Every finding on record at Quad County Home Health Agency

The Emergency Preparedness requirements were evaluated, in conjunction with the recertification survey, on 3/20/25. The Agency was in compliance with the Condition, 42 CFR 484.102, Establishment of the Emergency Program for this survey.

A recertification survey was conducted in conjunction with the evaluation of Emergency Preparedness requirements on 3/20/25. The Agency was not in compliance with 42 CFR 484, Standards for Home Health Agencies, for this survey.

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, document review, and interviews, it was determined for 2 of 5 (Pt #1 and Pt #4) patients, where home visits were conducted, the Agency failed to visualize all medications and compare them to the current medication profile to ensure patients were taking the correct medication(s). Findings include: 1. The Agency’s policy titled "Medication Reconciliation" (revised 7/16) was reviewed. The policy states, "Routine Home Visits: Medications are assessed during each nurse visit for compliance, changes, side effects, interactions, and contraindications as part of the routine skilled nurse (SN) visit…Therapy and other staff are to ask the patient during every home visit if there have been medication changes and notify the Registered Nurse (RN) Case Manager accordingly." 2. On 3/17/2025 at 9:00 AM, a home visit was conducted at Pt (patient) #1’s residence in an assisted living facility. Pt #1's Start of Care (SOC) began on 1/28/2025, with diagnoses including heart failure and chronic kidney disease. The Assisted Living Facility dispenses Pt #1's medications. While reviewing Pt #1’s medications with the Assisted Living nurse, the following discrepancies were noted: a. The following medications were listed on the Home Health Agency’s medication profile for Pt #1, but the medications had been discontinued per the Assisted Living Facility’s medication list: Jardiance (diabetic medication) 10mg (milligrams), 1 tablet orally once daily, Omeprazole (stomach acid reducer) 20mg, 1 capsule orally once daily, and Spiriva HandHaler (asthma medication) 18 micrograms inhalation capsule, 1 capsule inhaled once daily. 3. On 3/19/2025 at 11:00 AM, a home visit was conducted at Pt #4’s residence. SOC 2/5/2025, diagnosis: pressure ulcer of left heel stage 3. At no time was the Registered Nurse (E #2) observed visualizing the patient’s medication bottles to ensure they matched the current medication profile, ensuring proper medication administration and accurate medication profile. The following discrepancies were noted: a. Vitamin D3-50 50,000 units was not on the medication list (Pt #4 reports they have been taking this medication for a long time). b. The following medications were listed on the Agency’s medication profile for Pt #4, but the patient reports they do not take the medications anymore: Doxycycline Hyclate (antibiotic) 100mg (patient #4 reports they finished this medication a couple of weeks ago), Farxiga (diabetic medication) 5mg, Ondansetron (antinausea) 8mg, and Vistaril Pamoate (antihistamine) 25mg. 4. An interview was conducted with Registered Nurse (E#2) on 3/19/25 during the home visit at approximately 11:50 AM. While discussing Pt #4’s medications, E #2 stated, “I normally only have the patients pull their medication bottles out to do reconciliations at the start of care visits and at resumption of care visits. When the visit is a routine visit, I just ask the patient if there have been any medication changes.” 5. An interview was conducted with the Director (E #1) on 3/19/25 at approximately 3:30 PM. E #1 reviewed Pt #1 and Pt #4’s medication lists and verbally agreed with the above findings.