Every finding on record at Kochas Interim Healthcare, Inc.

An unannounced onsite recertification survey was conducted on 11/06/2023 to 11/07/2023 at Interim Healthcare of Wausau in Wausau, WI. Interim Healthcare of Wausau was found to be in compliance with Medicare Conditions of Participation for Emergency Preparedness 42 CFR 484.102 for Home Health Agencies.

An unannounced onsite recertification survey was conducted on 11/06/2023 to 11/07/2023 at Interim Healthcare of Wausau in Wausau, WI. Interim Healthcare of Wausau was found to be in compliance with Medicare Conditions of Participation 42 CFR 484 for Home Health Agencies. Standard level citations. A total of 10 patient charts were reviewed and 4 home visits were conducted for an unduplicated admission total of 500 for the past 12 months.

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 record review, observation and interview, the agency failed to maintain an accurate medication list as compared to what the patient is taking and/or ordered in 3 of 4 patient home visits observed (Patient #1, #3, and #4) in a total of 10 home health patient records reviewed. Findings include: Review of agency policy and procedure titled "Initial Comprehensive Assessment" dated 04/02/2021 revealed in part, "Policy: Initial comprehensive assessments are conducted in accordance with applicable law and regulation. Procedure: Assessment of Adult Patients Requiring Skilled Care: 2. The RN (Registered Nurse), PT (Physical Therapist), OT (Occupational Therapist) or SLP (Speech Language Pathologist) documents the findings of the initial comprehensive assessment on paper or electronically in standardized format. a) includes the elements of the following documents: i) the Medication Profile.” Record review of Patient #1’s “Home Health Certification and Plan of Care” medication orders dated 09/27/2023 – 11/25/2023 revealed “Metoprolol Succinate 50mg (milligrams) oral capsule 1 tablet daily by mouth. Amlodipine 5mg oral 1 tablet daily by mouth.” A home visit for Patient #1 was conducted at the patient's residence on 11/06/2023 from 1:20 PM to 1:55 PM. During the home visit, observed RN B ask Patient #1 if there were medication changes. Patient #1 replied, “No.” Upon cessation of home visit at 1:55 PM, writer asked Patient #1 to review the agency medication list as compared to what Patient #1 is taking. RN B remained in the home to review. Patient #1 stated, “I am taking Metoprolol 100mg. It changed when my blood pressure was getting high awhile back. I am not taking Amlodipine. Haven’t been taking that for a few weeks.” Record review of Patient #1’s record 09/27/2023 – 11/05/2023 revealed Patient #1 had an RN visit 3 times per week for a total of 6 weeks, and there were no documented order update or reconciliation of changes in the agency medication profile for Metoprolol or Amlodipine. A home visit for Patient #3 was conducted at the patient's residence on 11/06/2023 from 3:35 PM to 3:55 PM with PTA (Physical Therapist Assistant) D. PTA D did not remain in the home. Upon cessation of home visit at 3:55 PM, writer asked Patient #3 to review the agency medication list as compared to what Patient #3 is taking and observed Patient #3 take out a box of medications currently taking. Patient #3 removed a medication bottle that read “Potassium Chloride 10 meq (milliequivalent) take 1 tablet by mouth twice daily. Order date 10/02/2023.” Patient #3 stated, “Oh yeah, I take Potassium.” Patient #3 Daughter G stated, “[Patient #3] takes Potassium twice a day since beginning of October.” Writer reviewed the medication list and Patient #3 Daughter G confirmed Potassium was not on the medication list. When asked how often the nurse reviews medications, Patient #3 Daughter G replied, “[RN B] reviews medications weekly.” Record review of Patient #3’s “Home Health Certification and Plan of Care” medication orders dated 10/04/2023 – 12/02/2023 and review of “Medication Profile” (showing current medication orders and printed effective 11/07/2023) revealed Potassium Chloride was not listed as an active medication on this agency’s medication profile. During the timeframe of 10/04/2023 – 11/06/2023, an RN conducted a visit 1 time per week for a total of 5 weeks, and there were no documented order updates or reconciliation changes in the agency medication profile that Patient #3 had been taking Potassium Chloride. A home visit for Patient #4 was conducted at the ALF (Assisted Living Facility) where Patient #4 resides on 11/07/2023 from 9:00 AM to 9:45 AM with RN E. Writer did not observe RN E ask about Patient #4’s medications with ALF Staff F during this time. Upon cessation of home visit, RN E did not remain in the ALF. At 9:50 AM, writer asked ALF Staff F for the ALF’s MAR (Medication Administration Record) to compare the medication lists. Record review of the ALF MAR for month of November for Patient #4 revealed “Potassium Chloride 20 meq: Discontinued.” Record review of Patient #4’s “Home Health Certification and Plan of Care” medication orders dated 08/15/2023 – 10/13/2023 and 10/14/2023 – 12/12/2023, and review of “Medication Profile” (showing current medication orders and printed effective 11/07/2023) revealed “Potassium Chloride (Klor-Con 20) 1 tablet once daily by mouth” which did not match the medication profile for the ALF in which Patient #4 resides. During an interview with ALF Staff F on 11/07/2023 at 9:50 AM, when asked about Patient #4’s Potassium and if Patient #4 is taking this medication, ALF Staff F replied, “No, Patient #4 does not take Potassium. I don’t know when it was discontinued.” Record review of Patient #4’s RN visit documentation on 11/07/2023 under “Health Management” did not reveal any medication assessment or review completed (the agency’s software system has check boxes for ‘medication reconciled’, ‘new/changed medications in the home,’ ‘medication issues.’" During an interview with Administrator A on 11/07/2023 at 1:10 PM, when asked about the agency’s process and expectations for medication review and reconciliation, Administrator A replied, “On the first visit, we look at the bottles of medications and also compare their medication list to the facility list (if that is where they reside) and compare to referral information. On subsequent visits, we ask if there was a doctor appointment or any medication changes. They can add medications or change orders and send off for signed orders. If at a facility, they could talk to the facility nurse and review.” When asked if the agency had anything more specific regarding staff expectations for medication review to ensure patients and the agency have a most accurate list, Administrator A replied, “This is all we have. Nothing more specific.” Review of home visit findings were reviewed and confirmed with Administrator A on 11/07/2023 from 1:45 PM to 2:15 PM. During an interview with Administrator A on 11/07/2023 at 2:45 PM, in a follow up for Patient #4’s medication discrepancies, Administrator A stated, “Our Nurse Practitioner has Potassium on the list, but in looking at some communication notes, it shows the patient went to the cardiologist and Potassium was discontinued.” Record review for Patient #4’s Cardiology visit orders dated back on 08/15/2023 revealed, “Stop KCL (Potassium). Spoke with facility manager to discuss new orders.”

