Every finding on record at Glacial Ridge Home Care

A survey for compliance with CMS Appendix Z Emergency Preparedness Requirements, was conducted on 8/12/24 through 8/14/24, during a recertification survey. The agency is in compliance with the Appendix Z Emergency Preparedness Requirements.

On 8/12/24 to 8/14/24 a recertification survey was conducted. This resulted in a standard survey at Glacial Ridge Home Care Agency. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. Unduplicated census previous 12 months: 153 Total home visits conducted: 3 List Parent Location visited, including the addresses as verified while on site: Glacial Ridge Home Care 219 1ST ST. SE Glenwood, MN 56334 List all other branch offices for this agency and identify which of these were visited during this survey and which you pulled records from: N/A List Hours of Operation: 8 am to 4:30 p.m. List total number of records reviewed: 7

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, interview and document review, the agency failed to follow accepted standards of practice related to cleaning of reusable patient use equipment to prevent transmission of infections and communicable disease for 1 of 3 patients (P3) observed during a home visit. Findings include: P3's plan of care (POC) with certification period 6/19/24 to 8/17/24, included diagnoses of type 2 diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and a personal history of pneumonia. The POC also indicated skilled nurse visits (SNV) every other week for 7 weeks for medication management and monitoring. During a home visit on 8/12/24, at 3:45 p.m., registered nurse (RN)-A was observed to set up P3's medications and applied a continuous glucose monitoring device (a wearable device that tracked blood glucose levels throughout the day and night), with appropriate hand hygiene, and then proceeded to verbally assess P3's pain, bowel status, fall history, and skin. RN-A then took a blood pressure cuff, stethoscope, and oximeter out of her bag, and without using any disinfecting agent to clean the equipment, assessed P3's blood pressure, used the stethoscope to assess P3's lungs, and placed the oximeter on P3’s finger to assess oxygen level and pulse. RN-A gathered the medical equipment she used and used an alcohol wipe to clean the used equipment before putting the equipment back into her bag. RN-A asked P3 questions about upcoming appointments and wrote her next visit into P3’s calendar book. RN-A then prepared to leave. During an interview on 8/13/24 at 3:15 p.m., RN-A stated her practice was to clean used equipment with either an alcohol wipe or a “sani-wipe” (a medical-grade disinfection wipe used for non-invasive medical devices and non-porous hard surfaces), however, RN-A usually used an alcohol wipe because the disinfection wipes had such a strong odor. During an interview on 8/13/24 at 3:30 p.m., home care manager stated staff should be cleaning and disinfecting reusable medical equipment with a medical-grade disinfection wipe, after patient use, and prior to putting back into their bag. Review of the agency's policy revised 10/23, Infection Control Plan, identified equipment and surfaces requiring sanitation were cleansed with a hospital grade disinfectant/germicidal with minimal 1 minute contact time and allowed to air dry.

A survey with CMS Appendix Z Emergency Preparedness Requirements, was conducted on September 7th through 9th 2021, during a recertification survey. The facility is in compliance with the Appendix Z Emergency Preparedness Requirements.

On September 7, 8, and 9 2021, a partial extended survey was conducted at Glacial Ridge Home Care. The agency was found not in compliance with the requirements at 42 CFR. Part 484 for Home Health Agencies. Hours of Operation: Monday through Friday 8:30 a.m. to 5:00 p.m. Unduplicated census: 301 Total home visits conducted: 4 Branch office: Zero Total number of records reviewed: 12

