Every finding on record at Nashoba Nursing Service and Hospice

A Recertification survey was conducted at Nashoba Valley Service on 12/2/22,12/6/22 through 12/8/22 for compliance with 42 CFR Part 484.102 Emergency Preparedness for Home Health Agencies. As a result of this survey, it was determined the Agency was in compliance with these requirements. No deficiencies were cited.

A Recertification survey was conducted at Nashoba Nursing Service on 12/2/22, 12/6/22 through 12/8/22 to determine compliance with the 42 CFR Part 488 requirements for Home Health Agencies. As a result of this survey, it was determined the agency was not in compliance with these requirements. Deficiencies were cited.

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 its staff conformed with the Physician's orders for two Patients (#2 and #6), out of a total sample of 17 Patients. Specifically, the Agency failed to ensure its staff provided Home Health Aide (HHA) services for Patient #2 and Physical Therapy (PT) services for Patient #6 as ordered. Findings include: 1. Patient #2 was admitted to the Agency in June 2022 with a diagnosis of bilateral knee osteoarthritis (degenerative joint disease). Review of the Physician's order for certification period, 6/17/22 through 8/15/22, indicated the following: effective 6/19/22 HHA once a week for five weeks. Review of the clinical record indicated that for the week of 7/3/22 through 7/9/22, Patient #2 had not received a HHA visit as ordered. During an interview on 12/7/22 at 2:20 P.M., after reviewing the clinical record, the Clinical Manager said that Patient #2 had not received a HHA visit as ordered for the week of 7/3/22 through 7/9/22. She said the plan of care was not followed as ordered. 2. Patient #6 was admitted to the Agency in August 2022 with a diagnosis of a Chronic Obstructive Pulmonary Disease (a group of lung diseases that blocks airflow and make breathing difficult). Review of a Physician's order, dated 10/14/22, indicated: effective 10/16/22 PT once a week for one week. Review of the clinical record indicated that for the week of 10/16/22 through 10/23/22, Patient #6 had not received a PT visit as ordered. During an interview on 12/7/22 at 3:30 P.M., after reviewing the clinical record, the Clinical Manager said that Patient #6 had not received a PT visit as ordered by the Physician for the week of 10/16/22 through 10/23/22. She said the PT wrote a missed visit note on 10/18/22 that indicated the visit was not provided, but it did not indicate why. She said the PT did not follow the plan of care as ordered.

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure that the staff notified the Physician when services were not provided as ordered for two Patients (#2 and #6), out of total sample of 17 Patients. Specifically, for Patient #2, the staff did not notify the Physician when a Home Health Aide (HHA) visit was not provided and for Patient #6, the staff did not notify the Physician when a Physical Therapy (PT) visit was not provided. Findings include: Review of the Agency's Patient Care Plan policy, dated 2/9/22, indicated the following, the clinical staff promptly notifies the Physician of any changes that require an alteration to the plan of care. 1.Patient #2 was admitted to the Agency in June 2022 with a diagnosis of bilateral knee osteoarthritis (degenerative joint disease). Review of the Physician's order for certification period, 6/17/22 through 8/15/22, indicated the following, effective 6/19/22 Home Health Aide once a week for five weeks. Review of the clinical record indicated that for the week of 7/3/22 through 7/9/22, Patient #2 had not received a HHA visit as ordered. Further review of the clinical record indicated no documentation why the visit was not provided and that the Physician was notified of the missed HHA visit. During an interview on 12/722 at 2:20 P.M., the Clinical Manager said, after reviewing the clinical record, that there was no documentation that the Physician was notified that a HHA visit was not provided during the week of 7/3/22 through 7/9/22 as ordered. She said the HHA should have documented a missed visit note indicating why it was missed, and the Agency staff should have notified the Physician. 2. Patient #6 was admitted to the Agency in August 2022 with a diagnosis of a Chronic Obstructive Pulmonary Disease (a group of lung diseases that blocks airflow and make breathing difficult). Review of a Physician's order, dated 10/14/22, indicated, effective 10/16/22 PT once a week for one week. Review of the clinical record indicated that for the week of 10/16/22 through 10/23/22, Patient #6 had not received a PT visit as ordered. Further review of the clinical record indicated no documentation that the Physician had been notified of the missed PT visit. A note written on 10/18/22 by the PT did not indicated why the visit was not provided. During an interview on 12/7//22 at 3:30 P.M., the Clinical Manager said, after reviewing the clinical record, the PT should have documented why the visit was missed and should have notifiied the Physician of the missed visit, as required.

Required items in clinical record CFR(s): 484.110(a)(1) The patient's current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure that staff included complete and accurate medication orders in the medical record for one Patient (#8), out of total sample of 17 Patients. Findings include: Resident #8 was admitted to the Agency in October 2022 with diagnoses including digestive system surgery and Pancreatic Cancer. Review of a Physician's order, dated 11/26/22, indicated the following: -Discontinue Metoclopramide (a gut motility stimulator and antiemetic, also referred to as Reglan) 5 milligrams (mg) every eight hours as needed. -Add Metoclopramide 5 mg one tablet as directed. Review of a Physician's order, dated 11/29/22, indicated the following: add Reglan 5 mg two times a day. Review of Patient #8's Medication Report, included the order for Metoclopramide 5 mg as directed and 5 mg twice daily. During an interview on 12/8/22 at 12:30 P.M., with the Nurses caring for Patient #8, and after reviewing the clinical record, the Clinical Manager said that the order for the Metoclopramide (Reglan) 5 mg as directed was not complete. She said it did not indicate how often the medication would be administered. She said the Metoclopramide medication order needed to be clarified to ensure accuracy.

Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This ELEMENT is not met as evidenced by: Based on record review and interview, the Agency failed to ensure that the staff performed a weekly wound measurement for one Patient (#11), out of a total sample of 17 Patients. Findings include: Patient #11 was admitted to the Agency in October 2022 with a diagnosis of a Stage IV Pressure Ulcer (a deep pressure sore that extends into the muscles, ligaments or bones) to the sacrum (an area at the bottom of the spine). Review of the medical record indicated a weekly wound measurement was not done for the week of 10/6/22 through 10/12/22. Review of the Agency's policy dated (9/2012) and titled Assessment: Wound, included but not limited to: - Reassess the wound weekly using the nine wound status indicators. The wound status indicators includes monitoring, assessing and measuring the wound weekly. During an interview on 12/8/22 at 10:30 A.M., the Clinical Manager said weekly wound measurements are Standard Practice of Care and need to be done by the licensed staff. She further said the required weekly wound measurement for Patient #11 was not done for the week of 10/6/22 through 10/12/22.