Every finding on record at Marion Regional Homecare LLC

A recertification survey was conducted on 7/1/25 to 7/2/25 at Alabama Homecare Hamilton. The agency was found to be in substantial compliance with the Conditions of Participation for Emergency Preparedness.

A recertification survey was conducted on 7/1/25 to 7/2/25 at Alabama Homecare of Hamilton. Standard level deficiencies were cited that will require a Plan of Correction.

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 review of medical records (MR), observations, agency policy and procedure and interviews, it was determined the agency failed to keep the medication profile current. This policy did affect one of three home visits (HV) including HV # 1, and one of two active MRs reviewed including MR # 2 and had the potential to affect all persons served by the agency. Findings include: Agency Policy: Monitoring Medications Policy Number: 10.008 Date Revised: 7/1/24 Purpose: To provide a process to ensure continuous monitoring of medications in the patient's home. Policy: A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode... Procedure: 1a...Compare medication list...to actual medications the patient is taking. 1b. Review all medications including over the counter (OTC) medications, vitamins, herbs, and herbal products, creams, and topical ointments. 2. MR # 2 was admitted to the agency on 6/3/25 with a primary diagnosis of Chronic Obstructive Pulmonary Disease with Acute Exacerbation. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 6/3/25 to 8/1/25 revealed orders for the SN to visit once a week for nine weeks. Further review of the HHC and POC revealed orders for the SN to instruct regarding oxygen management including administration, skin care, care of equipment, proper storage and safety. A review of the Medication List revealed no documentation of oxygen listed as a medication. An interview was conducted on 7/2/15 at 11:50 AM with Employee Identifier (EI) # 1, Executive Director, who confirmed oxygen should have been listed on the medication list and staff failed to keep the medication profile current. 1. HV # 1 was admitted to the agency on 3/17/25 with a primary diagnosis of Type 2 Diabetes with foot ulcer. A review of the Plan of Care (POC) for the certification period dated 5/16/25 to 7/14/25 revealed skilled nurse (SN) visits ordered once a week for eight weeks. A HV was conducted on 7/1/25 at 11:00 AM with Employee Identifier (EI) # 3, Licensed Practical Nurse, performing wound care. During the HV, a review of the medication profile revealed two medications on the medication profile the patient stated they "no longer take". a. ED A-HIST 4 milligram (mg) - 10 mg tablet, one tablet every 6-8 hours as needed for congestion, with a start date of 3/25/25 was listed on the patient medications. The bottle was not present in the patient's home. When asked by the nurse if he had any of the medication, he stated the prescription ran out about a month ago and he/she had not gotten it refilled. b. Methocarbamol 750 mg tablet, one to two tablets every eight hours as needed for muscle spasms, with a start date of 6/4/25 was listed on the patient medications. The bottle was not present in the patient's home. When asked by the nurse if he had any of the medication, he stated it did not work for him and he flushed the remaining pills down the toilet a few days after they were prescribed. An interview was conducted on 7/12/25 at 12:15 PM with EI # 1, Executive Director, who confirmed staff failed to follow agency policy for medication reconciliation and failed to keep the medication profile current.