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 observation, interview, and record review, the agency failed to ensure medication profiles were accurate for 2 of 4 patients. (P5 and P7), observed during home visits to ensure accuracy of medications and to ensure a comprehensive review of all medications was conducted to ensure there were no potential adverse side effects and/or noncompliance. P5's plan of care (POC) indicated start of care (SOC) date of 7/14/21. The POC for certification date 7/14/21 to 9/11/21 included diagnoses of Alzheimer’s, dementia, hypertension, diabetes and hyperlipidemia. The POC indicated home health aide visit, one visit per week for eight weeks and four days, along with non-billable supervision, one visit every other month for one month and 29 days. P5's POC included the following medication: Aricept 10 mg by mouth (po) daily (qd), aspirin chewable tablet 81 mg po qd, atorvastatin 80 mg po in evening, ginko boloba capsule 60 mg po twice daily (bid), levothyroxine 50 mcg po qd, nitroglycerin tablet sublingual as needed (prn), vitamin D3 5,000 unit po qd. During a home visit on 9/8/21, at 1:30 p.m. P5 stated her daughter sets up her medications for her. The medications set up in the med ready machine, and the medication list the daughter left in home, indicated the following discrepancies: P3 had ½ tablet of 80 mg atorvastatin set up in the machine, to be taken daily. Also, the label for nitroglycerin indicated dose of 0.4 mg. P3 stated she knows nothing about her medications, just where her daughter keeps them. During interview on 9/9/21, at 11:10 a.m. P5’s daughter, family member (FM)-B, confirmed she sets up medications for her mother and stated the dose for atorvastatin had been ½ of 80 mg tab for the last couple years. FM-B stated she kept a current list of P5’s medications there with the medications. During interview on 9/9/21, at 12:40 p.m. registered nurse (RN)-D stated she admitted P5 and completed the medication reconciliation while FM-B was present. She did not recall P5’s medication list off of the top of her head. RN-D stated she will review this issue with FM-B this week as she was not sure how the correct dosage was missed. RN-D stated it was important to have dosages of medications on the medication profile and stated somehow the dosage for the nitroglycerin was missed. RN-D stated when family members set up medications, it was important to keep in communication with them regarding any changes or updates. P7's plan of care (POC) dated 8/31/21 to 10/29/21 included diagnoses of history of falls, peripheral vascular disease, and cerebral infarction. P7's POC indicated Calcium Carbonate-Vitamin D3 tablets 500 milligrams (mg) (1250mg)-400 international units (iu) daily, oral, instruction: take 1 tab (tablet) daily. During a home visit for P7 on 9/8/21 at 9:10 a.m. the following discrepancies were noted: Client had Calcium Carbonate 600mg in home. During interview on 9/8/21, at 9:45 a.m. P7 stated she was unsure of her calcium dosing or when the calcium was bought as her family sets up and buys her medications. During interview on 9/9/21, at 10:43 registered nurse (RN)-A stated when admitting someone to home care she goes out and does a medication reconciliation which includes going through the discharge medications with what the client is taking in the home. RN-A stated if client is unaware of medications they would then go over the medications with the family members. RN-A stated during her medication reconciliation with R7 she did have the calcium at home and unsure how she missed the dosing difference, but stated she will be addressing the dosage with the provider. RN-A stated it was important to have the medications correct on the plan of care to prevent medication errors from occurring. During interview on 9/9/21, at 12:22 p.m. family member (FM)-A stated that they buy her medication and set up her medications. FM-A stated that the calcium in P7's home was from what P7 already had in her home prior to admitting to homecare. Medication Management policy reviewed 1/2019, indicated "Registered nurse will conduct a face to face assessment with the client and or family to determine what medication management services will be provided and how the services will be provided. Assessment must include an identification and review of all medications the client is known to be taking. The review and identification must include indications for medication, side effects, contraindications, allergic or adverse reactions, and actions to address these issues. Nurse will question client regularly on any new medications in the home and seek physician orders for any medication the client has obtained that is no currently on the medication orders. Nurse can only set up medications that are on the official physician orders and match the prescription on the bottle from the pharmacy. Over the counter and dietary supplements obtained by the client will be reported to the physician for approval and inclusion in the medication orders before they can be set up.

