Every finding on record at Jersey County Health Dept

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 3/28/24. The Agency was in compliance with the Condition, 42 CFR 484.102, Establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 3/28/2024. The Agency was not in compliance with 42 CFR 484, Conditions of Participation for Home Health Agencies, for this survey. Abbreviations: Pt - Patient HHA - Home Health Agency SOC - Start of Care RN - Registered Nurse ER - Extended Release mg - Milligram mcg- Micrograms E - Employee # - Number

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, document review, and interview, it was determined for 1 of 3 (Pt #1) patients, where home visits were conducted, the Home HHA (Home Health Agency) failed to review all medications by comparing them to the Assisted Living current medication profile to ensure the patient was taking the correct medication(s). Findings include: 1. Pt #1 SOC (start of care) 3/7/2024, Diagnosis: Unspecified wound, left upper arm and abdomen. On 3/26/2024 at 12:00 PM a home visit was conducted with Registered Nurse (E #3) at Pt #1’s Assisted Living residence. During the review of the Assisted Living medication profile for Pt #1, it was noted the Assisted Living medication list lacked the following medication that were documented on the Home Health medication list. a. Amlodipine Besylate (Norvasc) 10 mg (milligram) orally daily – calcium channel blocker used to treat high blood pressure and chest pain. b. Linzess 145 mcg (microgram) orally at bedtime – used to treat irritable bowel syndrome with constipation. c. Docusate Sodium 100 mg orally daily- prevents and treats occasional constipation. Pt #1’s Home Health Agency’s medication listed lacked the following 6 over the counter medications a-f, and one prescription medication that appeared on the Assisted Living’s medication profile. a. Acetaminophen ER (extended release) 600 mg tab 1 tablet every 6 hours as needed. b. Healthy Eyes 2 Supervision one capsule daily by mouth. c. Loperamide 2 mg capsule one by mouth 1-2 times daily. d. Multivitamin tablet take one tablet by mouth two times a day. e. Neuriva Plus Brain Perform take one capsule by mouth daily. f. Slow Release Iron 45 mg tablet one tablet by mouth once daily on Tuesday and Friday. g. Quetiapine Fumarate 25 mg (Seroquel) tablet take one tablet by mouth - used as an antipsychotic to improve mood, thoughts and behaviors. 2. A review of Pt #1's medical record was completed on 03/26/2024 at approximately 1:30 PM. All 12 of the home visits made by the skilled nurses from 03/7/2024 SOC thru 03/22/24 indicated there were no discrepancies in the medication list reviewed and there were no changes in medication. 3. On 03/26/24 at approximately 1:30 PM the policy titled “Skilled Home Care Policies” was reviewed. The policy required, “Registered Nurse shall check all medicine that patient may be taking to identify possible ineffective drug therapy or adverse reactions, to promptly report any problems to patient’s physician within twenty-four (24) hours, and document in the clinical record. 4. On 03/26/2024 at approximately 2:00 PM an interview was conducted with the Agency Supervisor (E #2). E #2 reviewed Pt #1’s record and agreed stating "there were multiple discrepancies between the Assisted Living medication profile and our agency’s medication profile."

The Emergency Preparedness requirements were evaluated in conjunction with the recertification survey, on 03/24/2021.The Agency was in compliance with the Condition, 42 CFR 484.102, Establishment of the Emergency Program (EP), for this survey.

A recertification survey was conducted in conjunction with an Focused Infection Control (FIC) survey on 3/25/21. The Agency was not in compliance with the Standards for Home Health Agencies, 42 CFR 484, as evidenced by:

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on observation, document review, and interview it was determined for 1 of 3 (E #5) patient's clinical records reviewed, the Agency failed to accurately document the patient's living environment. This has the potential to affect all patients receiving care from an Agency with a census of 48 patients. Findings include: 1. On 03/23/2021 at approximately 11:50 AM, a home visit was conducted at Pt #5's house. The reason for the visit was to observe Certified Occupational Therapist Assistant (E #2) perform her assigned duties as outlined in the patient's plan of care. Upon opening the door to Pt #5's house, a strong, repulsive odor was noticed. Immediately upon entering there were 3 to 4 dog pads on the ground with old, dog feces on it. On the tan carpet was an area approximately 5 feet by 5 feet that was orange to yellow in color, saturated with what smelled, and appeared to be dog urine of unknown age. Pt #5 was observed sitting in a recliner, with a small dog on lap, approximately 6 feet from the feces and urine stained carpet. While E #2 was assisting Pt #5 ambulate to the bathroom with a wheeled walker, the patient, dog and E #2 had to walk over the urine stained carpet. The patient appeared to not be able to bend over to remove the dirty dog pads. 2. On 03/23/2021 at approximately 2:00 PM, the clinical record of Pt #5 was reviewed. Pt #5 was admitted on 03/21/2021, with the diagnoses of non-displaced, left, ulna spiral fracture, hypertension, and depression. The comprehensive assessment conducted on 03/19/2021 did not indicate Pt #5 was living in unhealthy conditions. 3. On 03/24/2021 at approximately 9:15 AM, an interview with the Clinical Manager (E #2) was conducted. E #2 explained that Pt #5 lived in those conditions "for some time." "I was the one who admitted the patient during the last admission, around the holidays, and those living conditions existed then. The patient has family living in the basement. During the last admission we contacted a multifaceted agency whose purpose was to provide an array of services to persons sixty and over, with emphasis on those persons who have greatest social or economic need, to help them stay in their own homes, independently for as long as possible, safely. They indicated they were not going into homes due to the COVID-19 virus." When asked if E #2 contacted that same agency for this admission, E #2 replied "No".