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 observations, review of agency policy and procedure, and staff interview, it was determined the agency failed to ensure staff performed hand hygiene per agency policy. This did affect one of three home visits including HV # 1, and had the potential to affect all patients served by the agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revision Date: 5/1/19 Policy: Staff are required to perform hand hygiene prior to, at specified time points during, and following patient contact. Procedure: 1. Staff performs hand hygiene... Before direct contact with patients, before performing an aseptic task (... wound care), after contact with... non-intact skin, wound dressings, contaminated surfaces, if moving from a contaminated body site to a clean body site during patient care, after contact with inanimate objects in the immediate vicinity of the patient, before and after removal of personal protective equipment, at the conclusion of the visit... 8. Other Aspects of Hand Hygiene: ...Change gloves during patient care if moving from a contaminated body site to a clean body site... 1. HV # 1 was admitted to the agency on 3/17/25 with a primary diagnosis of Type 2 Diabetes with foot ulcer. A HV was conducted on 7/1/25 at 11:00 AM with Employee Identifier (EI) # 3, Licensed Practical Nurse, to observe wound care provided. During the HV, the following was observed: 1. EI # 3 failed to perform hand hygiene, after removing his/her gloves, four times. 2. After obtaining the patient's vital signs, EI # 3 donned gloves without performing hand hygiene. 3. During wound care, EI # 3 reached into the box of clean supplies with gloves used to perform wound care. EI # 3 failed to remove his/her gloves and perform hand hygiene prior to obtaining clean supplies. An interview was conducted on 7/2/25 at 11:50 AM with EI # 1, Executive Director, who confirmed staff failed to perform hand hygiene per the agency policy.

Based on the recertification survey conducted on 6/9/22, Marion Regional Homecare was found to be in substantial compliance with the standards for Emergency Preparedness.

A recertification survey was conducted on 6/7/22 to 6/9/22, standard level deficiencies were cited and will require an acceptable plan of correction.

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 review of medical records (MR), policy and procedure, observations, and interviews, it was determined the agency failed to ensure staff reconciled medications for 3 of 3 Home Visits (HV) conducted. This affected HV # 1, HV # 2, HV # 3, and had the potential to affect all patients served by the agency.Findings include: Agency Policy: Monitoring MedicationsPolicy Number: 10.008Date Revised: 05/01/19Purpose:To provide a process to ensure continuous monitoring of medications in the patient's home.Policy:A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode.Procedure: a. Compare medication list ...and/or physician orders to actual medications patient is taking.b. Review all medications including over the counter (OTC) medications, vitamins, herbs and herbal products, creams and topical ointments... to identify issues...e. Notify the physician of any of the above identified issues/ discrepancies. Collaborate with the Patient Care Manager and ensure that supportive documentation is evident in the medical record.2. All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care... 3. HV # 3 was admitted on 4/26/2021 and recertified for home care from 4/21/22 to 6/19/22 with diagnoses including Venous Insufficiency, Non-Pressure Chronic Ulcer, and Hypertensive Heart Disease with Heart Failure. Review of the HHC and POC dated 4/21/22 revealed orders for SN 1 x a week for 8 weeks. A HV was conducted on 6/8/22 at 9:45 AM to observe care provided by the SN. During the HV, the medications in the home were compared the Medication List provided to the surveyor on 6/7/22. Jardiance 10 mg take one daily, prescription dated 4/7/22 was in the home and not on the Medication List. HV # 3 stated he/she had been taking the Jardiance daily since the prescription was filled on 4/7/22. In an interview conducted on 6/9/22 at 1:30 PM, EI # 1 confirmed the Jardiance was a current medication and the medications had not been reconciled per agency policy. 2. HV # 2 was admitted to the agency on 4/5/22 and recertified on 6/4/22 to 8/2/22 with diagnoses including Age-Related Osteoporosis without Current Pathological Fracture and Long Term (Current) Use of Inhaled Steroids. Review of the HHC and POC dated 4/5/22 revealed orders for Physical Therapy (PT) 2 times a week for 2 weeks then 1 time a week for 4 weeks. A HV was conducted on 6/7/22 at 1:00 PM to observe care provided by EI # 9, Physical Therapy Assistant (PTA). During the HV, a comparison was made between medications observed in the home and the CMR provided to the surveyor on 6/7/22 by the agency. The following discrepancy was observed: a. Oxygen concentrator, portable oxygen tanks, oxygen supplies and “oxygen in use” sign was observed in the home. The patient stated he/she uses oxygen at night. Oxygen was not listed on the CMR. An interview was conducted on 6/9/22 at 1:08 PM with EI # 3, ED Red Bay, who confirmed Oxygen was not on the CMR, and should have been. 1. HV # 1 was admitted to the agency on 8/8/17, and recertified for home care 5/14/22 to 7/12/22 with diagnoses including Vitamin B 12 Deficiency, Anemia Due to Intrinsic Factor Deficiency and Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 5/12/22 revealed an ordered Skilled Nurse (SN) visit frequency of 1 WK (week) 1, and 1 every 4 weeks for 4 weeks, effective 6/5/22. A HV was conducted on 6/7/22 at 2:42 PM to observe care provided by the SN. During the HV, a comparison was made with the Client Medication Report (CMR) provided by the agency on 6/7/22, and medications observed in the home. The following discrepancies were observed: a. Allergy Relief (Fexofenadine) 180 MG (milligram) tablet, one daily, was listed on the CMR. The patient stated he/she has only taken as needed for 5 years, not daily. b. Gabapentin 100 MG capsule, 1 capsule every AM (morning) and 2 capsules at bedtime was listed on the CMR. The patient stated he/she has not taken the AM dose for six months, and only takes the dose ordered for bedtime. c. Lexapro 20 MG tablet, 1 tablet two times daily, was listed on the CMR. The patient stated he/she has only been taking the Lexapro once a day, not two times a day, for 3 years. d. Primidone 50 MG tablet, 1 tablet two times daily, was listed on the CMR. The patient stated he/she has only been taking as needed, usually once daily, for several months, and not two times daily. e. Vitamin D3 125 Micrograms (MCG) (5000 Unit) Tablet, 125 MCG monthly, was listed on the CMR. A bottle of 50,000 International Units (IU) prescription strength, with fill date 4/18/2020 was observed in the home. The surveyor asked the patient if he/she had a more current prescription bottle. The patient stated he/she puts refills received back into the old bottles for most all his/her current medications. The patient further stated he/she has been taking the 50,000 IU dose of Vitamin D3 weekly for a couple of years. In an interview conducted 6/9/22 at 1:23 PM with Employee Identifier (EI) # 2, RN (Registered Nurse) Executive Director (ED) Fayette, EI # 2 confirmed the staff did not maintain accurate patient medication information per policy, and the current medications were not reconciled with the CMR .

