Every finding on record at Northeast Georgia Home Health III, LLC

At the time of the survey, HMC Home Care in Demorest, Ga. was in compliance with 42 CFR Part 484.22 Emergency Preparedness for Home Health Agencies as a result of a standard recertification survey conducted on September 15, 2021. A Focus Infection Control Survey was completed at the time of the survey. No deficiencies were cited.

At the time of the survey, HMC Home Care in Demorest, Georgia was in substantial compliance with 42 CFR Part 484, Requirements for Home Health Agencies as a result of the recertification survey conducted on September 15, 2021. A Focus Infection Control Survey was completed at the time of the survey. Current census 68. The follow deficiencies were 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 clinical record reviews, home visit observations, and staff interviews, it was determined the agency failed to ensure that patients' medication profiles were updated to reflect current medications for 3 of 7 (#2, #6 and #7) patients (P) observed during home visits. Findings were: 1. During a home visit observation on 9/14/21 at approximately 11:30 a.m., for patient (P) #2 with a certification period of 8/10/21 to 10/8/21, this surveyor reviewed the medication profile with the patient's caregiver. The medication profile was found to be inaccurate. The medication profile listed Voltaren, which the caregiver denies the patient uses. The medication profile also lists: hydrochlorothiazide, lisinopril-hydrochlorothiazide, amitriptyline, cyclobenzaprine and meclizine however, the caregiver denies that the patient takes these medications. Lastly, the list indicates the patient takes oxybutynin chloride 5mg daily, however the caregiver states the patient takes oxybutynin chloride 5mg 2 times daily. The agency failed to review the medication profile at each visit to ensure the medication profile accurately reflected the patient's current medication regime. During an interview with the Home Care Manager on 9/15/21 at approximately 2:00 p.m., the Manager stated that all staff are expected to review the medication profile at each visit and document any changes. 2. During a home visit observation on 9/13/21 at approximately 1:00 p.m. for P#6 with a certification period of 7/7/21 to 9/4/21 with a licensed practical nurse (LPN) employee #DD, this surveyor observed a sliding scale insulin regime posted on the patient's wall. The sliding scale indicated when the patient was to receive insulin based on blood glucose levels. The patient's medication profile did not list any medications related to insulin administration. The agency failed to review the medication profile at each visit to ensure the medication profile accurately reflected the patient's current medication regime. During an interview on 9/14/21 at 1:40 p.m., with employee #DD, the nurse stated that the licensed practical nurse (LPN) does not review the medications, only the registered nurse is required to reconcile the medication profile. During an interview with the Home Care Manager on 9/15/21 at approximately 2:00 p.m., the Manager stated that all staff are expected to review the medication profile at each visit and document any changes. 3. During a home visit observation on 9/13/21 at approximately 2:05 p.m., for (P) #7 with a certification period of 8/24/21 to 10/22/21, this surveyor reviewed the medication profile with the patient. The patient had a bottle of iron 65mg tablets and reports taking the iron pills two times a day however, this medication was not listed on the medication profile. The agency failed to review the medication profile at each visit to ensure the medication profile accurately reflected the patient's current medication regime. During an interview with the Home Care Manager on 9/15/21 at approximately 2:00 p.m., the Manager stated that all staff are expected to review the medication profile at each visit and document any changes.

