Every finding on record at Recover Health of Minnesota, Inc

A survey with CMS Appendix Z Emergency Preparedness Requirements, was conducted on October 19, 2021 through October 22, 2021, during a recertification survey. The facility is in compliance with the Appendix Z Emergency Preparedness Requirements.

A partial extended survey was conducted at Recover Health October 19, 2021 through October 22, 2021. The agency was found to have not met the requirements at 42 CFR. Part 484 for Home Health Agencies. Hours of Operation: 8:00 a.m.- 5:00 p.m. Unduplicated census: 606 Home visits completed: 5 Total number of records reviewed: 13 Branch offices include: 1. 1600 Broadway Street, Alexandria, MN 56308-2708, 320-774-0777. 2. 831 East Vasa Ave, Fergus Falls, MN 56537, 218-321-2100.

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 document review, the agency failed to complete a comprehensive drug review to ensure the accuracy of all medications/dosages for 3 of 13 patients (P1, P8, P9) whose medications were reviewed during home visits and record review. P1's plan of care (POC) dated 9/17/21 to 11/15/21, indicated start of care (SOC) date of 9/17/21. The POC included diagnoses of urinary tract infection, klebsiella pneumoniae, chronic atrial fibrillation, anxiety disorder, and atherosclerotic heart disease. The POC further indicated skilled nursing evaluation on 9/17/21, then three times per week for one week, two times per week for four weeks and one time per week four weeks for observation, assessment and education. The POC also indicated a physical therapy evaluation between 9/17/21 and 9/22/21 and two times per week for two weeks and one time per week for six weeks for strength training, safety and ambulation. OT was also indicated on the POC for evaluation between 9/17/21 and 9/21/21, then two times per week for one and one time per week for three weeks for assistance with self care management therapeutic exercises, safety and pain. P1's POC included the following medication: acetaminophen 325 milligrams (mg) two tablets oral (po) every (q) four hours as needed (prn) per day (qd); acetaminophen ER 650 mg po twice daily (bid) ; amiodarone HCL 200 mg po qd; artifical tears 0.5-0.6% opthalmic solution, place two drops (gtt) into both eyes (OU) qd; aspirin 81 mg po daily (qd); Clear Eyes Triple Action 0.05-0.5-0.6% two gtts OU qd; Eliquis 5 mg po bid; ecitalopram oxalate 20 mg po qd; famotidine 20 mg po bid prn; furosemide 20 mg po qd; gabapentin 100 mg po four times per day (qid); gabapentin 100 mg po qid prn; glucosamine 500 mg two capsules po q bedtime (hs); lisinopril 20 mg two tablets po qd; menthol-camphor 10-4%, per order, external, three times per day (tid); Ocuvite Eye Health Formula two tabs po qd; omeprazole (decrease acid reflux) 20 mg po qd; Requip 0.25 mg po q hs; Senna-S 8.6-50 mg, two tablets po qd; simvastatin 20 mg po q hs; Toprol XL 25 mg, half tab (12.5 mg) po qd; Viactiv Calcium Plus D 650-12.5-40 mg-unit-mcg chewable tablet po qd; and vitamin D3 50 micrograms (mgs) two tablets po qd. Upon review of the clinical record, the discharge orders dated 9/16/21 did not include furosemide 20 mg po qd. The chart did not reveal any communication with the provider to reconcile P1's medications upon her discharge from the hospital and admission to the agency. When interviewed on 10/21/21, at 3:30 p.m. the Branch Manager (BM) stated her expectation with a new admission and medication reconciliation, is that the clinician would compare the medications the client takes in the home to what was ordered upon discharge from an inpatient stay. If those items don't match, the clinician must contact the provider to reconcile the orders. At 4:10 p.m. BM verified that P1 was taking furosemide 20 mg po qd. P8's POC dated 9/28/21 to 11/26/21, indicated SOC date of 08/24/20. The POC included diagnoses of type two diabetes with hyperglycemia, hypertension, anxiety disorder, unspecified intellectual disability, long term use of insulin and long term use of aspirin. P8's POC further indicated skilled nursing one time per week for nine weeks beginning 9/28/21 ending 11/26/21 to prefill medications weekly and monitor medication adherence, educate client on medication management including medication uses, side effects , along with compliance, assessment and observation. P8's POC indicated the following medication: meclizine 25 mg po tid prn; Aspercreme 