Every finding on record at Eureka Springs Hospital Homecare, LLC

On 04/14/2025 at 1:20 PM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare recertification survey for compliance with 42 CFR Part 484 Conditions of Participation for Home Health Agencies. On 04/18/2025 at 10:30 AM, an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed.

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 clinical record review and staff interview, it was determined the Agency did not include all current medications in the review and reconciliation of the client's medications in 2 (#9 & #10) of 10 (#1-#10) of clinical records reviewed. This omission had the potential to delay identification of adverse effects such as drug interactions, significant side effects or side effects that may result in serious illness or rehospitalization. Findings as follows: Review of clinical record #9 revealed there wasn't documentation of drug interaction, significant side effect review for the use of 'Advanced Energy Support', an over the counter supplement. Review of clinical record #10 revealed there wasn't documentation of drug interaction, significant side effect review for the use of 'LV-GB Complex 1500 mcg' or for 'Pancreatic Enzyme 1000mg', both being over the counter supplements. The computer system utilized by the Agency had these medications highlighted in blue to indicate these have not been automatically checked for drug-drug interactions and for significant side effects. Therefore, the physician had not been contacted. On 04/17/2025 at 1:40 PM, the Branch Director confirmed these medications had not been thoroughly reviewed by manual means, documented, and physician informed as required.

. On 8/30/2022 at 3:00 PM, an entrance conference was conducted with Agency Representatives. The Agency was informed the purpose of the visit was to conduct a Medicare Recertification survey for compliance with the Conditions of Participation for Home Health. On 9/1/2022 at 10:15 AM an exit conference was conducted with Agency Representatives. Preliminary findings of the survey were discussed. .

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: 484.60(e) Written information to the patient. The HHA must provide the patient and caregiver with a copy of written instructions outlining: 484.60(e)(2) Patient medication schedule / instruction. Based on Clinical Record review and staff interview, the Agency failed to provide patients with a written copy of medication schedule / instructions in 1 ( #7) of 13 (#1 - #13) Clinical Records reviewed. This failed practice had the potential to affect all patients on census in that patients and families maybe unaware of the name, dosage, frequency, purpose, and specific instructions related to ordered medications. This failed practice may result in medication errors, noncompliance with drug therapy, and unreported side effects which could result in adverse events and hospitalizations. Review of Clinical Record #7 revealed the following: A. Document titled "Client Medication Report" which listed "Nitrostat 0.4 mg sublingual (under the tongue) tablet" and contained instructions written as "One tablet under the tongue continuous as needed for chest pain." B. Review of standard instructions for use of PRN (as needed) Nitrostat 0.4 mg on Drugs.com shows "Administer one tablet under the tongue at the first sign of an acute anginal attack (chest pain). Allow tablet to dissolve without swallowing. One additional tablet may be administered every 5 minutes until relief is obtained. No more than three (3) tablets are recommended within a 15 minute period. If the pain persists after a total of 3 tablets in a 15 minute perior, or if the pain is different than is typically experienced, seek prompt medical attention." There was no evidence these instructions were given to Patient # 7. C. During an interview on 9/1/22 at 9:30 AM, Personnel #1 confirmed the Patient's medication schedule / instruction was not complete for the Nitrostat.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on Clinical Record review, and staff interview the Agency failed to ensure a Discharge/Transfer Summary was completed and sent to the Physician after discharge in 1 (#12) of 4 (#11 - #13) Clinical Records reviewed with transfer/discharge status. This failed practice had the potential to place all patients currently on census at risk by preventing effective and efficient coordination of care among health care team members and providers. . Review of Clinical Record #12 revealed the following A. Document titled "Home Health Certification and Plan of Care (POC) dated 3/16/22 to 5/14/22. B Document titled "coordination note" read, "Hold Home Health services, Patient hospitalized [named hospital] 4/20/22 [for] complications of scheduled angiogram." C. During an interview on 9/1/22 at 9:30 A.M., Personnel #1, confirmed Patient #12 was not on service with the home health agency after being hospitalized on 4/20/22 and was referred to Hospice while in the hospital. Personnel #1 confirmed a discharge summary was not completed for Patient #12.