Every finding on record at Georgetown Hospital Home Health, LLC

An onsite unannounced Emergency Preparedness Survey and a COVID - 19 Staff Vaccination Survey were conducted at Amedisys Home Health Kingstree from 05/15/2023 to 05/17/2023. The Home Health Agency is in compliance with 42 CFR PART 484.102 (Establishment of the Emergency Program). The home health agency is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 60 staff members fully vaccinated, 21 approved religious exemptions, and 1 approved medical exemption.

An onsite unannounced Recertification Survey was conducted at Amedisys Home Health Kingstree from 05/15/2023 to 05/17/2023. The Home Health Agency was in substantial compliance with the Medicare Conditions for Participation at 42 CFR PART 484. 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 observations, record reviews, and interviews, the Home Health Agency's (HHA) Skilled Nurse (SN) staff did not ensure accurate reconciliation of the patient's medications 4 of 5 applicable patients. (Patient #2, #3, #5 and #8) Patient #5 During an observation home visit on 05/16/2023 between 8:35 AM and 9:20 AM, it was revealed discrepancies between the agency medication list and what the patient was taking. Patient reports taking Lantus Solostar U-100 insulin 100 units per ml subcutaneously 15 units at bedtime; agency medication list reports 10 units at bedtime. Patient reports taking over the counter Fish Oil 1 capsule daily by mouth; this is not listed on the agency medication list. Chart review on 05/17/2023 at 1 PM, RN #1 verifies the findings. Patient #8 During an observation home visit on 05/16/2023 between 11:32 AM and 12:26 PM, it was revealed discrepancies between the agency medication list and what the patient was taking. Patient reports taking potassium 10 meq 1 tablet by mouth daily. This medication is not listed on the agency medication list. Chart review on 05/17/2023 at 1:08 PM, RN #1 verifies the findings. Patient#2 has a Start of Care (SOC) of 1/7/22 and a diagnosis of Paralysis and Stage III Sacral Wound. It is observed during the home visit on 5/16/23 at 10:30am, the medication the patient is taking does not agree with the Medication Record (MAR) in the patient chart. In an interview with RN #3 during the home visit, it is confirmed that the medication is not on the MAR. Specifically, the patient has an implanted Baclofen pump in the right abdomen, which is not listed on the MAR in the record review. Patient #3 has a Start of Care (SOC) of 3/30/23 and diagnosis of Post-Triple Bypass, Hypertension, Heart Failure and Acute Respiratory Failure. It is observed during the home visit the medications the patient is taking does not agree with the Medication Record (MAR) in the patient chart. Specifically, the patient is taking 75mg Lasix every day while the MAR reads 40mg per day. The patient is taking Milk of Magnesia daily which is not listed on the MAR. The patient is taking 2.5 tablets of 2.5mg Warfarin on Tuesday, Thursday and Saturday while the MAR reads that the patient is taking 2.5mg daily. The patient is taking Ropinirole 1mg twice a day while the MAR reads that the patient is taking Ropinirole 1mg three times per day. The patient is no longer taking Doxycycline 100mg, but the drug still appears on the MAR. The patient is taking 50mg Colace daily, but the MAR specifies 100mg daily. Record review confirmed the analysis as did the interview with LPN #1 on site 5/16/23 at 9:30am.

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 did not document weekly measurements of wounds for 1 of 6 applicable patients. (Patient #11) On 05/17/2023 at 10:30 AM, review of Patient #11's chart revealed Patient #11 was admitted on 03/23/2023 with diagnosis Pressure Ulcer of Right Heel, Stage II. There was no documentation of wound measurements of the pressure ulcer right heel for the week of 3/26/2023, 04/02/2023, 04/17/2023, 04/30/2023. On 05/09/2023, the SN documented a new Stage 1 pressure wound of the patient's coccyx with no wound measurements. On 05/17/2023 at 1:50 PM, Registered Nurse (RN) #4 reported “Should have been done” and verified the finding.

