Every finding on record at Innovative Home Health Group

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

Recertification Survey. Abbreviations: LPN-Licensed Practical Nurse RN-Registered Nurse mg-milligrams TID-three times per day SN-Skilled Nurse

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 Patient's medication regimen was reviewed and updated for accuracy for 2 (#2 and #3) of 3 (#1, #2, and #3) patient home visits requiring medication monitoring. The agency census was 3. Findings: Review of the agency’s policy entitled Medication Reconciliation, revised October 2017, revealed, in part…the Agency will reconcile the patient’s medications at the time of admission and on an ongoing basis. The medication list/profile will be updated with each new or changed medication. Patient #2 Review of the clinical record for Patient #2 revealed a Start of Care date of 02/19/2025. Patient #2’s diagnoses included, in part… Idiopathic Aseptic Necrosis of Pelvis, Right Hip Replacement, Congestive Heart Failure, Stage 4 Chronic Kidney Disease, Transient Ischemic Attack, and Dementia. Review of the current medications for Patient #2 revealed Oxycodone 5mg one tablet by mouth three times daily (TID) initiated on 09/11/2024. Further review revealed Levofloxacin 750mg ½ tablet by mouth daily initiated on 03/19/2025. Review of the physician’s orders for Patient #2 revealed an order dated 03/19/2025 which included Levofloxacin 750mg ½ tablet daily x 14days, and Oxycodone was ordered as needed, not routine. Interview with S1 Administrator on 04/15/2025 at 11:05 a.m. revealed Patient #2 had completed the Levofloxacin. S1 Administrator confirmed the Levofloxacin should have been removed from Patient #2’s current medication record after 14 days, but had not been. S1 Administrator confirmed Patient #2’s medication record should have been updated on 03/19/2025 to change Oxycodone to as needed, but had not been. Observation/home visit with Patient #2 on 04/16/2025 at 8:30 a.m. revealed S4 RN reviewed Patient #2’s current medications. Upon review, Patient #2’s current medication record revealed Levofloxacin 750mg ½ tablet by mouth daily. S4 RN stated Patient #2 had completed the Levofloxacin. S4 RN confirmed the Levofloxacin should have been removed from the current medication record after 14 days, when it was completed, but had not been. S4 RN stated Oxycodone 5mg was ordered “three times a day”. S4 RN was advised review of Patient #2’s physician’s orders had revealed an order dated 03/19/2025 for Oxycodone to be provided as needed, not routinely. S4 RN confirmed Patient #2’s current medication record should have been updated to change Oxycodone 5mg to one tablet by mouth TID as needed, but had not. Patient #3 Review of the clinical record for the certification period of 03/23/2025 to 05/21/2025 revealed Patient #3 had diagnoses that included in part…Type 2 Diabetes Mellitus, Human Immunodeficiency Virus, and Hypertensive Chronic Kidney Disease. SN visits were ordered as follows: 2wk1 (2 visits per week for 1 week), 1wk8 (1 visit per week for 8 weeks). Observation during the home visit on 04/14/2025 at 11:00 a.m., S2 LPN was reviewing Patient #3’s current medications. Upon review of the medications, it was determined Patient #3 was currently prescribed Ferrous Sulfate 325mg by mouth daily on Monday, Wednesday, and Fridays, Clonidine 0.1mg by mouth every 8 hours as needed, and Levetiracetam 1500mg by mouth two times daily. Review of the patient’s medication record with S2 LPN at that time revealed the medication record did not include Ferrous Sulfate 325mg or Clonidine 0.1mg. Further review revealed the medication record incorrectly listed the Levetiracetam dose as 500mg by mouth two times daily. S2 LPN confirmed the Levetiracetam dose was incorrect on the medication record and the Ferrous Sulfate 325mg and Clonidine 0.1mg were not listed on the medication record, but should have been.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on record review, observation, and interview, the agency failed to ensure staff followed accepted standards of practice to prevent the transmission of infections and communicable diseases for 1 (#3) of 3 (#1, #2, and #3) patients observed during home visits conducted with agency staff. The skilled nurse failed to wear gloves while performing a finger stick to check Patient #3’s blood glucose level. Findings: On 04/16/2025, a review of the agency’s policy titled Standard Precautions last revised in February 2024 revealed in part…All healthcare workers will routinely use appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any patient is anticipated. Gloves will be worn before touching blood and body fluids, mucous membranes or non-intact skin of all patients; for handling items or surfaces soiled with blood or body fluids; and for performing venipuncture and other vascular access procedures. Patient #3 Review of the medical record for the certification period of 03/23/2025 to 05/21/2025 revealed Patient #3 had diagnoses that included in part…Type 2 Diabetes Mellitus, Human Immunodeficiency Virus, and Hypertensive Chronic Kidney Disease. SN visits were ordered as follows: 2wk1 (2 visits per week for 1 week), 1wk8 (1 visit per week for 8 weeks). Review of Patient #3’s Physician’s orders/Plan of Care revealed in part…Skilled nurse may perform capillary blood sugar analysis every skilled nurse visit if patient/caregiver unable/unwilling and if patient has a glucometer and strips in the home. During a home visit on 04/14/2025 at 11:10 a.m., S2 LPN was observed performing a finger stick to Patient #3 to check her blood glucose level without wearing gloves. S2 LPN was observed at this time sticking the patient’s finger with a lancet, holding the patient’s finger with blood on it to the strip, and then putting an alcohol wipe on the fingertip while barehanded. In an interview on 04/14/2025 at 11:55 a.m., S2 LPN confirmed she did not wear gloves while checking Patient #3’s blood glucose level, but should have. In an interview on 04/14/2025 at 1:10 p.m., S1 Administrator acknowledged S2 LPN checked Patient #3’s blood glucose by finger stick without wearing gloves. S1 Administrator confirmed S2 LPN should have worn gloves.

