Every finding on record at Mj Home Health Agency Inc

An Emergency Preparedness Recertification Survey was initiated with the Administrator on 06.28.23 at 12:45 PM. Census: 57 Licensed and Certified- 3 Licensed Home Health- 0 Personal Assistance Services- 54 An exit conference was conducted with the Administrator on 07.18.23 at 2:40 PM. The agency was in substantial compliance with 42 CFR Part 484.102 Emergency Preparedness Requirements for Home Health.

A Recertification survey was initiated with the Administrator on 06.28.23 at 12:45 PM. Census: 57 Licensed and Certified- 3 Licensed Home Health- 0 Personal Assistance Services- 54 An exit conference was conducted with the Administrator on 07.18.23 at 2:40 PM. The preliminary findings were discussed. The agency was given an opportunity to provide additional information. Acronyms used: AV- arteriovenous SN- Skilled Nurse SOC- Start of Care COPD- Chronic Obstructive Pulmonary Disease s/s- signs and symptoms MWF- Monday, Wednesday and Friday LUE- Left Upper Extremity (arm) AA/DON- Alternate Administrator/Director of Nurses POC- Plan of Care BP- blood pressure

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 reviews and interviews, the agency failed to ensure the patients’ plan of care was complete and included all the required elements for 1 (Patient # 4) of 1 patient who received dialysis treatment. This failure placed the patient at risk of complications with performance of the AV shunt access when the SN did not have written physician orders for an AV graft site assessment and precaution instructions to avoid blood pressures, venipunctures and injections on patient’s the left arm. FINDINGS: Definitions: Dialysis- a machine that cleans the blood from excess waste and water. AV Graft/Shunt- an access made by using a piece of soft tube to join an artery and vein in your arm. Venipunctures- the puncture of a vein as part of a medical procedure, typically to withdraw a blood sample or for an intravenous injection. Stenosis- narrowing or blockage Chronic kidney disease- when the kidneys no longer work to clean the blood of waste products and water. REFERENCES: 1- National Kidney Foundation resources May 2023: AV graft/shunt definition. 2- Nursing 2021 Clinical Do’s and Don’ts: in protecting a hemodialysis fistula, the arm with a fistula should be assessed by feeling for a thrill (vibration) by palpating (gentle presses) the fistula and listening for a bruit (whoosh or heartbeat sound) by auscultating (listening to) the area with a stethoscope. This assessment is done to prevent stenosis and ensure proper functioning of the fistula. 3- Lippincott manual 2022: Caring for a patient’s vascular access- to prevent injuries, identify, “no BP measurements, venipunctures (lab work), or injections on the affected aside. When blood flow through the vascular access is reduced, it can clot….” Patient #4: Record review revealed a POC dated 04/29/2023-06/27/2023 with a SOC 10/31/2022. The POC listed the following diagnoses: Chronic kidney disease with heart failure and End Stage Renal Disease. The POC included the following physician orders, “… Medical Necessity: … Patient attends dialysis 3 times a week…” The POC did not include instructions for the SN to assess the AV graft site or avoid procedures near the site. A comprehensive assessment, dated 04/27/2023 included on page 13, “DIALYSIS… AV Graft/Fistula, Assessment: Bruit, Thrill, Catheter site free from s/s of infection, Right upper arm, Dialysis Center (Identifier C), Frequency of Dialysis, 3 times a week MWF…” A SN visit note conducted by the AA/DON on 05/06/2023, included, “… Dialysis shunt- LUE ….” A phone interview was conducted with the AA/DON on 07/07/2023 at 3:20 PM, to clarify the location of the patients’ AV graft. The surveyor asked the AA/DON the location of the AV graft for Patient #4. The AA/DON stated the AV graft was actually located in the left upper arm and the blood pressure checks were always done on the patients’ right arm. In a phone interview with the AA/DON on 07/18/2023 at 10:35 AM, the surveyor reviewed the findings and asked why the POC did not include instructions for a SN to assess the patients’ AV shunt for bruit, thrill and s/s of infection and avoid the left arm for blood pressure checks, venipunctures and injections. The AA/DON stated, “that was just an omission (on the POC), I know and do it (assess) on the home visits.” Agency policy, dated 03/17/2023, quoted in part, “Plan of Care, PC.35 … Purpose: To ensure that care provided is appropriately planned in a timely manner to meet the patient’s/client’s specific needs and problems…. Policy: I. The Agency will use data/information gathered during patient/client assessments in the care planning process… Procedure: … III. Each patient/client must receive an individualized written plan of care … A. The individualized plan of care must include the following: … 10. All medications and treatments; 11. Safety measures to protect against injury; … 14. Patient/client-specific interventions….”