Every finding on record at Mcguffey Home Health Care, LLC

A Medicare Recertification Survey was conducted from February 28, 2023, through March 3, 2023, by the Michigan Department of Licensing and Regulatory Affairs at: McGuffey Home Health Care 1380 Coolidge Hwy, Suite 210 Troy, MI 48084 Vaccination requirements were reviewed during this survey. The agency did not have any other locations at the time of this survey. Clinical records reviewed for this survey included 1 active with a home visit and 6 discharge records. The agency only had one active patient. At the conclusion of the survey the agency was found to be out of compliance at the standard level with the conditions of participation at 42 CFR §484.80 (f)(3), home health agencies.

Health, psychosocial, functional, cognition CFR(s): 484.55(c)(1) The patient's current health, psychosocial, functional, and cognitive status; This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to conduct a patient-specific, comprehensive assessment that accurately reflected the patient's current health status based on past medical history that included dates of onset, exacerbations, treatments and outcomes, and history of events leading to current home care needs; and fails to reflect the patient's current health status in 3 of 7 records reviewed (MR#s 4, 5, and 6), resulting in incomplete clinical information to aide in determining the needs of the patient. Findings included: MR #4: The SOC was dated 2/21/22. The comprehensive assessment (OASIS) identified 10 diagnoses including lymphedema, diabetes and congestive heart failure. Review of the comprehensive assessment on 2/28/23, showed under "Past medical history" and the category of (M1021): "Patient Diagnoses", the only information provided was a list of 10 diagnoses, all having the same onset and exacerbation date. There was no information about the onset, exacerbations, prior treatments and outcomes, or history of how the above illnesses/events led to the need for the current home care admission. There was no further history/information about each diagnosis under each body system category (Endocrine, cardiac, etc.). MR #5: The SOC was dated 3/10/22. The comprehensive assessment (OASIS) identified 9 diagnoses including diabetes, atrial fibrillation and end stage renal disease. Review of the comprehensive assessment on 2/28/23, showed under "Past medical history" and the category of (M1021): "Patient Diagnoses", the only information provided was a list of 9 diagnoses, all having the same onset and exacerbation date. There was no information about the onset, exacerbations, prior treatments and outcomes, or history of how the above illnesses/events led to the need for the current home care admission. There was no further history/information about each diagnosis under each body system category (Endocrine, cardiac, etc.) MR #6: The SOC was dated 7/20/22. The comprehensive assessment (OASIS) identified 6 diagnoses including diabetes, hypertension and dementia. Review of the comprehensive assessment on 3/1/23, showed under "Past medical history" and the category of (M1021): "Patient Diagnoses", the only information provided was a list of 6 diagnoses, all having the same onset and exacerbation date. There was no information about the onset, exacerbations, prior treatments and outcomes, or history of how the above illnesses/events led to the need for the current home care admission. There was no further history/information about each diagnosis under each body system category (Endocrine, cardiac, etc.) During an interview on 3/2/23 at 10:45 a.m., the clinical manager (CM 1) acknowledged the above findings.

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 record review and interview, the agency failed to ensure the registered nurse completed a comprehensive drug review for 3 of 7 (MR #’s 2, 3 and 4) records reviewed resulting in the potential for undetected harmful medication side effects or interactions. Findings include: MR #2: This 66-year-old patient was admitted to the agency on 10/4/22 with diagnoses which included diabetes; seizure disorder; blood clot in a large vein; and heart disease. The clinical record was reviewed on 3/1/23. It was noted there was no signed Medication Profile within the clinical record and no other documentation indicating that a comprehensive drug review had been completed by an agency registered nurse (RN). MR #3: This 90-year-old patient was admitted to the agency on 1/4/22 with diagnoses which included pneumonia, diabetes, and heart failure. The clinical record was reviewed on 3/2/23. The start of care (SOC) was completed by the physical therapist (PT) on 1/4/22. The Medication Profile within the clinical record was signed by PT and indicated that a severe medication interaction had been identified. Neither the Medication Profile nor the SOC indicated which medication(s) had been found to have a severe interaction(s). There was no indication in the clinical record that the agency RN was notified of or became aware of any severe medication interactions or had completed a comprehensive drug review. These findings were reviewed and acknowledged by CM #1 during interview on 3/2/23 at 11:30 a.m. MR #4: The SOC was dated 2/21/22. The plan of care (POC) identified diagnoses of lymphedema, diabetes and congestive heart failure. Review of the comprehensive assessment on 2/28/23, showed skilled nursing completed the comprehensive assessment. During review of the record on 2/28/23, it was discovered that there was no documentation in the record that a skilled nurse reviewed the patient's medications. The medication profile dated 4/26/22, was signed by physical therapy (PT). During an interview on 3/2/23 at 10:45 a.m., the clinical manager (CM 1) acknowledged the above findings.

