Every finding on record at Homefirst Home Healthcare

An Emergency Preparedness Survey was conducted 8/2/2021-8/4/2021 at HomeFirst Home Healthcare. No Deficiencies were cited under 42 CFR 484.102.

A Recertification Survey was conducted on 8/2/2021-8/4/2021 at HomeFirst Home Healthcare. Deficiencies were cited under 42 CFR Part 484, Requirements for Home Health Agencies.

Receive all services in plan of care CFR(s): 484.50(c)(5) Receive all services outlined in the plan of care. This ELEMENT is not met as evidenced by: Based on policy review, medical record review and interview, the agency failed to ensure all services outlined in the Plan of Care (POC) was implemented for 1 (Patient #6) of 7 patient's reviewed. The findings included: Review of the agency policy, Plan of Care, effective date 9/15/2020, revealed "...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..." Medical record review revealed Patient #6 was admitted to the agency on 3/3/2021 with diagnoses including Type 2 Diabetes Mellitus with Foot Ulcer. Patient #6 was discharged from the agency on 4/19/2021.Medical record review of the Home Health Certification and Plan of Care dated 3/3/2021 revealed the skilled nurse was to record the patient's blood sugar three times weekly. Medical record review of the skilled nurse's notes revealed on 4/5/2021 the patient's blood sugar had not been recorded.Interview with the Administrator on 8/4/2021 at 9:19 AM, in the conference room, showed the skilled nurse instructs the patient to obtain their blood sugar and records the results in the medical record. If the patient refuses to take their blood sugar the nurse should put the refusal in a nurse's note. The Administrator confirmed that the nurse had not charted Patient #1's blood sugar on 4/5/2021.

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 agency policy review, medical record review, observation, and interview the agency failed to reconcile medications for 1 (Patient #2) of 7 patients reviewed. The findings include: Patient #2 was admitted to the agency on 6/15/2021 with diagnoses to include Low Back Pain, Contracture of Muscle, and Intervertebral Disc Degeneration, Lumbar Region. Review of the agencies policy Medication Reconciliation with an effective date of 9/15/2020 showed, "...The Agency will reconcile patient's medications at time of admission and on an ongoing basis in order to identify any potential adverse effects and drug reactions...the admitting...PT [Physical Therapist]...will...document a complete list of medications that patient is taking at home...The medication list/profile will be updated with each new or changed medication...." Medical record review of the Home Health Certification and Plan of Care (POC) with a certification period of 6/15/2021-8/13/2021 and revealed the following: . Aleve (pain reliever) 220 mg (milligram) oral, 2 tablets in the morning, and 1 tablet in the evening. . Amiodarone (medication used to restore normal heart rhythm) 200 mg oral daily. . Centrum Silver (vitamin) oral daily . Insulin Aspart FlexPen 100 units/ml (milliliter) subcutaneous (under the skin) daily at night. . Isosorbide dinitrate (medication used to treat chest pain) 30 mg oral daily. . Memantine (medication used to treat Dementia) 10 mg oral daily. . Omeprazole (medication used to treat acid reflux) 40 mg oral daily. . Sucralfate (medication used to treat ulcers) 1g (gram) oral daily at night. . Gas-X Extra Strength (medication used for gas relief) 125 mg oral daily as needed. . Mylanta Maximum Strength (medication used for gas relief or heart burn) 5 ml oral as needed. . Tums Chewy Bites (medication used for heart burn) 750 mg oral 2 tablets daily as needed. During a home visit with Resident #2 on 8/3/2021 with PT #1, a medication reconciliation showed 4 medications had not been listed on Resident #2's medication profile to include: . Xarelto (blood thinner) 20 mg oral daily. . Gabapentin (medication used to treat nerve pain) 300 mg oral three times a day. . Pravastatin (medication used to treat cholesterol) 80 mg oral daily. . Xanax (medication used to treat anxiety) 0.5 mg oral at night as needed. During an interview on 8/3/2021 at 11:20 AM, Resident #2's wife stated the resident had been on Xarelto, Pravastatin, Xanax, and Gabapentin since Resident #2's admission to the agency. During an interview on 8/4/2021 at 9:10 AM, the Vice President of Administration stated the Physical Therapist is expected to do a medication reconciliation and confirmed Xarelto, Pravastatin, Xanax, and Gabapentin had not been listed on Residents #2's medication profile.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on policy review, medical record review, and interview, the facility failed to update the Plan of Care (POC) for updated negative pressure wound therapy setting physician orders was received for 1 of 3 (Patient #4) patients reviewed with wounds. The findings included: Review of the agency's policy, Plan of Care, effective date 9/15/2020 revealed, "...All patient care orders, including verbal orders, must be recorded in the plan of care..." Medical record review for Patient #4 revealed a start of care date of 7/14/2021 with diagnoses which included Pressure Ulcer of the Left Hip, Stage 4, Pressure Ulcer of Sacral Region, Stage 3, and Quadriplegia. Review of the current Plan of Care dated 7/14/2021 showed apply negative pressure device (Wound Vac Therapy) at 120 mmHg. Review of a Physician Order for wound care dated 7/23/2021 showed Wound Vac Therapy "...160 mmHg..." Review of Care Coordination Visit Notes dated 7/28/2021, 8/2/2021, and 8/4/2021, showed applied suction at 160 mmHg. During an interview with the Administration on 8/4/2021 at 10:10 AM, in the conference room, confirmed the skilled nurse had received a verbal order from the physician on 7/23/2021 but had not updated the plan of care with the new orders.