Every finding on record at Georgia Homecare of Harris, LLC

A Recertification survey was conducted at Georgia Home Health on February 24, 2025, and concluded on February 26, 2025. At the time of the survey, the agency was in compliance with Chapter 42 Part 418.113, Emergency Preparedness.

A Recertification survey was conducted at Georgia Home Health on February 24, 2025, and concluded on February 26, 2025. At the time of the survey, the agency was not in compliance with Chapter 42 CFR Part 418, Rules and Requirements for Home Health and Hospice Agencies. The census was 235. The following deficiencies were cited.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on the Centers for Medicare & Medicaid Services (CMS) Home Health Agency (HHA) Error Summary by agency report, policy “OASIS Data Capture, Transmission, Verification, Display and Reports,” and staff interview, it was determined that the agency failed to electronically transmit monthly Outcome and Assessment Information Set (OASIS) data collected to the CMS system every 30 days. Findings include: Review of the policy titled “OASIS Data Capture, Transmission, Verification, Display and Reports” last revised 03/01/2021, revealed the following: Procedure: At least monthly, agency will electronically transmit accurate, completed, encoded and locked OASIS data to the state agency. All OASIS assessments completed must be transmitted within thirty (30) days of M0090 date. Review of CMS report titled “HHA Error Summary by Agency,” with report period of 01/01/2024-12/31/2024 and run date of 2/11/2025, revealed the agency failed to transmit OASIS data to CMS system within 30 days. During an in-office interview on 2/25/2025 at 12:07 p.m., the Executive Director revealed that she was aware that the 30-day OASIS submission timeframe requirements were not met during the time frame of 01/01/2024 through 12/31/2024. The Executive Director reported that the agency OASIS reviewing, and submission process was deferred due to complications with the agency’s workflow, specifically with staffing issues.

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on review of the policy titled “Plan of Care (POC),” clinical record reviews, and staff interview, it was determined the agency failed to ensure the plan of care included all medications and treatments related to pertinent diagnoses for two patients (P) (P#1 and P#15) of eighteen sampled patients. Findings include: Review of the policy titled “Plan of Care (POC),” Policy Number 2.1.007, revised 9/1/2024 reveals the following: Procedure: 2. The POC includes: f. Medications and treatments i. Patient specific interventions and education n. All patient care orders 1. Clinical record review reveals P#1 was admitted on 1/20/2025 with a diagnosis of rectal cancer, status post proctectomy on 1/7/2025 (a surgical procedure to remove all or part of the rectum). Patient was admitted to the home health agency with a Jackson-Pratt (JP) drain (a temporary tube and bulb that removes excess fluid from the body after surgery). P#1 had a surgically implanted port (a medical device that provides long-term access to a large vein, typically in the chest or arm) placed on 2/4/2025. Further review of the clinical record failed to reveal physician orders for care of the JP drain or the newly implanted port. 2. Clinical record review reveals P#15 was admitted to on 1/31/2025 with co-morbidities including long-term use of anticoagulants (medicines that increase the time it takes for blood to clot, commonly called blood thinners). On admission, P# 15 was prescribed Eliquis, a prescription blood thinner that prevents and treats blood clots. Further review of the clinical record failed to reveal interventions related to the increased risk of bleeding due to the Eliquis. An interview on 2/25/2025 at approximately 1:00 p.m., was conducted at the Home Health agency with the Executive Director (ED), who confirmed there were no physician orders for P#1’s JP drain or port and that the plan of care for P#15 failed to include bleeding precautions.

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 review of policy titled “Plan of Care (POC),” clinical record review, and staff interview, it was determined the agency failed to provide care only as ordered by the physician for one patient (P) (P#1) of eighteen sampled patients. Findings include: Review of the policy titled “Plan of Care (POC),” Policy Number 2.1.007, revised 9/1/2024 reveals the following: Procedure: 7. Medications, treatments, and interventions are provided by qualified staff as ordered by the physician or authorized practitioner. Clinical record review reveals P#1 was admitted to the agency on 1/20/2025 with a diagnosis of rectal cancer. On 1/7/2025, P#1 had a proctectomy and a Jackson-Pratt (JP) drain was in place on admission to the home health agency. Review of Client Coordination Note Report, dated 2/12/2025, revealed P#1’s JP drain was flushed with normal saline by the agency nurse. Further review of P#1’s clinical record failed to reveal physician orders for flushing the JP drain. An interview on 2/25/2025 at approximately 1:00 p.m. was conducted at the Home Health agency with the Executive Director (ED), who confirmed the clinical record for P#1 lacked a physician order to flush the JP drain.

