Every finding on record at Medical Services of America Home Health

An emergency preparedness survey was completed from 6/04/3034 to 6/06/2024 at Medical Services of America. The facility was in compliance with the Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

A recertification survey was conducted at Medical Services of America from 6/04/2024 to 6/06/2024. The facility was not in compliance with (CFR) 42, Part 484, Conditions of Participation Requirements for Home Health Agencies.

Encoding and transmitting OASIS CFR(s): 484.45(a) Standard: An HHA must encode and electronically transmit each completed OASIS assessment to the CMS system, regarding each beneficiary with respect to which information is required to be transmitted (as determined by the Secretary), within 30 days of completing the assessment of the beneficiary. This STANDARD is not met as evidenced by: Based on record reviews, interviews, and data report reviews, the agency failed to ensure that the Outcome and Assessment Information Set (OASIS) assessment was transmitted to the CMS system within 30 days of the M0090 (date assessment completed) to allow an outside contractor to complete a review of the OASIS data for one of 8 sampled Medicare/Medicare Advantage patients, #4. The findings include: A review of the Internet Quality Improvement Evaluation System (IQIES) Home Health Agency (HHA) Error Summary report for the year to date 01/01/2024-06/01/2024 indicated an error rate of 6.46%% for the error code 3330, Record Submitted Late (error 3330). A review of the available data for the current quarter, 04/01/24-06/01/2024, revealed an error rate of 5.39%. In total, 821 assessments were processed with 53 errors, noted as error 3330, and the record was submitted late. Reviewing the OASIS Agency Final Validation Reports dated 06/05/2024 indicated that 1 of 1 transmitted OASIS had error message 3330. According to the Centers for Medicare and Medicaid Services (CMS) OASIS Error Message User Guide dated January 18, 2023, the OASIS Provider Final Validation report is automatically generated within 24 hours of the successful submission of a file. All warning errors should be reviewed and corrected, if appropriate, to ensure the data uploaded is accurate and complete. Error 3330 message is “Record submitted late: The submission date is more than 30 days after M0090 on this new record. The potential cause is the assessment was not submitted within CMS timing guidelines. The submission date minus M0090 (date assessment completed) should be no more than 30 days.” CMS suggested actions include to “review the assessment timing schedule in the Current OASIS Guidance Manual and verify that all assessments are submitted in a timely manner." During an interview with the administrator on 06/06/2024 at 11:55 AM, she confirmed she was aware of the reporting errors. "We are working on it." The Director of Nursing was present during the interview and confirmed they were working on it. For Patient #4, the RN OASIS admission assessment was completed on 06232023 (M0090 date). However, the agency did not transmit this assessment until 8/05/2023, 43 days after its completion.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on observations, interviews, and record reviews, the agency failed to ensure the patient and caregiver received written information regarding the patient's medication regimen for 3 (#4, #5, and #7) patients out of 4 patient home care visits conducted. The findings included: A review of the agency policy titled Medication Management—Patient Information, which originated on 06/2012 and was revised on 11/2023, revealed the following: Purpose: To facilitate continuity of care, treatment, and/or services of agency patients by providing accurate and comprehensive information about patients' medications. To create and maintain an accurate medication history and current medication profile while the patient is receiving care, treatment, and or services from the home care agency. To safely order, prepare, dispense, administer, and monitor home health patients. To minimize the opportunity for medication-related errors. To uphold the patient's right to receive information and to be involved in decisions about his/her care, treatment, and/or services, as appropriate. Procedure (on page 3 of 3): the patient/family/caregiver is instructed about the patient's medications verbally and in written format. These instructions are presented in understandable formats to the patient/family/caregiver. The patient's/ family's/caregiver's response to instructions is documented in the medical record. A home care visit was conducted on 6/05/2024 at 10:15 AM for patient #4. A review of the home folder revealed that no medication list with instructions to follow was written for the patient. A home care visit was conducted on 6/05/2024 at 9:30 AM for patient #5. A review of the home folder revealed that no medication list with instructions to follow was written for the patient. During an interview with Staff E, Registered Nurse (RN), on 6/05/2024 at 9:45 AM, the nurse said that their medications are on the plan of care in the home folder. Patient #5 was interviewed on 6/05/2024 at 9:50 AM. He was given the plan of care in his home folder and asked where he could find the medications he took on the form. From 9:50 AM to 9:55 AM, patient #5 flipped back and forth through the pages of the plan of care and said, "I have never seen this." After five minutes, the medication on the plan of care was pointed out to patient #5, and he said he did not know his medications were on there because he had never seen that paper. Patient #7 had a home care visit on 6/05/2024 at 11:30 AM. Upon entrance, Staff D, the Physical Therapist, reviewed the plan of care with patient #7. During an interview on 6/05/2024 at 11:45 AM, Staff D stated that the patient's medication profile is their plan of care plan. An interview with the administrator was conducted on 6/06/2024 at 9:20 AM. The administrator said she was not aware that a separate medication profile should be provided for the patient.