Every finding on record at Stat Home Health, LLC

The entity is in compliance with the federal emergency preparedness requirements.

Recertification Survey, Re-licensing Survey, and Covid-19 Focused Infection Control Survey. Tag#536, #572 and #590 were cited as a result of the Recertification Survey. COVID-19 Focused Infection Control Survey with no related deficiencies 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 observation, record review, and interview the agency failed to ensure clinicians completed an accurate medication reconciliation for 5 of 7 patients (Patient #1, Patient #2, Patient #3, Patient #5, and Patient #6) observed during home visits in a total sample of 17. Findings: In an interview on 11/15/2021 at 10:54am, S2DON (Director of Nursing) and S3LPN (Licensed Practical Nurse) stated for every visit by a therapist or skilled nurse, the clinician should be conducting a medication reconciliation review by comparing the current medication bottles in the home to the medication list and any new physician orders. On 11/15/2021 at 3:45pm, S2DON presented the surveyor with the Client Medication Reports and confirmed all current medications for the patients were contained on the report as of the patients last visit with either the therapist or the skilled nurse. Patient #1 Review of Patient #1’s Record revealed Patient #1 had been seen daily by the skilled nurse for the entire certification period with the exception of 10/25/2021, 11/04/2021, and 11/05/2021. Review of Patient #1’s Client Medication Report revealed, in part, Dekas Essential (vitamin) 2,000 units one capsule daily, and PC Liver and Brain (vitamin) 48mg (milligrams) one capsule daily. Observation during home visit on 11/16/2021 at 9:50am revealed no evidence of Dekas Essential 2,000 units or PC Liver and Brain 48mg present in the home. In an interview on 11/16/2021 at 9:50am, Patient #1 stated she did not even remember how long ago she had stopped taking the Dekas, and had stopped the PC Liver and Brain several weeks ago. Patient #2 Review of Patient #2’s Record revealed Patient #2 was seen by the Physical Therapy Assistant on 11/11/2021, and was seen by the skilled nurse on 11/09/2021. Review of Patient #2’s Client Medication Report revealed, in part, Citalopram (antidepressant) 20mg one tablet by mouth daily; Ferrous Sulfate (iron pill) 325mg one tablet daily; and Buspirone (antianiety) 30mg tablet one tablet twice a day. Observation during a home visit on 11/16/2021 at 12:15pm, revealed no evidence of Citalopram or Ferrous Sulfate in the home. In an interview on 11/16/2021 at 12:15pm, Patient #2’s spouse stated Patient #2 had not taken Citalopram since the Buspirone was prescribed on 10/26/2021. Patient #2’s spouse further stated the patient had not taken Ferrous Sulfate for several months. Patient #3 Review of Patient #3’s record revealed Patient #3 had been seen in November on the following date 11/09/2021 by the skilled nurse and occupational therapist, and 11/13/2021 by the PTA. Review of Patient #3’s Client Medication Report revealed Buspirone (antianxiety medication) 10mg one tablet twice a day; Melatonin (supplement for sleep) 5mg one tablet at bedtime; and Trazodone (antidepressant) 50mg one tablet at bedtime (order date of 10/11/2021). Observation during home visit on 11/16/2021 at 1:15pm revealed no melatonin present in the home, and Buspirone 5mg one tablet twice a day with filled date of 10/13/2021. In an interview on 11/16/2021 at 1:15pm, Patient #3’s responsible party stated Patient #3 had not taken Melatonin since the Trazodone was prescribed, and had been taking Buspirone 5mg twice daily, and not 10mg as listed on the medication sheet. Patient #5 Review of Patient #5’s record revealed Patient #5 was seen by the skilled nurse on 11/10/2021. Review of Patient #5’s Client Medication Report revealed, in part: Clopidogrel (antiplatelet medication) 75mg one tablet three times a week; Doxycycline Hyclate (antibiotic) 50mg one tablet daily; Levocetirizine 5mg one tablet daily, and Temazepam 30mg one tablet daily. Observation during home visit on 11/16/2021 at 4:50pm revealed Clopidogrel 75mg one tablet daily filled on 10/09/2021. Further observation revealed no evidence of Doxycycline Hyclate, Levocetirizine (allergy medication), and Temazepam (medication for sleep) present in the home. In an interview on 11/16/2021 at 4:55pm, Patient #5 stated she was taking the medication per the directions on the medication containers provided to the surveyor, which was not the same as listed on the Client Medication Report. Patient #6 Review of Patient #6’s Record revealed Patient #6 was seen by the skilled nurse on 11/08/2021. Review of Patient #6’s Client Medication Report revealed, in part: Ditropan XL (extended release-long acting) (bladder medication)10mg one tablet twice a day, and Fycompa (seizure medication) 8mg one tablet daily. Further review revealed no evidence of Ondansetron HCL (medication for nausea and vomiting), Ciprofloxacin (antibiotic), or Zenpep (digestive enzyme) documented as medications received. Observation during home visit on 11/16/2021 at 2:00pm, revealed Ditropan XL 10mg one tablet daily with a filled date of 10/11/2021; Fycompa 10mg one tablet daily filled on 09/16/2021, Ondansetron HCL 4mg one tablet every eight hours as needed for nausea and vomiting filled on 11/02/2021, Ciprofloxacin HCL 250mg one tablet twice a day filled on 11/02/2021, Zenpep 15,000 units every day at lunch filled on 07/28/2021. In an interview on 11/18/2021 at 3:15pm, S2DON (Director of Nursing), and S3LPN (Licensed Practical Nurse) stated the agency was unable to present any information for the reason the medication profiles were not current and accurate. S2DON further stated the medication reconciliation review should have been updated anytime medication changes were assessed in the home.

