Every finding on record at Lake Area Home Health Agency

Complaint Survey #LA000106075

Document complaint and resolution CFR(s): 484.50(e)(1)(ii) (ii) Document both the existence of the complaint and the resolution of the complaint; and This ELEMENT is not met as evidenced by: Based on record review and interview the Provider failed to document both the existence of a complaint and resolution of a complaint for 1 of 1 complaint the Agency received. Review of the provider’s 04/03/2024 Beneficiary Complaint Form revealed a PCA Service Provider telephoned S2 Billing Manager to report on 04/03/2024 at approximately 3:41 p.m. that a staff DSW had witnessed S3 LPN “pop” Patient #1 in the mouth and poke him in the back. The complaint was received by S1 Branch Manager on 04/03/2024 at 3:41 p.m. by email from S2 Billing Manager. Review of the complaint revealed that there had been no resolution to the complaint. Interview on 04/29/2024 at 9:45 a.m. with S1 Branch Manager confirmed the complaint resolution was pending the investigation from the State and APS.

Protect patient during investigation CFR(s): 484.50(e)(1)(iii) (iii) Take action to prevent further potential violations, including retaliation, while the complaint is being investigated. This ELEMENT is not met as evidenced by: Based on record review and interview the Provider failed to take action to prevent further potential violations, including retaliation, while a complaint is being investigated for 1 (Patient #1) or 1 patient involved in a complaint. Review of the provider’s 04/03/2024 Beneficiary Complaint Form revealed on 04/03/2024 at 3:41 p.m. a complaint was called in to S2 Billing Manager concerning S3LPN. S2 Billing Manager then sent an email to S1 Branch Manager concerning this complaint on 04/03/2024 at 3:41 p.m. S1 Branch Manager attempted to contact S3 LPN, but was not successful. A message was left to return call. S3 LPN returned telephone call on 04/04/2024 at approximately 10:00 a.m. while she was working at Patient #1’s home. S1 Branch Manager discussed the complaint with S3 LPN with S3 LPN denying all allegations. S1 Branch Manager informed S3 LPN there would be an investigation concerning the complaint. Interview on 04/30/2024 at 12:13 p.m. with S1 Branch Manager confirmed that she had discussed the complaint with S3 LPN on 04/04/2024 at around 10:00 a.m. S1 Branch Manager stated she told S3 LPN there would be an investigation concerning the allegation of abuse. S1 Branch Manager stated S3 LPN worked with Patient #1 until her shift was over on 04/04/2024 at 5:00 p.m. S1 Branch Manager stated she did not remove S3 LPN from providing care to Patient #1 at the time of the call and she should have.

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

Recertification Survey Abbreviations: a.m. - morning LPN - Licensed Practical Nurse mcg - microgram mg - milligram ml - milliliter p.m. - evening po - per oral POC - Plan of Care prn - as needed RN - Registered Nurse BLS- Basic Life Support CPR- Cardiopulmonary Resuscitation BID-twice a day HHA-Home Health Aide CNA-Certified Nursing Assistant

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 interview and record review the Agency failed to ensure that each Patient received all services outlined in their plan of care for 1 (Patient #6) of 13 Sampled Patient records reviewed. Review of Patient #6’s 12/26/2022-02/23/2023 Plan of Care revealed Patient #6 was to receive HHA visits 3 times a week for 8 weeks then 2 times a week for 1 week. Review of Patient #6’s Visit Summary Report revealed Patient #6 received only 2 visits during the first week of the Recertification Period 12/26/2022 -12/31/2022. Interview on 01/20/2023 at 4:29 p.m. with S2 Branch Manager confirmed that Patient #6 did not receive HHA visits according to her Plan of Care

