Every finding on record at Liberty Home Care

An unannounced on-site recertification survey was conducted 03/31/25-04/02/25. No deficiencies for Emergency Preparedness were identified.

An unannounced on-site recertification survey was conducted 03/31/25-04/02/25. Standard level deficiencies to the Medicare Conditions of Participation were identified.

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 agency policy, clinical record review, and staff interviews, the agency failed to provide services as outlined in the plan of care for 1 of 4 patients receiving home health aide services (patient #7). Findings included: A policy, Patient Rights and Responsibilities (revised 07/2021), received on 04/01/2025 at 3:45 PM from the agency director stated, “The patient and representatives (if any) have the right: … To receive all services as outlined in the plan of care.” Patient #7 was admitted on 06/14/2024 with a diagnosis of Type 2 diabetes mellitus (a chronic condition where the pancreas produces little to no insulin) with chronic kidney disease. The plan of care for 06/14/2024-08/12/2024 included orders for home health aide (HHA) visits 2 times a week for 3 weeks and 1 time a week for 3 weeks. Review of the clinical record revealed that on 07/01/2024 the clinical manager documented, “No HHA visit this week due to delay of HHA license renewal” and on 07/04/2024 the clinical manager documented, “NO visit due to HHA license renewal.” Further review revealed that there was no documentation of the patient or representative being notified of the missed visits or being offered an alternate HHA. The clinical manager was not available for an interview. An interview conducted on 04/02/2025 at 10:45 AM with the agency director revealed that the expectation is to offer a visit from another HHA and to document a refusal if they decline.

All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This ELEMENT is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the agency failed to include physician’s orders in the plan of care for COVID-19 (an acute respiratory disease) testing for 1 of 1 patient requiring COVID-19 testing (patient #1). Findings included: A policy, Care Planning: Initial Care Plan and Updates to the Plan of Care (revised 03/2024), received on 04/02/2025 at 10:05 AM from the agency director stated, “All patient care orders, including verbal orders, must be recorded in the plan of care.” Patient #1 was admitted on 11/02/2024 with a diagnosis of Fx unsp part of nk of l femr (broken bone in the left upper leg). The plan of care (POC) for 11/02/2024-12/31/2024 included orders for physical therapy (PT) 1 time a week for 1 week, 2 times a week for 4 weeks, and 1 time a week for 1 week. Review of the clinical record revealed that on 12/18/2024 and 12/23/2024 PT #3 documented, “PT called patient’s PCP [primary care physician] … Spoke with nurse [name]… Nurse advised patient to schedule an appointment and do a home kit covid test. PT assisted with COVID test.” Further review revealed that physician’s orders for the COVID-19 test were not included in the POC. PT #3 was not available for an interview. An interview conducted on 03/31/2025 at approximately 3:45 PM revealed that the agency director was unsure if home test kits required orders.

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 agency policy, observation, and staff interviews, the agency failed to take precautions to prevent the spread of infection for 1 of 1 patient who received a occupational therapy visit (patient #1). Findings included: A policy, Bag technique, home care (revised 05/20/2024), received on 04/01/2025 at 3:45 PM from the agency director stated, “A home health care worker follow bag technique to prevent the transmission of microorganisms that may be present on the outside or the inside of the bag…Keep the bag closed in the presence of pets, pests, or young children.” Patient #1 was admitted on 03/14/2025 with a diagnosis of Partial quadricep (a group of four muscles in the front of your thigh that extend your leg at the knee) tear left knee wounds (a partial tear of the tendon connecting the quadriceps muscles to the kneecap). The plan of care for 03/14/2025-05/12/2025 included orders for OT (occupational therapy) visits 1 time a week for a week, 1 time a week for 4 weeks. A home visit was conducted on 04/01/2025 at approximately 11:05 AM with OT #7. OT #7 preformed hand hygiene and proceeded to unzip nursing bag, and proceeded with visit. The bag remained opened the entire visit. Patient #7 had a small dog in the home. The surveyor left due to personal activities about to take place. During an interview conducted on 04/02/2025 at 10:56 AM OT#7 stated, “Normally I don’t leave my bag open when unattended”. An interview on 04/02/2025 at 10:59 AM with the agency director revealed that the expectation is for the health staff to “Zip bag when leaving bag unattended.”

