Every finding on record at Tennessee In-Home Partner-III, LLC

An Emergency Preparedness (EP) survey was conducted on 3/22/2023 during the recertification. The facility was found to meet the requirements for EP.

A recertification survey was initiated on 3/202023 at 10:05 AM during an entrance conference with the Home Health Agency (HHA) Executive Director (ED). An exit meeting was held on 3/22/2023 with the ED and two Performance Improvement Coordinators (via zoom). The HHA staff were informed of the survey findings and were provided an opportunity to ask questions.

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 policy review, medical record review, observation and interview the facility failed to ensure medications were updated to reflect the current medication regimen for 1 of 4 (Patient #1) sampled patients observed during home visits. The findings included: 1. Review of the facility policy “Medication Management” revealed, “To provide a process to ensure continuous monitoring of medications in the patient’s home…all clinicians will participate in medication review and reconciliation throughout the episode…For patients receiving skilled nursing and therapy services, the skilled nurse is responsible for medication review and reconciliation throughout the episode. The therapist will participate by monitoring and reporting any identified medication issues or non-compliance to the Patient Care Manger…The discipline responsible for the drug regimen review will…Review all medications including over the counter (OTC) medications, vitamins, herbs and herbal products…All clinicians participating in the patient’s care plan are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care…” 2. Medical record review for Patient #1 revealed an 86-year-old female admitted on 3/9/2023 with the primary diagnosis of Hypertension. Observations in the home on 3/20/2023 at 12:00 PM, revealed the following medications not listed on the medicine list: over the counter (OTC) Mouth Coat spray for dry mouth, OTC Alka-Seltzer chewable tablets for heart burn, OTC Vicks vapor rub for congestion. The following medications were not documented accurately on the medicine list: Clonidine 0.1 milligram (mg) take one twice daily, Ergocalciferol (Vitamin D2) 1250 micrograms (MCG) 50,000 unit capsule take one time per month, Metformin 500 mg tablet take 1 and ½ tablets one time a day. In an interview Patient #1 confirmed she was taking the above referenced medications and she stated she used the OTC medications as needed. 3. Medical record review for Patient #4 revealed a 65-year-old male admitted on 12/19/2022 with the primary diagnosis of Striatonigral Degeneration (neurological disorder). Observations in the home on 3/20/2023 at 12:00 PM, revealed the following OTC medications not listed on the medicine list: Doterra Vegan Micro-plex with vitamins A, C, E, B and D combined and Doterra Alpha CRS a dietary supplement with botanical extracts. In an interview on 3/21/2023 at 1:30 PM, Patient #4's wife stated Patient #4 took the above referenced OTC supplements once daily.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on policy review, medical record review and interview, the facility failed to ensure the Plan of Care (POC) was followed for 1 of 1 (Patient #4) patients reviewed receiving speech therapy services. The findings included: 1. Review of the facility policy "Coordination of Care From Admit Through Discharge" revealed, "To establish processes and criteria so that the coordination of patient care will be optimal...At admission, throughout care, and at discharge, coordination of services is promoted through routine communication with the patient's physician...When a missed visit occurs altering the Plan of Care..." 2. Medical record review for Patient #4 revealed a 65-year-old male admitted on 12/19/2022 with the primary diagnosis of Striatonigral Degeneration (neurological disorder). A speech therapy (ST) evaluation was performed on 2/23/2023 with recommendations for ST two times per week for seven weeks. The physician signed the order for ST two times per week on 2/24/2023. There were no documented ST visits for the week of 3/5/2023. There was no documentation of physician notification of the alteration to the plan of care. 3. In an interview on 3/22/2023 at 11:04 AM, the Executive Director (ED) stated no ST visits were made the week of 3/5/2023 because the family reported Patient #4 was not feeling well. In an interview on 3/22/2023 at 11:18 AM, the ED verified there was no documentation in the medical record for the reason ST was omitted and no physician notification of the missed ST visits.