Every finding on record at Florence Visiting Nurses Service, Inc/Suncrest Home Health

An onsite Emergency Preparedness Program survey was conducted from )7/17/2023 - 07/19/2023. The Home Health Agency is in compliance with the Medicare Condition at 42 CFR 494.102 (Establishment of the Emergency Program).

An onsite unannounced Recertification Survey and a COVID - 19 Staff Vaccination Survey were conducted at Florence Visiting Nurses from 07/17/2023 to 07/19/2023. The Home Health Agency is in substantial compliance with the Medicare Conditions at 42 CFR PART 484 with standard level deficiencies cited. The home health agency is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 3 staff members fully vaccinated.

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 observations, patient chart reviews, and interview, the Home Health Agency failed to ensure its nursing staff maintained an accurate updated medication profile for 1 of 2 applicable patients. (Patient #1) The findings includes: During an observation visit on 07/18/2023 between 10:20 AM and 11:10 AM revealed Patient #1 reported he/she no longer takes Bupropion HCL 150 mg(milligrams) 12 hour sustained-release tablet, 1 tablet by mouth at bedtime. The Home Health Agency medication profile listed Bupropion HCL 150 mg(milligrams) 12 hour sustained-release tablet, 1 tablet by mouth at bedtime as active. Patient #1 reported he/she takes B-100 complex tablet 1 tablet by mouth every day, but B-100 complex tablet 1 tablet by mouth every day was not listed on the home health agency medication profile for the patient. On 07/19/2023 at 8:45 AM, the Administrator verified the findings.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on observations, patient record reviews, and interview, the home health agency failed to follow physician orders for 4 of 7 patient charts reviewed for care and services. (Patient #1, #2, #3, and #5) Patient #1 Chart review on 07/18/2023 at 1 PM reveals physician orders “When vital signs are obtained licensed professional to report vital signs falling outside the following established parameters…FBS 250…”. There is no documentation of glucose readings or results for RN visits on 06/12/2023 and 06/21/2023. Interview on 07/19/2023 at 8:45 AM, Administrator reports “should have been done” and verifies the findings. Patient #3 Chart review on 07/17/2023 at 1:40 PM reveals, physician orders “Skilled Nurse to provide instructions related to heart failure including…weight gain of 5 LBS overnight…”. RN visits on 05/05/2023, 05/08/2023 and 05/10/2023 have no documentation of patient weights. Interview on 07/19/2023 at 8:40 AM, Administrator reports “I see it was ordered” and verifies the findings. Patient #5 Chart review on 07/17/2023 at 1:11 PM reveals, physician orders “Skilled nurse may perform up to 2 Pro Re Nata (PRN) visits during this episode for cardiac complications such as…increase in weight of 5 LBS in 1 week…”. RN weekly visits on 04/25/2023, 05/02/2023, 05/09/2023, 05/16/2023, 05/23/2023, 05/30/2023, 06/06/2023 and 06/13/2023 have no documentation of weights. Interview on 07/19/2023 at 8:41 AM, Administrator reports “I see it was ordered” and verifies the findings. Observation on a home visit on 7/17/23 at 10:00 AM with patient #2 who is diagnosed with severe heart disease and chronic kidney disease, revealed the Registered Nurse (RN) did not 1) Go over the "Health Journal" as ordered in the physician orders for 'each visit', and 2) failed to measure the patient's ankle circumference per the orders 'each visit'. Chart review on 07/18/2023 at 1 PM reveals physician orders "Skilled Nurse to instruct patient on documenting health information in the Healthcare Journal". The patient states that she never uses the journal. Further, orders read "Skilled Nurse to obtain ankle circumference every visit by measuring one inch above ankle's bony prominence and notify physician of increase of one inch within one day". Interview on 07/19/2023 at 9:00 AM, the Administrator reports “should have been done” and verifies the findings.

Onsite supervisory visit every 14 days CFR(s): 484.80(h)(1)(i) If home health aide services are provided to a patient who is receiving skilled nursing, physical or occupational therapy, or speech-language pathology services, a registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in §484.80(g), must make an onsite visit to the patient's home no less frequently than every 14 days. The home health aide does not have to be present during this visit. This ELEMENT is not met as evidenced by: Based on patient chart reviews and interview, the home health agency failed to ensure the Registered Nurse (RN) performed supervisory visits for the Home Health Aide (HHA) every 14 days for 1 of 2 applicable patients. (Patient #1) The finding include: On 07/18/2023 at 1:00 PM, reviewof Patient 1's chart revealed documentation of HHA supervisory visits by RN on 06/21/2023 and 07/6/2023 which is a span of 15 days. On 07/19/2023 at 8:45 AM, the Administrator reported “She mostly does them every visit” and verified the finding.