Every finding on record at Saint Thomas Home Health, LLC

An Emergency Preparedness survey was conducted from 3/22/2022 to 3/24/2022 at Ascension at Home Saint Thomas. No deficiencies were cited under CFR Part 484.22 Condition of Participation for Home Health Agencies.

An Recertification survey was conducted from 3/22/2022 to 3/24/2022 at Ascension at Home Saint Thomas. Deficiencies were cited under CFR Part 484, Requirements for Home Care Organizations Providing Home Health Care.

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 medical record review and interview, the agency failed to obtain sliding scale insulin dosages/instructions from the physician for 1 patient (#4) of 1 patient who received sliding scale insulin. The findings include: Medical record review revealed Patient #4 was admitted to the agency on 3/11/2022 with diagnoses including Type 2 Diabetes Mellitus with Hyperglycemia and Diabetic Foot Ulcer. Medical record review of the Home Health Certification and Plan of Care (485) dated 3/11/2022 to 5/9/2022 revealed a physician's order for the skilled nurse to provide .."instructions/reinforcement of Diabetic care to include...administration of insulin, blood glucose testing...skilled nurse to reconcile medications as needed. Skilled nurse may instruct and reinforce medication teaching related to use of medications to treat disease processes..." Medical record review of a skilled nurse's note dated 3/11/2022 revealed the patient's usual blood sugars were between 250 and 400 (normal is between 70 and 120). Further review revealed the patient obtained her blood sugars 2 to 3 times a day. Medical record review of a skilled nurse's note dated 3/11/2022 revealed the patient's usual blood sugars "varies". Further review revealed the patient obtained her blood sugars "daily or sometimes twice daily". Medical record review of a physician's order dated 3/15/2022 revealed the medication Apidra (fast acting Insulin used to control blood sugars) was left off of the 485 dated 3/11/2022 to 5/9/2022. Further review revealed the frequency of the sliding scale insulin was three times a day and the dosage was listed as "per instructions". No instructions were noted on the physician's order. Medical record review of a skilled nurse's note dated 3/16/2022 revealed the patient's usual blood sugars were "mid level". Further review revealed the patient obtained her blood sugars "daily". Medical record review of a skilled nurse's note dated 3/18/2022 revealed the patient's usual blood sugars were "varies mid to high level". Further review revealed the patient obtained her blood sugars "daily." Interview with the administrator on 3/23/2022 at 1:30 PM confirmed the agency did not obtain specific sliding scale orders from the physician.

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 medical record review and interview, the agency failed to alert the physician that 1 patient (#2) was placed on hold pending insurance authorization of 13 patients reviewed. The findings include: Medical record review Patient #2 was admitted to the agency on 3/11/2022 with diagnoses including Anemia and History of Falling. Medical record review of the Home Health Certification and Plan of Care (485) dated 3/11/2022 to 5/9/2022 revealed a physician's order for skilled nurse services at 1 time a week for 1 week; 2 times a week for 2 weeks; and 1 time a week for 5 weeks. Further review revealed an order for physical therapy at 2 times a week for 3 weeks and then 1 time a week for 5 weeks beginning week of 3/13/2022. Medical record review of the skilled nurses notes revealed only the admission evaluation visit was completed on 3/11/2022. No other visits were completed thru 3/19/2022 which resulted in 2 missed skilled nurse visits the week of 3/13/2022. Medical record review of the physical therapy notes revealed only the evaluation visit was completed on 3/15/2022 and no other visits were completed thru 3/19/2022 which resulted in 1 missed visit the week of 3/13/2022. Medical record review of communication notes revealed no documentation the physician was alerted of the missed visits due to the patient placed on hold pending insurance authorization. Interview with the administrator on 3/23/2022 at 1:45 PM confirmed no documentation was noted which stated the physician was alerted to the missed visits secondary to the patient placed on hold pending insurance authorization.

Patient medication schedule/instructions CFR(s): 484.60(e)(2) Patient medication schedule/instructions, including: medication name, dosage and frequency and which medications will be administered by HHA personnel and personnel acting on behalf of the HHA. This ELEMENT is not met as evidenced by: Based on medical record review and interview, the agency failed to provide written and verbal information regarding frequency and dosage of sliding scale insulin for 1 patient (#4) out of 1 patient who received sliding scale insulin. Medical record review revealed Patient #4 was admitted to the agency on 3/11/2022 with diagnoses including Type 2 Diabetes Mellitus with Hyperglycemia and Diabetic Foot Ulcer. Medical record review of the Home Health Certification and Plan of Care (485) dated 3/11/2022 to 5/9/2022 revealed a physician's order for the skilled nurse to provide .."instructions/reinforcement of Diabetic care to include...administration of insulin, blood glucose testing...skilled nurse to reconcile medications as needed. Skilled nurse may instruct and reinforce medication teaching related to use of medications to treat disease processes..." Medical record review of a skilled nurse's note dated 3/11/2022 revealed the patient's usual blood sugars were between 250 and 400 (normal is between 70 and 120). Further review revealed the patient obtained her blood sugars 2 to 3 times a day. Medical record review of a skilled nurse's note dated 3/14/2022 revealed the patient's usual blood sugars "varies". Further review revealed the patient obtained her blood sugars "daily or sometimes twice daily". Medical record review of a physician's order dated 3/15/2022 revealed the medication Apidra (fast acting Insulin used to control blood sugars) was left off of the 485 dated 3/11/2022 to 5/9/2022. Further review revealed the frequency of the sliding scale insulin was three times a day and the dosage was listed as "per instructions". No instructions were noted on the physician's order. No documentation the agency attempted to contact the physician for clarification of "per instructions". Medical record review of a skilled nurse's note dated 3/16/2022 revealed the patient's usual blood sugars were "mid level". Further review revealed the patient obtained her blood sugars "daily". No documentation the patient was instructed to obtain her blood sugars 3 times a day for sliding scale insulin administration. Medical record review of a skilled nurse's note dated 3/18/2022 revealed the patient's usual blood sugars were "varies mid to high level". Further review revealed the patient obtained her blood sugars "daily." No documentation the patient was instructed to obtain her blood sugars 3 times a day for sliding scale insulin administration. Interview with the administrator on 3/23/2022 at 1:30 PM confirmed the agency did not provide instructions of sliding scale insulin frequency or administration.