A routine survey was conducted at Georgia Home Health in Columbus GA, on 2/23/22. The routine survey revealed that the agency was in substantial compliance with 42 CFR Part 484.22, Emergency Preparedness for Home Health Agencies. A Focused COVID-19 Infection control survey was completed at the time of the on-site visit. Census was 168 at the time of the on-site visit. No deficiencies were cited.

A routine survey was conducted at Georgia Home Health in Columbus GA, on 2/23/22. At the time of the on-site visit, the agency was found to be in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies. The census was 168 at the time of the on-site visit. The following 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 home visit observation, clinical record review and staff interview, it was determined that the agency failed to ensure that patient medication profiles were updated to reflect current medications at the time of the comprehensive assessment for four of six patients (P) during home visits conducted by the surveyor (P#1, P#2, P#5 and P#6). The findings include: 1. A home visit was conducted at 1:00 p.m. on 1/21/22, at the residence of Patient #1 Registered Nurse (RN) AA. P#1 was admitted to the home health agency on 11/29/21, with the diagnosis of hypertensive heart disease and chronic kidney disease with heart failure. The clinical record was reviewed for certification period 1/28/22 to 3/28/22. During the home visit the surveyor compared P#2's current medication list in the agency's electronic medical record (EMR) to the medications present in P#1's home. P#1 had the following medications in the home but not listed correctly in the agency EMR: Vitamin D3 1000 international units, which is used as a nutritional supplement.Novolog Mix 70/30, 18 units subcutaneously three times per day, which is used to treat hyperglycemia. The agency EMR had the medication listed as “Novolog Mix 70/30, 28 units subcutaneously three times per day. While reviewing medications in the home with RN #AA, RN #AA verbalized understanding of the requirement to reconcile all medications in the home with medications listed in the agency EMR during every comprehensive visit. 2. A home visit was conducted at 2:30 p.m. on 2/21/22, at the residence of Patient #2 with RN #FF. The patient was admitted to the home health agency on 12/27/21, with the diagnosis of acute pulmonary edema. The clinical record was reviewed for certification period 12/27/21 to 2/24/21. During the home visit the surveyor compared P#2’s current medication list in the agency’s EMR to the medications present in P#2’s home. P#2 had the following medications in the home but not listed correctly in the agency EMR:Nystatin Swish and Swallow 100,000 units/ml (milliliter), a medication used to treat oral yeast.Ipratropium/ Albuterol 0.5ml/ 3 ml nebulizer solution, a medication used to treat shortness of breath and lower respiratory congestion. While reviewing medications in the home with RN #FF, RN #FF verbalized understanding of the requirement to reconcile all medications in the home with medications listed in the agency EMR during every comprehensive visit. 3.A home visit was conducted at 9:30 a.m. on 2/22/22, at the residence of Patient #5 with Occupational Therapist (OT) #GG. The patient was admitted to the home health agency on 2/3/22, with the diagnosis of hypertensive heart disease and chronic kidney disease with heart failure. The clinical record was reviewed for the certification period 2/3/22 to 4/3/22. During the home visit the surveyor compared P#5’s current medication list in the agency’s EMR to the medications present in P#5’s home. P#5 had the following medication listed incorrectly in the agency EMR:Furosemide 40 mg was listed as once daily in the agency EMR. However, the medication bottle had instructions for P#5 to take the medication twice daily. The primary care giver confirmed that P#5 was taking the medication twice daily. Furosemide is a medication used to treat edema. While reviewing medications in the home with OT #GG, OT #GG stated being unaware of the requirement of all licensed clinical staff to reconcile all medication in the home with medications listed in the agency EMR for every comprehensive visit. 4. A home visit was conducted at 11:15 a.m. on 2/22/22, at the residence of Patient #6 with Physical Therapy Assistant (PTA) #CC. The patient was admitted to the home health agency on 12/14/21, with the diagnosis of displaced mid-cervical fracture of the right femur, subsequent encounter for closed fracture with routine healing. The clinical record was reviewed for the certification period 12/14/21 to 2/11/22. During the home visit the surveyor compared P#6’s current medication list in the agency’s EMR to the medications present in P#6’s home. P#6 had the following medication in the home but not listed in the agency EMR:Gabapentin 300 mg, which is a mediation used to treat pain. While reviewing medications in the home with PTA #CC, PTA #CC verbalized understanding of the requirement to reconcile all medications in the home with medications listed in the agency EMR during every comprehensive visit. During interview at the agency at 10:30 a.m. on 2/23/22, the acting Administrator was made aware that the medication profile was not updated to reflect current medications at the time of the comprehensive assessment for four of six home visits conducted during the survey (P#1, P#2, P#5 and P#6).

