Every finding on record at Home Health of Alexandria, LLC

The entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey Abbreviations: SN-Skilled Nurse CBC-Complete Blood Count CMP-Comprehensive Metabolic Panel A1C-Hemoglobin A1C

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure the patient's written Plan of Care was followed as evidenced by physician’s orders not followed for 1 (Patient #12) of 13 (Patients #1-#13) sampled patient records reviewed. Findings: Review of Patient #12’s medical record revealed an admit date of 08/13/2024 with diagnoses that included in part…Type 2 Diabetes Mellitus, Cellulitis of Right Lower Limb, and Pressure Ulcer of Left Buttock, Stage 2. Review of the certification period 08/13/2024 through 09/03/2024 revealed the patient was ordered to receive skilled nurse visits twice per week for two weeks, then once per week for 7 weeks. Review of the plan of care revealed an order as follows: 08/23/2024 order: Skilled Nurse to obtain CBC, CMP, Urinalysis, and A1C at next visit. Review of Patient #12’s medical record revealed the next visit after 08/23/2024 occurred on 08/29/2024 and the record contained no documentation that blood work and urine were collected, as ordered. In an interview on 01/15/2025 at approximately 12:00 p.m., S1 Director and S2 Area Vice President confirmed the bloodwork and urinalysis were not obtained, as ordered.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on record review and interview, the agency failed to ensure a Registered Nurse performed an assessment of a patient’s wounds at least weekly, including measuring the wound, per the agency policy for 1 (#12) of 1 sampled patients with pressure ulcers. Findings: Review of the agency’s policy on 01/15/2025 titled The Provision of Wound and Skin Care dated 12/12/2024 revealed in part…In accordance with best practice and standard of care, wounds will be measured a minimum of one time a week, preferably on the first visit of the week, by the same nurse, utilizing the same tool and measurement terminology. Review of Patient #12’s medical record revealed an admit date of 08/13/2024 with diagnoses that included in part…Type 2 Diabetes Mellitus, Cellulitis of Right Lower Limb, and Pressure Ulcer of Left Buttock, Stage 2. Review of the certification period 08/13/2024 through 09/03/2024 revealed the patient was ordered to receive skilled nurse visits twice per week for two weeks then once per week for 7 weeks. Review of the plan of care revealed an order as follows: Registered Nurse/Licensed Practical Nurse to perform/teach patient/caregiver wound care to pressure injury to left buttocks pressure wound. Irrigate/cleanse with wound cleanser, apply zinc oxide and foam dressing. Change dressing daily and as needed if soiled. Review of Patient #12's skilled nurse visit notes revealed there were no wound assessment with measurements performed or documented by the skilled nurse for the following visits: 08/17/2024 08/20/2024 08/23/2024 08/29/2024 Review of the skilled nurse visit notes for the above dates revealed the visits were made by a Licensed Practical Nurse. Review of the skilled nurse visit notes for the certification period revealed the patient was only seen by a Registered Nurse on one occasion on 08/13/2024, upon admit. In an interview on 01/15/2025 at 1:47 p.m., S2 Area Vice President confirmed Patient #12’s pressure ulcer should have been measured weekly by a Registered Nurse, but was not.

Recertification Survey Abbreviations: a.m. - morning HHA - home health aide LPN - Licensed Practical Nurse mg - milligram p.m. - evening po - by mouth POC - plan of care PT - physical therapist RN - registered nurse SN - skilled nurse SNV - skilled nurse visit

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 agency failed to ensure a review of all medications was conducted each visit in order to identify any potential adverse effects and drug reactions, and noncompliance with drug therapy. The agency failed to ensure an accurate Drug Regimen was obtained upon admission and reviewed for medication changes for 1 (#2) of 10 sampled patients. Findings: Review of patient #2's Home Health Certification and Plan of Care dated 01/14/2022 to 03/14/2022 revealed the following diagnoses: Sarcopenia, Major Depressive Disorder, Essential Hypertension, and History of Falling. Review of the Medication Profile revealed the orders for medications included: Amlodipine 5 mg po daily; Escitalopram 5mg po daily; Euthyrox 100mcg po daily; Hydrochlorothiazide 12.5mg po daily; Pantoprazole 40mg po daily; Ramipril 5mg po twice daily; Simvastatin 40mg po daily; Observation on 01/25/2022 at 12:30 p.m. during the home visit with S3 PT revealed the patient was seated at her kitchen table. Further observation revealed the patient’s daughter retrieved the patient’s medicine bottles from a cabinet in the kitchen. The patient’s daughter presented medication bottles which included the above medications and also a bottle of Coumadin 5mg, with instructions to take 1 tablet daily and a box of Alendronate 70mg, with instructions to take 1 tablet weekly. The patient was interviewed and the patient's medications were checked by S3 PT on 01/25/2022 at 12:40 p.m. The patient reported she had been on Coumadin and Fosamax for about 12 years and had never been on Pantoprazole. She further stated she had a pacemaker and been placed on Coumadin after her heart valve replacement surgery. She stated she had her blood drawn monthly at her physician’s office and recently had her dose adjusted because her blood was too thin. S3 PT further reviewed the patient's medication list attached to the POC in the patient’s home binder and found Coumadin and Fosamax were not included on the medication list or POC. Interview on 01/25/2022 at 12:41 p.m. with S3 PT confirmed the medications Coumadin and Fosamax, cardiac diagnosis information and lab monitoring information were not on the patient’s medication list or POC and should be. Interview on 01/26/2022 at 8:53 a.m. with S1 Director confirmed the patient had SNV’s on 01/14/2022, 01/18/2022, and 01/21/2022. She said the patient's medications should have been checked and reconciled each visit, and the POC should have been updated with accurate medication information, and diagnosis information and was not.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview the agency failed to include pertinent diagnoses and monitoring in the POC for 1 (#2) of 10 sampled patients for a patient receiving SN and PT services. Findings: Review of patient #2's Home Health Certification and Plan of Care dated 01/14/2022 to 03/14/2022 revealed the following diagnoses: Sarcopenia, Major Depressive Disorder, Essential Hypertension, and History of Falling. Interview on 01/25/2022 during a home visit revealed the patient had a pacemaker and been placed on Coumadin after her heart valve replacement surgery about 12 years ago. She stated she had her blood drawn monthly at her physician’s office and recently had her dose adjusted because her blood was too thin. Further review of the POC accompanied by S3 PT further revealed there was no documentation the patient had a diagnosis indicating the need for anticoagulant therapy, had routine lab work or routine education for monitoring for the use of anticoagulants in the POC. There was also no documentation the patient had a pacemaker. Interview on 01/25/2022 at 12:41 p.m. with S3 PT confirmed cardiac diagnosis information, anticoagulant use and lab monitoring information were not included in the patient’s POC and should be. Interview on 01/26/2022 at 8:53 a.m. with S1 Director confirmed the patient had SNV’s on 01/14/2022, 01/18/2022, and 01/21/2022. She said the patient's POC should have been updated with accurate medication information, lab monitoring and diagnosis information related to anticoagulant therapy and was not.