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 record review and interview, it was determined that the agency failed to ensure the plan of care included all safety measures in ...3 of 7 (MR# 4, 5 and 6) records reviewed from a total sample of 7 records reviewed, resulting in the potential for patient injury. Findings include: MR #4: The SOC was dated 2/21/22. The plan of care (POC) dated 2/21/22, identified diagnoses of lymphedema, diabetes and congestive heart failure. Review of the POC on 2/28/23, showed no diabetic safety precautions documented. MR #5: The SOC was dated 3/10/22. The POC identified diagnoses of diabetes, atrial fibrillation and end stage renal disease. Review of the POC on 2/28/23, showed no diabetic safety precautions documented. MR #6: The SOC was dated 7/20/22. The POC identified diagnoses of diabetes, hypertension and dementia. Review of the POC on 3/1/23, showed no diabetic safety precautions documented. During an interview on 3/2/23 at 10:45 a.m., the clinical manager (CM 1) acknowledged the above findings.

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 occupational therapy followed the visit frequency ordered by the physician as indicated in the patient plan of care in 1 (MR # 2) of 7 sample records reviewed resulting in potential for physical decline and unmet patient care needs. Findings include: MR #2: This 66-year-old patient was admitted to the agency on 10/4/22 with diagnoses which included diabetes; seizure disorder; blood clot in a large vein; and heart disease. The clinical record was reviewed on 3/1/23. It was noted during record review that the Occupational Therapist (OT) was ordered by the physician on 10/26/22 to see MR #2 with a frequency of 1 time a week for 1 week, and 2 times a week for 4 weeks (total of 9 visits in 5 weeks). There were 7 OT visits documented as ordered by the physician in weeks 1 through 4 (10/26/22 through 11/17/22). There were no visits entered for week 5 of care (11/20/22 through 11/26/22). There was no documentation indicating why the last 2 visits did not occur, no physician order for the change in frequency, and no documentation that the physician was notified of this change in frequency. This finding was reviewed and acknowledged by CM #1 during interview on 3/2/23 at 11:30 a.m.

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 observation, interview and record review, the agency failed to ensure the skilled nurse followed accepted standards of practice in Infection Control as directed by agency policy for 1 (MR #1) of 1 patients observed during a home visit, from a total of 7 records reviewed, resulting in the potential for the development and spread of infection. Findings include: MR #1: This 70-year-old patient was admitted to the agency on 2/10/23 with diagnoses which included fecal impaction (unable to pass stool); neuropathy (damage to nerves causing weakness and pain); diabetes; and high blood pressure. On 3/1/23 at 11:20 a.m., a joint home visit was conducted with the registered nurse (CM #1). During the visit, CM #1 was observed assisting MR #1 with collecting blood for a blood sugar reading due to MR #1 not having appropriate blood glucose monitoring equipment available. CM #1 used equipment which was brought by CM #1 to the visit and included a lancing pen device; lancet; glucometer; and carrying case. After using the equipment, CM #1 wiped the lancing pen device and glucometer with an alcohol prep pad and returned it to the carrying case, and then to a backpack brought by CM #1 at the start of the visit. Agency Policy titled “MCGUFFEY HOME HEALTH CARE, LLC X.15 HOME GLUCOSE MONITORING” was reviewed on 3/1/23. The policy stated: “Nurses will utilize home glucose monitoring (HGM) devices in accordance with manufacturer’s guidelines…” and “All nurses utilizing HGM devices will have evidence of: 1. Specific training on the HGM device…”. “C. The nurse will be responsible for maintaining the HGM device in optimal operating condition according to the manufacturer's instructions including cleaning, use of appropriate accessory equipment…” CM #1 was interviewed on 3/1/23 at 2:30 p.m. regarding the home health agency’s policies on home blood glucose monitoring equipment and disinfection. CM #1 stated the lancing device and glucometer was used as shared equipment for any patients who did not have blood glucose monitoring equipment or had a problem with their home equipment. CM #1 was asked if the equipment was labeled by the manufacturer as equipment that could be shared between patients and CM #1 was not aware of the manufacturers label. CM #1 stated that CM #1 cleans the testing devices with an alcohol prep pad after each blood glucose test however, CM #1 was not aware of the policy of the agency regarding disinfection of the devices. CM #1 was asked what the manufacturer recommended as a disinfection agent for the lancet pen device and glucometer, and CM #1 was not aware of manufacturer’s recommendations. CM #1 was queried regarding specific training received prior to the use of the lancet pen device and glucometer used on MR #1, and CM #1 stated that there was no specific training given to CM #1 regarding the blood glucose monitoring devices. Manufacturers guidelines for use and disinfection of the lancet pen device and glucometer used during the visit with MR #1 were not provided for review during the survey.

Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient's discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient's care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to ensure a detailed discharge summary was sent to the physician within 5 business days of discharge for 6 (MR #2, 3, 4, 5, 6 and 7) of 7 sample discharge records and failed to ensure that a transfer summary was sent to the health care facility providing care within 2 days of becoming aware of the unplanned transfer in 1 (MR #2) of 1 records reviewed in which a transfer to another health care facility took place potentially resulting in a lack of safe and effective transition of care. Findings include: MR #2: This 66-year-old patient was admitted to the agency on 10/4/22 with diagnoses which included diabetes; seizure disorder; blood clot in a large vein; and heart disease. The clinical record was reviewed on 3/1/23. It was noted in the clinical record that MR #2 was admitted to the hospital on Sunday 10/9/22 and a transfer summary had been completed on Tuesday 10/11/23 by the registered nurse (RN) after becoming aware that MR #2 went to the hospital. The Resumption of Care and updated Plan of Care dated 10/24/22 indicated that MR #2 had been in the hospital for a new onset diagnosis of stroke from 10/9/22 to 10/21/22. There was no evidence in the clinical record that the transfer summary had ever been sent to the hospital where MR #2 had been admitted after the agency discovered the transfer took place. During further review, it was noted that a discharge summary for nursing care was completed by the RN on 11/30/22 and a discharge summary of physical therapy services was completed by the physical therapist (PT) on 12/1/22. Documentation from both discharge summaries indicated that the physician had been notified of the discharge however, there was no documentation in the clinical record that either discharge summary was ever sent to the primary care physician after discharge. MR #3: This 90-year-old patient was admitted to the agency on 1/4/22 with diagnoses which included pneumonia, diabetes, and heart failure. The clinical record was reviewed on 3/2/23. It was noted that a discharge summary was completed by nursing on 3/2/22 and a discharge summary was completed by physical therapy on 3/3/22. Documentation from both discharge summaries indicated that the physician had been notified of the discharge however, there was no documentation in the clinical record that either discharge summary was ever sent to the primary care physician after discharge. These findings were reviewed and acknowledged by CM #1 during interview on 3/2/23 at 11:30 a.m., and CM #1 was not able to provide further documentation that discharge summaries had been sent to the physician after discharge from the agency. MR #4: The SOC was dated 2/21/22. The plan of care dated 2/21/22, identified diagnoses of lymphedema, diabetes and congestive heart failure. Review of the record on 2/28/23, indicated the patient was discharged on 4/12/22. There was no documented evidence in the record that a discharge summary was sent to the physician. MR #5: The SOC was dated 3/10/22. The POC identified diagnoses of diabetes, atrial fibrillation and end stage renal disease. Review of the record on 2/28/23, indicated the patient was discharged on 3/25/22. There was no documented evidence in the record that a discharge summary was sent to the physician. MR #6: The SOC was dated 7/20/22. The POC identified diagnoses of diabetes, hypertension and dementia. Review of the record on 3/1/23, indicated the patient was discharged on 7/29/22. There was no documented evidence in the record that a discharge summary was sent to the physician. MR #7: The SOC was dated 12/2/22. The POC identified diagnoses of malignant neoplasm of bladder and depression. Review of the record on 3/1/23, indicated the patient was discharged on 1/26/23. There was no documented evidence in the record that a discharge summary was sent to the physician. During an interview on 3/2/23 at 10:45 a.m., the clinical manager (CM 1) acknowledged the above findings.