Every finding on record at Incare Home Health, Inc

An onsite unannounced Emergency Preparedness Program (EPP) Survey and survey for the Medicare COVID - 19 Staff Vaccination requirements was conducted at Medical Services of America Home Health from 03/27/2023 to 03/30/2023. Medical Services of America Home Health is in compliance with the Medicare COVID-19 Staff Vaccine requirements with 49 staff members fully vaccinated and 7 approved religious exemptions. The Home Health Agency had standard level deficiencies in the Condition at 42 CFR 484.102 (Establishment of the Emergency Program).

Emergency Officials Contact Information CFR(s): 484.102(c)(2) §403.748(c)(2), §416.54(c)(2), §418.113(c)(2), §441.184(c)(2), §460.84(c)(2), §482.15(c)(2), §483.73(c)(2), §483.475(c)(2), §484.102(c)(2), §485.68(c)(2), §485.542(c)(2), §485.625(c)(2), §485.727(c)(2), §485.920(c)(2), §486.360(c)(2), §491.12(c)(2), §494.62(c)(2). [(c) The [facility] must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local laws and must be reviewed and updated at least every 2 years [annually for LTC facilities]. The communication plan must include all of the following: (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. *[For LTC Facilities at §483.73(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) The State Licensing and Certification Agency. (iii) The Office of the State Long-Term Care Ombudsman. (iv) Other sources of assistance. *[For ICF/IIDs at §483.475(c):] (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. (ii) Other sources of assistance. (iii) The State Licensing and Certification Agency. (iv) The State Protection and Advocacy Agency. This STANDARD is not met as evidenced by: Based on review of the Home Health Agency's (HHA) Emergency Preparedness Program (EPP) and interview, the HHA failed to show evidence of emergency officials contact information for all counties serviced. The findings are: On 3/30/23 at 10:45 AM, review of the HHA's EPP revealed there was no evidence of emergency officials contact information for all counties serviced by the agency. On 3/30/23 at 12:15 PM, the Interim Administrator confirmed the findings.

An onsite unannounced recertification survey was conducted from 03/27/2023 to 03/30/2023. Medical Services of America Home Health is in substantial compliance with the Medicare Conditions at 42 CFR PART 484 with standard level deficiencies cited.

