Every finding on record at Georgetown Hospital Home Health, LLC

An onsite unannounced Emergency Preparedness Program (EPP) Survey and survey for the Medicare COVID - 19 Staff Vaccination requirements was conducted at Amedisys Home Health Georgetown from 02/21/2023 to 02/23/2023. Amedisys Home Health Georgetown is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 36 staff members fully vaccinated, 1religious exemptions approved, and policies and procedures in place. The Home Health Agency is in compliance with 42 CFR 484.102 (Emergency Preparedness).

An onsite Recertification Survey was conducted at Amedisys Home Health Georgetown from 02/21/23 to 02/23/23. Amedisys Home Health Georgetown is in substantial compliance with the Medicare Conditions at 42 CFR PART 484. Standard level deficiencies existed at the time of the survey.

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 patient record reviews and interviews, the Home Health Agency (HHA) failed to ensure physician orders were followed for 2 of 17 patient records reviewed. (Patient #9 and #18) On 2/23/2023 at 9:35 AM, review of Patient #18's chart revealed physician orders at recertification for episode 12/25/2022 to 2/22/2023, revealed, “RECORD PATIENT REPORTED WEIGHT, OR WEIGH PATIENT AS NEEDED, REPORT INCREASED EDEMA OR WEIGHT GAIN OF > (greater than)2 LBS (pounds) IN 1 DAY OR >5 LBS IN 1 WEEK OR 5LBS OR MORE OVER TARGET WEIGHT.” Patient seen by Skilled Nurse (SN) once a week for 9 weeks. SN visits on 12/28/2022, 1/04/2023, 1/23/2023, 2/08/2023 and 2/15/2023 had no recorded weights. On 2/23/2023 at 12:24 PM, RN (Registered Nurse) #1 reported “weights should have been done” and verified the findings. The findings are: On 2/22/2023 at 12:00 PM, review of Patient #9 record revealed daily weights are to be obtained and recorded. Weight gains of over 2 pounds per day or 5 pounds per week are to be reported to the physician. The patient's progress notes had no weights recorded for week 3 of care, documented “the patient’s weight is stable”, but “bilateral lower extremities have 4+ (plus) weeping noted.” The patient was transferred to the hospital 2 days later. In an interview with the Administrator on 2/23/2023 at 1:30 PM, the Administrator confirmed the findings. HHA policy, titled, "TX-001 Physician Orders and Medical Supervision of the Plan of Care”, reads, “Drugs, services and treatments are administered as ordered by the physician…”.

