Every finding on record at Hamilton Medical Center

A Recertification survey was conducted at Hamilton Home Health on February 17, 2025, and concluded on February 18, 2025. At the time of the survey, the agency was in compliance with 42 CFR Part 418.113, Emergency Preparedness and Covid-19 infection control.

A Recertification survey was conducted at Hamilton Home Health on February 17, 2025, and concluded on February 18, 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 145. 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, agency policy, 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 Transmission,” effective date 5/2022, revealed the following: Procedure: The Organization will encode and transmit completed OASIS data for each applicable patient within thirty (30) days of the M0090 date, date assessment completed. Review of CMS report titled “HHA Error Summary by Agency,” report run date of 1/29/2025, and report period of 01/01/2024-12/31/2024 revealed the agency failed to transmit OASIS data to CMS system within 30 days. During an in-office interview on 2/19/2025 at 12:00 pm, the Administrator confirmed awareness of the 30-day OASIS submission timeframe requirements not met during the time frame of 01/01/2024 - 12/31/2024. The Administrator explained the agency OASIS reviewing and submission process was delayed due to complications with the agency’s workflow, specifically with staffing issues.

At the time of the survey Hamilton Home Health in Dalton, GA was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a recertification survey conducted on February 17, 2022. A Focus Infection control survey was completed at the time of the survey. Current census 233. No deficiencies cited.

At the time of the survey, Hamilton Home Health in Dalton , GA was in compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of a recertification survey conducted on February 17, 2022. A Focus Infection control survey was completed at the time of the survey. Current census 233. Following deficiencies 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 clinical record reviews, home visit observations, and staff interviews, it was determined the agency failed to ensure that patients' medication profiles were updated to reflect current medications for two of seven (P#) (#12,and #14) patients participating in home visit observations. Findings include: 1. Review of the plan of care/treatment for P# 12 with a certification period of 1/10/22 to 3/10/22, revealed that patient has a diagnosis of Type 2 diabetes mellitus. During a home visit observation on 2/14/22 at approximately 2:30 p.m., this surveyor compared the medications found in the home with the agency medication profile. According to patient's caregiver, the patient is taking Januvia (anti-diabetic ) 50 milligrams once daily and Toviaz (treatment for overactive bladder) 4 mg once daily. However, the agency medication profile did not include these medications. The agency staff failed to update agency medication profile to reflect the patient's current medications. 2. Review of the plan of care/treatment for P# 14 with a certification period of 2/2/22 to 4/2/22, revealed that patient has a diagnosis of acute respiratory failure. During a home visit observation on 2/15/22 at approximately 11:25 a.m. , this surveyor compared the medications found in the home with the medication profile. According to the patient’s caregiver, patient does not take the following medications as were listed on the agency medication profile: Demadex 20 mg ( to reduce extra fluid in the body) 2 tablets daily at night and Demadex 20 mg 3 tablets every morning . Ubiquinone ( used for coenzyme Q-10 deficiency)200 MG one capsule once daily. The agency staff failed to update the medication profile to reflect the patient's current medications. During an interview on 2/17/22 at 11:30 a.m., the Administrator and the Director of Nursing confirmed that medication profile had not been updated to reflect the patient's current medications.

