Every finding on record at Home Health Services of California, 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: 145 Active Patients: 12 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 medication expiration dates for three of seven sampled patients (Patient 1, 2, and 5). This failure placed the patients at risk for medication errors and adverse drug reactions which can be life threatening. c. A review of Patient 5’s Patient Information Sheet indicated a Start of Care (SOC) date on 2/9/2022 with a primary diagnosis of Spinal Stenosis (when the spaces in the spine narrow and create pressure on the spinal cord and nerve roots), lumbar (lower spine) without neurogenic claudication (compression of the spinal nerves in the lumbar (lower) spine). A review of Patient 5’s “Home Health Certification and Plan of Care (POC)” for certification period 2/10/2023 to 4/9/2023, indicated the physician ordered the skilled nurse (SN) to evaluate patient only and physical therapy (PT) evaluation and follow up to assess and evaluate the patient for physical/functional assessment, treatment/skilled intervention, pain management, and home exercise and functional mobility. The PT evaluation, dated 2/10/2023 indicated PT visit once a week for eight weeks. A review of Patient 4’s Medication Profile indicated for the following: Gabapentin 300 mg, 1 tablet three times a day by mouth. During a joint home visit with RN 1 on 3/10/2023 at 11:20 am, Patient 4 was observed sitting on a couch in the living room. Patient 4 alert, oriented, and well-groomed. PT 1 performed vital signs and PT exercises with Patient 5. During the medication review, it was observed that the label of the gabapentin bottle indicated 300 mg and “one tab three times a day by mouth.” PT 1 confirmed that the label on the gabapentin bottle dose was 300 mg and that the Medication profile indicated 600 mg. During an interview on 3/10/2022 at 2:23 pm, the Director of Patient Care Services (DPCS) stated the nurse should review the medication, and therapist should be reviewing the medication every visit. The DPCS stated that the medication profile, the doctor’s orders, and the medication bottle label should be checked to make sure the medication name, dosage, frequency, and expiration date are correct. The DPCS stated that this was important for patient safety and to ensure that the patient takes the medication as ordered and receives the proper treatment. A review of the HHA’s policy (undated) titled “Medication Profile,” indicated that the registered nurse/therapist will complete a medication profile for each client at the time of admission. The medication profile shall include all prescription and over-the-counter medications. The profile will be updated as needed to reflect current medications the client is taking. The policy indicated that at the time of admission, the RN/Therapist 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. The RN/Therapist shall promptly report any identified problems to the physician. a. A review of Patient 1’s Patient Information Sheet indicated a start of care (SOC) date of 2/23/23 for encounter for change or removal of surgical wound dressing and lower back pain. A review of Patient 1’s plan of care (POC) indicated a certification period from 2/23/23 to 4/23/23. Patient 1 had secondary diagnoses that include spondylolisthesis (spinal disorder in which a bone slips forward onto the bone below it), hypertensive chronic kidney disease (kidney damage caused by high blood pressure), chronic obstructive pulmonary disease (COPD-lung disease that blocks airflow and makes it difficult to breathe) and hypothyroidism (condition where the thyroid gland doesn’t produce enough thyroid hormones) and dementia (condition characterized by impaired brain function). The POC indicated that the skilled nurse (SN) is to instruct the patient/caregiver on medication regimen dose, indications, side effects, and interaction. On 3/9/23, at 10:30am, a home visit was conducted with certified home health aide 1 (CHHA 1) and Patient 1’s medications were reviewed. The following discrepancies were found between Patient 1’s medication profile and the patient’s actual medications at home. Levothyroxine Sodium (medication to treat hypothyroidism) 50 micrograms (mcg-unit of measurement) 1 tablet (tab) daily. Patient 1 did not have this medication, and stated he was not currently taking. Amlodipine Besylate (medication to lower high blood pressure) 5 milligrams (mg-unit of measurement) 1 tab daily. Patient 1’s medication bottle dosage was 2.5 mg. Memantine (used to treat moderate to severe confusion related to dementia]) 10mg, 1 tab twice a day. Patient 1 did not have this medication, and stated he was not currently taking. Folic Acid (vitamin) 1000 mcg, 1 tab daily. Patient 1 did not have this medication, and stated he was not currently taking. A review of Patients one’ s Change of Medication Order, dated 3/2/23, indicated that Levotyroxine, Memantine and folic acid were discontinued, and the dosage for Amlodipine was changed from 5 mg to 2.5mg. b. A review of Patient 2’s Patient Information Sheet, indicated a SOC date of 2/9/23 with a diagnosis ischemic cardiomyopathy (condition where there is reduced blood flow to the heart, damaging the muscles. A review of Patient 2’s POC indicated a certification period from 2/9/23 to 4/9/23. P2 had secondary diagnoses that included hypertension (high blood pressure), rheumatoid arthritis (inflammatory disorder affecting many joints, including those in the hands and feet) and chronic kidney disease (when the kidneys cannot filter waste from the blood properly) The POC indicated that the skilled nurse (SN) is to instruct the patient/caregiver on medication regimen dose, indications, side effects, and interaction. On 3/9/23, at 11:30am, a home visit was conducted with CHHA 1. Patient 2’s medications were reviewed, and the following discrepancies was found… acetaminophen (medication for pain) 325 mg, take 2 tabs every 6 hours as need for pain. At home Patient 2 was taking Excedrin extra strength (acetaminophen 250mg plus aspirin 250 mg). pantoprazole (medication to treat stomach ulcers) 40 mg, 1 tab daily. Patient 2 did not have this medication, and stated she was not currently taking. A review of Patient 2’s Change of Medication Order, dated 3/6/23, indicated that Acetaminophen 325 mf 2 tabs, was changed to 500mf, 1 tab every 6 hours as needed. Pantoprazole was discontinued. During an interview on 3/10/23, at 12pm, the director of patient care services (DPCS) stated that a patient’s medications are changed, it is the registered nurse’s (RN) responsibility to update the medication profile. DPCS stated that the medication profile should be updated as soon as possible when there is a change to medication ordeers, because there are different staff member to look at the medication profile and they need to what the patient is currently taking