Every finding on record at Louisiana Home Healthcare Partners,LLC

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

Recertification Survey

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, record review, and interview the agency failed to ensure the nurse was accurately reconciling patient medications for 1 of 3 sampled patients (Patient #3) reviewed for medication reconciliation during a home visits in a total sample of 7. Findings: Review of Patient #3’s record revealed the registered nurse had completed a visit on 06/20/2022. In interview on 06/21/2022 at 11:50am, S1Administrator stated every visit a medication reconciliation should be completed and the nurse should make any changes to the medication profile as needed, which was verified by S3DON. S3DON confirmed the surveyors were to be given a medication profile for home visits which should be updated as of the last clinician’s visit. Observation on 06/22/2022 at 5:10pm, revealed the following medications were present in Patient #3’s home, in part, Levothyroxine (medication for thyroid disorder) 75mcg (micrograms) one tablet by mouth daily with a filled date from the pharmacy of 05/16/2022; Myrbetriq (medication for overactive bladder) 50mg (milligrams) one tablet by mouth daily in a sample bottle (from the physician office not a pharmacy); Eliquis (medication for blood clotting disorder) 5mg one tablet by mouth twice a day with a filled date from the pharmacy of 04/28/2022; Potassium CL (Chloride) ER (electrolyte supplement) 20meq (milliequillivants) one tablet by mouth once a day with a filled date from the pharmacy of 05/14/2022; and Zaleplon (medication used to assist with sleeping) 10mg one tablet by mouth every night with a filled date of 10/24/2021. Further observation revealed no evidence of Metoprolol Succinate ER (Extended Release) (medication for elevated blood pressure), Spironolactone (medication for elevated blood pressure), or Pradaxa (medication for blood clotting disorders) having been present in the home. Review of Patient #3’s Client Medication Report revealed the following, in part, Metoprolol Succinate ER 25mg one tablet daily; Spironolactone 25mg one tablet daily; and Pradaxa 150mg one tablet daily. Further review revealed no documented evidence, and the agency presented no documented evidence of the following medications having been identified of Patient #3’s Client Medication Report, in part, Levothyroxine; Myrbetriq; Zaleplon; Eliquis; and Potassium CL ER. In an interview on 06/22/2022 at 5:10pm, Patient #3 stated he has been taking Levothyroxine, Myrbetriq, Eliquis, and Potassium CL ER for a while now. Patient #3 further stated the physician had replaced the Pradaxa with Eliquis, and the physician had discontinued Metoprolol and Spironolactone for a while now. Patient #3 also stated the Zaleplon was only taken as needed when he could not sleep. In an interview on 06/24/2022 at 12:10pm, S1Administrator confirmed Patient #3’s above mentioned medication reconciliation issues. S1Administrator further stated since the nurse was providing services two to three times a week this discrepancy should not have happened.

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 failed to ensure a patient’s weight or bilateral ankle circumferences were obtained at every skilled nurse visit per physician orders for 1 of 2 sampled patients (Patient #6) reviewed for congestive heart failure monitoring in a total sample of 7. Findings: Review of Patient #6’s Home Health Certification and Plan of Care for certification period of 01/06/2022 thru 03/06/2022 revealed Patient #6 had a diagnosis of Chronic Diastolic Heart Failure (Congestive Heart Failure). Further review revealed a physician’s order for the skilled nurse to obtain a weight on Patient #6 at every visit and report a weight gain of 2-3 pounds overnight, or 4-6 pounds in one week to the physician. Further review of the physician’s orders revealed if Patient #6 was unable to be weighed, the skilled nurse was to obtain measurements of Patient #6’s bilateral ankles at each visit and report an increase in measurements to the physician. Review of Patient #6’s Medical Record revealed no documented evidence and the agency was unable to present any documented evidence of either a weight or bilateral ankle circumferences having been obtained on the following dates: 01/06/2022, 01/13/2022, 01/18/2022, and 01/20/2022. In an interview on 06/24/2022 at 2:28pm, S3DON (Director of Nursing) stated the skilled nurses had failed to obtain either a weight or bilateral ankle circumference on some of the visits per physician’s orders.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to: 1. Ensure the skilled nurse measured all wounds weekly to assess for deterioration or healing of the wound for 2 of 3 sampled patients (Patient #6 and Patient #7) reviewed for wounds; and 2. Ensure the skilled nurse documented the assessment of the wound bed tissue type for 1 of 3 sampled patients (Patient #7) reviewed for wounds in a total patient sample of 7. Findings: Review of the Wound Ostomy and Continence Nurses Society's Guidelines revealed assessment and documentation of wound status, which includes comprehensive clinical data demonstrating evidence of progress in healing or failure to heal. Comprehensive wound assessment includes, in part: dimensions and depth; presence, location and depth of any sinus tracts or undermining areas; status and characteristics of the wound bed; volume, color, and odor of exudates. Further review revealed when recorded over time this information can be used to track the progress of wound healing. Patient #6 Review of Patient #6’s Physician Orders dated 01/13/2022 revealed Patient #6 was to receive skilled nursing services once a week for one week; three times a week for one week; two times a week for one week; three times a week for one week; then two times a week for one week. Review of Patient #6’s record revealed the week of 02/06/2022 through 02/12/2022 revealed Patient #6 received nursing services on 02/08/2022 and 02/10/2022. Review of Patient #6’s Visit Note Report dated 02/08/2022 and 02/10/2022 revealed, in part, the following wounds were treated, in part, stage 2 pressure ulcer to the left lateral third toe, unstageable wound to the left lateral lower buttock, and stage 2 pressure ulcer to the right lower buttock. Further review of the assessment revealed wound measurements were not obtained due to the wound measurements were “not due”. There was no documented evidence and the agency did not present any documented evidence that wound measurements were obtained from 02/06/2022 through 02/12/2022. In an interview on 06/24/2022 at 2:28pm, S1Administrator stated wound care measurements for Patient #6’s pressure ulcers were not obtained for the week of 02/06/2022 thru 02/12/2022, and wound care measurements should be obtained by the registered nurse weekly. Patient #7 Review of Patient #7’s Home Health Certification and Plan of Care for certification period of 10/22/2021 through 12/20/2021 revealed Patient #7 was to receive, in part, skilled nursing services for once a week for one week, then twice a week for two weeks, then once a week for six weeks. Review of Patient #7’s Nursing Visit Note dated 11/17/2021 revealed, in part, Patient #7 had a stage 2 to the right hip. Further review revealed the wound had no drainage, nor any irritation or swelling around the wound site. Further review revealed no documented evidence and the facility presented no documented evidence of the wound having been measured, or the tissue type having been documented for the wound. Review of Patient #7’s Record revealed Patient #7 was discharged on 11/19/2021 with no further visits having been made after 11/17/2021. In an interview on 06/24/2022 at 2:55pm, S3DON (Director of Nursing) stated the wound documentation for Patient #7 did not include wound tissue type and/or wound care measurements.