Every finding on record at Fairfield Home Health Agency Inc

EMERGENCY PREPAREDNESS SURVEY At the time of the emergency preparedness survey completed on 03/08/23, Fairfield Home Health Agency Inc is in compliance with the provisions of 42 CFR Part 484.102, Conditions of Participation for Home Health Agencies.

Partial Extended Recertification Survey An entrance conference was conducted on 03/03/23 at 10:30 AM with the Administrator. An exit conference was made the afternoon of 03/08/23 with administrative staff. The following deficiencies are based on the partial extended recertification survey completed on 03/08/23. Fairfield Home Health Agency Inc 369088, is not in compliance with the requirements at 42 CFR Part 484, Subpart B, C for Home Health Agencies.

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, policy review, and interview, the facility failed to ensure a review of all medications the patient is currently using was conducted for one of two patients with home visits (Patient #1). The sample was eight patient records. The patient census was 34. Findings include: Review of the medical record for Patient #1 revealed the certification period dated 02/23/23 to 04/23/23 included diagnoses of Type 2 Diabetes, dementia and aneurysms. The physician ordered plan of care for the certification period included orders for home health aide services 12 hours a week for nine weeks. Patient #1's caregiver was his mother and he resided with her in the same home. Review of the list of medications on the plan of care during the home visit on 03/06/23 at 9:00 AM revealed Topiramate (anticonvulsant and nerve pain medication) 50 milligrams (mg) one tablet by mouth daily. The pill bottle in the home revealed Topiramate 50 mg take one half tablet two times a day. The plan of care also included Cholestyramine (for high blood pressure) 4 grams/9 grams powder for suspension two times a day. Staff B's signature with a date of 02/21/23 was on the medication profile to indicate that she reviewed Patient #1's medications for this certification period. Interview with Patient #1's caregiver on 03/06/23 at 9:15 AM revealed Patient #1 had not taken the Cholestyramine for a long time. The caregiver voluntarily stated when the nurse was here, she reviewed all of the medications. This finding was confirmed with Staff A who was present in the home during the home visit on 03/06/23. Review of the policy titled, Medication Reconciliation, revised 2014, revealed at the time of admission, the admitting registered nurse (RN) will create and document a complete list of medication that the patient is taking at home, including dose, route, and frequency. Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication.

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 and interview, the agency failed to ensure each patient received home health services that are written in the plan of care for one of four patients reviewed with orders for home health aide services (Patient #4). The sample was eight patient records. The patient census was 34. Findings include: Review of the physician ordered plan of care for Patient #4 for the certification period dated 12/19/22 to 02/16/23 revealed orders for home health aide (HHA) services 35 hours a week for nine weeks. Review of the HHA weekly visits revealed for the week of 12/18/22 Patient #4 received 14 hours of home health aide services. There was a missed visit on 12/23/22 and 12/24/22 due to inclement weather; for the week of 12/25/22 the patient received 21 hours of home health aide services. There was a missed visit on 12/25/22 because of the holiday; for the week of 01/01/23 the patient received 28 hours of home health aide services; for the week of 01/08/23 the patient received 14 hours of home health aide services; for the week of 01/15/23 the patient received 14 hours of home health aide services; for the week of 01/23/23 the patient received 28 hours of home health aide services; for the week of 01/28/23 the patient received 28 hours of home health aide services; and for the week of 01/29/23 the patient received 14 hours of home health aide services. There was no documentation the physician was notified that the patient was not receiving home health aide services as ordered. Interview with Staff B on 03/07/23 at 4:00 PM revealed the case manager did not want the HHA hours decreased from 35 hours, but the agency did not have another aide to send. Staff B revealed she was not sure if the Administrator made the physician aware that the patient was not receiving 35 hours of home health aide services per week.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) 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 ELEMENT is not met as evidenced by: Based on record review, interview, and policy review, the agency failed to promptly alert the relevant physician(s) or allowed practitioner(s) that the plan of care should be altered for one of eight patient medical records reviewed (Patient #2). The patient census was 34. Findings include: Review of the medical record for Patient #2 revealed for the certification period dated 12/22/22 to 02/19/23 diagnoses including crushing injury to right elbow, and primary generalized osteoarthritis. The services ordered were for skilled nursing one time a week for nine weeks. Review of a skilled nursing note dated 01/26/23 revealed Patient #2's general practitioner told her to obtain TED hose (antiembolism stockings) for the swelling in her feet, which she had yet to do. Review of the medical record revealed there was no documentation of a physician follow up for the TED hose. Interview with Patient #2 during a home visit on 03/07/23 at 2:30 PM revealed her physician did tell her to get TED hose. Patient #2 revealed she told her son. She also revealed that she called her case manager (CM) about the TED hose. The CM told Patient #2 that she would need to be measured and Patient #2 further revealed it went no further than that. Staff B, who was present during the home visit, told Patient #2 that she would follow up with the case manager about the TED hose. Review of the policy titled, Nursing Services, revised 2014, revealed that professional nursing service will be provided by a registered nurse including, informing the physician and other staff of changes in the patient's needs.