Every finding on record at Enhanced Rehabilitation Services, Inc

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 05/21/21, Enhanced Rehabilitation Services, Inc is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Partial Extended Recertification Survey COVID-19 Focused Infection Control Survey An entrance conference was conducted with administrative staff at 8:45 AM on 05/17/21 and an exit conference was conducted with adminitrative staff at 9:50 AM on 05/21/21. The following deficiencies are based on the partial extended recertification survey completed 05/21/21. Enhanced Rehabilitation Services, Inc 368122 is not in compliance with the requirements found at 42 CFR Part 484, Subpart B,C for Home Health Agencies. A COVID-19 Focused Infection Control Survey conducted concurrently revealed the facility is in compliance with the requirements at 42 CFR Part 484.70 related to Infection Control.

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, observation and patient and staff interview, the agency failed to ensure all medications the patient is using is reviewed for 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 for one of 13 patient records reviewed (Patient #1). This could affect all patients receiving services from the agency. The census was 95. Findings include: Review of Patient #1's medical record and physician orders dated 05/03/21 revealed wound care orders to use Calmoseptine cream (moisture barrier) and A&D and Zinc ointment (for irritated skin) to wounds twice a day. Review of the current medication list did not reveal the two creams. On 05/17/21 at 12:45 PM a home visit was made for Patient #1. Patient #1 confirmed the two creams were currently being used and the surveyor observed the two creams during the medication review. Per interview on 05/20/21 at 3:30 PM, Staff P confirmed this finding.

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: 2. Review of the medical record for Patient #3 revealed physician orders dated 05/07/21 to notify the doctor of vital sign parameters out of range including oxygen (O2) saturation less than 90%. Review of Staff Q's visit sheets, co-signed by Staff C, revealed three of three visits, 05/13/21, 05/15/21 and 05/18/21, did not have O2 saturations documented. 3. Review of the medical record for Patient #8 revealed physician orders dated 12/11/2020 to notify the doctor of vital sign parameters out of range including O2 saturation less than 90%. Review of Staff Q's visit sheets, co-signed by Staff C, revealed visits on 03/23/21 and 03/30/21 did not have O2 saturations documented. Review of Staff J's visit sheets for 03/24/21, 03/26/21 and 03/29/21 revealed no heart rate or O2 saturation had been documented. Per interview on 05/20/21 at 4:15 PM, Staff P confirmed these findings. Based on medical record review, agency policy and procedure review and staff interview, the agency failed to ensure services were provided that were ordered by the physician or allowed practitioner as indicated in the plan of care for three of 13 medical records reviewed (Patient #3, #8 and #12). The agency census was 95. Findings include: Review of the agency's undated policy and procedure titled, General Medical Care policies under the subheading of Vital Signs revealed that vital signs shall be taken routinely on each visit, unless otherwise ordered by the attending physician. 1. Patient #12 was admitted to the agency on 04/02/21 with diagnoses which included dementia, Diabetes Mellitus Type 2, hypertension, atrial fibrillation (abnormal heart rhythm), atherosclerosis heart disease (hardening of the arteries) and history of long term use of insulin and anticoagulation medicines. The Medicare certification period under review was 04/02/21 through 05/31/21. The plan of care included orders for the patient to have physical therapy (PT) one time per week for one week, twice per week for two weeks and once per week for six weeks. Occupational therapy was ordered once per week for seven weeks. The physician order revealed PT will instruct caregiver on proper diabetic management such as signs/symptoms of hypoglycemia, daily foot assessment and medication administration. Notify physician of vital sign parameters out of range. Review of the physical therapy notes for visits completed between 04/02/21 and 05/20/21 revealed no documentation of diabetic management, no signs or symptoms of hypoglycemia or hyperglycemia, no daily foot assessment and no evaluation of compliance with medication used in the treatment of diabetes. Review of the physical therapy notes revealed Staff Q failed to collect the oxygen saturation on the following dates per the agency policy, 04/07/21, 04/10/21, 04/13/21, 04/16/21 and 04/24/21. Review of the visits notes by Staff J revealed the staff member had made skilled occupational therapy visits on the following dates 04/12/21, 04/21/21, 04/26/21, 05/03/21, 05/11/21 and on 0517/21. Review of the clinician visit notes revealed Staff J only collected the blood pressure and temperature at each visit. The documentation failed to record any results for the patient's heart rate, respiratory rate, or oxygen saturation rate as directed by agency policy. Interview with Staff P on 05/20/21 at 12:11 PM confirmed vital signs were not obtained per agency policy nor was the management of diabetes documented in the medical record during the physical therapy visits.