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, record reviews, and interviews, the Home Health Agency did not follow physician orders for 8 of 17 patient records reviewed care and services. (Patient #1, #3, #4, #6, #10, #11, #16, and #17) Patient #6 Chart review on 05/16/2023 at 2:35 PM reveals Patient #6 admitted to service on 03/13/2023 with diagnosis Hypertensive Heart and Chronic Kidney Disease with Heart Failure and Stage 1-4/UNSP CHR Kidney and Chronic Diastolic (Congestive) Heart Failure. Physician orders “Record patient reported weight or weigh patient every visit. Report increased edema or weight gain of >2 LBS in 1 day or 2 LBS in 1 day or Patient #1 has a Start of Care (SOC) of 6/9/22 has a diagnosis of Stage IV Pressure Ulcer. Physician orders include the Nurse to visit 1 time for 1 week, then 2 times a week for 8 weeks. Record review for week 3 reveals that the Nurse made 3 attempts to see the patient resulting in 3 missed visit notes. The Physician was not notified for 2 of those missed visits. Week 4 for the Nurse had 1 missed visit note, without notifying the Physician. Week 5 for the Nurse had 1 missed visit note, without notifying the Physician. Week 6 the patient is admitted to the Medical University of South Carolina in Septic Shock, thus discharged from the agency. In an interview on 5/17/23 at 1:00pm with RN #2, this information is confirmed. Facility policy requires that the Physician be notified each time the patient visit is missed. Patient #3 has a Start of Care (SOC) of 3/30/23 and diagnosis of Post-Triple Bypass, Hypertension, Heart Failure and Acute Respiratory Failure. It is observed during the home visit the medications the patient was taking did not agree with the Medication Record (MAR) in the patient chart. Specifically, the patient is taking 75mg Lasix every day while the MAR reads 40mg per day. The patient is taking Milk of Magnesia daily which is not listed on the MAR. The patient is taking 2.5 tablets of 2.5mg Warfarin on Tuesday, Thursday and Saturday while the MAR reads that the patient is taking 2.5mg daily. The patient is taking Ropinirole 1mg twice a day while the MAR reads that the patient is taking Ropinirole 1mg three times per day. The patient is no longer taking Doxycycline 100mg, but the drug still appears on the MAR. The patient is taking 50mg Colace daily, but the MAR specifies 100mg daily. Record review confirmed the analysis as did the interview with LPN #1 on site 5/16/23 at 9:30am. The patient had Physician orders for Occupational Therapy effective 4/2/23 for 1 visit for 1 week, then twice a week for 6 weeks. A Certified Occupational Therapy Assistant (COTA) was assigned by the Occupational Therapist to see the patient, but no supervisory visits were made during the episode. In an interview with RN#1 on 5/17/23 at 2:00pm it was confirmed that a supervisory visit was not made during the 7 week episode. RN#1 also confirmed facility policy outlines that the supervisory visit for COTA is due monthly. The patient had Physician orders for Physical Therapy effective 4/2/23 for 1 time for 1 week, then 2 times a week for 2 weeks, then 3 times a week for 1 week, then 2 times a week for 2 weeks. Both the Physical Therapist and the Physical Therapy Assistant (PTA) saw the patient, but no supervisory visits were made during the episode. In an interview with RN#1 on 5/17/23 at 2:00pm it is confirmed that a supervisory visit is not made during the 6 week episode. RN#1 also confirmed that facility policy outlines the supervisory visit for PTA is due monthly. Patient #4 has a Start of Care (SOC) of 3/30/23 has a diagnosis of Hypertension, Heart Failure and Diabetes. The Physician order includes the Nurse to visit 1 time a week for 9 weeks with 2 as needed visits. The Physician orders include reporting abnormal blood sugar levels to the Physician under 70mg/dl or above 350mg/dl. Record review found no recording of blood sugar levels in the chart. In an interview with RN #1 on 5/17/23 at 2:45pm, it is confirmed that the blood sugar levels are not being monitored per Physician orders. Patient #16 with a Start of Care (SOC) of 4/6/23 has a diagnosis of Diabetes and After Care for Joint Replacement surgery (right hip). Physician orders dated 4/6/23 are for Physical Therapy (PT) to visit 1 time in week 1, then 2 times every 2 weeks for 2 weeks, then 2 times a week for 2 weeks, then 1 time a week for 2 weeks, then 1 time every 2 weeks for 2 weeks. During record review, it is revealed in week 4 the PT made a second visit contrary to Physician orders. There are no “as needed” visits ordered. This information is confirmed in an interview 5/17/23 at 2:00pm with RN #2.

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 record review and interview, the facility failed to ensure that supervisory visits by the Nurse of the Home Health Aide were accomplished for 1 out of 1 patient visits by the Home Health Aide. (Patient #15) Patient #15 has a Start of Care (SOC) of 3/28/23 and a diagnosis of Hypertension with a Wound. The physician order includes the Nurse 1 time a week for 9 weeks, and a Home Health Aide (HHA) 2 times per week for 3 weeks. Record review reveals no supervisory visits of the HHA is made by the Nurse during the 3 week episode. This information is confirmed by Nurse #2 during an interview on 5/17/23 at 2:30pm during which time it is confirmed that facility policy requires a supervisory visit of the HHA every 2 weeks.