Every finding on record at The Medical Team Inc

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

Recertification Survey

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 the skilled nurses were reconciling medication every visit for 3 of 7 sampled patient (Patient #1, Patient #2, and Patient #6) reviewed during home visits in a total investigative sample of 17. Findings: Patient #1 Review of Patient #1’s Home Health Certification and Plan of Care for certification period of 02/12/2022 thru 04/12/2022 revealed Patient #1 was to receive skilled nursing services twice a week for eight weeks. Review of Patient #1’s record revealed the skilled nurse had last seen Patient #1 on 04/01/2022. Review of Patient #1’s Patient Medication Record revealed, in part: Metformin HCL (hydrochloride) (diabetic medication) 500mg (milligrams) one tablet per peg tube (artificial feeding tube) daily; Gabapentin (medication for nerve pain) 300mg one capsule per peg three times a day; Aubagio (neuromuscular medication) 14mg per peg daily; Zinc Sulfate (medication used for wound healing) 220mg one tablet per peg daily; Linzess (medication for constipation) 145mcg (micrograms) one capsule daily as needed for constipation; Topamax (seizure medication) 25mg two tablet by mouth at bedtime; Tizanidine HCL (muscle relaxer) 4mg one tablet three times a day per peg tube; Baclofen (muscle relaxer) 20mg one tablet per peg four times a day. Further review revealed no documented evidence of Lexapro (antidepressant) having been documented as a current medication. Observation on 04/06/2022 at 9:20am with Patient #1’s son revealed the following: Metformin HCL 500mg (milligrams) one and half tablet per peg tube (artificial feeding tube) every other day with filled date of 03/25/2022; Gabapentin 400mg one capsule per peg three times a day with a filled date of 02/16/2022; Aubagio was not present in the home and Patient #1’s son stated she was not currently taking the medication; Zinc Sulfate was not present in the home and Patient #1’s son stated she was not currently taking the medication; Linzess 290mcg one capsule daily as needed for constipation (sample bottle); Topamax was not present in the home and Patient #1’s son stated she was not currently taking the medication; Tizanidine HCL 4mg one tablet three times a day per peg tube and two tablets per peg at bedtime with filled date of 02/08/2022; Baclofen 20mg one tablet per peg every morning and two tablets at bedime with filled date of 02/23/2022; and Lexapro 10mg one tablet per peg once a day with a filled date of 01/31/2022. In an interview on 04/06/2022 at 9:20am, Patient #1’s son confirmed the medication was taken as documented in the observations. In an interview on 04/08/2022 at 2:27pm, S1Administrator/DON (Director of Nursing) and S2Alternate Administrator/DON stated the agency had no further information to present regarding the medication discrepancy for Patient #1. Patient #2 Review of Patient #2’s Home Health Certification and Plan of Care for certification period of 03/07/2022 thru 05/05/2022 revealed Patient #2 was to receive skilled nursing services once a week for nine weeks. Review of Patient #2’s record revealed Patient #2 was last seen by the skilled nurse on 03/31/2022. Review of Patient #2’s Patient Medication Record revealed, in part, Amitriptyline HCL (antidepressant) 25mg one tablet by mouth once every night. Observation on 04/06/2022 at 9:40am, revealed no Amitriptyline HCL present in the home. In an interview on 04/06/2022 at 9:40am, Patient #2 stated he had stopped the Amitriptyline HCL about two months ago because it made him weak. In an interview on 04/06/2022 at 2:30pm, S1Administrator/DON stated the nurses should reconcile medications every visit. Patient #6 Review of Patient #6’s Home Health Certification and Plan of Care for certification period of 02/12/2022 thru 04/12/2022 revealed Patient #6 was to receive skilled nursing services once a week for nine weeks. Review of Patient #6’s record revealed Patient #6 was last seen on 04/01/2022. Review of Patient #6’s Patient Medication Record revealed no documented evidence of Tizanidine HCL having been documented as a medication. Observation on 04/07/2022 at 9:00am revealed Tizanidine HCL 4mg one tablet by mouth every eight hours as needed with filled date of 03/21/2022. In an interview on 04/08/2022 at 2:27pm, S1Administrator/DON (Director of Nursing) and S2Alternate Administrator/DON stated the agency had no further information to present regarding the medication discrepancy for Patient #6.

