Every finding on record at Legacy Homecare, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the California Department of Public Health: Surveyor # 19096, Health Facilities Evaluator Nurse Surveyor # 36459, Health Facilities Evaluator Nurse Unduplicated Admissions - 200 Active Patients - 53 Sample Size - 7 Patients Home Visits – 3

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 staff failed to review all medications the patient is currently using for two of seven patients (Patients 1 and 6). The deficient practice has the potential to place the patient at risk for medication errors and adverse reactions. Findings: Patient 6's electronic record was reviewed. Review of Patient 6's plan of care (POC) for the certification period of 8/4/2022 to 10/2/2022, indicated the start of care (SOC) date of 9/19/2022, with diagnoses which included chronic venous hypertension( chronic vein insufficiency), type 2 diabetes mellitus,( A chronic condition that affects the way the body processes blood sugar ( insulin) in which the body does not produce enough insulin , or it resist insulin)., and obstructive sleep apnea ( intermittent airflow blockage during sleep). The POC included a physician's order for skilled nurse to visit the patient twice a week for eight weeks to assess/observe vital signs and competency and compliance with diet and medication. During a home visit on 11/16/22, at 11:00 a.m., Patient 6's medications were reviewed and revealed Patient 6's medications currently taken were not listed in the patient's medication profile as follows: High potency vitamin D3 10,000 IU/250 micrograms (unit of measure) and Zinc 50 milligrams. During an interview with the Director of Nurses (DON) she stated all medications should be reviewed every visit. A review of the HHA’s document titled “Medication Management” dated 2019 indicated medication reconciliation (Verify, Validate, Clarify) Ask to see all medications the patient is taking. This included prescription, over the counter, topical, herbal, vitamins/nutritional supplements, drops. Medication profile: check-Info-interactions for information, interactions, and contraindications. Fill in date teaching performed as your review and teach patient. At each visit- update the medication profile in the home when changes or additions occur. Ask if there has been a physician visit and/or if there are new or changes to their medications. A review of Patient 1's clinical record indicated a start of care date (SOC) of 10/12/2021, with a diagnosis of cutaneous T-cell lymphoma (rare type of cancer [the body's cells grow uncontrollably and spread to other parts of the body] that affects the skin). A review of Patient 1's Plan of Care (POC) for the certification period of 11/07/2022 to 12/05/2022, indicated for a skilled nurse (SN) scheduled to visit the patient two times a week for eight weeks. The POC indicated for the SN to assess and observe competency and compliance with diet and medications. On 11/16/2022, at 11:25 a.m., a joint home visit with Licensed Vocational Nurse (LVN 1) was conducted at Patient 1’s residence. A review of Patient 1’s Medication Profile provided by the agency did not indicate Patient 1 was taking Carboxymethylcellulose Sodium 0.5 percent eye lubricant (used to relieve dry, irritated eyes). During an interview with Patient 1 on 11/16/2022, at 12:20 p.m., stated she takes the eye drops two times per day as needed for dryness. Patient 1 further stated she started taking the eye drops one month ago. During an interview with the Administrator (ADM) on 11/18/2022, at 11:59 a.m., stated medication reconciliation should be done every visit. A review of the agency’s policy and procedure titled “Medication Reconciliation/ Profile,” dated 09/2011, indicated the licensed staff will make every effort to reconcile patient’s medications from each point of care/admission, resumption of care and/or recertification period.

Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This ELEMENT is not met as evidenced by: Based on interview, and record review, the home health agency (HHA) failed to ensure the patient or caregiver received education and training on glucose monitoring and machine calibration for one of seven patients (Patient 6). This deficient practice has the potential to put the patient at risk for an inaccurate blood sugar level results that could impact the patient's health status and well-being. Findings: A review of Patient 6's electronic record indicated a start of care (SOC) date of 9/19/2022. The diagnoses included Type 2 diabetes mellitus (A chronic condition that affects the way the body processes blood sugar (insulin) in which the body does not produce enough insulin), chronic venous hypertension (increased pressure inside the veins), and obstructive sleep apnea (intermittent airflow blockage during sleep). Patient 6's plan of care (POC) included a physician's order for skilled nurse to visit the patient twice a week for eight weeks to assess/observe vital signs and competency and compliance with diet and medication. During a home joint home visit with LVN 1on 11/16/22, at 11:00 a.m., Patient 6's glucometer monitoring log was reviewed and disclosed no evidence it was done. Patient 6 was asked if his glucometer needed to be calibrated (calibration is required when using a new box of test strips to ensure the calibration strips matches the code displayed on the glucometer and on the test strips in the box). Patient 6 stated he did not know what that meant. During a concurrent interview with LVN 1 stated Patient 6’s glucometer does need to be calibrated, the agency was trying to get him new glucometer through Patient 6’s health insurance. LVN 1 further stated Patient 6’s glucometer has not been calibrated. During an interview with the Administrator on 11/18/22, stated the glucometer should be calibrated, and they will notify his insurance for a new machine.