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on medical record (MR) review, policies and procedures, and interview, it was determined the agency failed to coordinate care with the physician to ensure the physician order for the patient to perform daily blood glucose testing was followed. This affected 1 of 4 active records reviewed with the diagnosis of diabetes, including MR # 1, and had the potential to affect all patients served by the agency. Findings include: Agency Policy: Plan of Care (POC) Policy Number: 2.1.007 Revision Date: 12/01/21 Purpose: To assure an appropriate plan of care is developed and revised in a timely manner for each patient. To assure that physician/authorized practitioner's orders are followed. Policy: Each patient has an individualized POC developed in consultation with the patient, physician or authorized practitioner, and staff... to address patient problems, needs and goals, as well as to address specific services being provided. Procedure: 1. A POC is developed for all patients... 2. The POC includes: ...i. Patient specific interventions and education: measurable outcomes and goals... ...n. All patient care orders. Agency Policy: Coordination of Care, From Admit Through Discharge Policy Number: 2.1.017 Revision Date: 8/1/19 Policy: The agency provides care and services within an integrated continuum of care system. This is accomplished by: - Identifying patient needs through assessment and communication with other health care providers. Procedure: ...4. Coordination of care with physician: At admission, throughout care...coordination of services is promoted through routine communication with the patient's physician: ...e. When there is a need to change the patient's plan of care. ...8. Coordination of Care for Updates to the Plan of Care: 1. MR # 1 was admitted to the agency on 3/29/19 with diagnoses including Encounter For Change Or Removal Of Non-Surgical Wound Dressing, and Type 2 Diabetes With Diabetic Peripheral Angiopathy Without Gangrene. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 5/12/22 to 7/10/22 revealed a physician order for the patient to perform blood glucose testing daily with a therapeutic CBG (capillary blood glucose) fasting range of 60 to 250. Review of the Skilled Nurse (SN) Visit Note Reports (VNR) dated 5/20/22, 5/23/22, and 5/24/22, revealed the SN documented under Endocrine Assessment, "CBG results not applicable, patient refused checks." Review of the SN VNR dated 5/26/22 revealed the SN documented under Endocrine Assessment, "CBG results not applicable, MD (medical doctor) not ordered to." Review of the SN VNR dated 5/27/22 revealed the SN documented under Endocrine Assessment, "CBG results not applicable, patient refused checks." Review of the SN VNR dated 6/3/22 revealed the SN documented under Endocrine Assessment, "CBG results not applicable, patient does not have a glucose monitor." Review of the SN VNR dated 6/6/22 revealed the SN documented under Endocrine Assessment, "CBG results not applicable, not in home." The physician order for the patient to perform blood glucose testing daily was not followed as ordered. There was no documentation the physician was notified daily blood glucose testing was not being performed as ordered. In an interview conducted 6/9/22 at 12:47 PM with Employee Identifier (EI) # 2, Executive Director Fayette, EI # 2 confirmed the patient had a glucometer in the home, but the glucometer, "went missing at some point", that the blood sugar's were not being checked as ordered, and the SN should have notified the physician the order was not being followed.