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: Notify the physician for a patient with a change in wound status for 1 (Patient #9) of 17 sampled patients reviewed for change in status; andEnsure the physician was aware of abnormal labs for 1 (Patient #15) of 3 sampled patients reviewed with lab orders, in a total investigative sample of 17. Findings: Patient #9 Review of Patient #9’s Home Health Certification and Plan of Care for certification period of 03/02/2022 to 04/30/2022 revealed Patient #9 was to receive skilled nursing services once a week for nine weeks. Review of Patient #9’s Skilled Nursing Visit Note dated 03/23/2022 revealed Patient #9 was identified as having a Stage 1 pressure ulcer to sacrum (red skin which does not lighten when pressed). Review of Patient #9’s Skilled Nursing Visit Note dated 03/30/2022 revealed stage 2 pressure ulcer (wound which skin was not intact) noted to sacrum. Further review revealed no documented evidence and the agency did not present any documented evidence of Patient #9’s physician having been notified of the newly open wound. In an interview on 04/08/2022 at 2:49pm, S2Alternate Administrator/DON (Director of Nursing) stated the agency was unable to provide any information of Patient #9’s physician having been notified when Patient #9’s wound changed from a stage 1 to a stage 2 pressure ulcer, and the physician should have been notified. Patient #15 Review of Patient #15’s Home Health Certification and Plan of Care for certification period of 11/16/2021 to 01/14/2022 revealed Patient #15 was admitted with diagnoses of, in part: Hypertensive Heart Disease, Chronic Kidney Disease, Congestive Heart Failure, and Diabetes Mellitus Type II. Review of Patient #15’s Physician Order dated 11/18/2021 revealed skilled nurse for venipuncture to collect for Comprehensive Metabolic Profile (CMP); Magnesium, B-type Natriuretic Peptide (BNP) level; and Phosphorous run STAT (immediately) on skilled nurse visit on 11/22/2021. Review of Patient #15’s Lab Results dated 11/22/2021 revealed 17 lab values which were not within normal limits. Review of Patient #15’s Physician Order dated 11/30/2021 revealed skilled nurse for venipuncture to collect for CMP; Magnesium, BNP level; and Phosphorous run STAT on skilled nurse visit on 12/06/2021. Review of Patient #15’s Lab Results dated 12/06/2021 revealed 14 lab values which were not within normal limits. Review of Patient #15’s record revealed the labs were faxed on 11/22/2021 and 12/06/2021; however, the agency had no documentation of confirming the physician received the results or follow-up on the labs. In an interview on 04/08/2022 at 3:07pm, S1Administrator/DON stated the agency did not have any documented evidence of Patient #15’s physician having reviewed and followed up on Patient #15’s labs.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on observation, record review, and interview the agency failed to ensure: The HHA (Home Health Aide) used a barrier for equipment for 1 of 7 sampled patients (Patient #1) observed during home visits; The HHA cleaned equipment prior to and/or after patient use for 1 of 7 sampled patients (Patient #1) observed during home visits; andThe skilled nurse removed her gloves and used hand hygiene between cleaning wounds, and dirty and clean wound care procedures for 1 of 2 patients (Patient #2). The agency had a total investigative sample of 17. Findings: Review of the agency’s Standard Precautions Policy and Procedure revealed, in part: -Reusable equipment must be wiped with alcohol or other appropriate cleaning solution prior to returning to carrying case; -Disposable gloves will be removed and discarded after contact with each fluid item or surface. Patient #1 Review of Patient #1’s Home Health Certification and Plan of Care for certification period of 02/12/2022 thru 04/12/2022 revealed the home health aide was to provide services twice a week for eight weeks. Observation on 04/06/2022 at 9:10am revealed S3HHA (Home Health Aide) entered Patient #1’s room and placed her bag on a bench near the patient’s bed without a barrier under the bag. Further observation revealed the equipment (blood pressure cuff and thermometer) was not cleaned prior to being used on Patient #1, then after use were not cleaned prior to being placed back in the bag. In an interview on 04/07/2022 at 9:55am, S1Administrator/DON (Director of Nursing) stated the above observation was a break in infection control standards. Patient #2 Review of Patient #2’s Home Health Certification and Plan of Care for certification period of 03/07/2022 thru 05/05/2022 revealed Patient #2 was to receive skilled nursing services once a week for nine weeks. Observation on 04/06/2022 at 9:40am revealed S4RN (Registered Nurse) cleaned Patient #2’s left anterior (front of) ankle and applied a new bandage; S4RN then without changing gloves removed Patient #2’s right ankle dressing, cleaned the wound and without changing gloves or using hand hygiene applied the new dressing. In an interview on 04/07/2022 at 10:00am, S1Administrator/DON stated the nurse should have changed her gloves between wounds, and dirty and clean tasks.