10% one application qid external prn; aspirin 325 mg one tablet po daily before bed (q hs); atorvastatin 40 mg po q hs; buspirone hydrochloride 15 mg po q morning and hs; cetirizine HCL 10 mg po q morning prn; loratadine 10 mg po q hs; ferrous sulfate 325 mg po q morning; cyclobenzaprine 10 mg po twice per bid prn; glucophage 1000 mg po bid; guaiatussin ac five to ten milliliters (ml) po q four hours prn; losartan 25 mg po qd; milk of magnesia 30 ml po qd prn; nabumetone 500 mg po bid prn; nexium 40 mg po qd; novolog 70/30 100unit/ml, 32 units subcutaneously (sq) with breakfast; novolog 70/30 100unit/ml, 25 units sq before supper; triamcinolone 0.1% with nystatin topically bid prn; pioglitazone HCL 15 mg po qd; Refresh one gtt OU prn; saline nasal spray, two sprays each nostril q two hours prn; Systane one gtt OU qid prn; tussin-DM HM 100 mg/5 ml po q six hours prn; acetaminophen 325 mg one to two tablets q four to six hours prn; vitamin B12 500 micrograms (mcg) po qd, vitamin D3 50,000 units po q Friday; and Voltaren gel, two grams topically up to qid prn. During home visit on 10/20/21, at 10:00 a.m. P8 showed surveyor numerous bottles of medication on her dresser in her bedroom. These bottles included: five bottles of 500 mg acetaminophen (two of which were expired), one bottle of Zaditor eye gtts, one bottle of Ketotifen fumarate (antihistamine eye gtts), two bottles of Aleve (naproxen), three bottles of fluticasone nasal spray, and one bottle of expired Sinex nasal spray. P8 stated she did take these medications. None of these medications were listed on the POC. During P8's home visit on 10/20/21, registered nurse (RN)-E, stated she would need to go through all the medications and call the pharmacy to see if she had orders for any of them. She stated it was usual practice to perform a drug review at every nurse visit. RN-E confirmed the medications on P8's dresser were not on the POC, noted there was an order for acetaminophen, but it was the wrong dose. When interviewed on 10/20/21, at 4:10 p.m. RN-E stated when she would find medication discrepancies, she would call the physician. She stated if the medications differ from the plan of care or if clients refuse, she would also contact the physician. She stated she tried to watch expiration dates also. P9's POC dated 9/7/21 to 11/5/21, SOC date of 9/7/21. The POC included diagnoses of amyotrophic lateral sclerosis, dysphagia, foot drop right and left foot, pseudobulbar affect and history of falling. P9's POC indicated skilled nursing evaluation 9/7/21 to 9/9/21 to review Call Me First handout with client and caregiver; occupational therapy evaluation 9/7/21 to 9/12/21 and one visit per week for five weeks to assess and instruct on and activities of daily living, balance, safety, strength and home exercise program; and physical therapy evaluation on 9/7/21 and two visits per week for two weeks, then one visit per week for five weeks to assess ambulation, balance, safety, and range of motion and to instruct on home exercise program and neuromuscular re-education. P9's POC indicated the following medication: BEC/Zinc one tablet po qd; naltrexone one mg, two tablets q hs; and vitamin D3 250 mcg one tablet po qd. During home visit on 10/20/21, at 12:20 p.m. P9's spouse informed surveyor that she had started a new medication after seeing her physician on 9/30/21. He stated it was baclofen 10 mg po qd to help with spasticity. This medication was not on the medication profile. When interviewed 10/20/21, at 12:10 p.m. occupational therapist (OT)-A stated she always asks if any new meds or changes at the beginning of every visit. OT-A stated if any changes, she would report to a nurse. Upon record review, visit note dated and signed by OT-A on 10/7/21, indicated that P9 had appointment at ALS clinic and started a new medication to help with her tone. Visit note signed and dated 10/6/21 by physical therapist (PT)-A indicated P9 had seen physician at Mayo and would be taking low dose anti spasticity medication. The clinical record lacked communication with nurse or an update to medication profile. When interviewed 10/21/21, at 2:45 p.m. RN-A stated therapists are expected to ask clients if any medications have changed at every visit. She stated if so, the therapist can provide education if able and also must report to nurse in order to update medication profile, run interaction report and send to physician.