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 observations and patient chart reviews, the Skilled Nursing (SN) staff failed to ensure an accurate list of the patient's medications in the initial patient assessment for 5 of 6 applicable patients. (Patient #2, #3, #4, #5 and #6) The Finding includes: Patient #4 Home observation visit on 03/28/2023 at 10:33 AM reveals Patient #4 taking Mirapex 75mg tablet taking ½ tablet by mouth daily. This medication is not listed on the home health medication list. Patient #4 was admitted to service on 03/09/2023. Observation was verified by Registered Nurse (RN) # 2. Patient #5 Home observation visit on 03/28/2023 at 12:20 PM reveals Patient #5 taking Janumet 50/100 mg one tablet by mouth twice a day, Metoprolol 25 mg one tablet by mouth daily, Lasix 40 mg one table by mouth daily and Buspar 10 mg one tablet by mouth twice a day. These medications are not listed on the home health medication list. Patient #5 was admitted to service on 03/12/2023. Observation was verified by RN # 4. Patient #6 Home observation visit on 03/28/2023 at 1:30 PM reveals Patient #6 taking Eliquis 5mg tablet one tablet by mouth twice a day. Home health medication lists Eliquis 5 mg one-half tablet by mouth twice a day. Patient #6 was admitted to service on 02/27/2023, transferred to the hospital with resumption of care on 03/10/2023. Observation was verified by RN # 3. PATIENT #2 On 3/28/23 at 1:30 PM, a home visit was made to Patient #2 with the Occupational Therapist (OT). The patient's medications and medication list were reviewed with OT. There were discrepancies between the medications the patient was taking and the HHA patient medication list. The patient was taking duloxetine 60 mg twice daily but the medication list indicated duloxetine 30 mg twice daily. The fill date on the bottle of duloxetine was 10/4/22 and the patient confirmed that was what he had been taking; The patient was not taking Cyanocobalamin but it was on his medication list. He stated he had never taken this medication. The patient said he had been taking "Tylenol" (acetaminophen) two tablets every night at bedtime for awhile. The bottle of acetaminophen he was taking indicated it was 650 mg tablets. Acetaminophen was not on his medication list. The patient said he was taking four tablets of melatonin 3 mg, but the medication list indicated one tablet. During a concurrent interview with the OT, he/she confirmed the findings. PATIENT #3 On 3/28/23 at 2:45 PM, a home visit was made to Patient #3 with the Physical Therapist (PT). The patients medications and medication list were reviewed. There were discrepancies between the medications the patient was taking and the HHA medication list. There was a bottle of mirtazapine 15 mg once a day with a pharmacy fill date of 2/23/23. The medication list indicated mirtazapine 7.5 mg once a day. There was a bottle of hydrocodone-acetaminophen 5-325 mg with instructions to take 1/2 tablet. The medication list indicated one tablet. There was a bottle of torsemide 20 mg once a day with a pharmacy fill date of 1/23/23 but this medication was not on the patient's medication list. The patient also had bottles of a probiotic and a multivitamin which she indicated she was taking but these were not on the medication list. During a concurrent interview with the PT, he/she confirmed the findings.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on patient chart reviews and interview, the home health agency (HHA) staff failed to follow the physician orders regarding visit schedules for 4 of 17 patient charts reviewed. (Patient #1, #9, #13 and #17) The findings include: Patient #9 Chart review on 03/29/2023 at 3:11 PM reveals, Patient admitted to service on 12/29/2022 with orders for Physical Therapy (PT) visits twice a week for 2 weeks, once a week for 7 weeks starting week of 01/01/2023. Week starting 01/08/2023 has documentation for only 1 PT visit. Interview on 03/30/2023 at 1:45 PM with interim Administrator reports “I concur” and verifies the finding. Patient # 13 Chart review on 03/29/2023 at 1:50 PM reveals, Patient #13 admitted to service on 02/24/2023 with orders for Occupational Therapy (OT) starting 02/27/2023 one visit a week for two weeks. OT visits are documented on 02/27/2023 and 03/03/2023 in the same week. Interview on 03/30/2023 at 1:25 PM with interim Administrator reports “I concur” and verifies the finding. PATIENT #1 On 3/29/23 at 10:00 AM, Patient #1's record was reviewed. The document titled, "Home Health Certification and Plan of Care," dated 3/5/23 to 5/3/23, indicated the visit frequency for the Aide was one time a week for three weeks beginning 3/9/23. There was no documented evidence of Aide visits for the weeks of 3/9/23 and 3/12/23. On 3/30/23 at 1:00 PM, during an interview with the Director of Patient Services, she/he confirmed the findings. PATIENT #17 On 3/29/23 at 10:40 AM, Patient #17's record was reviewed. The document titled, "Home Health Certification and Plan of Care," dated 1/12/23 to 3/12/23, indicated the Physical Therapist (PT) was supposed to visit Patient #17 one time a week for one week, two times a week for one week and then one time a week for four weeks beginning 1/12/23. There was no documented evidence a PT visited the patient the weeks of 1/22/23, 1/29/23, and 2/5/23. The Plan of Care also indicated the Occupational Therapist (OT) was supposed to visit Patient #17 two times a week for three weeks beginning 1/16/23. There was no documented evidence the OT visited the patient a second time the week of 1/15/23, and there was no documented evidence the OT visited the patient the weeks of 1/22/23, 1/29/23 and 2/5/23. On 3/30/23 at 2:00 PM, during an interview with the Director of Patient Services (DOPS), she/he confirmed the PT and OT did not visit Patient #17 as ordered by the physician.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on observations, patient chart reviews, and interview, the home health staff failed to obtain physician orders for treatments and visits provided to 5 of 17 patients (Patient #6, #7, #9, #10 and #11). On 3/29/23 at 2:30 PM, Patient #10's record was reviewed. The nursing visit note dated 2/21/23 indicated the nurse instructed the caregiver to administer the medications dulcolax and senna-s. There was no documented evidence of physician's orders for dulcolax or senna-s in the record. On 3/30/23 at 1:30 PM, during an interview with the Director of Patient Services (DOPS), she/he confirmed the findings. The finding includes: Patient #6 Chart review on 03/29/2023 at 1:50 PM reveals, Patient #6 was admitted to service on 02/27/2023, transferred to the hospital with resumption of care on 03/10/2023 with open surgical wound. Observation visit on 03/28/2023 at 1:30 PM confirms open draining wound with RN #3 providing wound care. There is no documentation in the chart of orders for wound care. Interview on 03/30/2023 at 1:53 PM with interim Administrator reports “I can’t find any orders” and verifies the finding. Patient #7 Chart review on 03/29/2023 at 1:50 PM reveals, Patient #7 admitted to service on 03/14/2023 transferred to the hospital and ROC on 03/19/2023 with orders for Occupational Therapy (OT) to evaluate. OT visit is documented on 03/22/2023. There are no documented physician orders for OT schedule, treatments, or goals in the chart. Interview on 03/30/2023 at 2 PM with interim Administrator reports “I can’t find any orders” and verifies the finding. Patient #9 Chart review on 03/29/2023 at 1:50 PM reveals, Patient #9 admitted to service on 12/29/2022 with PEGG tube and orders for Nothing per Mouth (NPO) and for Speech Therapy (ST) evaluation week of 01/15/2023. ST visits are documented on 01/20/2023, 01/26/2023, 01/31/2023, 02/03/2023, 02/06/2023, 02/08/2023 and 02/13/2023. There are no documented physician orders for ST schedule, treatments, or goals in the chart. Interview on 03/30/2023 at 1:35 PM with interim Administrator reports “I can’t find any orders” and verifies the finding. Patient #11 Chart review on 03/30/2023 at 8:45 AM reveals, Patient #11 admitted to service on 06/30/2023 with orders for PT and OT evaluations. PT visits are documented on 07/05/2022, 07/07/2022, 07/12/2022, 07/24/2022, 07/20/2022 and 07/25/2022. OT visits are documented on 07/07/2022, 07/14/2022, 07/19/2022 and 07/22/2022. There are no documented physician orders for PT and OT schedule, treatments, or goals in the chart. Interview on 03/30/2023 at 2:21 PM with interim Administrator reports “I can’t find any orders” and verifies the finding.

