Every finding on record at Nhc Homecare South Carolina, LLC

An unannounced onsite Emergency Preparedness Program (EPP) Survey was conducted at NHC Homecare Murrells Inlet from 07/22/24 to 07/24/24. The hospice is in substantial compliance with the Medicare Condition of Participation at 484.102 (Establishment of the Emergency Preparedness Program).

An unannounced onsite Recertification Survey was conducted at NHC Homecare Murrells Inlet from 07/22/24 to 07/24/24. The facility is in substantial compliance with the Medicare Conditions of Participation at 42 CFR PART 416 with Standard level deficiencies cited.

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) failed to ensure the medication lists were accurate for two of two patients reviewed for reconciliation of medications, Patients #6 and #7. Findings include: Review of Patient #6's record on 07/22/24 at 3:08 PM revealed Patient #6 was admitted to the HHA on 06/18/24 with a diagnosis of surgical repair of a fractured right humerus (upper arm). Patient #6's medication list included Eliquis 5 mg (milligram) daily, Metoprolol 25 mg daily and Tramadol 50 mg every six hours as needed. On 07/23/24 at 12:30 PM, a home visit was made to Patient #6 with Occupational Therapist (OT) #1. Patient #6 stated she/he was not taking Eliquis, Metoprolol or Tramadol or any other medications and had not been for "months." In an interview with OT #1 immediately after the visit at 1:35 PM, she/he confirmed the findings and confirmed Eliquis, Metoprolol and Tramadol were on Patient #6's list of current medications. OT #1 stated she/he normally asked Patient #6 if there were any changes to her/his medications but did not look at the bottles of medication. A home visit was made to Patient #7 on 07/23/24 at 1:56 PM with Registered Nurse (RN) #1. Reconciliation of Patient #7's medications by RN #1 revealed discrepancies. Patient #7 is receiving Simvistatin 40 mg one each evening per the family caregiver (FCG) and the fill date on the bottle of medication is 03/22/24. Simvistatin is not on Patient #7's medication list. Patient #7 is receiving Clonazepam 1 mg at bedtime, the fill date on the bottle is 10/21/23 and the FCG states the dose has not changed. The medication list indicates Clonazepam 0.5 mg one tablet at bedtime. Patient #7 is receiving Humalog Kwikpen Insulin 100 units/milliliter (u/ml) twice a day. The medication list indicates Humalog Kwikpen 100 u (units)/ml (milliter) "4 TIMES DAILY." The FCG and RN #1 state the order was changed "a couple of weeks ago." Lantus Solostar Insulin 100 u/ml is on the medication list for "daily" and "bedtime" but the FCG and RN #1 state it was "stopped a (one) week ago." In an interview with RN #1 immediately after the visit at 2:50 PM, he/she confirmed the findings. RN #1 stated he/she normally asked Patient #7 and his FCG if there were any changes to the medications but did not normally look at the bottles except for at the time of admission. Review of Patient #7's record revealed Patient #7 was admitted to the HHA on 06/14/24 (five weeks ago) with a diagnosis of Diabetes Mellitus (elevated blood sugar levels). Review of the HHA policy titled, "MEDICATION REVIEW and RECONCILIATION" on 07/24/24 revealed, "...Medication compliance, effects and changes are assessed at every skilled visit...Medication review and reconciliation is a multi-faceted and on-going process performed via interview and observation techniques. It includes...Assessment for medication compliance and consideration of the multiple factors that influence adherence to ordered medications in the home health population. These factors must be assessed through observation, interviews...".