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 clinical record reviews and staff interviews, it was determined the agency failed to include orders to cover all pertinent diagnoses to ensure the patients' identified needs were addressed and failed to ensure disease specific treatments/interventions were included on plans of care/treatment for 5 of 17 (#6, #9, #10, #13 and #16) sampled patients (P). Findings were: 1. Review of the plan of care/treatment for P#6 with a certification period of 7/7/21 to 9/4/21 revealed a pertinent diagnosis of Type 2 diabetes mellitus with diabetic neuropathy. The patient currently takes insulin therapy to control diabetes however, the plan of care lacks interventions such as blood glucose parameters or frequency for monitoring blood glucose levels which would prompt the staff to notify the physician for early intervention and treatment of diabetic exacerbation. The agency failed to ensure the plan of care/treatment was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 9/15/21 at 2:00 p.m., the Home Care Manager and Clinical Supervisor provided no evidence the plan of care/treatment included patient specific interventions to monitor the patient's diabetic status. 2. Review of the plan of care/treatment for P#9 with a recertification period of 8/21/21 to 10/19/21 revealed a pertinent diagnosis of Type 2 diabetes mellitus without complications however, the plan of care lacks interventions such as blood glucose parameters or frequency for monitoring blood glucose levels which would prompt the staff to notify the physician for early intervention and treatment of diabetic exacerbation. The plan of care instructs the patient /caregiver to check finger stick blood glucose as ordered by the physician however, the plan of care does not specify when or how often to monitor the blood glucose level. The agency failed to ensure the plan of care/treatment was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 9/15/21 at 2:00 p.m., the Home Care Manager and Clinical Supervisor provided no evidence the plan of care/treatment included patient specific interventions to monitor the patient's diabetic status. 3. Review of the plan of care/treatment for P #10 with a recertification period of 8/25/21 to 10/23/21 revealed a primary diagnosis of Type 2 diabetes mellitus without complications. The plan of care lacks interventions such as blood glucose parameters or frequency of monitoring blood glucose levels which would prompt the staff to notify the physician for early intervention and treatment of diabetic exacerbation. The agency failed to ensure the plan of care/treatment was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 9/15/21 at 2:00 p.m., the Home Care Manager and Clinical Supervisor provided no evidence the plan of care/treatment included patient specific interventions to monitor the patient's diabetic status. 4. Review of the plan of care/treatment for P#13 with a certification period of 5/22/21 to 7/20/21 (closed record) revealed a pertinent diagnosis of Type 2 diabetes mellitus without complications. The patient currently takes insulin therapy to control diabetes however, the plan of care lacks interventions such as blood glucose parameters or frequency for monitoring blood glucose levels which would prompt the staff to notify the physician for early intervention and treatment of diabetic exacerbation. The agency failed to ensure the plan of care/treatment was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 9/15/21 at 2:00 p.m., the Home Care Manager and Clinical Supervisor provided no evidence the plan of care/treatment included patient specific interventions to monitor the patient's diabetic status. 5. Review of the plan of care/treatment for P#16 with a recertification period of 2/13/21 to 4/13/21(closed record) revealed a pertinent diagnosis of Type 2 diabetes mellitus without complications however, the plan of care lacks interventions such as blood glucose parameters or frequency for monitoring blood glucose levels which would prompt the staff to notify the physician for early intervention and treatment of diabetic exacerbation. The plan of care instructs the patient /caregiver to check finger stick blood glucose as ordered by the physician however, the plan of care does not specify when or how often to monitor the blood glucose level. The agency failed to ensure the plan of care/treatment was complete and comprehensive for the care and monitoring of the patient's diabetic status. During an interview on 9/15/21 at 2:00 p.m., the Home Care Manager and Clinical Supervisor provided no evidence the plan of care/treatment included patient specific interventions to monitor the patient's diabetic status.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on clinical record reviews and staff interviews, it was determined the agency staff failed to ensure the home health aide care plan was updated to provide safe instructions for the provision of care to meet the patient's current needs for 1 of 3 sampled patients (P) requiring home health aide services (#3). Findings were: 1. Review of the home health aide (HHA) care plan for patient (P) #3 with a recertification period of 7/7/21 to 9/4/21 required the home health aide to provide a shower bath at each visit. During a HHA home visit observation on 9/15/21, this surveyor observed the HHA providing a chair bath to the patient instead of the ordered shower bath. According to the HHA, the patient is no longer able to take a shower as he/she is unable to raise legs high enough to step into the tub. However, the care plan does not reflect this change in the patient's current health status. The clinical staff failed to update the HHA care plan to provide clear instruction for the care and safety of the patient. During an interview on 9/15/21 at 1:00 p.m., the Home Care Manager and Clinical Manager (CM) acknowledged the clinical staff failed to update the HHA care plan to meet the care and safety needs of the patient.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on staff interview and review of the agency's group of professional personnel meeting minutes it was determined that the advisory group failed to meet quarterly, as documented by dated minutes, to advise the agency on professional issues and to participate in the agency's total program evaluation. Findings were: This surveyor requested the agency's group of professional personnel (GOPP) meeting minutes from the last 3 quarters. According to the Home Care Manager, the agency's GOPP does not meet quarterly. The last GOPP meeting minutes documented are from 2/20. The agency failed to ensure the GOPP meetings were held quarterly to advise the agency on professional issues as required. During an interview on 9/14/21 at 12:30 p.m., the Home Care Manager acknowledged that the quarterly requirements for the group of professional personnel meetings were not met.

