Every finding on record at Traditions Health Care of Longview LLC

The agency was in compliance with 42 CFR § 484.22, emergency preparedness requirements for home health agencies.

A recertification survey entrance conference was conducted on 01/10/22 at 9:30 a.m. with the administrator. Census: 67 L & C: 67 LHH: 0 PAS: 0 An exit conference was conducted on 01/12/22 at 12:25 p.m. with the administrator. The preliminary findings were discussed. Written instructions were provided for submitting a plan of correction within 10 days of the receipt of the Statement of Deficiencies. Acronyms used: L & C - Licensed and Certified LHH - Licensed Home Health mg - milligram PAS - Personal Assistance Services RN - Registered Nurse

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, interview, and record review, the agency failed to maintain a current medication list for 2 of 8 patients reviewed for medications. (Patient #’s 1 and 2) 1.Patient #1’s medication profile did not include Zocor 40 mg (treats high cholesterol) and Loratadine 10mg (treats seasonal allergies). Patient #1’s medication profile included Escitalopram 10mg (treats anxiety) and Mirtazapine 30mg (treats depression) that Patient #1 was not taking. 2.Patient #2’s medication profile did not include Atorvastatin 20mg daily, Divalproex 250mg daily, Folic acid 1mg daily, and Acetaminophen 500mg as needed. This failure could place patients at risk for significant side effects, drug interactions, and ineffective drug therapy. Findings included: 1.Record review of Patient #1’s plan of care dated 12/01/21 to 01/29/22 indicated she was 66 years old with a start of care date of 12/01/21. Her diagnoses included anxiety and hyperlipidemia (high cholesterol). Patient #1’s plan of care orders included for the skilled nurse to review the medication profile and reconcile medications as needed. During an observation and interview on 01/11/22 at 10:00 a.m., RN D reviewed Patient #1’s medications in the home against the medication profile. Patient #1’s medications included Zocor 40mg (treats high cholesterol) and Loratadine 10mg (treats seasonal allergies). RN D was unable to locate Patient #1’s Escitalopram 10mg (treats anxiety) or Mirtazapine 30mg (treats depression). Patient #1 said her physician switched her to Sertraline 50mg (treats anxiety) and she no longer was taking Escitalopram 10mg. She said she had not taken Escitalopram for a few months. Patient #1 said she did not take Mirtazapine 30mg and had no history of taking the medication. Patient #1 said she took Loratadine 10mg and Zocor 40mg every day and had for months. Record review of Patient #1’s medication profile indicated her admission date was 12/01/21. Patient #1’s current medications included Escitalopram 10mg daily, Sertraline 50mg daily, and Mirtazapine 30mg at bedtime. Patient #1’s medication profile did not include Zocor 40 mg and Loratadine 10mg. During an interview on 01/11/22 at 10:15 a.m., RN D said Patient #1’s medication profile was not current. She said Zocor 40mg and Loratadine 10mg should be on the medication profile and Escitalopram 10mg should have been removed. RN D said she would contact Patient #1’s physician about Mirtazapine 30mg to see if the medication was prescribed. RN D said she reviewed and updated patients’ medication profiles during each visit. RN D said she was a traveling nurse and she did not see Patient #1 on a regular basis. 2.Record review of Patient #2’s plan of care dated 12/27/21 to 02/24/22 indicated she was 69 years old with a start of care date of 12/27/21. Her diagnoses included vascular dementia, depression, anemia (low number of red blood cells), and hyperlipidemia (high cholesterol). Patient #2’s plan of care orders included for the skilled nurse to review the medication profile and reconcile medications as needed. During an observation and interview on 01/11/22 at 11:05 a.m., RN E reviewed Patient #2’s medications in the home against the medication profile. Patient #2’s medications included Atorvastatin 20mg daily (treats high cholesterol), Divalproex 250mg daily (treats seizures, migraine headaches, and psychiatric conditions) Folic acid 1mg daily (treats anemia), and Acetaminophen 500mg as needed (treats mild to moderate pain). Patient #2 said she took Atorvastatin, Divalproex, and Folic acid daily and Acetaminophen as needed and had taken the medications since admitting to home health services. Record review of Patient #2’s medication profile indicated her admission date was 12/27/21. Patient #2’s medication profile did not include Atorvastatin 20mg daily, Divalproex 250mg daily, Folic acid 1mg daily, and Acetaminophen 500mg as needed as current medications. During an interview on 01/11/22 at 11:45 a.m., RN E said Patient #2’s medication profile was not current. She said Atorvastatin 20mg daily, Divalproex 250mg daily, Folic acid 1mg daily, and Acetaminophen 500mg should be listed on Patient #2’s medication profile and she would add the medications to the patient’s medication profile. RN E said nurses should review and update medication profiles during each home visit. RN E said today (01/11/22) was her first home visit with Patient #2. During an interview on 01/12/22 at 10:20 a.m., the administrator said she expected nurses to review and update the medication profile during every skilled nurse visit. She said the when the medication profile was not correct, nurses could be teaching the patient’s about wrong medications, potentially leading to a negative outcome. Record review of the agency’s medication list policy dated 08/01/20 indicated “…the agency will maintain a current, accurate list of all prescription, over-the-counter medications, herbals and home remedies taken by the patient/client (Medication Profile) …professional clinical staff will update the medication list with any change in the medication regimen…”

