Every finding on record at Home Health Integrated Services, Inc.

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health : Surveyor # 44916, Health Facilities Evaluator Nurse Surveyor # 22303, Health Facilities Evaluator Nurse Surveyor # 35893, Health Facilities Evaluator Nurse Unduplicated Admissions - 27 Active Patients - 27 Sample Size - 8 Home Visits- 6

Eligibility for Medicare home health benefit CFR(s): 484.55(b)(2) Except as provided in paragraph (b)(3) of this section, a registered nurse must complete the comprehensive assessment and for Medicare patients, determine eligibility for the Medicare home health benefit, including homebound status. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to assess the patient's continuing need for skilled nursing services for one of eight patients. (Patient 7). This deficient practice has the potential to result in the provision of an unnecessary continuous home health services to the patient who did not need skilled nursing services. A review of Patient 7's Patient Profile indicated, a start of care date of 2/11/21, with a diagnosis of osteoarthritis to bilateral knees (tissue at the ends of bones wear down). During a review of Patient 7's plan of care (POC) for the period of 2/11/21 to 2/5/22, included for SN to visit once a week for nine weeks, for assessment of all body systems and medication compliance. Patient 7's clinical record review indicated no admissions to the hospital or any significant changes of condition of the patient to determine the need for continued HHA services. During an interview with the Director of Patient Care Services (DPCS) on 2/18/22, at 1:15 p.m., she stated the agency recertified the patient for monitoring medications and patient safety. DPCS confirmed there were no changes of the patient's medications and no changes of condition. DPCS stated the family member was pushing for skilled nursing services. The DPCS stated she should discharge the patient because goals are met. A review of the agency's undated policy "Discharge Criteria and Process" indicated services will be terminated when the goals of home health have been attained or are no longer attainable.