Services provided by HH aide CFR(s): 484.80(g)(2) A home health aide provides services that are: (i) Ordered by the physician or allowed practitioner; (ii) Included in the plan of care; (iii) Permitted to be performed under state law; and (iv) Consistent with the home health aide training. This ELEMENT is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the agency failed to alert the RN (registered nurse) of a change of condition for 1 of 7 patients with a documented change of condition (patient #9) related to elevated blood pressure. Findings included: A policy, Coordination and Communication Activities (revised on 03/2024), received on 04/02/2025 at 09:53 AM from agency director stated, “Home Health staff will maintain on- going communication with all physicians involved in the plan of care which includes verbal, and/or written reports that address the following, at a minimum.Significant changes in the patient’s condition, including findings that are outside of established reporting parameters”. Patient #9 was admitted on 01/31/2025 with diagnoses of HTN (high blood pressure). The plan of care for 01/31/2025- 03/31/2025 included orders for HHA (home health aide) 2 times a week for 8 weeks. “HHA to provide assistance with personal care and ADL’s as indicated by limitations on functional and physical status impeding self- care.” Review of the clinical record revelated the following information on 03/17/2025 Patient #9 had an elevated blood pressure of 196/87 documented by HHA #2. There was no evidence that HHA notified the RN. During an interview conducted on 04/02/2025 at 10:35 AM, HHA #2 revealed that HHA #2 does not always notify RN (registered nurse) of abnormal vital signs. An interview conducted on 04/02/2025 at 10:42 AM with the agency director revealed that the expectation is for the HHA to notify the RN or clinical manager of abnormal vital signs.

An onsite recertification survey was conducted 04/25/22-04/26/22. No deficiencies to the Emergency Preparedness Program were identified. ABH

An onsite recertification survey was conducted 04/25/22-04/26/22. A deficiency to the Medicare Conditions of Participation was identified. ABH

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, virtual home visits, patient/ caregiver and staff interviews, the agency failed to include all medications in the comprehensive assessment for (1 of 4) virtual home visits conducted. (#10). Findings include: According to the agency policy, “ Medication Profile and Drug Regimen Review” that was provided by the Agency Director (AD) on 04/26/2022 at 12:09 p.m. stated, “The comprehensive assessment of the patient includes a review of all medications the patient is using, both prescription and non- prescription in order to identify potential clinically significant medication issues. A current listing of all medications the patient is using is maintained in the clinical record at all times.” Patient #10 had a Start of Care date of 03/25/2022. Diagnosis on the Plan of Care (POC) for the Certification period 03/25/2022 through 05/23/2022 included Stable burst fracture first lumbar vertebra, subs for fracture with routine heal ; Unspecified fall, subsequent encounter; Hemangioma (usually benign vascular tumor derived from blood vessel cell types) of other sites; Spinal stenosis, lumbar region without neurogenic claudication [a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries]. Skilled nurse (SN) was ordered 1 time per day times 1 day/ 1 time per week for 5 weeks with 3 PRN (as needed) for complications/ medication changes. Physical Therapy (PT) was ordered 1 time a day for 1 day/2 times per week for 3 weeks/ 1 time per week for 6 weeks. Occupational Therapy (OT) was ordered for 1 time a day for 1 day/ 1 time per week for 8 weeks. A virtual home visit was conducted on 04/26/2022 at 11:30 a.m. with OT #4. A review of current medications was conducted with the patient/caregiver during the virtual home visit. The review revealed the following discrepancy: Dorzolamide HTI Timolol ophthalmic drops (decreases the amount of fluid within the eye) 1 drop in both eyes twice daily was not included on the medication profile. Interview with the patient/caregiver on 04/26/2022 at 11:45 a.m. revealed the patient had been taking the medication since “05/26/2021 for glaucoma.” A staff interview on 04/26/2022 at 11:45 a.m. with OT #4 confirmed the medication was not on the active medication profile.