Every finding on record at Equinox Home Care, LLC

Unannounced visits were concluded at Equinox Home Care, LLC on 07/09/2024 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits concluded on 07/09/2024 at Equinox Home Care, LLC in Stratford for the purpose of recertification and re-licensure. Standard-level deficiencies were identified.

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 clinical record reviews, review of an agency policies and interview with agency staff, for three of nine patients (Patient #4, #5 and #8) the agency nurses failed to follow physician’s orders. The findings include: a. Patient #4 had a start of care date of 05/15/2023 with diagnoses that included diastolic congestive heart failure, type two diabetes, asthma, ulcerative colitis, hypertension, and hyperlipidemia. The physician’s orders for the certification period of 06/09/2024 to 08/07/2024 included nursing services once per week for nine weeks for nursing assessments, pre-filling insulin syringes, weighing the patient every visit and report a weight gain of five pounds in a week or greater than two pounds in twenty-four hours. i. Interview and review of Patient #4’s clinical record with the Administrator on 07/09/2024 at 12:30 PM, identified the agency’s nurses failed to weigh the Patient on 06/11/2024, 06/17/2024 and 06/26/2024 in accordance with the plan of care dated 06/09/2024. b. Patient #5 had a start of care date of 02/08/2024 with diagnoses that included heart failure, obesity, constipation, acute kidney failure and osteoarthritis. The physician’s orders for the certification period of 06/07/2024 to 08/05/2024 included nursing services once per week for eight weeks for nursing assessments and weighing the patient every visit and report a weight gain of five pounds in a week or greater than two pounds in twenty-four hours. ii. Interview and review of Patient #5’s clinical record with the Administrator on 07/09/2024 at 12:30 PM, identified the agency’s nurses failed to weigh the Patient on 06/05/2024, 06/13/2024. 06/20/2024 and 06/26/2024 in accordance with the plan of care dated 06/07/2024. c. Patient #8 had a start of care date of 02/13/2024 with diagnoses that included chronic kidney disease requiring hemodialysis, cerebral infarction, and chronic knee pain. The physician’s orders for the certification period of 04/13/2024 to 06/11/2024 included nursing services twice per month for one month and once per month for one month for nursing assessments. iii. Interview and review of Patient #8’s clinical record with the Administrator on 07/09/2024 at 12:45 PM, identified the agency’s nurses failed to assess the Patient’s right arm arteriovenous fistula (a connection that is made between an artery and a vein for dialysis access) for bruit and thrill (a sound and vibration both indicating blood flow in a vessel or fistula) on 04/25/2024, 0514/2024 and 05/30/2024 in accordance with the plan of care dated 04/13/2024. Review of the agency’s Assessment policy identified the purpose was to provide thorough, ongoing patient care based on accurate assessment, which gives basis for interventions and realistic expected outcomes. All interventions are based on assessment. Physician orders are obtained as appropriate and problems requiring immediate intervention are communicated effectively and resolved. All further interventions are recorded in the patients’ charts to be followed and updated by the Registered Nurse case manager.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on clinical record reviews, review of an agency policies and interview with agency personnel, for three of nine patients (Patient #4, #5 and #8) in the survey sample, the agency nurses failed to provide the necessary assessments. The findings include: a. Patient #4 had a start of care date of 05/15/2023 with diagnoses that included diastolic congestive heart failure, type two diabetes, asthma, ulcerative colitis, hypertension, and hyperlipidemia. The physician’s orders for the certification period of 06/09/2024 to 08/07/2024 included nursing services once per week for nine weeks for nursing assessments, pre-filling insulin syringes, weighing the patient every visit and report a weight gain of five pounds in a week or greater than two pounds in twenty-four hours. i. Interview and review of Patient #4’s clinical record with the Administrator on 07/09/2024 at 12:30 PM, identified the agency’s nurses failed to weigh the Patient on 06/11/2024, 06/17/2024 and 06/26/2024 in accordance with the plan of care dated 06/09/2024. b. Patient #5 had a start of care date of 02/08/2024 with diagnoses that included heart failure, obesity, constipation, acute kidney failure and osteoarthritis. The physician’s orders for the certification period of 06/07/2024 to 08/05/2024 included nursing services once per week for eight weeks for nursing assessments and weighing the patient every visit and report a weight gain of five pounds in a week or greater than two pounds in twenty-four hours. ii. Interview and review of Patient #5’s clinical record with the Administrator on 07/09/2024 at 12:30 PM, identified the agency’s nurses failed to weigh the Patient on 06/05/2024, 06/13/2024. 06/20/2024 and 06/26/2024 in accordance with the plan of care dated 06/07/2024. c. Patient #8 had a start of care date of 02/13/2024 with diagnoses that included chronic kidney disease requiring hemodialysis, cerebral infarction, and chronic knee pain. The physician’s orders for the certification period of 04/13/2024 to 06/11/2024 included nursing services twice per month for one month and once per month for one month for nursing assessments. iii. Interview and review of Patient #8’s clinical record with the Administrator on 07/09/2024 at 12:45 PM, the agency’s nurses failed to assess the Patient’s right arm arteriovenous fistula (a connection that is made between an artery and a vein for dialysis access) for bruit and thrill (a sound and vibration both indicating blood flow in a vessel or fistula) on 04/25/2024, 0514/2024 and 05/30/2024 in accordance with the plan of care dated 04/13/2024. Review of the agency’s Assessment policy identified the purpose was to provide thorough, ongoing patient care based on accurate assessment, which gives basis for interventions and realistic expected outcomes. All interventions are based on assessment. Physician orders are obtained as appropriate and problems requiring immediate intervention are communicated effectively and resolved. All further interventions are recorded in the patients’ charts to be followed and updated by the Registered Nurse case manager.