Every finding on record at Slh Health Corp

Purpose: Recertification Survey Entrance Date: 8/9/2022 Census: Licensed and Certified patients - 101 The agency was in compliance with 42 CFR Part 484.22, Emergency Preparedness Requirements for Home Health Agencies.

Purpose: Recertification Survey Entrance Date: 8/9/2022 Census: Licensed and Certified patients - 101

Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This ELEMENT is not met as evidenced by: Based on record review and interview, the agency failed to provide written notice in advance of the termination of care in compliance with 42 Code of Federal Regulations requirements 405.1200 in 3 (#8, #9, #10) of 3 discharged patient records reviewed. The failure placed at risk, the patients' right to participate in their care and the right to request an expedited determination that services should continue. 42 Code of Federal Regulations: 405.1200 read in part; "Notifying beneficiaries of provider service terminations. (a) Applicability and scope. (1) For purposes of §§ 405.1200 through 405.1204, the term, provider, is defined as a home health agency (HHA), skilled nursing facility (SNF), comprehensive outpatient rehabilitation facility (CORF), or hospice. (2) For purposes of §§ 405.1200 through 405.1204, a termination of Medicare-covered service is a discharge of a beneficiary from a residential provider of services, or a complete cessation of coverage at the end of a course of treatment prescribed in a discrete increment, regardless of whether the beneficiary agrees that the services should end. A termination does not include a reduction in services. A termination also does not include the termination of one type of service by the provider if the beneficiary continues to receive other Medicare-covered services from the provider. (b) Advance written notice of service terminations. Before any termination of services, the provider of the service must deliver valid written notice to the beneficiary of the provider's decision to terminate services. The provider must use a standardized notice, as specified by CMS, in accordance with the following procedures: (1) Timing of notice. A provider must notify the beneficiary of the decision to terminate covered services no later than 2 days before the proposed end of the services. If the beneficiary's services are expected to be fewer than 2 days in duration, the provider must notify the beneficiary at the time of admission to the provider. If, in a non-residential setting, the span of time between services exceeds 2 days, the notice must be given no later than the next to last time services are furnished. (2) Content of the notice. The standardized termination notice must include the following information: (i) The date that coverage of services ends; (ii) The date that the beneficiary's financial liability for continued services begins; (iii) A description of the beneficiary's right to an expedited determination under § 405.1202, including information about how to request an expedited determination and about a beneficiary's right to submit evidence showing that services must continue; (iv) A beneficiary's right to receive the detailed information specified under § 405.1202(f); and (v) Any other information required by CMS. (3) When delivery of the notice is valid. Delivery of the termination notice is valid if - (i) The beneficiary (or the beneficiary's authorized representative) has signed and dated the notice to indicate that he or she has received the notice and can comprehend its contents; and (ii) The notice is delivered in accordance with paragraph (b)(1) of this section and contains all the elements described in paragraph (b)(2) of this section..." Patient #8: Record review of Patient #8's clinical record revealed a Plan of Care dated 4/19/2022 to 6/17/2022. The Plan of Care indicated that Patient #8 started services with the agency on 4/19/2022. The Plan of Care listed Unspecified Open Wound, Right Lower Leg, Chronic Pain, Osteoarthritis, Heart Disease of Native Coronary Artery, Hypertension, Major Depressive Disorder, and Back Pain as diagnoses. The Plan of Care contained an order for skilled nursing visits weekly. Patient #8's contained a Discharged Comprehensive Assessment dated 6/13/2022 conducted by the Director or Nursing. The clinical record did not contain evidence that the agency provided Patient #8 written notice of the termination of care prior to discharge from the agency on 6/13/2022. Patient #9: Record review of Patient #9's clinical record revealed a Plan of Care dated 12/21/2021 to 2/18/2022. The Plan of Care indicated that Patient #9 started on the agency's services on 12/21/2022. The Plan of Care listed Pneumonia Unspecified Organism, Hypoxemia, Anorexia, Hypertension, Mixed Hyperlipidemia, Vitamin D Deficiency, and Benign Prostatic Hyperplasia as diagnoses. The Plan of Care contained an order for skilled nursing visits weekly. Patient #9's clinical record contained a Discharged Comprehensive Assessment dated 2/17/2022 conducted by the Director of Nursing. The clinical record did not contain evidence that the agency provided Patient #9 written notice of the termination of care prior to discharge from the agency on 2/17/2022. Patient #10: Record review of Patient #10's clinical record revealed a Plan of Care dated 1/8/2022 to 3/8/2022. The Plan of Care indicated that Patient #10 started on the agency's services on 11/9/2021. The Plan of Care listed COVID-19, Hypertension, Hemiplegia following Cerebral Infarction Affecting Right Dominant Side, Diabetes Mellitus, Essential Tremor, Back Pain, Chronic Obstructive Pulmonary Disease, Heart Disease of Native Coronary Artery, and Hyperlipidemia as diagnoses. The Plan of Care contained an order for skilled nursing visits weekly. Patient #10's clinical record contained a Discharged Comprehensive Assessment dated 3/4/2022 conducted by ex-employee Registered Nurse C. The clinical record did not contain evidence that the agency provided Patient #10 written notice of the termination of care prior to discharge from the agency on 3/4/2022. During an interview on 8/11/2022 at approximately 10:10 a.m. with the Administrator and Director of Nursing, the surveyor discussed and asked questions regarding discharge notice. The Director of Nursing stated that, "(Patient #8's family member) was notified verbally. During an interview on 8/12/2022 at approximately 2:30 p.m. with the Administrator, the Administrator informed the surveyor that the agency looked for the discharge notices. The Administrator stated, "We don't have them."

