Every finding on record at Madison Healthcare Services

A survey for compliance with CMS Appendix Z Emergency Preparedness Requirements, was conducted on 7/24/23-7/26/23 during a recertification survey. The facility is in compliance with the Appendix Z Emergency Preparedness Requirements.

On 7/24/23-7/26/23 a recertification survey was conducted. This resulted in a partial extended survey at Madison Home Health Agency. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. The cumulative effects of these findings resulted in the Home Health Agency’s inability to ensure provision of quality of care. Unduplicated census previous 12 months: 39 Total home visits conducted: 3 List Parent Location: 900 Second Avenue, Madison, MN 56256 List Hours of Operation: 8:00 a.m- 4:30 p.m. List total number of records reviewed: 7 In addition to the recertification, the following complaints were reviewed. As a result: No deficiency was issued for complaints: H71110965C (iQIES 98234) H71114007C (iQIES 96063)

Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient's mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient's risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This ELEMENT is not met as evidenced by: Based on interview and document review the agency failed to ensure the plan of care (POC) included all required components for treatment orders required for 2 of 5 patients (P2 and P3) who were actively receiving skilled services from the agency. P2’s POC for certification period 5/26/23-7/26/23, identified start of care (SOC) was 5/26/23. P2 had orders for physical therapy, two visits weekly and skilled nursing, 1 visit weekly. P2’s diagnoses included type 2 diabetes mellitus, muscle weakness and repeated falls. P2’s POC failed include durable medical equipment including walker and gait belt (used for patients with mobility issues). On 7/25/23, at 2:45 p.m. during a home visit P2 was observed using a walker and gait belt when walking and doing standing exercises. P3’s POC for certification period 6/2/23-7/31/23, identified SOC was 2/2/23. P3 had orders for weekly skilled nursing visit. P3’s diagnoses included end stage chronic kidney disease, diabetes mellitus, and left lower extremity amputation. P3’s POC failed to include durable medical equipment include a wheelchair, glucose monitor, nebulizer machine and oxygen. On 7/25/23, at 1:15 p.m. during a home visit P3 was observed using a wheelchair for mobility in the home and blood glucose monitor on her arm. P3 stated she used a nebulizer machine for breathing treatments and oxygen via nasal cannula when sleeping. On 7/26/23, at 11:55 a.m. home care director (HCD) stated she expected durable medical equipment was noted on the POC. It is important to include this, so the patient’s primary provider and home care team know what is used. Agency policy, Plan of Care, indicated the POC should include information include medical equipment used by the patient.

Duties of a HH aide CFR(s): 484.80(g)(3) The duties of a home health aide include: (i) The provision of hands-on personal care; (ii) The performance of simple procedures as an extension of therapy or nursing services; (iii) Assistance in ambulation or exercises; and (iv) Assistance in administering medications ordinarily self-administered. This ELEMENT is not met as evidenced by: Based on interview and record review the agency failed to insure the home health aide (HHA) only performed duties an HHA is allowed to perform for 1 of 2 patients reviewed (P5) who was provided medication administration from an unlicensed staff. P5’s plan of care (POC) for certification period 5/29/23-7/27/23, identified a start of care (SOC) date of 3/1/17. The POC identified HHA duties included assistance with medications including aspercreme to right hip and low back and Systane eye drops in each eye. On 7/26/23, at 10:15 a.m. home care director (HCD) confirmed unlicensed staff administer prescription eye drops as well as prescription creams and ointments. HCD was not aware that unlicensed staff were not able to complete this task after training. Agency policy, Administration of Medication, Treatment and Therapy by Unlicensed Personnel for Assisted Living and Home Health, directed unlicensed personnel that satisfy training requirements may administer medications orally, through eye drops, through ear drops, by use of inhalant or nebulizer or topically.