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

Recertification Survey

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on observation, interview and record review the Agency failed to assure the identification of patient needs and factors that could affect the patient safety and treatment effectiveness and the coordination of care for 1 (Patient #2) of 7 (#1, #2, #3, #4 #5, #6, and #7) sampled patients. Findings: Review of Patient #2’s 04/06/2022 RN Admission Assessment revealed the following in part: Patient #2’s medication was reconciled with no discrepancies noted. Further review revealed “All medication purposes and possible side effects reviewed with patient. One problem identified and all meds not present in home. Patient demonstrates knowledge deficit regarding prescribed medication regimen and requires further education. Appointment tomorrow for medication review with NP.” The following medications were listed during this visit: ASA 81 mg; Atorvastatin 10 mg; Furosemide 20 mg; Gabapentin 300 mg; HCTZ 25 mg; Lantus 100U/ml 15U SQ; Lispro 3U SQ; Meclizine 25 mg; Metoprolol Succinate ER 200 mg; KCl 10 mEq; Ramipril 10 mg. There was no frequency noted for the above medications. Review of Patient #2’s 04/06/2022 – 06/04/2022 Plan of Care revealed the following in part: Patient #2 had the following diagnoses including: Type 2 DM with Hyperglycemia and Hypertensive Chronic Kidney Disease with Stage 1-4 Chronic Kidney Disease. Physician orders revealed in part: SNV 2WK1, 1WK2, and 1Q2WK6; skilled nurse for instructions/reinforcement of diabetic care to include diet, skin care, administration of insulin, blood glucose testing and diabetic foot care; skilled nurse to review medication profile and reconcile medications as needed; and skilled Nurse may instruct and reinforce medication teaching related to use of medications to treat disease processes,” Review of Patient #2’s 04/08/2022 SN Visit Note Report revealed no documentation that the patient’s medication was reconciled. Review of the Narrative revealed the following in part: “Fasting CBG is 331. Sliding Scale given. New order for Lantus 20U BID, but MD office did not order needles for insulin pen. Called MD office and left a detailed note about CBG being elevated and needing needles called to drug store. Pt complaining of blurred vision and has an eye apt set for 05/03/22. Educated pt. on insulin pen, checking CBG.” Review of patient #2’s medical record revealed there was no orders or documentation for a PRN SNV, or to increase SNVs for the week of 04/06/2022 to assess Patient #2’s blood sugars, vision and availability of insulin pen needles. Review of Patient #2’s 04/14/2022 Client Coordination Note Report revealed a missed visit notification dated 04/14/2022A SNV was scheduled, but the patient was not home after multiple attempts to schedule. Case Manager and MD notified. Review of Patient #2’s 04/19/2022 Visit Note Report revealed the following in part: Medications were reconciled with discrepancies found. “SN assessed meds with discrepancies noted. SN assessed non-fasting CBG of 575 mg/dl. SN instructed pt. to go to ER for eval and treatment r/t elevated CBG, pt. refused. A home visit was conducted on 04/19/2022 at 8:25 a.m. at Patient #2’s home with S2 LPN. S2 LPN assessed the patient and began medication reconciliation. During medication reconciliation the following discrepancies were found: 1. HCTZ 25 mg was on Agency medication list, but was not in the home. 2. Patient #2 had been taking Norvasc 5 mg, but it was not on the Agency’s medication list and the bottle was filled 04/03/2022. 