Verbal orders CFR(s): 484.60(b)(3)(4) (3) Verbal orders must be accepted only by personnel authorized to do so by applicable state laws and regulations and by the HHA's internal policies. (4) When services are provided on the basis of a physician or allowed practitioner's verbal orders, a nurse acting in accordance with state licensure requirements, or other qualified practitioner responsible for furnishing or supervising the ordered services, in accordance with state law and the HHA's policies, must document the orders in the patient's clinical record, and sign, date, and time the orders. Verbal orders must be authenticated and dated by the physician or allowed pracitioner in accordance with applicable state laws and regulations, as well as the HHA's internal policies. This ELEMENT is not met as evidenced by: Based on record reviews and interviews, the Home Health Agency (HHA)failed to ensure physician orders were authenticated within 30 days of receipt of the physician orders for 1 of 17 patient records. (Patient #12) The findings are: On 2/22/2023 at 2:00 PM, review of Patient #12's record revealed the patient’s Start of Care (SOC) was dated 12/6/2022. Physician orders were not authenticated until 1/12/2023 which was 37 days later. HHA policy, titled, TX-001, revealed, “The agency requires submission and return of physician orders according to state-minimum standards, but not longer than 30 days.” In an interview with the Administrator on 2/23/2023 at 1:00 PM, the Administrator verified the finding.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on patient chart review and interview, the Home Health Agency (HHA) Registered Nurse (RN) failed to provide a specific Home Health Aide (HHA) Plan of Care (POC) for 1 of 2 applicable patients. (Patient #2) The findings are: On 2/23/2023 at 10:21 AM, review of Patient #2's chart revealed Home Health Aide (HHA) visits once a week for one week, twice a week for three weeks, and once a week for 5 weeks beginning 12/05/2022. Review of the HHA's POC instructed the HHA to obtain the patient's temperature, pulse, respirations, and blood pressure “DAILY” and to perform shower “DAILY”. Patient #2 did not receive HHA visits daily. On 2/23/2023 at 12:10 PM, RN#1 reported “Should not have been marked as Daily but Every Visit”.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on observations, patient chart reviews, and interviews, the Home Health Agency (HHA)Registered Nurse (RN) failed to update the patient medications in the home with the HHA's medication profile for 2 of 6 applicable patients. (Patient #7 and #13) The findings are: During a home observation visit on 2/22/2023 from 10:45 AM to 11:27 AM, Patient #7's caregiver reported the patient takes Aspirin 81 mg (milligrams) 1 tablet daily by mouth and Betamethasone topical cream is to be applied daily around the patient's suprapubic urinary catheter site. Aspirin 81 mg and Betamethasone topical cream were not part of the HHA's medication profile for the patient. Review of the HHA's medication profile revealed the patient takes Potassium Citrate ER 10 meq (milliequivalents) 2 tablets by mouth twice a day, but the patient's caregiver reported the patient takes Potassium Citrate ER 10 meq 1 tablet twice a day. On 2/22/2023 at 11:15 AM, RN #3 verified the findings. During a home observation visit on 2/22/2023 from 12:02 PM and 1:00 PM, Patient #13's caregiver revealed the patient has an Albuterol inhaler 90 mcg (micrograms)per puff, 2 puffs a day and takes Mucinex over the counter. Albuterol inhaler 90 mcg (micrograms)per puff, 2 puffs a day and takes Mucinex were not part of the HHA's medication profile for the patient. On 2/23/2023 at 12:30 PM, RN #1 verified the findings.

A survey of the Home Health Agency's (HHA) Emergency Preparedness Program(EPP) was conducted from 08//2321 to 08/26/2021. Based on observations, record reviews, interviews, and review of the HHA's EPP and policies and procedures, it was determined the HHA is in compliance with the Condition at 42 CFR 484.102 (Establishment of the Emergency Program).

The Home Health Agency's (HHA) Recertification Survey was conducted in conjunction with the COVID-19 focused Infection Control requirements from 08/232021 to 08/26/2021. Based on observations, record reviews, interviews, and review of the HHA's policies and procedures, it was determined the HHA is in compliance with the COVID - 19 focused Infection Control requirements, and standard level deficiencies resulted from the HHA's Recertification Survey.