Home health aide assignments and duties CFR(s): 484.80(g)(1) Standard: Home health aide assignments and duties. Home health aides are assigned to a specific patient by a registered nurse or other appropriate skilled professional, with written patient care instructions for a home health aide prepared by that registered nurse or other appropriate skilled professional (that is, physical therapist, speech-language pathologist, or occupational therapist). This STANDARD is not met as evidenced by: Based on observations, patient chart reviews, and interview, the Registered Nurse (RN) failed to provide specific individualized instructions in the Certified Nurse Assistant (CNA) for 4 of 4 applicable patient charts. (Patient #1, #7, #11 and #12) PATIENT #1 On 3/28/23 at 9:30 AM, a home visit was made to Patient #1 with Certified Nursing Assistant (CNA/Aide) #1. CNA #1 was observed providing a chair bath to Patient #1. On 3/29/23 at 11:45 AM, Patient #1's record was reviewed. The document titled, "Aide Care Plan," dated 3/5/23 - 5/3/23, indicated, "...Bed bath if unable to shower..." The initial nursing assessment document titled, "OASIS-E Start of Care," dated 3/5/23, indicated, "...unable to use the shower..." On 3/30/23 at 1:17 PM, during an interview with the Director of Patient Services (DOPS), she/he confirmed the findings. The DOPS confirmed the Aide Care Plan was not specific to Patient #1. The DOPS confirmed the Aide was not supposed to determine what type of bathing the patient should receive. PATIENT #12 On 3/30/23, at 8:40 AM, Patient #12's record was reviewed. The record included a document titled, "Aide Care Plan," dated 6/7/22. The Aide Care Plan indicated, "...Assist to Dress...PRN (as needed)...Comb Hair...PRN...Complete Bath...PRN...Shampoo Hair...PRN...Shower...PRN...Universal Precautions...PRN..." The Aide Care Plan was not specific to Patient #12. On 3/30/23 at 1:37 PM, during an interview with the Director of Patient Services (DOPS), she/he confirmed the findings. The DOPS confirmed the Aide Care Plan was not specific to Patient #12. The DOPS confirmed the Aide was not supposed to determine what type of bathing the patient should receive. The Findings include: Patient #7 Chart review on 03/29/2023 at 1:50 PM reveals, Patient #7 admitted to service on 03/14/2023 transferred to the hospital and ROC on 03/19/2023 with orders for CNA visits twice a week for two weeks starting 03/26/2023. Home observation visit on 03/28/2023 with CNA #2. CNA assignment instructs incontinent care, nail care, oral hygiene to be done “as needed”; shower each visit, partial bath/sponge “if too tired to shower”; port to right upper chest, please cover with saran wrap and picture frame with waterproof tape. Interview on 03/30/2023 at 2 PM with interim Administrator reports “it is not specific and should not even be showering with the perma cath”. Patient #11 Chart review on 03/30/2023 at 8:45 AM reveals, Patient #11 admitted to service on 06/30/2023 with orders for CNA visits twice a week for 2 weeks starting 07/05/2022. CNA assignment instructs incontinent care “every visit as needed”; Complete bath “every visit on non-shower days”, Shampoo hair “weekly”; Shave “weekly as needed” and Shower “every visit as tolerated”. Interview on 03/30/2023 at 2:21 PM with interim Administrator and RN #1 reports “it is not specific”.