machine to remove toxins and excess blood from the body). Further review revealed a SN frequency of two visits week 1 (2w1), four visits a week for eight weeks (4w8), and 3 visits prn. In addition, in section titled "Medication" it listed Amoxicillin oral 500 mg po caps 1/2 po daily and Pro-Renal with Vitamin D was not listed. Review of the "infection Control" form dated 5/13/21 revealed Patient #1 had a skin infection and was ordered Amoxicillin - Potassium Clavulanate Oral 500-125 mg 10 tabs 1/2 q 24 hrs po and that the infection resolved (no date). Review of the "Medication Profile" dated 3/23/22 through 5/21/22 revealed Amoxicillin and Pro-Renal with Vitamin D was not listed. Review of the "Discontinued Medication" list (dated 3/23/22 through 5/21/22) revealed "Start Date: 5/12/21 Amoxicillin-Pot Clavulante oral 500-125 10 tabs 1/2 q 24 hours po Discontinue Date 5/31/21 and a Discontinued Date of 9/21/21 for Pro-Renal + D oral 1 tab daily." 2. During a current home visit and interview on 5//1022 at 1:55 p.m., with Client #1 and LVN A, Patient #1 brought over a black thermal bag with the medication bottles and handed them to the Surveyor. The Surveyor and LVN A reviewed the bottles and found a bottled with a label affixed to it that read "Amoxil (Amoxicillin)/Clav/Pot tab 500 mg take 1/2 tab po q 24 hours with a filled date of 3/2/22. Further review revealed a bottle with a label affixed to it that read "Pro-Renal + D oral tablet by mouth qd with a dispense date of 2/11/21." Client #1 stated that he was taking both medications. During the home visit and record review with LVN A he brought up Patient #1's "Discontinued Medication" list (dated 3/23/22 through 5/21/22) and LVN A stated that the Amoxicillin had an end date of 5/31/21 and that the Pro-Renal had a discontinued date of 9/21/21. He further stated that he did not know why the client was still taking the Pro-Renal and the Amoxicillin. 3. During an interview on 5/11/22 at 9:30 a.m., with the Alternate Admin/Supervising Nurse she stated that after the home visit LVN A called her and that she called Client #1's wound clinic to find out about the Amoxicillin and also called the client's dialysis unit to find out about the Pro-Renal with Vitamin D. She further stated that she was waiting for a call back. She added that the medication list should be current and accurate and that at each visit the nurse was to ask the client about any medication changes. She further added that the LVN should inform the RN if there were any medication changes and that during the re-certification the nurse was to review all the client's medication bottles. Finally, she stated that this could impact care and lead to medication errors. 4. Review of the agency's policy titled "Medication List and Monitoring" dated 8/1/20 revealed in part "...The Agency will maintain a current, accurate list of all prescription and over-the-counter (OTC) medications taken by the patient/client (Medication Profile)..."

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to enforce a written policy that detailed its client care practices for planning client care for one of one active L&C patients (Patient #1) in that, there was no documented evidence that the patient's POC included safety measure for a client receiving Eliquis (a blood thinner to prevent strokes and causes bleeding risk). This deficient practice could place Client #1 at risk for bruising and can easily bleed after a accident and cause a decline in health. The findings included: 1. Review of site titled "Drugs.com" (found on the intranet) dated 5/13/22 revealed in part "Eliquis blocks the activity of certain clotting substances in the blood. Eliquis is used to lower the risk of a stroke due to a blood clot...Warning and Precautions: Bleeding Risk: Eliquis increases the risk of bleeding and can cause serious, potentially fatal bleeding...Eliquis may also increase your risk of bleeding from a minor fall or bump on the head. Contact your doctor if you experience an injury or have bleeding that will not stop..." 2. Review of Client #1's clinical record revealed a POC with a SOC date of 8/11/18 for a certification period from 3/23/22 through 5/21/22 with a diagnosis of Non-Pressure Chronic Ulcer (skin sores) on the Rt. and Lt foot, Diabetes (high blood sugar) and ESRD (the kidneys no longer work to sustain life and requires dependence on a dialysis machine to remove toxins and excess blood from the body). Further review revealed a SN frequency of two visits week 1 (2w1), four visits a week for eight weeks (4w8), and 3 visits prn and in section titled "Medication" revealed Eliquis oral 2.5 mg 1 tab daily." In addition, in the section titled "Safety Measures" there was no documented evidence that bleeding precautions was listed Review of the "Medication Profile" dated 3/23/22 through 5/21/22 revealed Eliquis 2.5 mg tab daily po. 3. During a current home visit and interview on 5/10/22 at 1:55 p.m., with Client #1 and LVN A, Client #1 brought over a black thermal bag with the medication bottles and handed them to the Surveyor. The Surveyor and LVN A reviewed the bottles and found a bottled with a label affixed that read Eliquis 2.5 mg po tab daily. The client stated that he took this medication daily. During an interview on 5/11/22 at 5/11/22 with the Alternate Admin/Supervising Nurse she stated that the POC did not include bleeding tendencies as a safety measure and it should have. She further stated that since the client was on dialysis the agency staff should be looking for bruising. She added that this could impact client care if a new nurse would not know what to look for and it could lead to a decline in the client's health. 4. Review of the agency's policy titled "Plan of Care" dated 1/1/22 revealed in part "...Policy 1. The Agency will use data/information gathered during patient's/client's assessments in the care planning process which involve the identification of patient's/client's goals, actions, interventions that will resolve or alleviate the patient's/client's problems and/or needs...A. The Individualized plan of care must include the following: 11. Safety Measures to protect against injury..."