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 reviews and interview, the Home Health Agency (HHA) staff failed to document measurable outcomes for goals in the patient's plan of care for 13 of 17 patient records reviewed care and services. (Patient #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #15, #16, and #17 ) Patient #6 On 8/23/2021 at 2:42 PM, a review of Patient #6’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, demonstrate effective, safe management of medications, signs and symptoms that put the patient at risk for hospitalization, identify fall risk factors, and verbalize an ability to adhere to fall reduction). This finding is verified by the Administrator at 2:00 PM on 8/25/2021. Patient #7 On 8/24/2021 at 1:43 PM, a review of Patient #7’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, and demonstrate effective, safe management of medications). This finding is verified by the Administrator at 2:08 PM on 8/25/2021. Patient #3 On 8/25/2021 at 8:26 AM, a review of Patient #3’s chart reveals a non- measurable outcome (Verbalize understanding of signs and symptoms that put the patient at risk for hospitalization). This finding is verified by the Administrator at 2:03 PM on 8/25/2021. Patient #5 On 8/25/2021 at 8:43 AM, a review of Patient #5’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, signs and symptoms that put the patient at risk for hospitalization, when to call 911, changes in skin integrity, and patient will have no complications). This finding is verified by the Administrator at 1:57 PM on 8/25/2021. Patient #10 On 8/25/2021 at 9:08 AM, a review of Patient #10’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, demonstrate effective, safe management of medications, signs and symptoms that put the patient at risk for hospitalization, changes in skin integrity, and identify fall risk factors). This finding is verified by the Administrator at 2:11 PM on 8/25/2021. Patient #8 On 8/25/2021 at 10:13 AM, a review of Patient #8’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, signs and symptoms that put the patient at risk for hospitalization, changes in skin integrity, patient will have no complications, and improved functional strength). This finding is verified by the Administrator at 2:09 PM on 8/25/2021. Patient #4 On 8/25/2021 at 10:19 AM, a review of Patient #4’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, demonstrate effective, safe management of medications, signs and symptoms that put the patient at risk for hospitalization, when to call 911, signs of sepsis, and post-sepsis syndrome interventions). This finding is verified by the Administrator at 2:03 PM on 8/25/2021. Patient #16 On 8/25/2021 at 11:38 AM, a review of Patient #16’s chart reveals non- measurable outcomes (A plan of care will be established, personal care and hygiene, identify signs of hyperglycemia, ability to perform wound care, demonstrate oxygen saturation, changes in co-morbid conditions, changes in skin integrity, demonstrate effective, safe management of medications, fall risk factors, and signs and symptoms that put the patient at risk for hospitalization,). This finding is verified by the Administrator at 2:15 PM on 8/25/2021. Patient #15 On 8/25/2021 at 12:09 PM, a review of Patient #15’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, demonstrate effective, safe management of medications, signs and symptoms that put the patient at risk for hospitalization, and fall risk factors). This finding is verified by the Administrator at 2:12 PM on 8/25/2021. Patient #17 On 8/25/2021 at 12:42 PM, a review of Patient #17’s chart reveals non- measurable outcomes (A plan of care will be established, demonstrate oxygen saturation, demonstrate effective, safe management of medications, and ability to perform wound care). This finding is verified by the Administrator at 2:17 PM on 8/25/2021. Patient 1 On 08/23/2021 at 2:30 PM, a review of Patient 1’s chart revealed all of the patient outcomes within the POC were not measurable: patient will demonstrate oxygen saturation with normal limits; when to notify SN of complications/decline and when to call 911. The findings were verified by the administrator on 08/25/21 at 2:30 PM. Patient 2 On 08/25/2021 at 8:30 AM, a review of Patient 2’s chart revealed all of the patient outcomes within the POC were not measurable: verbalize understanding of pain management; understanding of signs and symptoms that put patient at risk; when to notify SN of complications/decline and when to call 911. The findings were verified by the administrator on 08/25/21 at 2:35 PM. Patient 9 On 08/25/2021 at 9:30 AM, a review of Patient 9’s chart revealed all of the patient outcomes within the POC were not measurable: understanding of signs and symptoms that put patient at risk; when to notify SN of complications/decline and when to call 911. minimize fall risk. The findings were verified by the administrator on 08/25/21 at 2:39 PM. Patient 12 On 08/25/2021 at 10:30 AM, a review of Patient 9’s chart revealed all of the patient outcomes within the POC were not measurable: patient will demonstrate oxygen saturation with normal limits; will receive assistance with personal care and hygiene. The findings were verified by the administrator on 08/25/21 at 2:45 PM. Patient 14 On 08/25/2021 at 11:30 AM, a review of Patient 9’s chart revealed all of the patient outcomes within the POC were not measurable: plan of care will be established; patient will demonstrate oxygen saturation with normal limits; understanding of signs and symptoms that put patient at risk; minimize fall risk. The findings were verified by the administrator on 08/25/21 at 2:50 PM.