Every finding on record at Health Watch Provo, Inc.

Based on a recertification survey conducted 5/17/21 through 5/18/21, it was determined that Health Watch Provo, INC was found in compliance with the Conditions of Participation for Emergency Preparedness; 42 CFR (Code of Federal Regulations) 484.22 and 484.102. No deficiencies were cited in this area.

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 interview and medical record review, it was determined that the home health agency did not ensure that all patient medications had been reviewed as part of the comprehensive assessment and updated on the patients' medication profile for 1 of 1 sampled medicaid patients. (Patient identifier: 11) Findings include: On 5/18/2021, a review of patient 11's medical record was completed. Patient 11 was admitted on 9/14/2015, with a diagnosis of Larsen Syndrome. Patient 11's medication profiles dated 12/11/2020, 2/11/2021, and 4/14/2021, were reviewed. Each medication profile listed the following medications: Albuterol Sulfate, inhalation as needed Cholecalciferol (Vitamin D3) 2000 units daily Ibuprofen 200 mg (milligrams) as needed Acetaminophen (Tylenol) 325 mg as needed Polyethylene Glycol 3350 as needed Gabapentin 600 mg three times per day In a nursing visit note dated 1/7/2021, it was documented, "Pt (patient) just received a prescription for Ultram. Pt's mother is going to fill the prescription today." In a nursing visit note dated 2/8/2021, it was documented, "Oxycodone HCL (hydrochloride) 5 mg 1-3 tabs Q (every) 4 hrs (hours) for pain. Pt also has Narcan for emergencies." In a nursing visit note dated 2/17/2021, it was documented, "Administered pt's antibiotic Cefazolin 1500mg/15 mls (milliliters) IV (intravenous) push via pt's PICC (peripherally inserted central catheter) line." In a nursing visit note dated 3/11/2021, it was documented, "Pt's legs were shaking a lot, so I gave her 1 tab of Baclofen 5 mg PO (by mouth)". In a nursing visit note dated 3/19/2021, it was documented, "IV antibiotics are finished. Pt no longer taking pain medication." In a nursing visit note dated 4/15/2021, it was documented, "Pt taking Doxycycline Monohydrate 100 mg PO once per day for boils on her legs and Terbinafine 250 mg PO daily for toe fungus." In a nursing visit note dated 5/6/2021, it was documented, "Pt has a new prescription for Progesterone 100 mg SL (sublingual) up to four tablets every 10 minutes as needed for migraines." None of the documented medication additions or changes were updated on the patient's medication profile. On 5/18/2021 at 1:39 PM, an interview was conducted with the HHA's administrator (ADM). The ADM stated they were confused and did not think medicaid patients needed anything documented other than a summary.

Update of the comprehensive assessment CFR(s): 484.55(d) Standard: Update of the comprehensive assessment. The comprehensive assessment must be updated and revised (including the administration of the OASIS) as frequently as the patient's condition warrants due to a major decline or improvement in the patient's health status, but not less frequently than- This STANDARD is not met as evidenced by: Based on interview and record review, it was determined the home health agency (HHA) did not ensure an updated comprehensive assessment was performed on all patients. Specifically, for 1 of 1 sampled medicaid patients, there was no documented comprehensive assessment. (Patient identifier: 11) Findings include: On 5/18/2021, a review of patient 11's medical record was completed. Patient 11 was admitted on 9/14/2015, with a diagnosis of Larsen Syndrome. A document titled Comprehensive Adult Assessment and dated 4/14/2021, was reviewed. In the section titled Skilled Services Provided this Visit and Patient Response, a documented summary included the following: the patient was paralyzed from the waist down, had a gastrostomy tube, a suprapubic catheter, a "bowel flush site", severe contractures of both arms and hands, clubfoot, had asthma and was susceptible to respiratory infections, required hearing aides in both ears, had undergone several surgeries for bowel obstructions, and had just undergone surgery to remove an abscess from her left buttock/femur area. Most of the detailed assessment sections in the Comprehensive Adult Assessment document were blank, including; Patient History and Diagnoses, Living Arrangements, Psychosocial Status, Sensory Status, Integumentary Status, Respiratory Status, Cardiac Status, Elimination Status, Nutritional Status, Neuro/Emotional/Cognitive Status, Functional Abilities and Goals, Fall Risk Assessment, Medications, and Care Management. Seven other Comprehensive Adult Assessments dated from 4/20/2020 through 2/11/2021, were reviewed. Each document revealed a documented summary and the same detailed assessment sections left blank. On 5/18/2021 at 1:39 PM, an interview was conducted with the HHA's administrator (ADM). The ADM stated they did not require the nurse seeing patient 11 to complete the assessment document. She stated they thought they only needed to document a summary.