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 document review, the agency failed to ensure field staff wore proper Personal Protective Equipment, based on the current guidance from the Center for Disease Control (CDC), while providing home care service to 5 of 5 patients (P8, P9, P5, P6 and P7) observed during a home visit. P5’s current care plan with certification dates 9/28/21-11/26/21 indicated P5’s diagnoses included anxiety, obstructive sleep apnea and diabetes mellitus. P5 had orders for home health aide for two hours each week to assist with dressing, shower and to shampoo hair. P5 also had orders for homemaker for six hours each week to assist with meal prep and cleaning tasks. On 10/20/21, at 12:30 p.m. unlicensed personnel (ULP)-A was observed providing homemaking services in P5’s home. HHA-A was not wearing eye protection and was wearing a cloth mask. On 10/20/21, at 3:10 p.m. ULP-A stated she was not aware she needed to wear eye protection, she preferred to not wear eye protection because they fog up. “When I wear glasses, I guess I’m getting some protection.” She wore a cloth mask because the surgical mask caused her face to sweat and break out. ULP-A did not make management aware of her concerns with the cloth mask but was aware she could wear a face shield. She did not want to wear a face shield because, “when we talk, we tend to spit and that is just gross.” ULP-A confirmed she had received education from the agency regarding PPE use and COVID. ULP-A did not feel she was at risk for getting COVID if she did not wear eye protection when providing cares and services, “unless they are spitting my eyes then I met get it.” P6’s current care plan with certification dates 9/23/21-11/21/21 indicated P6’s diagnoses included diabetes mellitus, atrial fibrillation, osteomyelitis (an infection in the bone) and hypertension. P6 had orders for weekly skilled nurse to check vital signs, provide education on diagnoses and change the dressing on P6’s PICC line (a catheter that passed through to the larger veins near the heart), a sterile procedure. On 10/20/21, at 11:00 a.m. registered nurse (RN)-C was observed less than two feet from P6 while for approximately 20 minutes checking vital signs, providing education, and completing the sterile dressing change. RN-C was not wearing eye protection during this visit. P7’s current care plan with certification dates 10/5/21-12/3/21 indicated P7’s diagnoses included anxiety, depression, and polyneuropathy (malfunction of nerves). P7 had order for weekly skilled nurse visits to check vital signs, provide education on diagnoses and every other week medication set up. On 10/20/21, at 9:00 a.m. licensed practical nurse (LPN)-A was observed sitting less than three feet from P7 for approx. 1.5 hours while completing vital signs, providing education, and setting up medications. LPN-A was not wearing eye protection during the visit. On 10/20/21, at 3:40 p.m. LPN-A confirmed she was trained on PPE use during home visits. Use of eye protection for eye protection was not required unless the patient had COVID-19. On 10/21/21, at 9:47 a.m. RN-D confirmed she completes supervision visits in the patient’s home with the ULP present. The supervision visit included ensuring appropriate PPE use by the ULP. RN-D completed a supervision visit with ULP-A. RN-D stated she observed ULP-A wearing a cloth mask in the client’s home but did not provide education to ULP-A, “I guess I didn’t really think of it at the time.” RN-D stated use of a surgical mask was important to prevent possible spread of viruses such as COVID-19. On 10/21/21, at 10:13 a.m. RN-A indicated her expectation for PPE use in the patient’s home include a surgical mask. Cloth masks were not appropriate. If the ULP was wearing a cloth mask during a supervision visit, RN-A expected the supervising nurse to instruct the ULP to change to a