3. Ramipril 10 mg was on the Agency’s medication list but the resident did not have this medication in her home. 4. Losartan/HCTZ 100/25 was in the home, but not on the Agency medication list. Observation and interview of Patient #2 during the above dated home visit revealed Patient #2 had Lantus insulin injectable pens 04/07/2022 but she stated she had never received needles for the pens, so she was unable to take the medication. Review of the label on the Lantus insulin revealed the dosage on the Lantus insulin label read 20U SQ BID and the Agency medication list read 15U BID. Patient #2 stated her blood sugar on Sunday (04/17/2022) was 536. S2 LPN performed a CBS and obtained a reading of 575. S2 LPN encouraged Patient #2 to go to the ER, but the patient refused. Review of Patient #2’s 04/19/2022 SN Visit Note Report revealed the following in part: Medications were reconciled with discrepancies found. SN assessed meds with discrepancies noted. SN assessed non-fasting CBG of 575 mg/dl. SN instructed pt. to go to ER for eval and treatment r/t elevated CBG, pt. refused. Review of the Agency’s Policy on Medication Reconciliation revealed in part: 1. At time of admission, the admitting RN, PT, or SLP will create and document a complete list of medications that patient is taking at home, including dose, strength, route, and frequency”. 2. Medications ordered while the patient is receiving care will be compared to the medication list/profile. The medication list/profile will be updated with each new or changed medication. The patient’s medication list in the home will also be updated. Review of the Agency’s Policy of Medication Profile revealed in part: 2. The admitting RN, PT, or SLP checks all medications a patient may be taking and documents on the medication profile. 4. The nurse or therapist will add all new/changed medication(s) to the medication profile. Discontinued medications will be documented and dated. The medication profile will be reviewed every home visit and updated as changes occur. Interview on 04/20/2022 at 10:22 a.m. with S1 Regional Clinical Supervisor confirmed that Patient #2 should have received more SNV’s to provide instructions concerning diabetic care and medication administration. She stated more follow-up visits were needed during the week of 04/06/2022. Interview on 04/20/2022 at 11:21 a.m. with S1 Regional Clinical Supervisor revealed a SNV had been scheduled for today for Patient #2. She further stated she had called the NP office and the needles for the injectable insulin were ordered on 04/11/2022 and she had called the pharmacy and they never received the order. She further stated that the SN should have checked on the status of the insulin needles prior to today.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Tag 682 Based on observation and interview the HHA failed to ensure an agency nurse followed accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases during patient care, for 1(S2 RN) of 3 (S2 RN, S3 LPN and S4 HHA) staff members observed during home visit observations. S2 RN failed to wear a mask, screen the patient for signs and symptoms of COVID-19, use hand hygiene, clean and disinfect equipment after use, and ensure a clean environment was created to place her nursing bag. Findings: A home visit was conducted on 04/19/2022 at 9:15 a.m. with S2 RN. Upon entrance to the home, S2 RN did not have a mask in place and did not question the patient concerning COVID-19 signs or symptoms. S2 RN placed her nursing bag onto the patient’s floor without a barrier sheet. She then started the assessment without washing her hands or using hand sanitizer. The RN did not clean equipment before or after use. Review the Agency’s Policy on Nursing Bag Technique revealed the following in part: “Upon entering the home, place the bag on a clean surface; paper towels or plastic bag may be used to create a clean area if indicated.” Review of the Agency’s Policy on Methods of Disinfection revealed in part: “Stethoscopes and blood pressure cuffs will be cleaned with Agency approved disinfectant after each use by the employee who has possession of the equipment.” Telephone interview on 04/20/2022 at 10:00 a.m. with S2 RN concerning observation findings from home visit conducted on 04/19/2022 confirmed she did not wear a mask during the visit, did not screen the patient for COVID-19, did not wash or disinfect her hands prior to assessing the patient or clean equipment prior to or after use, and that she placed her nursing bag on the floor and did not create a clean area to place her nursing bag.