Every finding on record at Safe Home Care LLC

EMERGENCY PREPAREDNESS At the time of the emergency preparedness survey completed on 04/13/23, Safe Home Care, LLC is in compliance with the provisions of 42 CFR Part. 484.102.

Partial Extended Recertification Survey The following deficiencies are based on the partial extended standard recertification survey completed on 04/13/23.

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 medical record review, observation, family interview, staff interview and policy review, the agency failed to ensure medications taken by the patient matched the current medication profile. This affected two (Patient #1 and Patient #3) of three patient home visits conducted with the potential to affect all patients cared for by this agency. The facility census was 21. Review of the medical record for Patient #1 revealed the patient was admitted on 12/08/22 with a primary diagnosis of malignant neoplasm of the esophagus. The certification periods reviewed was for 02/06/23 through 04/06/23 and 04/07/23 throught 06/05/23. A home health aide (HHA) was ordered and scheduled for 40 hours per week. This patient had a re-certification visit on 04/04/23 with an updated medication profile. A home visit observation was completed on 04/11/23 at 9:00 AM with a HHA. Medications were reviewed in the home with Patient #1’s family and compared to the medication profile and plan of care (POC). Clonipine 0.2 milligram (mg)/24 hour transdermal film, extended release once a week by mouth was listed on the POC and medication profile. An interview with Patient #1’s daughter in-law revealed this medication was stopped over one month ago. A review of the medical record with Staff A on 04/12/23 at 10:00AM revealed this medication was not deleted off the POC or medication profile when the re-certification occurred on 04/04/23. Interview at this time with Staff A verified the findings. Review of the medical record for Patient #3 revealed Patient # 3 had a start of care (SOC) date of 09/12/22 with a primary diagnosis of cerebral palsy. The certification period reviewed was for 03/11/23 through 05/09/23. A re-certification was completed on 03/06/23 with a skilled nurse (SN) ordered two times per day seven days per week to monitor vital signs and give medications. A home visit observation was completed on 04/11/23 at 2:00 PM with Licensed Practical Nurse (LPN) Staff G. Medications were reviewed with Staff G and verified with the POC, medication profile and medication list in the home. The following medications were listed on the POC and the medication profile but not on the home medication sheet: benztropine (treats excessive movement) 1 mg by mouth at night, cariprazine 4.5 mg (treats schizophrenia), diphenhydramine (itching) 25 mg by mouth, L-methylfolate (treats low folate levels), lurasidone 120 mg (treats schizophrenia) and ranitidine (decreases stomach acids) 150 mg two capsules by mouth. An interview with Staff G at the time of this visit verified these medications are all old and were discontinued prior to the re-certification. A review of the medical record with Staff A on 04/12/23 at 10:00AM revealed the medications were not updated during the re-certification on 3/06/23. Interview at this time with Staff A verified the findings. Review of the agency policy titled "Medication Profile," (Feb.2022) instructed staff to update the medication profile upon Start of Care, Resumption of Care, Recertification and Discharge.

A qualified HH aide successfully completed: CFR(s): 484.80(a)(1)(i-iv) A qualified home health aide is a person who has successfully completed: (i) A training and competency evaluation program as specified in paragraphs (b) and (c) respectively of this section; or (ii) A competency evaluation program that meets the requirements of paragraph (c) of this section; or (iii) A nurse aide training and competency evaluation program approved by the state as meeting the requirements of §483.151 through §483.154 of this chapter, and is currently listed in good standing on the state nurse aide registry; or (iv) The requirements of a state licensure program that meets the provisions of paragraphs (b) and (c) of this section. This ELEMENT is not met as evidenced by: Based on a review of personnel files, staff interview, and review of the job description for home health aides (HHA), the facility failed to have HHAs on staff who have completed the required qualified training program. This has the potential to affect all clients receiving HHA care from this agency. The personnel files of five HHAs were reviewed on 04/12/23 along with the HHA job description. Listed under the job summary for a HHA included a paraprofessional person who is specifically trained, competent and performs functions of personal care to the patient in their residence under the direction, instruction and supervision of the registered nurse (RN). Listed under the qualifications includes the HHA must meet the Conditions of Participation (COP’s) for Home Health Aide training program and competency. The personnel files for Staff B, D, E and F all have documentation of a HHA Competency Test and Skills checklist but do not have documentation of completion of a qualified training program. Interview with Staff A on 04/12/23 at 2:00 PM revealed they were not aware of this requirement stating the waiver programs do not require this. The findings of not having all HHA qualified and trained per this requirement was verified with Staff A on 04/13/23 at 3:00 PM.