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 reviews and staff interviews, it was determined the agency staff failed to include orders to cover all pertinent diagnoses and ensure the patients' needs were addressed to include disease specific interventions/treatments were included on the plans of care for ten of seventeen ( #1, , #3, #4, , #6, #7, #9, #10,#12, #14 and #16) sampled patients (P). Findings include: 1. Review of the plan of care/treatment for P# 12 with a certification period of 1/10/22 to 3/10/22, revealed that patient has a diagnosis of Type 2 diabetes mellitus and patient is taking Januvia (anti-diabetic ) 50 milligrams once daily. The plan of care lacked specific teaching and assessments of diabetes mellitus; frequency to check the blood sugar, teaching on diabetic complications, such as hyper and/or hypoglycemia and other diabetic complications to be reported to the nurse and to the physician. The agency failed to ensure the plan of care was complete and consistent to include the specific teaching and assessments of diabetes and its complications. 2. Review of the plan of care/treatment for P#1 (closed record) with a certification period of 8/19/21to 10/17/21 revealed that patient has a diagnosis of cardiomyopathy with long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. 3. Review of the plan of care/treatment for P#3 (closed record) with a certification period of 1/20/21to 3/20/21 revealed that patient has a diagnosis of ischemic cardiomyopathy and atrial fibrillation with long-term use of aspirin 81 mg (blood thinner) once daily and Plavix (blood thinner) 75 mg 1 tablet daily . The plan of care lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. 4. Review of the plan of care/treatment for P#4 (closed record) with a certification period of 9/30/21 to 11/28/21 revealed the patient has a pertinent diagnosis of atrial fibrillation with long term use of anticoagulant therapy (Eliquis 5 mg two times daily). However, the plan of care lacked patient specific orders to assess and monitor anticoagulant therapy. The agency staff failed to include orders to assess and monitor patient's anti-coagulant therapy on the plan of care. The agency failed to ensure that plan of care/treatment covered all pertinent interventions for the comprehensive care of the patient's anticoagulant therapy. 5. Review of the plan of care/treatment for P#6 with a certification period of 1/4/22 to 3/4/22 revealed that patient has a diagnosis of Arteriosclerotic heart disease (ASHD) with long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. 6. Review of the plan of care/treatment for P#7 with a certification period of 1/4/22 to 3/4/22 revealed that patient has a diagnosis of occlusion and stenosis of carotid artery with long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. 7. Review of the plan of care/treatment for P#10 with a certification period of 1/4/22 to 3/4/22 revealed that patient has a diagnosis of Acute respiratory failure with long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. 8. Review of the plan of care/treatment for P#9 with a certification period of 1/6/22 to 3/6/22 revealed that patient has a diagnosis of Type 2 diabetes mellitus and long-term use of aspirin 81 mg (blood thinner) once daily. The plan of care lacked teaching and assessment of bleeding complications. Furthermore, the plan of care required the skilled nurse (SN) to check patient's blood sugar log each visit and report blood sugar greater than 350 or less than 50. However, the plan of care/treatment lacked orders for the frequency of blood glucose monitoring to instruct the patient on how often to monitor blood glucose levels to monitor for early complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of diabetes mellitus and anticoagulation therapy and its complications. 9. Review of the plan of care/treatment for P#16 with a certification period of 1/26/22 to 3/26/22 revealed that patient has a diagnosis of Type 2 diabetes mellitus with long term use of hypoglycemic drug Glucophage XR 500 mg(anti-diabetic) 1 tablet once daily, and Arteriosclerotic heart disease (ASHD) with long-term use of aspirin 81 mg (blood thinner) once daily and long-term use of antithrombotic and antiplatelet. The plan of care lacked specific teaching and assessments of diabetes mellitus; frequency to check the blood sugar, teaching on diabetic complications, such as hyper and/or hypoglycemia and other diabetic complications to be reported to the nurse and to the physician. The plan of care also lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of diabetic management and anticoagulation therapy and its complications. 10. Review of the plan of care/treatment for P#14 with a certification period of 2/2/22 to 4/2/22 revealed that patient has a diagnosis of heart failure with long term use of aspirin 81 mg 1 tab once daily . The plan of care lacked teaching and assessment of bleeding complications. The agency failed to ensure the plan of care was complete and consistent to include specific teaching and assessments of anticoagulation therapy and its complications. During an interview on 2/17/22 at 11:30 a.m., the Administrator and the Director of Nursing verbalized that plan of care/treatment did not cover all pertinent interventions for the comprehensive care of the patient's diabetic status and anticoagulant therapy.