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 record review and interview, the agency staff failed to assess the patient’s wound to include wound measurements in accordance with physician orders and agency policy in 2 of 3 wound patients (Patient #6 and #10) in a total of 10 patient records reviewed. Findings include: Review of the agency policy, titled "Developing a Plan to Meet Patient/Client Needs," dated 4/21/2021, revealed: "Wound: The clinician measures the wound(s) weekly and documents the results." Record review of Patient #6's "Home Health Certification and Plan of Care" orders (dated 10/11/2023 to 12/09/2023) revealed in part, “SN (Skilled Nurse): 2 times a week for 8 weeks. SN to perform assessments with emphasis on wound care (right buttock) and heart failure. SN indicated for wound care management based on physician orders due to the inherent complexity of wound. SN to assess wound progression or decline.” Record review of Patient #6's SN visits from 10/11/2023 to 11/06/2023 revealed two visits were made the week of 10/15/2023, with no documented evidence of measurement of the buttock wound. Record review of Patient #10’s "Home Health Certification and Plan of Care" orders (dated 08/15/2023 to 10/03/2023) revealed in part, “SN (Skilled Nurse): 1 time a week for 9 weeks. SN to perform complete physical assessment each visit with emphasis on wound care to left great toe. SN indicated for wound care management based on physician orders due to the inherent complexity of wound. SN to assess wound progression or decline.” Record review of Patient #10’s SN visits from 08/15/2023 to 10/03/2023 revealed the weeks of 08/20/2023 and 08/27/2023, two visits were made each week (08/22/2023, 08/25/2023, 08/29/2023, and 09/01/2023) and no evidence of documented measurement of the left great toe wound. During an interview on 11/07/2023 from 1:45-2:15 PM, Administrator A stated, "Wound measurements should be done weekly." Record review findings for Patients #1 through #10 were reviewed and confirmed with Administrator A on 11/07/2023 from 1:45 PM to 2:15 PM.