surgical mask immediately and further education was provided outside of the patient’s home. RN-A referred to agency policy for PPE for eye protection as eye protection, “routine visit current policy is for surgical mask not eye protection.” RN-A was not aware of current CDC guidance for eye protection. RN-A was not aware of the risks involved when wearing a cloth mask and not wearing eye protection, “we do what our policy says.” On 10/21/21, at 12: 34 p.m. regional director and registered nurse (RN)-B indicated the last guidance from the CDC she was aware was in June 2021, and provided direction they could stop using eye protection. Staff are encouraged to wear the level of eye protection they are comfortable with. RN-B expected staff to wear a surgical mask during home visits. RN-B was not able to clearly state the risk of and not wearing eye protection, “they’ve gone back and forth so many times they don’t even know.” RN-B indicated the risk when not wearing a surgical mask included possible transmission of viruses such as COVID-19. On 10/21/21, at 12:34 p.m. Branch Manager stated she expected staff wear eye protection or a face shield during home visits and surgical mask. Each branch has eye protection and surgical masks available for staff to use. Agency policy, Coronavirus Protocol dated 8/16/20, provided direction for cleaning eye protection but failed to direct staff on use of eye protection during visits. Surgical masks are required for all direct care staff, therapies, and paraprofessionals. P8's POC dated 9/28/21 to 11/26/21, indicated SOC date of 08/24/20. The POC included diagnoses of type two diabetes with hyperglycemia, hypertension, anxiety disorder, unspecified intellectual disability, long term use of insulin and long term use of aspirin. P8's POC further indicated skilled nursing one time per week for nine weeks beginning 9/28/21 ending 11/26/21 to prefill medications weekly and monitor medication adherence, educate client on medication management including medication uses, side effects , along with compliance, assessment and observation. On 10/20/21 at 10:00 a.m. during a home visit lasting over an hour, RN-E was observed providing an assessment, vital signs and setting up medications to P8 without eye protection on. When interviewed at 4:10 p.m. that day, she stated staff at the agency was no longer required to wear eye protection with COVID-19 negative clients since early summer. P9's POC dated 9/7/21 to 11/5/21, SOC date of 9/7/21. The POC included diagnoses of amyotrophic lateral sclerosis, dysphagia, foot drop right and left foot, pseudobulbar affect and history of falling. P9's POC indicated skilled nursing evaluation 9/7/21 to 9/9/21 to review Call Me First handout with client and caregiver; occupational therapy evaluation 9/7/21 to 9/12/21 and one visit per week for five weeks to assess and instruct on and activities of daily living, balance, safety, strength and home exercise program; and physical therapy evaluation on 9/7/21 and two visits per week for two weeks, then one visit per week for five weeks to assess ambulation, balance, safety, and range of motion and to instruct on home exercise program and neuromuscular re-education. On 10/20/21 at 11:30 a.m. during a home visit, OT-A was observed providing therapeutic exercises to P9 within a two to four foot range for approximately 35 minutes.

An abbreviated survey was conducted at your agency on 5/24/21 through 5/25/21. Recover Health, was found NOT to be in compliance with requirements at 42 CFR Part 484, requirements for Home Health Agencies. The following complaint was found to be SUBSTANTIATED: H7185010C (MN62450) with a deficiency cited at G486 and G488 The following complaint was found to be UNSUBSTANTIATED: H7185009C (MN67431) The facility's plan of correction (POC) will serve as your allegation of compliance upon the Department's acceptance.