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 record review and interview the agency failed to: Ensure the patient’s weight was assessed at every skilled nurse visit per their plan of care for 1 of 17 patients (Patient #12) reviewed for care per the plan of care; and Ensure labs were obtained as ordered by the physician for 1 of 5 patients (Patient #14) with orders for lab work in a total sample of 17. Findings: Patient #12 Review of Patient #12’s Home Health Certification and Plan of Care for certification period of 10/20/2021 to 12/18/2021 revealed Patient #12 was to receive skilled nursing services once a week for nine weeks. Further review revealed the skilled nurse to assess for weight increase at every visit (arm circumference measurement may be substituted for weight). Review of Patient #12’s Visit Note Reports dated 11/02/2021 and 11/08/2021 revealed no documented evidence of the skilled nurse having obtained an arm circumference measurement or weight on the visits. Review of Patient #12’s record revealed no documented evidence, and the agency provided no documented evidence of the skilled nurse having assessed or obtained a weight or arm circumference measurement on 11/02/2021 and 11/08/2021. In an interview on 11/18/2021 at 2:57pm, S2DON (Director of Nursing) stated the agency could not present any documented evidence of an arm circumference measurement or weight being obtained on Patient #12 on 11/02/2021 or 11/08/2021. Patient #14 Review of Patient #14’s Physician Orders dated 03/24/2021 revealed an order for CBC (Complete Blood Count) with Differential, CMP (Complete Metabolic Panel), TSH (Thyroid Stimulating Hormone), Hgb (Hemoglobin) A1c (blood test that checks for 3 month range of blood sugars), Lipid Panel, and Vitamin D 1 25-Dihydroxy (Vitamin D level) at the next skilled nurse visit. Review of Patient #14’s Record revealed no documented evidence, and the agency did not provide any documented evidence of Patient #14’s labs collected as ordered during the skilled nurse visits on 03/26/2021, 03/29/2021 and 03/31/2021. In an interview on 11/18/2021 at 3:02pm, S2DON and S3LPN (Licensed Practical Nurse) stated the agency was unable to present any documented evidence of Patient #14’s 03/24/2021 lab orders having been obtained or attempted to be obtained during the skilled nurse visits on 03/26/2021, 03/29/2021, and 03/31/2021. S2DON further stated the skilled nurse should have documented the labs were either obtained, unable to be obtained, or communicated with the physician as to why the labs were not obtained, and the skilled nurses did not document any of this information.

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 record review and interview the agency failed to ensure the physician or nurse practitioner was notified of new wounds for 1 of 17 patients (Patient #14) reviewed for a change in condition. Findings: Review of Patient #14’s Visit Note Report dated 02/28/2021 revealed, in part, Patient #14 was assessed as having a new fluid filled blister noted to the bilateral lower extremity. Further review revealed no documented evidence and the agency did not present any evidence of the registered nurse having notified Patient #14’s physician and/or nurse practitioner. In an interview on 10/18/2021 at 3:02pm, S2DON (Director of Nursing) and S3LPN (Licensed Practical Nurse) stated the agency was unable to present any information to the surveyor of the physician and/or nurse practitioner having been notified of Patient #14’s new wounds. S2DON and S3LPN further stated the nurse should have contacted the physician for further orders.