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 medical record (MR) review, policy and and procedure, and interview, it was determined the agency failed to ensure a diabetic patient received education after low blood sugar in the home required emergency medical treatment at the hospital. This affected 1 of 4 active records reviewed for patients with diagnosis of diabetes, including MR # 2, and had the potential to negatively affect all patients served by the agency. Findings include: Agency Policy: Patient Education Policy Number: 3.001 Revision Date: 11/01/17 Policy: The agency plans, supports, and coordinates patient and caregiver education designed to promote optimal patient health and safety. Patients receive oral and/or written information for this purpose on an ongoing basis while being cared for by the agency. Procedure: ...3. The patient and caregiver receive ongoing information specific to the identified needs,...including: ...c. Nutritional interventions and/or modified diets. ...6. Per assessed knowledge deficit, patients and caregivers receive oral and/or written information on medication education to include: a. Dosage, route, duration b. Description, purpose, expected actions c. Potential side effects, contraindications... 7. Using the progress/visit note, the clinician documents the level of patient/caregiver comprehension, ...compliance and any follow up with team members. 1. MR # 2 was admitted to the agency on 9/5/21 with diagnoses including Type 2 Diabetes Mellitus With Foot Ulcer, and Non-Pressure Chronic Ulcer Other Part Right Foot With Fat Layer Exposed. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 5/2/22 to 7/1/22 revealed an ordered Skilled Nurse (SN) visit frequency of 1 time a week for 8 weeks, beginning 5/8/22. Further review of the HHC and POC revealed medication orders for Humalog insulin, 100 units per ML (milliliter), 3 units subcutaneous three times daily, and Novolin 70/30 insulin, 100 units per ML, 15 units subcutaneous three times daily. Review of the SN Visit Note Report (VNR) dated 5/16/22 revealed the SN documented in the Narrative, "PT (patient) reports having low blood sugar last night, but was corrected with snacks." There was no documentation the SN provided diabetic education during the visit. Review of the SN VNR dated 6/2/22 revealed the SN documented in the Narrative, "PT did have hypoglycemic episode this morning and was transported to ... ER (emergency room) due to blood sugar 28. Blood sugar was stabilized and PT reports (he/she) was discharged home." There was no documentation the SN provided diabetic education during the visit. In an interview conducted 6/9/22 at 1:13 PM with Employee Identifier (EI) # 2, Executive Director (ED) Fayette, EI # 2 confirmed there was no documentation the SN provided diabetic teaching during the visits identified, and should have.