Communication with all physicians CFR(s): 484.60(d)(1) Assure communication with all physicians or allowed practitioners involved in the plan of care. This ELEMENT is not met as evidenced by: Based on interview and record review, it was determined the home health agency (HHA) did not assure communication with all physicians involved in the plan of care. Specifically, for 1 of 12 sampled patients, the physician was not notified when blood sugar levels were not within the physician's ordered range, or when registered nurses were administering different insulin doses. (Patient identifier: 10) Findings include: 1. Patient 10 was admitted to the agency on 4/12/19 and readmitted after a hospitalization on 3/6/21, with a diagnosis of diabetes mellitus type II. A review of patient 10's medical record was completed on 5/18/21. The following physician orders dated 3/11/21 were documented on patient 10's medication profile: a. Administer Basaglar KwikPen (a long-acting insulin) 50 units every morning and adjust it by 1 to 3 units every 3 to 4 days until patient 10's fasting blood sugar was 100-140. b. Administer Humalog (a rapid-acting insulin) 15 units 15 minutes before breakfast. If blood sugar (BS) 70-100 take half the dose, if under 70 hold Humalog. Nursing note documentation from 3/11/21 to 5/17/21 was reviewed and revealed: i. On 3/21/21 patient 10's BS was 209 and her Basaglar dose was increased to 56 units. On 3/22/21 patient 10's BS was 256 and 54 units of Basaglar was administered along with the 15 units of Humalog. No documented evidence could be found to explain why the patient's insulin dose had been decreased after the increase on 3/21/21. ii. On 3/24/21 patient 10's BS was documented as 76 and 56 units of Basaglar and 15 units of Humalog were administered. No documented evidence could be found to explain why patient 10's Humalog dose was not halved as indicated by the physician order. iv. On 3/28/21 patient 10's Basaglar dose was increased to 59 units. On 3/29/21 there was no documented evidence of a nursing visit. On 3/30/21 it was documented patient 10's Basaglar dose was increased to 60 units. No documented evidence could be found to explain why patient 10's Basaglar dose had been increased prior to the 3 to 4 day timeline indicated by the physician order. vi. From 4/3/21 to 5/17/21 it was documented that patient 10 received 62 units of Basaglar. During that time period patient 10's BS was over 140 on 4/3/21, 4/5/21, 4/10/21, 4/13/21, 4/14/21, 4/15/21, 4/17/21, 4/18/21, 4/20/21, 4/21/21, 4/26/21, 4/27/21, 4/28/21, 5/1/21, 5/4/21, 5/5/21, 5/6/21, 5/10/21, 5/12/21, 5/13/21, and 5/17/21. With no nursing notes documented on 5/15/21 and 5/16/21. Patient 10's BS was over 140 during 20 out of the 43 documented visits. No documented evidence could be found to indicate there was coordination with the physician to explain why patient 10's Basaglar dose had not been increased as indicated by the physician order. v. From 4/9/21 to 5/17/21 patient 10's BS was documented as below 100 on 4/9/21, 4/16/21, 4/25/21, 4/30/21, 5/9/21 and 5/14/21. For each of these days it was documented patient 10 received 15 units of Humalog. No documented evidence could be found to explain why patient 10's Humalog dose was not halved as indicated by the physician order. On 5/18/21 at 1:36 PM, a telephone interview was conducted with the agency administrator, quality director, and newly appointed director of nursing (DON). The DON stated she was one of the nurses who saw patient 10. The DON stated patient 10's daughter kept records of patient 10's blood sugar levels and gave those to the physician every month. The DON further stated if the physician wanted to make any changes based on the notes provided by patient 10's daughter he would send an order to the agency. The DON stated another nurse had been working with patient 10's daughter and physician to adjust patient 10's insulin doses. The DON stated there should have been documentation in patient 10's medical record regarding this communication. The DON stated she was not aware of a blood sugar range wherein patient 10's Humalog dose would not be given or adjusted. No documented evidence could be found to indicate the agency had been coordinating with patient 10's physician.