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 record review and interview, the agency failed to include a review of all medications that the patients were taking at the time of discharge as part of the discharge comprehensive assessment in 3 (#8, #9, #10) of 3 discharge records reviewed. The failure placed the agency's patients at risk for adverse drug reactions, over-medication, under-medications, side-effects, drug interactions, and exacerbation of disease processes. Patient #8: Record review of Patient #8's clinical record revealed a Plan of Care dated 4/19/2022 to 6/17/2022. The Plan of Care indicated that Patient #8 started services with the agency on 4/19/2022. The Plan of Care listed Unspecified Open Wound, Right Lower Leg, Chronic Pain, Osteoarthritis, Heart Disease of Native Coronary Artery, Hypertension, Major Depressive Disorder, and Back Pain as diagnoses. The Plan of Care contained an order for skilled nursing visits weekly. The Plan of Care listed the following medications: Acetaminophen 325 milligrams - used to treat pain Acetaminophen-Codeine #3 - used to treat pain Aspirin 81 milligrams - used to prevent heart attack and stroke Cetirizine 10 milligrams - used to treat hay-fever and allergies Cholecalciferol 25 micrograms - used to treat vitamin D deficiency Plavix 75 milligrams - used to prevent heart attack and stroke Docusate Sodium 100 milligrams - used to treat constipation Escitalopram 5 milligrams - used to treat depression and anxiety Hydrochlorothiazide 25 milligrams - used to treat high blood pressure and fluid retention Hydroxyzine Hydrochloride 25 milligrams - used to treat itching caused by allergies Lovastatin 40 milligrams - used to treat high cholesterol and triglyceride levels Metoprolol Succinate 50 milligrams - used to treat chest pain and high blood pressure Multivitamin - dietary supplement Spiriva 18 micrograms - used to prevent bronchospasms caused by chronic obstructive pulmonary disease Patient #8's contained a Discharged Comprehensive Assessment dated 6/13/2022 conducted by the Director of Nursing. The clinical record did not contain evidence that a review of all medications that Patient #8 was taking at the time of discharge was included as part of the Discharge Comprehensive Assessment. Patient #9: Record review of Patient #9's clinical record revealed a Plan of Care dated 12/21/2021 to 2/18/2022. The Plan of Care indicated that Patient #9 started on the agency's services on 12/21/2022. The Plan of Care listed Pneumonia Unspecified Organism, Hypoxemia, Anorexia, Hypertension, Mixed Hyperlipidemia, Vitamin D Deficiency, and Benign Prostatic Hyperplasia as diagnoses. The Plan of Care contained an order for skilled nursing visits weekly. The Plan of Care listed the following medications: Cefdinir 300 milligrams - used to treat infections Losartan 100 milligrams - used to treat high blood pressure Ergocalciferol 1.25 milligrams - used to treat and prevent Vitamin D deficiency Atorvastatin 40 milligrams - used to treat high cholesterol and triglyceride levels Albuterol 2.5 milligrams/ 3 milliliters - used to treat or prevent bronchospasm. Megestrol Acetate 40 milligrams/milliliter - used to treat breast cancer and endometrial cancer Metoprolol Succinate 100 milligrams - used to treat chest pain and high blood pressure Oxybutynin 10 milligrams - used to treat overactive bladder Tramadol 50 milligrams - used to treat moderate to severe pain Carisoprodol 350 milligrams - used to treat pain and muscle stiffness from muscle spasms Patient #9's clinical record contained a Discharged Comprehensive Assessment dated 2/17/2022 conducted by the Director of Nursing. The clinical record did not contain evidence that a review of all the medications that Patient #9 was taking at the time of discharge was included as part of the Discharge Comprehensive Assessment. Patient #10: Record review of Patient #10's clinical record revealed a Plan of Care dated 1/8/2022 to 3/8/2022. The Plan of Care indicated that Patient #10 started on the agency's services on 11/9/2021. The Plan of Care listed COVID-19, Hypertension, Hemiplegia following Cerebral Infarction Affecting Right Dominant Side, Diabetes Mellitus, Essential Tremor, Back Pain, Chronic Obstructive Pulmonary Disease, Heart Disease of Native Coronary Artery, and Hyperlipidemia as diagnoses. The Plan of Care contained an order for skilled nursing visits weekly. The Plan of Care listed the following medications: Amoxicillin-Clavulanate 875/125 milligrams - used to treat infections Prednisone 10 milligrams - used to treat disease associated with inflammation Atorvastatin 80 milligram - used to treat high cholesterol and triglyceride levels Plavix 75 Milligrams - used to prevent heart attack and stroke Metformin 500 milligrams - used to treat diabetes Fenofibrate 145 milligrams - used to lower cholesterol and triglyceride levels Lisinopril 100 milligrams - used to treat high blood pressure Novolog 70/30 10 units - used to treat diabetes Basaglar 70 units - used to treat diabetes Tamsulosin 0.4 milligrams - used to treat enlarged prostate Ibuprofen 800 milligrams - used to treat pain Patient #10's clinical record contained a Discharged Comprehensive Assessment dated 3/4/2022 that was conducted by ex-employee Registered Nurse C. The clinical record did not contain evidence that a review of all the medications that Patient #10 was taking at the time of discharge was included as part of the Discharge Comprehensive Assessment. During an interview on 8/11/2022 at approximately 10:10 a.m. with the Administrator and the Director of Nursing, the surveyor discussed the Discharge Comprehensive Assessment and medication reviews. The Director of Nursing informed the surveyor that the agency's nursing staff knew that medication reviews were to be conducted at the comprehensive assessments. The Director of Nursing could not state why it was not done. The agency was given the opportunity to provide evidence that a review of the patients medications was conducted as part of the Discharge Comprehensive Assessment. No evidence was provided to the surveyor by exit on 8/12/2022.