An unannounced on-site Complaint survey was conducted on 05/15/2023 to 05/16/2023 at Interim Healthcare of Wausau in Wausau, WI in response to complaint #WI00097269. Complaint #WI00097269 was substantiated. Interim Healthcare of Wausau was found to be in compliance with Medicare Conditions of Participation 42 CFR 484 for Home Health Agencies. Citations are issued at a standard level or below.

Ensure that HHA employs qualified personnel CFR(s): 484.105(b)(1)(iv) (iv) Ensure that the HHA employs qualified personnel, including assuring the development of personnel qualifications and policies. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to ensure employee personnel records contained agency required qualifications upon hire for experience and competency evaluation in 2 of 10 employee (Physical Therapist A and Physical Therapist H) and proof of CPR certification (Cardiopulmonary Resuscitation) in 3 of 10 employee (Physical Therapist A, Physical Therapist H, and Physical Therapist I) personnel records reviewed. Findings include: Record review of agency policy titled "File Maintenance of Employees that Provide or Manage Patient Care/Client Service" dated 05/10/2013 revealed "Procedure: 3. The Administrator/Manager or designee ensures the following additional information is included in each employee's file who provides or manages patient care/client service: f) A completed competency test as applicable; g) A copy of CPR certification." Record review of agency policy titled "Assessment and Documentation of Competency" dated 11/29/2019 revealed "Procedure: Assessment of Competency Prior to Assignment 1. b) Reviewing the employee's previous experience and current level of self-assessed independence by ensuring that each employee who provides care/service completes the appropriate Home Care Skills Evaluation & Experience Checklist related to their job responsibility prior to assignment." Record review of this agency's contract with Contract L, dated 11/11/2022, revealed "V. Implementation, Supervision, and Evaluation: B. The Agency shall maintain overall responsibility for the services provided under this agreement. X. Employment Relationship: Upon request, Provider shall furnish to Agency documents evidencing the Provider employees: Meet personnel requirements established by law, regulation or agency policy; Are currently certified in the administration of CPR as required by law, regulation or agency policy." During an interview with Adminstrator B on 05/15/2023 at 12:30 PM, when asked what the agency requirement is for skilled professionals for training and competency upon hire, Administrator B replied in part, "Upon hire, we ask about home heatlh background...We go out with field staff and orient each discipline they work with...Therapists, I don't believe we have anything specific for competency, just need to be licensed and have continuiing education or CEUs (Continuing Education Units) and do an overall Competency experience evaluation." When asked if there are requirements for agency staff to have CPR up-to-date, Administrator B replied, "CPR is required." Record review of personnel file for PT A, date of hire 11/03/2022, revealed no evidence of a Skills Evaluation & Experience Checklist related to job responsibilities and no evidence of CPR certification upon hire. Record review of personnel file for current direct employee PT H, date of hire 08/02/2022, revealed no evidence of a Skills Evaluation & Experience Checklist related to job responsibilities and no evidence of CPR certification upon hire. Record review of personnel file for current contracted employee PT I, date of hire 08/16/2017, revealed no evidence of CPR certification upon hire. During an interview with Administrator B on 05/15/2023 at 3:30 PM, when asked about the proof of CPR certification for PT H upon hire, Administrator B replied, "I know she had it done. I just can't find it." During an interview with Administrator B on 05/16/2023 at 8:45 AM, when asked about the missing CPR certification for contracted employee PT I, Administrator B replied, "I sent a message to the contract service yesterday and today. They keep that information." During an interview with Administrator B on 05/16/2023 at 9:30AM, when asked about employees PT A and PT H personnel records missing CPR certification and the competency evaluation and experience checklist per agency policy, Administrator B replied, "We had an HR (Human Resource) person who we realized was not doing their job at the time. The HR person is no longer employed here, was not following up on things we needed completed for new hires."