Every finding on record at Lakes Regional Healthcare

A Recertification Survey was conducted by the Department of Inspections and Appeals from 12/18/23 through 12/20/23 and the home health agency was found to be operating in compliance with the requirements of the Establishment of Emergency Preparedness.

The Iowa Department of Inspections and Appeals conducted a Recertification Survey from 12/18/23 through 12/20/23. The recertification survey identified the home health agency was operating out of compliance with the following standard level home health regulations. The agency identified a census of 30 current patients.

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 agency policy review, clinical record review and agency staff interview, the agency failed to complete a drug regimen review DRR) with all of the required components and patient specific for each patient for 2 of 7 sampled patients requiring a DRR (Patients #1 and #6). Failure to ensure medications reviewed at the time of each drug regimen review are current and accurate and failure to identify actual/ potential concerns increased the potential for unidentified medication interactions and side effect risks to the patient at the time of each comprehensive assessment. Findings include: According to the agency policy titled HC Medication Administration - DRR, dated 5/2023, in pertinent part, A drug regimen review is completed 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. During an interview on 12/20/23 at 10:00 AM, the Administrator reported that the significant interaction section of the DRR should list specific medications or that no interactions were found. 1. Patient #1 had an admission date of 12/14/23. Review of the clinical record revealed the following: a. The Plan of Care (POC), dated 12/14/23 to 2/11/24, included orders for skilled nursing services and orders for medications. The medication orders included medications with potential adverse interactions which included amitriptyline (anti depressant) and trazodone (anti depressant). b. The comprehensive assessment completed by a Registered Nurse (RN), dated 12/14/23, included the following documentation related to the DRR: " Potential for sedation and respiratory depression when given concurrently." The document failed to include which medications identified potential adverse reactions. The agency staff failed to identify individual patient outcomes of the DRR including potential adverse interactions. 2. Patient #6 had an admission date of 10/4/23. Review of the clinical record revealed the following: a. The POC, dated 10/4/23 to 1/1/24, included orders for skilled nursing services and orders for medications. The medication orders included medications with potential adverse interactions which included antidepressant medications; sertraline and mirtazapine. b. The comprehensive assessment completed by the RN, dated 10/4/23, included the following documentation related to the DRR: "See DRR, potential if some medications are given concurrently" The document failed to include which medications identified with potential adverse reactions. The agency staff failed to identify individual patient outcomes of the DRR including potential adverse interactions. The above findings were reviewed with the Administrator prior to the end of the survey. No additional information was provided.

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 agency policy review, clinical record review and agency staff interview, the agency failed to provide medications, treatments or services only as ordered by the physician for 1 of 4 sampled patients with wound treatment, Patient #6. The agency reported a current patient census of 30 patients. Failure to ensure staff obtain physician orders for administration of medications, treatments or services provided by agency staff placed agency patients at risk for inconsistent care/treatment and possible harm. Findings include: According to agency policy, in pertinent part, titled HC Medical Orders dated 12/2020, interim orders from the physician/practitioner must be obtained to cover any changes in medications administered by the agency’s home care staff. Patient #6 had a start of care date of 10/4/23. Review of the clinical record revealed the following: 1. An order dated 10/8/23 for wound treatment as follows: a. Apply Duoderm Thin to each buttock ulcer. b.PRN (as needed) topical care if Duoderm unsuccessful: c. Apply premade collagen/clear aid mixture. d.Apply non-adherent pad in between buttock wounds. Nurse visit documentation on 10/13/23 revealed that the nurse “Collagen mixture applied to wounds and duoderms applied with pressure for 1 minute.” In an interview on 12/20/23 at 10:00 AM, the Administrator reported that, according to visit documentation, the nurse combined the 2 wound care treatments. The above findings were reviewed with the agency Administrator. The agency provided no additional information prior to the end of the survey.

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 clinical record review, agency policy review, and agency staff interview, the agency failed to update individualized and specific written patient care instructions from a registered nurse (RN) to agency home health aides for 1 of 5 sampled patients receiving home health aide services Patient #4. The agency reported a census of 30 patients, including 18 who received care provided by a home health aide. Failure to ensure agency registered nurses provided patient specific written instructions directing the care provided by the agency's home health aides for each patient increased the risk agency patient's would receive inappropriate or inconsistent home health aide services. Findings include: According to the agency policy, titled HC-HS Supervision of Aide Services, dated 5/2023, in pertinent part, the Clinical Manager will be responsible for the clinical direction of the organization and take reasonable steps to assure that care and services provided by organization personnel and contracted organization personnel are coordinated and integrated. In an interview on 12/20/23 at 10:00 AM, the Administrator agreed that the nurse needed to update the patient’s care plan to direct the change in topical treatment used by the Home Care Aide (HCA). Patient #4 had a start of date of 1/17/21 and received every other week skilled nursing services and two times per week home health aide services from the agency. Clinical record review revealed: a.RN visit note documentation on 11/13/23 that the patient had a new open area of skin to her left buttock and a red area of intact skin to her right buttock. An order was obtained to apply clear aid daily with peri cares. b.HCA visit documentation on 11/14/23 and 11/17/23 revealed a directive on the care plan to apply calazime cream to bilateral buttocks. c.The HCA care plans on these dates did not include the directive to apply clear aid. d. The HCA documentation on these dates included that the patient received assistance with showering. The above findings were reviewed with the agency Administrator. The agency provided no additional information prior to the end of the survey.