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 clinical record reviews and staff interviews, it was determined the agency failed to ensure the clinical records included clear and accurate documentation of all interventions and responses to the interventions in accordance with professional standards for 6 of 17 ( #3, #5, #6, #8, #10 and #16) sampled patients (P). Findings were: 1. Review of the plan of care for P#3 with a recertification period of 7/7/21 to 9/4/21 revealed an incomplete suprapubic catheter order which reads as follows: cleanse with normal saline or wound cleanser or soap/water: apply drain sponge, secure with tape. The order lacked a suprapubic catheter size or balloon inflation size specific to the patient. Also, the skilled nurse (SN) visited the patient on 8/25 and 9/1/21 and documented the suprapubic catheter procedure was accomplished. However, the agency failed to ensure the procedures performed were documented in full so that the record was clear and concise to reflect the care was provided as ordered by the physician. During an interview on 9/15/21 at 12:30 p.m., the Home Care Manager and the Clinical Manager acknowledged the suprapubic catheter orders and documentation were incomplete. 2. Review of the plan of care for P#5 with a certification period of 9/11/21 to 11/9/21 revealed an incomplete oxygen therapy order. The order reads as follows: oxygen 3 liters via nasal cannula. The order is incomplete because it does not contain a frequency of use. The SN failed to obtain an order to specify how often oxygen therapy is needed. During an interview on 9/15/21 at 12:30 p.m., the Home Care Manager and the Clinical Manager acknowledged the oxygen therapy order was incomplete. 3. Review of the plan of care for P#6 with a certification period of 7/7/21 to 9/4/21 required the SN to perform wound care to the sacral wound as follows: clean area with wound cleanser, pat dry. Apply alginate dressing to open area. Cover with mepilex sacral dressing every three day and as needed until healed. The SN visited the patient 8/25 and 9/1/21 and documented procedure accomplished. However, the visit notes lacked documentation of the products used or the steps taken during the procedures. The agency failed to ensure the procedures performed were documented in full so that the record was clear and concise to reflect the care was provided as ordered by the physician. During an interview on 9/15/21 at 12:30 p.m., the Home Care Manager and the Clinical Manager acknowledged the wound care documentation was incomplete. 4. Review of the plan of care for P #8 with a recertification period of 7/13/21 to 9/10/21 required the SN to perform wound care to the left below knee amputation (BKA) as follows: cleanse with wound cleanser, normal saline or soap and water, pat dry with gauze. Do not apply any other ointment, powder, cream or dressing directly to incision site. May apply Xerform to blister below incision line if needed. Wrap stump with rolled gauze and follow with wrapping with ace bandage. Apply stump sock protector and protection device. The SN visited the patient 8/23/21 and documented that are currently no specific wound care instructions and the SN assessed the patient’s wounds and assisted the patient to re-dress them. The SN failed to document the wound care procedure used to redress the wounds. The SN also visited the patient on 8/31/21 and documented the wounds were redressed per orders however, the visit note lacked documentation of the products used or the steps taken during the procedures. The agency failed to ensure the procedures performed were documented in full so that the record was clear and concise to reflect the care was provided as ordered by the physician. During an interview on 9/15/21 at 12:30 p.m., the Home Care Manager and the Clinical Manager acknowledged the wound care documentation was incomplete. 5. Review of the plan of care for P #10 with a recertification period of 8/25/21 to 10/23/21 required the SN to perform wound care to both lower extremities as follows: cleanse with wound cleanser, normal saline or soap and water, pat dry with gauze. Cover open blisters or areas of weeping with viscopaste gauze, cover with optilock dressing, secure with rolled gauze and tape. The SN visited the patient 8/24, 8/30, and 9/3/21 and documented wound care was accomplished however, the visit notes lacked documentation of the products used or the steps taken during the procedures. The agency failed to ensure the procedures performed were documented in full so that the record was clear and concise to reflect the care was provided as ordered by the physician. During an interview on 9/15/21 at 12:30 p.m., the Home Care Manager and the Clinical Manager acknowledged the wound care documentation was incomplete. 6. Review of the plan of care for Patient #16 with a recertification period of 2/13/21 to 4/13/21 revealed an incomplete Foley catheter order which reads as follows: Urinary catheter care foley, straight. The order was not complete as it did not specify the foley size or the frequency to be used for straight foley catherization. The SN failed to obtain a complete order for the care and maintenance of the catheter. During an interview on 9/15/21 at 12:30 p.m., the Home Care Manager and the Clinical Manager acknowledged the foley catheter order was incomplete.