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 review of all medications was conducted each visit in order to identify any potential adverse effects and drug reactions and noncompliance with drug therapy. The agency failed to ensure Drug Regimens were reviewed for medication changes and accuracy for 3 (#1, #2, and #9) of 13 sampled patients. #9 Observation during a home visit conducted on 01/11/2023 at 10:55 a.m. revealed S4 RN conducted a medication reconciliation of Patient #9’s medications. Patient #9 was taking the following medication dosages that were different or omitted from the medications listed on Patient #9’s Plan of Care. 1. Metoclopramide HCl 5 mg po every 4 hours prn 2. Hydrocodone-Acetaminophen 7.5-325 mg po every 4 hours prn – Prescription bottle dated 08/25/2022 3. Loratadine 10 mg po daily prn sinus congestion – Prescription bottle was dated 11/28/2022 4. Fluticasone Propionate 50 mg 1 spray each nostril prn BID – Dated 11/28/2022 5. ASA 81 mg daily -OTC Interview on 01/11/2023 at 11:55 a.m. with S4 RN confirmed there were 5 medication discrepancies noted with Patient #9’s medication. She confirmed that there had not been a medication reconciliation performed on previous skilled nurse visits and there should have been. Review of Patient #9’s 12/26/2022 – 02/23/2023 Plan of Care revealed the following medication dosages associated with the above discrepancies: 1. Metoclopramide HCl 10 mg po every 4 hours prn nausea 2. Hydrocodone-Acetaminophen 5-325 mg 1 tab po every 4 hours prn Review of the Agency’s Medication Profile revealed in part: Procedure: 4. During subsequent home visits, the medication profile will be used as a care planning and teaching guide to ensure that the patient and family/caregiver, as well as other clinicians, understand the medication regimen. This includes, but not limited to: A. Using the medication profile, in conjunction with other pertinent data, to evaluate the use of the drugs in the home setting. C. Using the mediation profile as a communication tool for other clinicians involved in care. #1 Observations during a home visit on 01/11/2023 at 9:00 a.m. revealed S3 LPN obtained vital signs, performed a brief physical assessment, and began filling Patient #1’s weekly pill planner. Further observation revealed S3 LPN was not checking Patient #1’s medication profile or POC while filling the pill planner. Interview at the time of observation revealed she had been seeing the patient for a while so she knew his medications off the top of her head. S3 LPN was instructed to check medications on hand against orders and the following discrepancies were identified: Linzess 145mcg capsule po daily; medication not in home; Patient #1 states has not taken in 2 months. Folic Acid 1mg po daily; medication not in home; Patient #1 states he is no longer taking this medication. Vitamin B12 oral 1000mcg 1 tab po daily; medication bottle in home dose reads 5000mcg. Furosemide oral 40mg 1 tablet by mouth every other day; medication bottle in home reads 40mg po daily. Ergocalciferol 50mcg 1 tab weekly; medication not in home; Patient #1 states has not taken in over a year Toujeo Max 300unit/ml inject 42 units subcutaneous every night; prefilled syringe package dosing instructions read 48 units subcutaneously nightly. Medication regimen discrepancies confirmed with S3 LPN on 01/11/2023 at 9:45 a.m. Interview on 01/11/2023 at 10:00 a.m. with S3 LPN confirmed she had not been checking Patient #1’s medication regimen for accuracy at each visit and she should have been. #2 Observations during a home visit on 01/11/2023 at 11:00 a.m. revealed medication discrepancies as follows: Rosuvastatin Calcium 10mg 1 po daily at bedtime; medication bottle in the home reads 20mg po daily at bedtime, date filled 12/28/2022. Lubiprostone 24mcg cap take one capsule po daily; medication not in home; Patient #2 states has not taken since March. Interview on 01/11/2023 at 11:15 a.m. with S3 LPN confirmed the above discrepancies. Interview on 01/11/2023 at 11:45 a.m. with S1 Administrator revealed medications should be checked against orders and updated at every visit and Patient #1 and Patient #2’s had not 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 observation and interview the Agency failed to follow accepted standards of practice to prevent the transmission of infections and communicable diseases for 1 of 5 home visits conducted. Observation on 01/11/2023 at 9:00 a.m. of a home visit conducted for Patient #3 revealed S5 CNA did not use standards precautions prior to or after assessing the Patient. S5 CNA did not place a barrier sheet prior to placing her bag on Patient #3’s ottoman. S5 CNA did not wash or sanitize her hands prior to assessing Patient #3. S5 CNA immediately placed the BP cuff, Oxygen Saturation Monitor and Thermometer into her bag without cleaning after using on Patient #3. Interview on 01/11/2023 at 9:10 a.m. with S5 CNA confirmed she did not clean her equipment after using on Client #3. She further revealed she did not have a barrier sheet to place her bag. Review of the Agency Bag Technique Policy revealed the following in part: Bag Technique: 1. The bag will be placed on a clean dry surface in the car and in the home. 2. Prior to administering care, alcohol-based hand rub or soap, and paper towels will be removed, and hands will be washed. These supplies will be left at the sink for hand washing at the end of the visit. Hand washing will always be completed before opening the nursing bag. 3. After hand washing, supplies and/or equipment needed for the visit will be removed from the bag. 5. When the visit is completed, reusable equipment will be cleaned using alcohol and/or soap and water as appropriate, hands will be washed, and equipment and supplies will be returned to the bag. 6. Hands will be decontaminated prior to returning clean equipment to bag.