Every finding on record at Sjc Home Health Services, Inc.

A routine survey was conducted at Advantage Home Health in Brunswick, GA from 11/1/21 to 11/3/21. The routine survey revealed that the agency was in substantial compliance with 42 CFR Part 484.22, Emergency Preparedness for Home Health Agencies. A COVID-19 Focused Infection Control Survey was completed at the time of the on site visit. No deficiencies were cited.

A routine survey was conducted at Advantage Home Health in Brunswick, GA from 11/1/21 to 11/3/21. The routine survey revealed that the agency was in substantial compliance with Chapter 111-8-31, Rules and Regulations for Home Health Agencies. The census was 117 at the time of the on site visit. The following citations 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 home visit observation, clinical record review and staff interview it was determined that the home health agency failed to ensure that the medication profile was updated in to reflect current medications at the time of the comprehensive assessment for one of six (P#4) sampled patients (P) observed during home visits. Findings were: Patient #4 was admitted to the agency on 10/22/21, with the primary diagnosis of encounter for surgical aftercare following surgery on the circulatory system. P#4’s clinical record was reviewed for the certification period 10/22/21 to 12/20/21. A home visit was conducted on 11/2/21, at approximately 10:30 a.m. at the residence of P#4 with Registered Nurse (RN) #FF. The surveyor compared P#4's current medication list in the agency's electronic medical record (EMR) to the medications present in P#3's home. The patient had the following medications present in the home but not documented in the agency’s EMR:Tylenol 325 mg (milligrams) was present in the home and P#3 stated he “takes one in between my pain medicine”. Tylenol is an-over-the counter medication for mild pain. However, the medication was not listed in the agency’s EMR.Metformin 500 mg, which is used to lower blood sugar, was present in the home. The medication instructions on the bottle were as follows: “one pill twice daily”. However, the medication was not listed in the agency’s EMR.Eliquis 2.5 mg, which is used to treat and prevent blood clots, was present in the home. The medications instructions on the bottle were as follows: “one pill twice daily”. However, the medication was not listed in the agency’s EMR.Carvedilol 25 mg, which is used to treat high blood pressure, was present in the home. The medications on the bottle were as follows: “one pill twice daily”. However, the medication listed in the agency EMR was “Coreg (brand name for carvedilol) 3.125mg tablet 2 times daily oral”.During an interview with RN #FF during the home visit, RN #FF acknowledged that the medications listed in the agency’s EMR were not updated to reflect the medications present in P#3’s home. The agency Administrator was informed of these findings in an interview at the agency on 11/3/21 at 12:00 p.m.

Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This ELEMENT is not met as evidenced by: Based on clinical record review, it was determined that the agency staff failed to ensure treatments were administered only as ordered by the physician for three of 17 (#2, #3 and #11) sampled patients (P). Findings were: Patient #2 was admitted to the agency on 10/4/21, with a primary diagnosis of type 2 diabetes mellitus with foot ulcer. The clinical record was reviewed for certification period 10/4/21 to 12/2/21. P#2’s clinical record revealed the following wound care order dated 10/27/21: “Cleanse wound with saline. Apply gauze, wrap with kerlix and secure with tape. Change dressing daily.” The order lacked a location of the wound as well as lacked designation of who was responsible for doing the wound care when the skilled nurse was not present. Patient #3 was admitted to the agency on 9/26/21, with a primary diagnosis of stage 4 pressure ulcer of sacral region. The clinical record was reviewed for certification period 9/26/21 to 11/24/21. P#3’s clinical record revealed the following wound care order dated 10/4/21: “Skilled nurse to clean wound with normal saline apply Opticell plain and secure with Allevyn Gentle Boarder using clean technique.” The order lacked a location of the wound, the frequency of the wound care and lacked designation of who was responsible for doing the wound care when the skilled nurse was not present. P#3’s clinical record also revealed the following wound car order dated 10/7/21: “Skilled nurse to clean wound with normal saline apply Hydrofera blue classic foam and secure with Allevyn gentle boarder using clean technique”. The order lacked a location of the wound, the frequency of the wound care and lacked designation of who was responsible for doing the wound care when the skilled nurse was not present. Patient #11 was admitted to the agency on 9/16/21, with a primary diagnosis of stage 3 pressure ulcer of right heel. The clinical record was reviewed for certification period 9/16/21 to 11/14/21. P#11’s clinical record revealed the following wound care order dated 9/16/21: “Skilled nurse to assess and perform/teach wound care to incision/suture site located left anterior proximal pretibial amputation site. SN (skilled nurse) to observe surgical site for s/s(signs/symptoms) of infection every visit such as redness, edema, green drainage, or elevated temp (temperature)”. The order lacked specific instructions on how often to do wound care, who was responsible for wound care when the skilled nurse was not present. The order also lacked instructions for what product was to be used to clean the wound and how wound was to be covered or secured. The agency Administrator was informed of these findings in an interview at the agency on 11/3/21 at 12:00 p.m.