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 Home Health Agency (HHA) failed to include parameters for blood sugar levels to be reported to the physician in the plan of care for two of two patients reviewed with a diagnosis of Diabetes Mellitus (DM - elevated blood sugar levels), Patients #7 and #1. Findings include: Review of Patient #7's record on 07/22/24 at 3:30 PM revealed Patient #7 was admitted to the HHA on 06/14/24 with a primary diagnosis of DM. Review of the plan of care for the period 06/14/24 to 08/12/24 revealed there were no parameters for blood sugar levels to be reported to the physician. A home visit was made to Patient #7 on 07/23/24 at 1:56 PM with Registered Nurse (RN) #1. Patient #7's Family Caregiver (FCG) stated Patient #7 started requiring insulin during his/her recent hospitalization. The FCG stated he/she was checking Patient #7's blood sugar four times a day until a couple of weeks ago when it changed to two times a day. In an interview with the Clinical Manager/Administrator on 07/24/24 at 2:05 PM, she/he reviewed Patient #7's record and plan of care and confirmed Patient #7's primary diagnosis was DM and there were no blood sugar parameters to be reported to the physician in the plan of care. Review of Patient #1's record on 07/22/24 at 2:00 PM revealed Patient #1 was admitted to the HHA on 04/17/24 with a primary diagnosis of Gastroenteritis and a secondary diagnosis of DM. Review of the plan of care for the period 04/17/24 to 06/14/24 revealed the nurse was to instruct and reinforce diabetic care including blood glucose monitoring. The plan of care did not indicate any parameters for blood sugar levels to be reported to the physician. In an interview with the Clinical Manager/Administrator on 07/24/24 at 2:15 PM she/he reviewed Patient #1's record and plan of care and confirmed the findings.

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 Home Health Agency (HHA) failed to ensure patient care staff adhered to infection control measures to prevent the transmission of infections during patient home visits for two of three home visits observed, Patients #5 and #6. Review of Patient #5's medical record on 07/22/24 at 9:00 AM revealed Patient #5 was admitted to the HHA on 05/24/24 with a diagnosis of Normal Pressure Hydrocephalus (excess fluid in the brain). A home visit was made to Patient #6 on 07/23/24 at 11:00 AM to observe the Physical Therapist (PT) #1. PT #1 took Patient #5's vital signs with a blood pressure cuff, thermometer and pulse oximeter and set each one on a barrier on the counter after use and then without disinfecting his/her hands, disinfected the equipment and placed it into the backpack hanging on the back of a chair. PT #1 placed an electronic tablet on Patient #6's table, took the screen portion out and gave it to the Patient to sign, disinfected the screen and placed it back in the tablet case. PT #1 did not disinfect the tablet case. In an interview with PT #1 immediately after the visit at 1:30 PM, he/she confirmed the findings. Review of Patient #6's medical record on 07/22/24 at 3:08 PM revealed Patient #6 was admitted to the HHA on 06/18/24 after surgery for a fractured right humerus (upper arm). A home visit was made to observe Occupational Therapist (OT) #1 on 07/23/24 at 12:30 PM. With gloved hands, OT #1 took Patient #6's blood pressure. OT #1 did not remove the gloves or perform hand hygiene. OT #1 then disinfected the blood pressure cuff and placed it on a barrier and with the same gloves still donned took Patient #6's temperature and used the pulse oximeter. With the same gloves still on, OT #1 disinfected the thermometer and pulse oximeter and then put all vial sign equipment back in the medical bag with the same gloves on. In an interview with OT #1 immediately after the visit at 1:35 PM, she/he confirmed the findings. Review of the HHA policy titled, "INFECTION PREVENTION AND CONTROL" on 07/24/24 revealed, "...HAND HYGIENE is the most important infection prevention activity used in bag technique...Hand hygiene must be completed prior to entering or re-entering the bag to remove or return equipment or supplies...".

An on-site Emergency Preparedness Program (EP) survey was conducted at NHC Home Care Murrells Inlet from 11/15/2021 to 11/18/2021. The clinic was in compliance with the Conditions of Participation at 42 CFR 484.102 (Establishment of the Emergency Program).

An on-site COVID-19 focused Infection Control survey was conducted with the Recertification survey at NHC Home Care Murrells Inlet from 11/15/2021 to 11/18/2021. The home health agency was not in substantial compliance with the Conditions of Participation at 42 CFR Part 484. The following deficiencies were identified during the survey.

Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on record review and interview, the agency staff failed to document measure goals for all goals listed on the Plan of Care (POC) in seven out of seven records reviewed (Patient #1-#7). Patient #1 On 11/17/2021 at 9:49 AM, a review of Patient #1’s chart reveals the POC has goals which are not measurable [Occupational Therapy (OT) evaluation will be completed, demonstrate improved function in response of specific exercises, demonstrate improved bed mobility, demonstrate safe transfers, demonstrate understanding of instructions, demonstrate increased independence, and Physical Therapy (PT) POC]. This finding is verified by the Administrator and the Regional Administrator at 10:03 AM on 11/18/2021. Patient #2 On 11/17/2021 at 10:46 AM, a review of Patient #2’s chart reveals the POC has goals which are not measurable (POC for nursing needs, PT evaluation , and OT evaluation). This finding is verified by the Administrator and the Regional Administrator at 10:17 AM on 11/18/2021. Patient # 3 On 11/17/2021 at 11:10 AM, a review of Patient #3’s chart reveals the POC has goals which are not measurable [Speech Therapy (ST) evaluation, POC ordered by ST, and tolerate least restrictive diet]. This finding is verified by the Administrator and the Regional Administrator at 8:57 AM on 11/18/2021. Patient # 4 On 11/17/2021 at 11:31 AM, a review of Patient #4’s chart reveals the POC has goals which are not measurable (POC for nursing needs, PT evaluation, OT evaluation, and PT POC) This finding is verified by the Administrator and the Regional Administrator at 10:36 AM on 11/18/2021. Patient # 5 On 11/17/2021 at 11:46 AM, a review of Patient #5’s chart reveals the POC has goals which are not measurable (POC for nursing needs, PT evaluation, OT evaluation, demonstrate improved function, demonstrate safe transfers, demonstrate increased safety, demonstrate increased independence, and demonstrate decreased fall risk). This finding is verified by the Administrator and the Regional Administrator at 9:35 AM on 11/18/2021. Patient # 6 On 11/17/2021 at 12:18 PM, a review of Patient #6’s chart reveals the POC has goals which are not measurable (POC for nursing needs, cardiovascular exacerbations, changes in skin integrity, ability to perform wound care, changes in co-morbid status, PT evaluation, OT evaluation, demonstrate improved function, demonstrate sage transfers, verbalize effective pain control, and demonstrate increased independence). This finding is verified by the Administrator and the Regional Administrator at 10:33 AM on 11/18/2021. Patient # 7 On 11/17/2021 at 12:42 PM, a review of Patient #7’s chart reveals the POC has goals which are not measurable (PT POC, OT evaluation, demonstrate improved function, demonstrate safe transfers, and demonstrate decreased fall risk). This finding is verified by the Administrator and the Regional Administrator at 10:37 AM on 11/18/2021.

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 staff failed to follow physician orders per the plan of care in three of seven records reviewed (Patient #2, #3, and #5). Patient #2 On 11/17/2021 at 10:46 AM, a review of Patient #2’s chart reveals the Skilled Nurse (SN) has a frequency of 3 X week X 1, 1 X week X 2, then 1 every 2 weeks x 6 with a Start of Care (SOC) dated 9/30/2021. The chart documentation reveals the SN made one visit the week of 9/30/2021 on 9/30/2021. This finding is verified by the Administrator and the Regional Administrator at 10:17 AM on 11/18/2021. Patient # 3 On 11/17/2021 at 11:10 AM, a review of Patient #3’s chart reveals the frequency for Speech Therapy (ST) is listed as 4 X week X 4 then 1 X week X 5 with a SOC dated 11/9/2021. The documentation in the chart reveals ST made one visit during the week of 11/9/2021 on 11/12/2021. This finding is verified by the Administrator and the Regional Administrator at 8:57 AM on 11/18/2021. Patient # 5 On 11/17/2021 at 11:46 AM, a review of Patient #5’s chart reveals the SN frequency is 1 X week X 2 with 2 As Needed (PRN) visits with the SOC dated 8/27/2021. The chart documentation shows the RN made visits on 8/27/2021, 9/2/2021, 9/9/2021, and 9/16/2021. The 9/9/2021 and 9/16/2021 visits were not documented as PRN visits. SN discharged the patient from nursing services on 9/16/2021. SN made further visits on 9/30/2021, 10/1/2021 (documented a a RPN visit), 10/7/2021, 10/12/2021, and 10/20/2021 with no physician orders for all except 10/20/2021 visit. The SN provided wound care on visits 9/30/2021 to 10/12/2021 with no wound care orders. Wound care orders were documented on 10/20/2021. This finding is verified by the Administrator and the Regional Administrator at 9:35 AM on 11/18/2021.