In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This ELEMENT is not met as evidenced by: Based on record review and interview the agency failed to obtain weekly wound care measurements to assess for wound status per professional standards for 3 of 7 patients (Patient #1, Patient #2 and Patient #13) reviewed for wound care in a total investigative sample of 17. Findings: Review of Wound Care Educator's Article on Wound Measurements and Techniques revealed wound measurement is an essential part of wound management. Without techniques firstly to assess the size and extent of a wound and then to measure its progress, it is difficult to formulate an effective wound management strategy. Review of the agency’s Wound Assessment Policy and Procedure revealed for patients with wounds, wound assessment together with measurements will be documented in the clinical record. Further review of the agency’s Wound Assessment Policy and Procedure revealed the patient’s wounds would be measured at least weekly by the licensed personnel. Patient #1 Review of Patient #1’s Home Health Certification and Plan of Care for certification period of 02/12/2022 thru 04/12/2022 revealed Patient #1 was to receive skilled nursing services twice a week for eight weeks. Further review revealed Patient #1 had a stage 4 pressure ulcer to the left buttock and a stage 3 pressure ulcer to the right buttock. Review of Patient #1’s Record revealed no documented evidence of wound measurements obtained on the following weeks: 02/14/2022 to 02/20/2022; 02/21/2022 to 02/27/2022; 02/28/2022 to 03/06/2022; and 03/14/2022 to 03/20/2022. In an interview on 04/08/2022 at 2:27pm, S1AdministratorDON (Director of Nursing) and S2Alternate Administrator/DON stated the agency nurses were to measure all wounds on a weekly basis. S1AdministratorDON (Director of Nursing) and S2Alternate Administrator/DON stated Patient #1’s wounds were not measured weekly per agency policy. Patient #2 Review of Patient #2’s Home Health Certification and Plan of Care for certification period of 03/07/2022 thru 05/05/2022 revealed Patient #2 had a right ankle wound. Further review revealed the skilled nurse to provide services once a week for nine weeks. Review of Patient #2’s Record revealed no documented evidence of wound measurements obtained on the following weeks: 03/14/2022 to 03/20/2022; 03/21/2022 to 03/27/2022; and 03/28/2022 to 04/03/2022. In an interview on 04/08/2022 at 2:30pm, S1AdministratorDON (Director of Nursing) and S2Alternate Administrator/DON stated the agency nurses should have measured the wound weekly. Patient #13 Review of Patient #13’s Home Health Certification and Plan of Care for certification period of 03/22/2021 thru 05/20/2021 revealed the skilled nurse was to provide services twice a week for one week then once a week for eight weeks. Review of Patient #13’s Physician Orders dated 03/25/2021 revealed left lateral wound cleanse with normal saline apply gentian violet to wound edges, apply Santyl to wound bed and pack lightly with Silver Alginate tope and cover with bordered gauze dressing daily and as needed. Review of Patient #13’s record revealed no documented evidence and the agency presented no documented evidence of Patient #13’s wound having been measured the weeks of 04/12/2021 to 04/18/2021 and the week of 04/19/2021 to 04/25/2021. In an interview on 04/08/2022 at 2:57pm, S1AdministratorDON (Director of Nursing) and S2Alternate Administrator/DON stated the agency did not have any evidence of the nurse having measured the wounds on the weeks in question.