Every finding on record at Home Care Elite LLC

A recertification and follow up (SI8K11) survey entrance conference was conducted on 01/09/23 at 9:00 a.m. with the Alternate Administrator. Census: 176 Licensed and Certified: 176 An exit conference was conducted on 01/12/23 at 8:30 a.m. with the Administrator and Alternate Administrator. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. Acronyms used: mg – milligram mcg - microgram

A recertification and follow up (SI8K11) survey entrance conference was conducted on 01/09/23 at 9:00 a.m. with the Alternate Administrator. Census: 176 Licensed and Certified: 176 An exit conference was conducted on 01/12/23 at 8:30 a.m. with the Administrator and Alternate Administrator. The preliminary findings were discussed. The agency was afforded the opportunity to provide additional information. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. Acronyms used: mg – milligram mcg - microgram

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 skilled nurse failed to follow the agency’s policy to check medications currently being used against the medication list in the plan of care for 1 of 7 patients reviewed for medication regimen review. (Patient #1) This failure could place patients at risk of receiving incorrect medications or incorrect dosages. Findings included: Record review of an agency policy titled Medication Monitoring and Documentation, dated 2002, indicated the purpose of the policy was “to ensure that each patient is monitored on an ongoing basis for medication effectiveness and actual or potential medication-related problems.” Record review of an agency policy titled Medication Administration, dated 2002, indicated the purpose of the policy was “to ensure that each patient is monitored on an ongoing basis for medication effectiveness and actual or potential medication-related problems.” The policy indicated “The nurse will check all medication that the patient is taking on every visit to determine accuracy against physician orders.” Record review of Patient #1’s plan of care with a recertification period of 1/7/23 to 3/7/23 and a start of care date of 9/9/22 indicated Patient #1 was 90 years old with diagnoses including type 2 diabetes mellitus with chronic kidney disease, unspecified heart failure, atrial fibrillation and venous insufficiency. The plan of care indicated Patient #1 was to receive skilled nurse visits once a week for eight weeks, and the skilled nurse was to instruct/reinforce patient or caregiver on all changed/new medications. The care plan did not indicate the skilled nurse was to review medication regimen each visit. Record review of Patient #1’s Plan of Care Medication Profile indicated she was to receive medications including: Lasix 20 mg daily (diuretic) Rivastigmine transdermal 4.6 mg/24 hours (to treat dementia) Levothyroxine sodium 100mcg daily (thyroid hormone) Amlodipine besylate 10 mg daily (to treat high blood pressure) Eliquis 2.5 mg twice a day (anticoagulant) Colace 100 mg twice a day (laxative) Citalopram hydrobromide 20 mg daily (antidepressant) Ambien 10 mg at bedtime as needed (hypnotic/sedative) Pravastatin Sodium 40 mg at bedtime (to treat high cholesterol) Cyanocobalamin 1000 mcg daily (hematopoietic agent) During an observation of a skilled nurse visit on 1/10/23 at 10:15 a.m., RN C compared a printed Medication Profile with the handwritten medication list in Patient #1’s home folder. RN C did not look at actual medications nor review the information on the medication labels as part of the medication review. During an interview on 1/10/23 at 10:50 a.m., RN C said she reviewed Patient #1’s medication by comparing the written medication list in the home folder with the Medication Profile. RN C said she did not look at the actual medications and did not review the medication labels. RN C said, “the only time I actually look at the bottles is when I do a recertification visit.” During an interview on 1/10/23 at 11:00 a.m., the Clinical Manager said she had instructed the nurses to check the medications on every visit, adding “I tell them all the time.” The Clinical Manager said nurses should be looking for any changes, and to make sure the patient is taking their medication correctly. The Clinical Manager said RN C should have checked Patient #1’s medications when she did the medication review. The Clinical Manager said nurses had been told to visually look at the medications, and that they should do it each visit. During an interview on 1/11/23 at 4:08 p.m., the Clinical Manager said any nurse who does a skilled nurse visit should address any problems. The Clinical Manager said all medications should be in the electronic record (medication profile), and the nurse should look at the medication bottles and make sure it matches the medication profile and the written medication list in the home folder during every visit.