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 observation, interview, and document review the agency failed to ensure the plan of care (POC) included a description of the risk for emergency department visits and hospital re-admissions, and all necessary interventions to address the underlying risk factors for 12 of 12 patients (P7, P8, P10, P11, P1, P2, P3, P5, P6, P4, P9 and P12). P1 POC indicated SOC date of 2/3/21. The POC for certification date 8/2/21 to 9/30/21 included diagnoses of hypertensive heart disease with heart failure, atrial fibrillation, pulmonary hypertension, hypothyroidism, and diastolic congestive heart failure. P1's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P2 POC indicated SOC date of 5/13/21. The POC for certification date 7/12/21 to 9/9/21 included diagnoses of bilateral osteoarthritis of the knee, hypertensive heart and chronic kidney disease with heart failure, type 2 diabetes, atrial fibrillation, anemia, and cerebral ischemia. P2's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P3 POC indicated SOC date of 9/2/19. The POC for certification date 8/22/21 to 10/20/21 included diagnoses of type 2 diabetes, hypertension, atrial fibrillation, and history of falling. P3's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P5 POC indicated SOC date of 7/14/21. The POC for certification date 7/14/21 to 9/11/21 included diagnoses of Alzheimer’s, dementia, hypertension, type 2 diabetes and hyperlipidemia. P5's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P6 POC indicated SOC date of 5/19/21. The POC for certification date 7/18/21 to 9/15/21 included diagnoses of bone cancer, atrial fibrillation, prostate cancer, hypertension and gastroesophageal reflux. P6's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P4’s POC dated 7/23/21 to 9/20/21, identified diagnoses of ataxia (a lack of muscle control or coordination of voluntary movements, such as walking or picking up objects), type 2 diabetes, restless legs syndrome, obesity and hyperlipidemia. P4’s POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P9’s POC dated 2/9/21 to 4/9/21, identified diagnoses of Alzheimer’s disease, Dementia, parkinsonism and history of falling. P9’s POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P12’s POC dated 8/17/21-10/15/21, identified diagnoses of hypertension, anxiety, and hyperlipidemia (high cholesterol). P12’s failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. On 9/9/21, at 11:50 a.m. clinical manager (CM)-A stated she expected the risk for emergency department visits, hospital re-admission and the necessary interventions were on the POC in the narrative and the goals. Admission to homecare program policy dated 12/20, indicated "Patient's are accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, social and related health needs can be adequately met in the patient's place of residence. Admitting registered nurse completes an initial evaluation to determine if patient meets admission criteria and consults the homecare manager as needed to determine appropriateness for admission. A client will sign and receive a copy of a service plan which includes the following. A description of the services to be provided, fees for services, and the frequency of each service according to the client's current review or assessment and client preferences; A identification of the persons or categories or persons who are to provide the services; the schedule and methods of monitoring reviews or assessments of the client; frequency of sessions of supervision of staff. Any modification to the service plan must be communicated to the client or the client's responsible person and must be documented in the client's record. The agency will implement and provide all services required by the current service plan. An individualized, comprehensive assessment must be conducted in person by a registered nurse or appropriate health professional within five days after initiation of home care services." Requested a policy for what all had to be on a plan of care. Per clinical manager CM)-A stated 9/9/21 2:00 p.m. they did not have such policy. P7's plan of care (POC) dated 8/31/21 to 10/29/21, included diagnoses of history of falls, peripheral vascular disease, and cerebral infarction. P7's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P8's POC dated 5/11/21 to 7/9/21, included diagnoses of Infection and inflammatory reaction due to internal right knee prosthesis (knee replacement with infection), Heart disease, hypertension, and bipolar disorder. P8's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P10's POC dated 12/27/20 to 2/24/21, included diagnosis of Bipolar, paranoid schizophrenia, chronic obstructive pulmonary disease, essential hypertension, and dependence on supplemental oxygen. P10's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. P11 POC dated 8/2/21 to 9/30/20, included diagnosis of heart disease, hypertension, old myocardia infarction (heart attack), and history of falls. P11's POC failed to identify a description of the risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. During interview on 9/9/21 at 10:34 a.m. registered nurse (RN)-A stated the risk for emergency departments and hospital re-admissions was completed in the electronic medical record but was not located on the plan of care.

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 observation, interview and document review the agency failed to ensure medications were set up to patients only as ordered by the physician for 1 of 2 patients (P4) reviewed for medication set up. Findings include: P4 had a start of care (SOC) date of 11/25/20. P4’s plan of care (POC) with certification date of 7/23/21-9/20/21 identified diagnoses of ataxia (a lack of muscle control or coordination of voluntary movements, such as walking or picking up objects), type 2 diabetes, restless legs syndrome, obesity and hyperlipidemia. The POC also identified P4 required skilled nursing visits (SNV) weekly for various assessments and medication set up at each SNV. During home visit on 9/8/21, at 10:00 a.m. P4’s medications were reviewed with registered nurse (RN)-C while RN-C set up P4’s medications into pill boxes. The Medication Report dated 9/8/21, RN- referred to while set up the medications include cholecalciferol (vitamin D3) 2000 units with instructions, “set up two 1000 unit tabs to=2000 units per day daily in AM.” The prescription label on the cholecalciferol indicated the dose filled in the bottle was 2000 units. RN-C was observed to set up two tablets, each being 2000 units=4000 units, into the pill box for each day of the week, Sunday-Saturday. On 9/9/21, at 8:24 a.m. RN-C confirmed the prescription label on the cholecalciferol indicated the medication was filled on 4/14/21. RN-C stated she had been using this bottle to fill P4’s medication pill box for an unknown amount of time, but likely started using it within two weeks from the fill date. RN-C was not able to recall if she was filling the medication pill box with one or two tabs but confirmed she did place two tabs in the medication pill box on 9/8/21. On 9/9/21, at 11:50 a.m. clinical manager (CM)-A stated she expected medications were set up as ordered by the provider. Agency policy, Medication Set up review date 1/19, indicated the nurse will compare the medication bottle with the current medication list on hand, noting that the medication name, prescribe dose/strength, and timing of medication are consistent.