Every finding on record at Medcare Home Health Services, Inc

The following reflects the findings of the California Department of Public Health during a Recertification Survey. Representing the Department of Public Health: Surveyor ID # 25046, RN, Health Facilities Evaluator Nurse Surveyor ID # 09697, RN, Health Facilities Evaluator Nurse Number of unduplicated admissions for the past 12 months: 15 Active patients: 3 Sample Size - 7 Patients Home Visits - 3

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, interview, and record review, the home health agency (HHA) staff failed to review all the medications and update the medication profile with currently used medications; and ensure the medications taken by the patient were expired for one of 7 sample patients (Patient 2). This deficient practice had the potential to put the patient at risk for medication errors and adverse drug reactions, and putting the patient at risk of not meeting the therapeutic level of the medication to treat the patient's illness. A review of Patient 2's plan of care (POC) for the certification period from 2/1/2022 to 4/1/2022, indicated start of care (SOC) dated 2/1/2021, with diagnoses that included hypertensive heart disease, chronic congestive heart failure, atrial fibrillation [quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications], and presence of cardiac pacemaker (a medical device that generates electrical impulses delivered by electrodes to contract the heart muscles and regulate the electrical conduction system of the heart). The skilled nurse (SN) was to visit twice a week for 2 weeks, once a week for 7 weeks for complete assessment, observation, evaluation and intervention of all body system, compliance with prescribed medications/diet, medication education/review, response to therapeutic management. On 3/4/2022, at 12:15 p.m., during a home visit with the Director of Patient Care Services (DPCS), Patient 2 was observed sitting in a sofa, and Caregiver 1 was next to Patient 2. Patient 2 was alert and oriented, and able to communicate. At 12:30 p.m., Patient 2's current medications were reviewed and reconciled with the medication profile provided by the agency, it was indicated the patient had following medications: A container of Lasix 20 milligram (mg) one tablet twice a day (labeled to use by 9/12/2020) while the medication profile indicated to take Lasix 20 mg one tablet daily.A container of Omeprazole 40 mg (dated 2/2/2022) to take daily while it was not included in the medication profile. During a concurrent interview with the DPCS, she stated the nursing staff should have checked the patient’s medications on each visit and updated the medication profile after being verified with the physician for the discrepancies and instructed the patient/PCG accordingly. The DPCS also stated the expired medication should have been removed. A review of the agency's undated policy of the "Medication Profile" indicated if the physician changes the medication orders, the nurse must add newly ordered drugs or medication changes to the Medication Profile.

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 observation, interview and record review, the HHA failed to ensure the Plan of Care (POC) included all treatment and medications identifying the patient's pacemaker information to provide instructions to the patient/primary caregiver (PCG) the safety measures and to address interventions underlying the risk factors for one of 7 sample patients (2). This deficient practice can delay detecting malfunction of the pacemaker and delay responding in an emergency situation. A review of Patient 2's plan of care (POC) for the certification period from 2/1/2022 to 4/1/2022, indicated start of care (SOC) dated 2/1/2021, with diagnoses that included hypertensive heart disease, chronic congestive heart failure, atrial fibrillation [quivering or irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure and other heart-related complications]and presence of cardiac pacemaker (a medical device that generates electrical impulses delivered by electrodes to contract the heart muscles and regulate the electrical conduction system of the heart). The skilled nurse (SN) was to visit twice a week for 2 weeks, once a week for 7 weeks to assess cardiovascular status, and to instruct regarding cardiac pacemaker status for risk factors, safety precautions and some devices that may interfere with cardiac pacemaker, and on energy conservation. A review of Patient 2's POC did not include the patient’s acceptable parameter of heart rate/pulse along with the pacemaker set rate to notify the physician/cardiologist. The POC did not include the information of the patient’s pacemaker that included the type, model number, serial number, set rate, the date for the battery was to be changed, and the cardiologist’s name and phone number. On 3/4/2022, at 12:15 p.m., during a home visit with the Director of Patient Care Services (DPCS), Patient 2 was observed sitting in a sofa, and PCG 1 was next to Patient 2. Patient 2 was observed with a pacemaker on the right upper chest. During a concurrent interview with Patient 2, PCG 1, and DPCS regarding the pacemaker, they all stated they did not know about serial number, model number, set rate, or when the battery was to be changed. During further concurrent interview with Patient 2, and PCG 1, stated the agency staff did not instruct about the management of pace maker. During an interview with the DPCS, she stated the agency did not have information about pacemaker and did not know who the cardiologist was. The DPCS was not aware of the need that the SN should have obtained the information about the pacemaker and instructed/educated the patient/family about the pacemaker management (including cell phone use, carrying the pacemaker identification card to the doctors and dentist). A review of the agency’s “Surgical Teaching Guides (pacemaker)” dated 1989 indicated as follow: Take pulse for one full minute daily and report if rate is less than set amount.Report excessive palpitation, vertigo, and syncope.Avoid areas of high voltage such as power plants, radio transmitters, large industrial magnets, and certain anti-theft alarm systems.Carry a pacemaker identity card, which includes the settings and function of the pacemaker.Inform airport officials at the metal detector about pacemaker and show identification card.

Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This ELEMENT is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) failed to coordinate the Oxygen therapy care with the durable medical equipment company (DME) regarding the management of Oxygen tubing/canula for 1 of 7 sample patients (Patient 1). This deficient practice can result in respiratory infection by not cleaning/changing the oxygen tubing/canula properly. A review of Patient 1's plan of care (POC) for the certification period from 2/1/2022 to 4/1/2022, indicated start of care (SOC) dated 2/1/2022, with diagnoses that included hypertensive heart disease, mild intermittent asthma, and dependence on supplemental Oxygen. The POC included an order for the skilled nurse (SN) visit two times a week for two weeks, once a week for 7 weeks for complete assessment, observation, evaluation, and intervention of all body system. The SN was to teach/ instruct the patient/primary care giver (PCG) on pulmonary hygiene and teach proper usage of Oxygen and precaution to follow. The physician ordered Oxygen 2 liters per minute via nasal canula as needed for shortness of breath. On 3/4/2022, at 11 a.m., during a home visit with the Director of Patient Care Services (DPCS), Patient 1 was alert, oriented, ambulatory, and was able to communicate well. At 11:35 a.m., an oxygen concentrator was observed in the patient’s room. There was an oxygen tubing and nasal canula connected to the oxygen concentrator with no date labeled. During an interview with the patient, she stated she did not know when she had changed/cleaned the nasal canula and she did not know how often she was to change the nasal canula. She also stated that the last time the patient used the canula was last night. Patient 2 stated she had been wiping the outside of nasal canula out with alcohol swab occasionally. During an interview with the DPCS at the same time, she did not know when the patient had changed/cleaned the nasal canula and how often the nasal canula was to be changed or how it should be cleaned. The DPCS stated it was the DME company’s responsibility, not the agency’s responsibility to instruct the patient/PCG about oxygen equipment maintenance including changing/cleaning oxygen tubing or canula. A review of the agency’s “Oxygen Therapy Teaching Guide” published in the year of 1989 did not include the management of oxygen tubing/canula. It indicated the home health nurse is responsible for ensuring that oxygen is administered as prescribed and evaluating response to therapy, and to follow manufacturer recommendations on the use of oxygen delivery systems at home. During an interview with the DPCS on 3/7/2022, at 11:30 a.m., she stated the agency did not have the manufacturer’s guideline of Patient 1’s concentrator, and she did not know how often the nasal canula was to be changed or how it should be cleaned because she did not know the manufacturer’s information including the telephone number.