Every finding on record at Guardian Home Care, Inc.

An unannounced Federal recertification survey was completed at this agency on 8/11/2022. The agency was surveyed for compliance with 42 CFR Conditions of Participation for Home Health Agencies, Part 484.102 Emergency Preparedness. An entrance conference was held with the Home Health Branch Director/Administrator on 8/9/2022 at 10:40 AM. The purpose of the survey and the survey needs were explained. An opportunity was provided for questions, answers, and comments. No deficiencies were cited. Definitions and abbreviations: CFR - Code of Federal Regulations

An unannounced Federal recertification survey was completed at this agency on 8/11/2022. The agency was surveyed for compliance with 42 CFR Conditions of Participation for Home Health Agencies, Part 484. An entrance conference was held with the Home Health Branch Manager/Administrator on 8/9/2022 at 10:40 AM. The purpose of the survey and the survey needs were explained. An opportunity was provided for questions, answers, and comments. Definitions and abbreviations: BD - Branch Director CFR - Code of Federal Regulations CMS - Centers for Medicare and Medicaid Services HHA - Home Health Agency MG - Milligram PRN - As Needed RDO - Regional Director of Operations # - number

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on interview and review of medical records, it was determined the agency failed to provide the patients with complete medication schedule/instructions for 4 of 13 patient records reviewed (Patients #9, #11, #12, and #13). Findings: Patient #9: Review of the document titled "Home Health Certification and Plan of Care," for the certification period of 7/28/2022 to 9/25/2022, revealed the following medication order: "NITROGLYCERIN 0.6 MG SUBLINGUAL TABLET; 1 tablet AS NEEDED/PRN; Reason: ANGINA." The order failed to provide complete instruction regarding frequency interval and maximum doses to be taken of medication before seeking medical help. During an interview with the BD/Administrator and the RDO on 8/11/2022 at 11:55 AM, both employees acknowledged the medication order was not complete. BD/Administrator stated, "That was from the label on the bottle. It should have been clarified on admission." Further review of the document titled "Home Health Certification and Plan of Care," for the certification period of 7/28/2022 to 9/25/2022 for Patient #9, revealed the following medication order: "PROMETHAZINE 25 MG TABLET; ORAL; 1 tablet; as needed/prn; Reason: to prevent nausea." The order failed to provide complete instruction regarding frequency and/or a maximum daily dose. Patient #11: Review of the document titled "Home Health Certification and Plan of Care," for the certification period of 7/26/2022 to 9/23/2022, revealed the following medication order: "CETIRIZINE 10 MG TABLET; ORAL; 1 tablet; AS NEEDED/PRN; Reason: ALLERGY." The order failed to provide complete instruction regarding frequency interval and/or a maximum daily dose. During an interview with the BD/Administrator and the RDO on 8/11/2022 at 11:55 AM, both employees acknowledged the medication order was not complete. Patient #12: Review of the document titled "Home Health Certification and Plan of Care," for the certification period of 8/1/2022 to 9/29/2022, revealed the following medication order: "POLYVINYL ALCOHOL 1.4% EYE DROPS; ophthalmic (eye); 1 Drops; AS NEEDED/PRN; Reason: EYE HEALTH." The order failed to provide complete instruction regarding the frequency interval and site (right or left eye) for administration of the medication. During an interview with the BD/Administrator and the RDO on 8/11/2022 at 11:55 AM, both employees acknowledged the medication order was not clear on instruction to the patient/caregiver. Patient #13: Review of the document titled "Home Health Certification and Plan of Care," for the certification period of 7/20/2022 to 9/17/2022, revealed the following medication order: "BAQSIMI 3 MG/ACTUATION NASAL SPRAY; NASAL; 1 spray; AS NEEDED/PRN; Reason: SEVERE HYPOGLYCEMIA; Instructions: 1 SPRAY FOR SEVERE HYPOGLYCEMIA." The order failed to define or give parameters for "Severe Hypoglycemia," the frequency interval for medication administration and when to stop administration of medication and seek medical attention. During an interview with the BD/Administrator and the RDO on 8/11/2022 at 11:55 AM, both employees acknowledged the medication order was not complete. Further review of the document titled "Home Health Certification and Plan of Care," for the certification period of 7/20/2022 to 9/17/2022 for Patient #13, revealed the following medication order: " EPINEPHRINE 0.3MG/0.3ML INJECTION SYRINGE; INJECTION; 0.3 mg; AS NEEDED/PRN; Reason: ANAPHYLAXIS; Instructions: INJECT 0.3ML INTO THE MUSCLE AS NEEDED FOR ANAPHYLAXIS." The order failed to give parameters of when medication should be stopped and to seek medical attention. During an interview with the BD/Administrator and the RDO on 8/11/2022 at 11:55 AM, both employees acknowledged the medication order was not clear with instruction on how often the medication can be repeated and when to seek medical attention.