Protect patient during investigation CFR(s): 484.50(e)(1)(iii) (iii) Take action to prevent further potential violations, including retaliation, while the complaint is being investigated. This ELEMENT is not met as evidenced by: Based on interview and document review the facility failed to investigate timely and protect other residents during an investigation related to an allegation of rough cares for 1 of 3 clients (P3) reviewed for abuse allegation. Finding include: P3's certification and plan of care dated 5/12/21 through 7/10/21, identified diagnosis of anxiety, major depressive disorder, essential tremors, atypical chronic myeloid leukemia, sensorineural hearing loss bilateral. Safety measures include anticoagulant precautions, slow position changes, use of assistive devices, and safety in activities of daily living. Orders included, home health aide services two hours a week for eight weeks, physical therapy one time a week for six weeks. Skilled nurse one time a week for 6 weeks. Home health aid (HHA) to assist with dressing if needed, shower twice a week, physical therapy will assign exercises/teach home health aid to assist client to prevent future decline in strength, provide light housekeeping, Mental status: is oriented, forgetful, depressed and anxious. Internal investigation form dated 5/20/21 through 5/25/21, indicated family member (FM)-A stated "HHA-A is always on her phone, they feel like she rushes P3 through his showers and is rough with him. RN-A had educated HHA-A about complaints from FM-A regarding phone usage, not informing client when going to be late and rough/rude/rushing through tasks and leaving before all cares planned tasks are completed. HHA-A denied being rough with client and stated she talks loud to him and maybe that is why they thought she was rough. HHA-A was educated by clinical manager the importance of being gentle with all clients, slow down and do not rush though tasks. HHA-A verbalized understanding. on 5/24/21 Registered nurse (RN)-A called and spoke with FM-A in regards to the statement of rough cares and FM-A stated HHA-A was not rough and P3 does not mind her coming out and does not want to lose his HHA he was just saying she is not as good as the previous HHA. P3 had stated to FM-A that HHA was not to rough with him and that he just does not care for her. Employee schedule dated 5/25/21, indicated HHA-A continued to work with other clients on 5/21/21 and 5/24/21. During interview on 5/24/21, 5/25/21, and 5/26/21, P3 and FM-A were unable to be reached, multiple attempts were made with message and phone number to return call. During interview on 5/24/21, at 2:08 p.m. RN -C stated all allegation of abuse should be investigated within 24 hours which allows time to gather information. During interview on 5/25/21, at 9:55 a.m. HHA-A denied ever being rough with P3 or any other clients. HHA stated P3 is very specific on how he wants his cares and home tasks to be completed. During interview on 5/25/21, at 11:50 a.m. RN-B stated as of 5/24/21 RN-A had been talking with FM-A to gather more information and thinking the vulnerable adult report was filed yesterday. RN-B stated allegations of abuse or mistreatment should be reported and investigated within 24 hours for the safety of all clients. During interview on 5/25/21, at 1:00 p.m. RN-A stated FM-A stated HHA-A was not rough and that P3 just doesn't care for her and felt his previous HHA-A worker was better, but he still wanted HHA-A to return to his home to care for him. RN-A further stated all allegations of abuse are to be investigated, reported within 24 hours, and the alleged perpetrator normally would be suspended pending investigation. RN-A stated HHA-A was not suspended right away due to this investigation falling through the cracks. RN-A stated it is important to suspend the accused staff to make sure all clients are safe. RN-A stated she dropped the ball on this investigation with both investigating it and reporting it in a timely manor. RN-A stated she did not read the email until the next day. RN-A further stated that they are mandated reporters and we need to keep our clients safe. RN-A stated the HHA-A only saw one other client on Friday and the facility was in contact with all of HHA-A's clients. FM-A had reported to agency on 5/20/21 allegation of rough cares. HHA-A was educated on 5/21/21 regarding rough cares, phone usage, and notifying family when going to be late. Abuse, Neglect, & Misappropriation investigation dated 8/5/2014, indicated "Recover Health will comply fully with the Vulnerable Adults Act and the Maltreatment of Minors Act. The agency shall encourage and accept reports of suspected abuse or neglect. The agency will thoroughly investigate any and all reports of suspected abuse or neglect and shall take all reasonable steps necessary to correct situations leading to, or providing the potential for, abuse or neglect of clients. All state requirements and reporting procedures will be strictly adhered to by all staff. "Report to CEP. Once an internal report is received, the Director of Nursing, or Branch/Unit Manger shall determine whether a report is required. A report is required whenever there is reason to believe maltreatment has occurred or the VA has sustained an injury not reasonably explained. If a report is required, the report must be made "immediately" means as soon as possible but no longer than 24 hours from the time initial knowledge of the incident is received. (The time that the person making the internal report came into possession of the information).

