Every finding on record at Fayette Medical Center Homecare, LLC

A recertification survey was conducted 4/2/24 to 4/3/24 at Fayette Medical Center HomeCare and was found to be in substantial compliance with the requirements for Emergency Preparedness.

A recertification survey was conducted at the Fayette Medical Center HomeCare on 4/2/24 to 4/3/24, standard level deficiencies were cited and will require a plan of correction.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on observations, medical record (MR) review, agency policy and procedures, and interviews it was determined the agency failed to ensure physician's orders for wound care were followed. This affected one of two MR reviewed of patients with wounds including Home Visit (HV) # 3 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Wound Assessment, Documentation, and Photography Policy Number: 2.2.001 Revised Date: 08/01/22 ...Procedure: ...2. Perform wound care according to LHC adopted clinical skills guidelines and physician orders. 3. Document the following in the medical record: ...i. Exact wound care performed, following physician orders... HV # 3 was admitted to the agency on 2/17/24 with diagnoses including Encounter for Other Orthopedic Aftercare, Type Two Diabetes Mellitus with Other Specified Complication, and Other Chronic Osteomyelitis, Left Ankle and Foot. Review of the Resumption of Care, physician's orders, dated 3/8/24, revealed orders to clean the left lateral mid tibia surgical wound with Vashe (a solution that contains pure hypochlorous acid) and gauze. A HV was conducted on 4/3/24 at 8:47 AM to observe wound care provided by Employee Identifier (EI) # 3, Licensed Practical Nurse. EI # 2, Registered Nurse (RN), Patient Case Manager (PCM) was also present during the visit as an observer. EI # 3 removed the wound vac (Vacuum Assisted Closure Therapy) dressing from the left lower leg and cleaned the wound and wound edges with saline soaked gauze. EI # 3 failed cleanse the wound with Vashe per physician's orders. Review of the Visit Note report dated 4/3/24 revealed the nurse documented the wound was cleansed with Vashe. The staff failed to cleanse the wound per physician's orders. In an interview conducted on 4/3/24 at 3:50 PM, EI # 1, RN, Administrator, confirmed the physician orders for wound care were not followed.

A recertification survey was conducted at Fayette Medical Center Homecare on 3/23/2021 to 3/24/2021. The agency was found to be in substantial compliance in the Conditions of Participation for Emergency Preparedness.

A recertification survey was conducted on 03/23/2021 to 03/24/2021. Standard level deficiencies were cited.

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 review of medical records (MR), policy and procedure, observations, and interviews, it was determined the agency failed to ensure staff reconciled medications for 2 of 4 Home Visits (HV) conducted. This affected HV # 3, HV # 2, and had the potential to affect all patients served by the agency. Findings include: Policy: Monitoring Medications Policy Number: 10.008 Date Revised: 05/01/19 Purpose: To provide a process to ensure continuous monitoring of medications in the patient's home. Policy: A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode... Procedure: ...b. Review all medications including over the counter (OTC) medications, vitamins, herbs and herbal products, creams and topical ointments... to identify issues... e. Notify the physician of any of the above identified issues/ discrepancies. Collaborate with the Patient Care Manager and ensure that supportive documentation is evident in the medical record. 2. All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care... 1. HV # 3 was admitted to the agency on 02/02/21 with diagnoses including Cellulitis of Face, Essential Primary Hypertension, and Type 2 Diabetes Mellitus Without Complications. A HV was conducted to observe Employee Identifier (EI) # 6, Certified Occupational Therapy Assistant (COTA) perform a therapy visit. EI # 2, Patient Care Manager (PCM) was also present on the visit. During the HV, the patient's medications in the home were compared to the Client Medication Report (CMR) printed on 03/23/21, and provided to the surveyor. The following discrepancies were observed: a. Preservision Areds 7,160 Unit-113 Milligrams (mg) - 100 Unit Tablet was on the CMR as 1 tablet daily. The patient stated he/she took 1 capsule twice daily. b. Pantoprazole 40 mg tablet, delayed release (DR) 1 tablet daily, was on the CMR. The patient stated he/she only took it when having stomach pain and did not take daily. c. Benadryl Cream over the counter (OTC) was observed in the box with other patient medications. Patient stated he/she uses daily. It was not on the CMR. d. Hydrocodone 5 mg-Acetaminophen 325 mg tablet, 1 tablet every 6 hours, take only as needed, was on the CMR. There was no hydrocodone in the home. EI # 2 contacted the patient's sponsor by phone to inquire about the hydrocodone. EI # 2 stated sponsor said he/she was not aware of any hydrocodone and did not recall filling a prescription for it. During the HV, the medication discrepancies were confirmed by EI # 2. 2. HV # 2 was admitted to the agency on 12/19/2020 and re-certified for home care on 2/17/2021 with diagnoses including Hemiplegia following Cerebral Infarction, Dysarthria, Facial Weakness, and Hypertensive Heart Disease. On 3/23/2021 at 11:05 AM a home visit was conducted at the patient's residence. During the HV a review of the current medications was conducted by EI # 5, RN. Review of the Medicine List provided to the surveyor prior to HV revealed Digoxin 0.125 mg, one half tablet to be taken daily. The Caregiver stated HV # 2 had been taking one whole tablet daily since his/her last Doctor visit 2 months ago. EI # 5 confirmed the medication discrepancy while in the home.