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 home health agency (HHA) failed to maintain an accurate, and current medication profiles for six of eight sampled patients (Patients 1, 2, 3 , 4, 6, and 7) This failure had the potential risk to result in medication errors and adverse drug reactions. a. A review of Patient 3's clinical record indicated a start of care dated 11/27/21, with primary diagnosis of polyosteoarthritis (a condition where pain and inflammation occur in multiple joints at once).A review of Patient 3's plan of care from 1/26/22 to 3/26/22, included an order for SN (skilled nurse) visits of once a week for 9 weeks, to perform skilled assessment/observation of vital signs with emphasis on the musculoskeletal (muscle) status. The POC indicated for the SN to teach and validate management of medications , actions, side effects and adverse reactions. A physician's order included in the plan of care was to administer Meloxicam 15 mg (milligrams) one tab by mouth daily. On 2/17/22, at 11:45 a.m., a joint home visit was made to Patient 3's residence with the DPCS (director of patient care services). Patient 3 was observed sitting on the couch and uses a cane for ambulation. During a review of Patient 3's medications indicated a bottle of Meloxicam 15 mg one tab as needed . On 2/17/22, at 11:50 a.m., during an interview with Patient 3, he stated that he takes Meloxicam 15 mg one tab as needed when he has pain. On 2/17/22, at 12 p.m., during an interview with the DPCS, she agreed the visiting nurse should have checked the Meloxicam medication and notify the physician for the correct order. b. A review of Patient 4's clinical record indicated a start of care dated 11/27/21, with primary diagnosis of bilateral osteoarthritis of knee (a condition where pain and inflammation occur in multiple joints at once).A review of Patient 4's plan of care from 1/26/22 to 3/26/22, included an order for SN (skilled nurse) visits of once a week for 9 weeks, to perform skilled assessment/observation of vital signs with emphasis on the musculoskeletal (muscle) status. The POC indicated for the SN to teach and validate management of medications , actions, side effects and adverse reactions. A physician's order included in the plan of care was to administer Meloxicam 15 mg (milligrams) one tab by mouth twice daily. On 2/17/22, at 12:30 p.m., a joint home visit was made to Patient 4's residence with the DPCS (director of patient care services). Patient 4 was observed sitting on the couch and walks with a steady gait. During a review of Patient 4's medications indicated a bottle of Meloxicam 15 mg one tab daily. On 2/17/22, at 12:45 p.m., during an interview with Patient 4, she stated that she takes Meloxicam 15 mg one tab daily as ordered. On 2/17/22, at 12:55 p.m., during an interview with the DPCS, she agreed the visiting nurse should have checked the Meloxicam medication and notify the physician for the correct order. c. A review of Patient 6's Patient Profile indicated, a start of care (SOC) date of 2/11/21, with a diagnosis of Alzheimer's disease (a progressive disease that destroys memory and other important mental functions). During a review of Patient 6's Plan of Care (POC), for the re-certification period from 2/6/22 to 4/6/22, included an order for skilled nurse (SN) to visit onve a week for nine weeks. The SN should instruct the patient on new or changed medications and provide management on medication regimen. On 2/17/22 at 10:15 a.m., a home visit was conducted at Patient 6's residence with licensed vocational nurse (LVN 2) . During a review of Patient 6's medications indicated a bottle of calcium 50 milligrams (mg- unit of measurement) once daily . The medication was not on the medication profile for Patient 6. During an interview on 2/17/22 at 10:20 a.m., LVN stated the medication profile should be kept up to date. d. A review of Patient 7's Patient Profile indicated, a SOC date of 2/11/21, with a diagnosis of osteoarthritis to bilateral knees (tissue at the ends of bones wear down). During a review of Patient 7's POC, for the re-certification period from 2/6/22 to 4/6/22, included an order for SN to visit once a week for nine weeks. The SN should instruct the patient on new or changed medications and provide management on medication regimen. On 2/17/22 at 10:30 a.m., a home visit was conducted with LVN 2. During a review of Patient 7's medications indicated a bottle of zinc 50 mg once daily and magnesium chloride 100 mg in the evening. The medications were not on the medication profile for Patient 7. During an interview on 2/17/22 at 10:40 a.m., LVN stated the medications should be checked to ensure no medication errors. The HHA's undated policy and procedure titled " Medication Monitoring" indicated medications will be assessed through direct observation during home visits. A review of Patient 1's Patient Profile indicated, a start of care (SOC) date of 6/21/21, with a diagnosis of Dementia (general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). During a review of Patient 1's Plan of Care (POC), for the re-certification period from 2/16/22 to 4/16/22, included an order for skilled nurse (SN) to visit once a week for nine weeks. The SN should instruct the patient on new or changed medications and provide management on medication regimen. On 2/16/22 at 3:00 p.m., a home visit was conducted at Patient 1's residence with Director of Nursing (DON) . During a review of Patient 1's medications indicated a bottle of sertraline 50 milligrams (mg- unit of measurement) once daily and Furosemide 40 mg ½ tablet daily . The medication was not updated and on the medication profile for Patient 1. During an interview on 2/16/22 at 4:00 p.m., DON stated the medication profile should be kept up to date and has doctors orders. A review of Patient 2's Patient Profile indicated, a SOC date of 2/25/21, with a diagnosis of rhabdomyolysis (A breakdown of muscle tissue that releases a damaging protein into the blood). During a review of Patient 2's POC, for the re-certification period from 12/22/21 to 2/19/22, included an order for SN to visit once a week for nine weeks. The SN should instruct the patient on new or changed medications and provide management on medication regimen. On 2/17/22 at 11:15 a.m., a home visit was conducted with LVN 1. During a review of Patient 2's medications indicated bottles of Tylenol 500 mg once as needed, vitamin C 500 mg daily, vitamin D3 50 mcg daily (micrograms- a unit of measurement), Iron 325 mg daily, Atorvastatin 20mg 1 tablet daily and Lasix 20 mg daily. These medications were not on the medication profile for Patient 2. During an interview on 2/17/22 at 11:15 a.m., LVN stated the medications should be checked to ensure no medication errors. LVN 1 further stated to check and teach patient medications every visit. The HHA's undated policy and procedure titled " Medication Monitoring" indicated medications will be assessed through direct observation during home visits.