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 observation, interview, and record review, the agency failed to ensure each patient received home health services that were written in the individualized plan of care for 1 of 8 patients reviewed for plan of care. (Patient #1) The agency did not ensure Patient #1’s weight was obtained during each home visit as ordered in her plan of care. This failure could plan patients at risk of weight loss/gain, not receiving interventions, and a decline in health. Findings included: Record review of Patient #1’s plan of care dated 12/01/21 to 01/29/22 indicated she was 66 years old with a start of care date of 12/01/21. Her diagnoses included dysphagia and unspecified protein calorie malnutrition. Patient #1’s plan of care orders included for the skilled nurse to obtain weight every visit and notify the RN or physician of a weight gain or loss of 3 pounds within 7 days. The goals listed in Patient #1’s plan of care indicated the patient would maintain stable weight during the episode. The plan of care indicated the Patient #1’s goals were to get better and gain weight. Record review of Patient #1’s visit notes indicated the following: *12/01/21-Patient #1 weighed 95 pounds; *12/09/21-Patient #1 weighed 96 pounds; *12/17/21- Patient #1 weighed 96 pounds; *12/23/21- Patient #1 weighed 96 pounds; *12/30/21-no weight documented for Patient #1; *01/06/22- no weight documented for Patient #1; *01/11/22- no weight documented for Patient #1. During an observation and interview on 01/11/22 at 10:00 a.m., RN D asked Patient #1 if she had a weight scale in her home and the patient said no. Patient #1 said she weighed 95 pounds the last time she weighed and she had diarrhea for the last 2 weeks. Patient #1 was not weighed during the home visit. During an interview on 01/11/21 at 10:15 a.m., RN D said the agency ordered a weight scale for Patient #1 on 12/28/21 but the patient had not received it. During an interview on 01/12/22 at 10:05 a.m., the supervising nurse said she was not aware that Patient #1 did not have a weight scale in the home. During an interview on 01/12/22 at 10:20 a.m., the administrator said she expected nurses to follow the plan of care. She said she was not aware that Patient #1 did not have a weight scale in the home. The administrator said some nurses carried weight scales in their vehicles, but they needed to ensure all nurses kept a weight scale in their vehicles. She said when the plan of care was not followed, it could potentially lead to a negative outcome of not being able to manage a patient’s disease process in the home. Record review of the agency’s plan of care policy dated 01/01/22 indicated “…each patient/client must receive the home health services that are written in an individualized plan of care that identified patient/client-specific measurable outcomes and goals…”