Every finding on record at Home Health Plus 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: Health Facilities Evaluator Nurse, Surveyor ID: 44290 Health Facilities Evaluator Nurse, Surveyor ID: 44802 Unduplicated Admissions: 106 Active Patients: 77 Sample Size: 7 Home Visits: 3

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Health Facilities Evaluator Nurse, Surveyor ID: 44290 Health Facilities Evaluator Nurse, Surveyor ID: 44802 Unduplicated Admissions: 106 Active Patients: 77 Sample Size: 7 Home Visits: 3

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 a current medication profile and check the medication expiration dates for two of seven patients (Patient 1 and 4). This failure had the potential to place the patients at risk for medication errors and adverse drug reactions which can be life threatening. b. A review of Patient 4’s Patient Profile indicated a Start of Care (SOC) date on 12/12/2022 with a primary diagnosis of Type 2 Diabetes Mellitus (DM, a chronic condition that affects the way the body processes blood sugar) with hyperglycemia (high blood sugar). A review of Patient 4’s “Home Health Certification and Plan of Care (POC)” for certification period 2/10/2023 to 4/10/2023, indicated the physician ordered the skilled nurse (SN) to visit starting week of 2/12/2023 once a week for eight weeks. The SN was to continue skilled nursing evaluation and assessment of all body systems. assess competency and compliance with dietary and medication regimen, and check patient’s vital signs every visit. The SN was to notify the physician if blood pressure was more than 160/100 millimeters of Mercury (mmHg) or less than 90/60 mmHg. A review of Patient 4’s Medication Profile indicated for the following: Losartan 50 mg, 1 tablet by mouth once daily. During a joint home visit with RN 1 on 2/10/2023 at 11:00 a.m., Patient 4 was observed sitting on a couch next to her Caregiver (CGR 1) in the living room watching television. Patient 4 alert, oriented, and well-groomed. RN 1 performed vital signs, skilled nursing assessment and medication review. During the medication review, it was observed that the label of the losartan bottle indicated date filled 10/20/2022 and to “Take two tablets by mouth every day. Discontinue losartan 50 mg once a day.” RN 1 stated that the label on the losartan bottle should match Patient 4’s Medication Profile. CGR 1 stated that Patient 4 takes two tablets of Losartan every day. During an interview on 3/3/2022 at 10:00 am, the DPCS stated the nurse should make sure the right list of medications is sent to office from initial assessment and are periodically reviewed weekly to check if any medication that has been change or discontinued. The DPCS stated that nurse should ask the patient if they had any medication updates during every visit and if there is a new order to call the doctor to make sure the order is correct. A review of the HHA’s policy titled “Medication Profile,” dated 1/15/2019, indicated that at the time of admission, the admission professional shall check all medications a patient may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindicated medication. A review of the HHA’s policy titled “Identification of Medication or Medication Management for Administration/Medication Management,” dated 1/15/2019, indicated that Medication reconciliation and review of medication list and update will be preformed during the following situations: a. Any new order received from Physician b. Any change of order such as dosage, frequency, etc. c. Any discontinuation of medication as ordered by Physician d. Upon knowing by clinicians that the patient had received any prescription/medication from pharmacy during non-Skilled Nurse visit days e. During recertification/resumption of care/and even discharge from service visits by RN. f. During review of Plan of Care 485 by the DPCS or RN Supervisor g. During Supervisory visits. a. A review of Patient 1’s Patient Demographic Sheet indicated a start of care (SOC) date of 4/24/22, with a diagnoses of Parkinson’s disease (a disorder of the central nervous system that affects movement, often including tremors), diabetes mellitus type 2 (disease where there is too much sugar in the blood leading to disorders of the circulatory, nervous, and immune system) and dementia (a condition characterized by impairment of at least two brain functions, such as memory loss and judgment). A review of Patient 1’s plan of care (POC) indicated Patient 1 was to have skilled nursing (SN) visits starting the week of 2/19/23, two times a week for two weeks. The POC indicated the SN is to teach the patient and caregiver about their medication regimen and actions and side effects. On 3/2/23, at 9 a.m. a home visit was conducted at Patient 1’s assisted living with Registered Nurse 1 (RN 1). RN 1 reviewed Patient 1's medications. RN 1, in the presence of the surveyor found the following medication discrepancies: Famciclovir (antiviral-medication to treat viral infections) 500 milligram (mg-unit of measurement) tablet (tab), take one tab three times a day for seven days. The medication was ordered on 5/24/22. This medication had already been completed, but was not removed from the medication list, or listed as discontinued from the medication profile. Carbidopa-Levodopa (medication to treat Parkinson’s disease) 25-100mg, take 1 tablet daily was the order written on Patient 1’s medication profile. The order that was written on Patient 1’s medication list. However, the medication packet observed at the assisted living facility indicated to take the medication three times a day. The medication prescription was filled on 2/7/23. During an interview on 3/2/23, at 9:15 am, RN 1 stated the Drop Box for the medication profile was not up to date. RN 1 stated the licensed vocational nurse (LVN 1) is to check the medications on every visit and review the medications once a month.

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 interview and record review, the Hospice Agency failed to follow the plan of care (POC) for one of seven sampled patients (Patient 4), when the skilled nurse and home health aide failed to notify the physician of a high blood pressure reading. This deficient practice placed the patient at risk for complications of high blood pressure and hospitalization. A review of Patient 4’s Patient Profile indicated a Start of Care (SOC) date of 12/12/2022, with a primary diagnosis of type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar) with Hyperglycemia (high blood sugar). A review of Patient 4’s “Home Health Certification and Plan of Care (POC)” for certification period 2/10/2023 to 4/10/2023, indicated the physician ordered the skilled nurse (SN) to visit starting the week of 2/12/2023, once a week for eight weeks. The SN was to continue skilled nursing evaluation and assessment of all body systems, assess competency and compliance with the dietary and medication regimen, and check Patient 4's vital signs every visit. The SN was to notify the physician if Patient 4's blood pressure was more than 160/100 millimeters of mercury (mmHg) or less than 90/60 mmHg. A review of Patient 4’s Skilled Nurse note, dated 2/13/2023, indicated Patient 4’s blood pressure was 174/89. A review of Patient 4’s Home Health Aide note, dated 2/14/2023, indicated Patient 4’s blood pressure was 168/64. During a joint home visit with RN 1 on 2/10/2023 at 11:00 am, Patient 4 was observed sitting on a couch next to her Caregiver (CGR 1) in the living room watching television. Patient 4 was alert, oriented, and well-groomed. RN 1 performed vital signs, a skilled nursing assessment and a medication review. During the medication review, it was observed that the label of the losartan bottle indicated the prescription filled date was on 10/20/2022 and the instructions indicated to “Take two tablets by mouth every day. Discontinue losartan 50 mg once a day.” RN 1 stated the label on the losartan bottle should match Patient 4’s Medication Profile. CGR 1 stated Patient 4 takes two tablets of Losartan every day. During an interview on 3/3/2023 at 10:08 am, the Director of Patient Care Services stated when the vitals are out of parameters, the nurse or home health aide should call the office so the doctor is notified and can order another dose of blood pressure medication, if needed. The DPCS stated it was important to notify the physician of the blood pressure readings so that we know the medication status and how well the medication is working for the patient. The DPCS stated when the physician is notified, a communication note is uploaded into the patient’s electronic chart. A review of the HHA’s policy, “Reporting of Critical Values,” dated 1/15/2019, indicated the agency will review all critical test result values and promptly notify the physician or their designee of the critical values. The policy indicated to ensure accurate and timely reporting of test results that could affect the patient care plan and health status.