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on clinical record review, observation and staff interview it was determined that the agency failed to ensure the plan of care contained all the treatments necessary to provide care to six of 17 sampled patients (P) (P#1, P#4, P#5, P#8, P#11 and P#14). Findings include: Patient #1 was admitted to the home health agency on 11/29/21, with the diagnosis of hypertensive heart disease and chronic kidney disease with heart failure. Pt #1 also had the diagnoses of type 2 diabetes mellitus and long-term insulin use. The clinical record was reviewed for the certification period 1/28/22 to 3/28/22. The clinical record revealed that P#1 was taking Novolog Mix 70/30 insulin, a medication to treat hyperglycemia. However, the clinical record did not contain physician’s orders for monitoring of hyperglycemia via monitoring finger stick blood sugar testing. Patient #4 was admitted to the home health agency on 12/3/21, with the diagnosis of paroxysmal atrial fibrillation. Pt#4 also had the diagnoses of type 2 diabetes mellitus and long-term insulin use. The clinical record was reviewed for the certification period 2/1/22 to 4/1/22. The clinical record revealed that P#4 was taking Humalog insulin, a medication to treat hyperglycemia. However, the clinical record did not contain physician’s orders for monitoring hyperglycemia via finger stick blood sugar testing.Patient #5 was admitted to the home health agency on 2/3/22, with the diagnosis of hypertensive heart disease and chronic kidney disease with heart failure. The clinical record was reviewed for certification period 2/3/22 to 4/3/22. The clinical record revealed the following physician’s order dated 2/7/22: Skilled nurse to monitor “For weight gain of 2 to 3 lbs (pounds) or 5 lbs over one week.” However, the order did not contain a frequency for the patient, caregiver or nurse to weigh P#5.Patient #8 was admitted to the home health agency on 1/7/22, with the diagnosis of chronic obstructive pulmonary disease. The clinical record was reviewed for certification period 1/7/22 to 3/7/22. The clinical record revealed the following physician’s order dated 1/7/22: Skilled nurse to monitor Skilled nurse to monitor “For weight gain of 2 to 3 lbs or 5 lbs over one week. If patient unable to stand perform body measurement of right lower extremity 30 cc (cubic centimeter) above heel”. However, the order did not contain a frequency for the patient, caregiver or nurse to weigh P#8 nor a frequency for the patient, caregiver or nurse to perform measurement of the lower right extremity. Patient #11was admitted to the home health agency on 1/3/22, with the diagnosis of Covid-19. The patient also had a diagnosis of systolic congestive heart failure. The clinical record was reviewed for certification period 1/3/22 to 3/3/22. The clinical record revealed the following physician’s order dated 1/3/22: Skilled nurse to monitor “For weight gain of 2 to 3 lbs or 5 lbs over one week increase. If patient unable to stand perform body measurement of right lower extremity 30 cm (centimeter) above heel”. However, the order did not contain a frequency for the patient, caregiver or nurse to weigh P#11, nor a frequency for the patient, caregiver or nurse to perform measurement of the lower right extremity.Patient #14 was admitted to the home health agency on 6/21/21 with the diagnosis of hypertensive heart and chronic kidney disease with heart failure, chronic atrial fibrillation and acute on chronic diastolic congestive heart failure. The clinical record was reviewed for certification period 6/21/21 to 8/19/21. The clinical record revealed the following physician’s order dated 6/21/21: “For weight gain of 2 to 3 lbs over night or 5 lbs over one week increase. If patient unable to stand perform body measurement of lower extremity”. However, the order did not contain a frequency for the patient, caregiver or nurse to weigh P#14, nor a frequency for the patient, caregiver or nurse to perform measurement of the lower right extremity. Finally, the order did not contain specific information regarding which lower extremity to measure and what area to measure. During interview at the agency at 10:30 a.m. on 2/23/22, the acting Administrator was made aware that agency failed to ensure the plan of care contained all the treatments necessary to provide care to six of 17 sampled patients (P) (P#1, P#4, P#5, P#8, P#11 and P#14).