Immediate reporting of abuse by all staff CFR(s): 484.50(e)(2) Any HHA staff (whether employed directly or under arrangements) in the normal course of providing services to patients, who identifies, notices, or recognizes incidences or circumstances of mistreatment, neglect, verbal, mental, sexual, and/or physical abuse, including injuries of unknown source, or misappropriation of patient property, must report these findings immediately to the HHA and other appropriate authorities in accordance with state law. This ELEMENT is not met as evidenced by: Based on interview and document review the facility failed to report an allegation of abuse for 1 of 3 clients (P3) who had reported an allegation of rough cares. Findings include: P3's certification and plan of care dated 5/12/21 through 7/10/21, identified diagnosis of anxiety, major depressive disorder, essential tremors, atypical chronic myeloid leuk, sensorineural hearing loss bilateral. Safety measures include anticoagulant precautions, slow position changes, use of assistive devices, and safety in activities of daily living. Home health aide services two hours a week for eight weeks, physical therapy one time a week for six weeks. skilled nurse one time a week for 6 weeks. Home health aid (HHA) is to assist with dressing if needed, shower twice a week, physical therapy will assign exercises/teach home health aid to assist client to prevent future decline in strength, provide light housekeeping, Mental status is oriented, forgetful, depressed and anxious. Internal investigation form dated 5/20/21 through 5/25/21, indicated family member (FM)-A stated "HHA-A is always on her phone, they feel like she rushes P3 through his showers and is rough with him. RN-A had educated HHA-A about complaints from FM-A regarding phone usage, not informing client when going to be late and rough/rude/rushing through tasks and leaving before all cares planned tasks are completed. HHA-A denied being rough with client and stated she talks loud to him and maybe that is what they thought she was rough. HHA-A was educated by clinical manager the importance of being gentle with all clients, slow down and do not rush through tasks. HHA-A verbalized understanding. On 5/24/21 Registered nurse (RN)-A called and spoke with FM-A in regards to the statement of rough cares and FM-A stated HHA-A was not rough and P3 does not mind her coming out and does not want to lose his HHA. He was just saying she is not as good as the previous HHA. P3 had stated to FM-A that HHA was not to rough with him and that he just does not care for her. FM-A reported rough cares to the agency on 5/20/21 and the allegation was not reported to the state agency. During interview on 5/24/21, at 2:08 p.m. RN -C stated all allegation of abuse should be reported and investigated within 24 hours which allows time to gather information. During interview on 5/25/21, at 11:50 a.m. RN-B stated as of 5/24/21 RN-A had been talking with FM-A to gather more information and thinking the report was filed yesterday. RN-B stated allegations of abuse or mistreatment should be reported and investigated within 24 hours for the safety of the clients. During interview on 5/25/21, at 1:00 p.m. RN-A stated FM-A stated that HHA-A was not rough and that P3 just doesn't care for her and felt his previous HHA-A worker was better and he still wanted HHA-A to return to his home to care for him. RN-A further stated all allegations of abuse are to be investigated, reported within 24 hours, and the alleged perpetrator normally would be suspended pending investigation. RN-A stated she dropped the ball on this investigation with both investigating it and reporting it in a timely manor. RN-A stated she did not read the email until the next day. RN-A further stated that they are mandated reporters and we need to keep our clients safe. Abuse, Neglect, & Misappropriation investigation dated 8/5/2014, indicated "Recover Health will comply fully with the Vulnerable Adults Act and the Maltreatment of Minors Act. The agency shall encourage and accept reports of suspected abuse or neglect. The agency will thoroughly investigate any and all reports of suspected abuse or neglect and shall take all reasonable steps necessary to correct situations leading to, or providing the potential for, abuse or neglect of clients. All state requirements and reporting procedures will be strictly adhered to by all staff. "Report to CEP. Once an internal report is received, the Director of Nursing, or Branch/Unit Manger shall determine whether a report is required. A report is required whenever there is reason to believe maltreatment has occurred or the VA has sustained an injury not reasonably explained. If a report is required, the report must be made "immediately" means as soon as possible but no longer than 24 hours from the time initial knowledge of the incident is received. (The time that the person making the internal report came into possession of the information).