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 clinical record review and home visit observation it was determined that the agency staff failed to ensure treatments were administered only as ordered by the physician for two of 17 sampled patients (P). (#2 and #7). The findings include: Patient #2 was admitted to the home health agency on 12/27/21, with the diagnosis of pulmonary edema. P#2 also had the diagnosis of nonthermal blister to left foot and nonthermal blister to right foot. The clinical record was reviewed for certification period 12/27/21 to 2/24/22. The clinical record revealed the following physician’s orders dated 2/11/22: “Wound care to blisters to left dorsal foot every other day and prn (as needed) if dressing soiled. Cleanse wound with wound cleanser. Pat dry with gauze. Apply Santyl. Lightly cover with ABD (abdominal) pads. Apply 2 layer compression up to knees. Using clean technique. SN (skilled nurse) to perform on SN visit days and patient/ CG (caregiver) in between SNV (skilled nurse visit) and wound care visits. Instruct patient/ caregiver signs/ symptoms of wound infection and proper disposal of dressings.” “Skilled nurse to perform/ instruct/ reinforce patient/ caregiver procedure of wound care to blisters to right dorsal foot every other day and prn if dressing soiled. Cleanse with wound cleanser. Pat dry with gauze. Using clean technique apply Santyl. Cover with ABD pads. Apply 2 layer compression up to knees. SN to perform on SN visit days and patient/ CG in between SNV, instruct patient/ caregiver signs/ symptoms of wound infection and proper disposal of dressings.” A home visit was made to the residence of P#2 in conjunction with Registered Nurse (RN) #FF at 2:30 p.m. on 2/21/22. RN #FF was observed providing wound care to both the right dorsal foot and the left dorsal foot during the visit. However, RN #FF was observed cleaning both wounds with normal saline instead of wound cleanser as ordered by the physician.Patient #7 was admitted to the home health agency on 11/15/21, with the diagnosis of hypertensive heart disease without heart failure and venous insufficiency. The clinical record was reviewed for certification period 1/14/22 to 3/14/22. The clinical record revealed the following physician’s order dated 1/25/22: “Wound care to traumatic open left lateral ankle as follows, cleanse with mild soap and water, pat dry, apply a saline moistened gauze to wound, cover with gauze wrap with roll gauze and secure with tape, wound care to be done daily, may have prn visits for soiling and wound changes, SN to provide on SN visit days, patient/ caregiver to provide on non SN visit days.” A home visit was made to the residence of P#7 in conjunction with licensed practical nurse (LPN) #DD at 1:00 p.m. on 2/22/22. LPN #DD was observed providing wound care to the left lateral ankle during the visit. However, LPN #DD was observed cleaning the wound with normal saline instead of mild soap and water as ordered by the physician. In an interview at the agency at 10:30 a.m. on 2/23/22, the acting Administrator was informed that the agency staff failed to ensure treatments were administered only as ordered by the physician for two of 17 sampled patients (P). (#2 and #7).