Every finding on record at Traditions Healthcare of Ponchatoula, LLC

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

Recertification Survey BID twice a day mg milligram mcg microgram TID three times a day

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 observations during home visits, interviews, and record review, the agency failed to ensure the patients’ comprehensive assessments included a review of all medications the patients were currently using. The agency failed to ensure skilled nursing staff reconciled a patient’s medications for 2 (#1 and #3) of 4 (#1, #2, #3, and #4) patients reviewed with home visits. Review of the agency’s policy titled “Medication List and Monitoring” revealed the following, in part: Purpose: To outline a process for ongoing medication monitoring Procedure: 1. The agency will maintain a current, accurate list of all prescription, over the counter and sample medications, herbals and home remedies taken by the patient/client. Professional clinical staff will update the medication list with any change in the medication regimen. 5. The registered nurse will compare the medication information (list) the patient/client is currently taking with the medication ordered to identify and resolve discrepancies to include omissions, duplications, contraindications, unclear information, and changes. Patient #1 Review of the Clinical Record for Patient #1 revealed a start of care date of 03/24/2023 and a current certification period of 03/24/2023 – 05/22/2023. Patient #1’s diagnosis was Infection/Inflammation reaction due to Internal Left Knee Prosthesis. Further review revealed Patient #1 received Skilled Nursing Visits once a week for one week, twice a week for one week and three times a week for 3 weeks. A home visit was conducted with Patient #1 on 04/17/2023 at 1:30 p.m. Patient #1’s medications were reviewed with S3LPN during the visit. The following medication discrepancies were identified based on the current Medication Profile provided by the Home Health Agency and medications Patient #1 was receiving: Linzess 290 mcg capsule – take daily - on Medication Profile but not present in the home. Lopressor 50mg tablet take 1 tablet BID - on Medication Profile but not present in the home. Magnesium 400mg 1 capsule TID - on Medication Profile but not present in the home. Ramipril 2.5mg capsule take 1 capsule daily - on Medication Profile but not present in the home. Tradjenta 5mg tablet – take 1 tablet daily - on Medication Profile but not present in the home. Zinc Sulfate 50mg take 1 tablet daily - on Medication Profile but not present in the home. An interview was conducted on 04/17/2023 at 1:45 p.m. with S3LPN. She said the nursing staff should reconcile Patient #1’s medications each visit. She said she was unaware Patient #1 was out of several of his medications. She said she was unaware that he had not had his eye drops for Glaucoma for the last week. Patient #3 Review of the Clinical Record for Patient #3 revealed a start of care date of 10/13/2022 and a current certification period of 02/10/2023 – 04/10/2023 and 04/11/2023 – 06/09/2023. Patient #3 had diagnoses, which included, Pressure Ulcer of Sacral Region, Stage 4, Paraplegia and Heart Failure. Further review revealed Patient #3 currently received Skilled Nursing Visits twice weekly for 9 weeks. A home visit was conducted with Patient #3 on 04/18/2023 at 1:00 p.m. Patient #3’s wife said she managed Patient #3’s medications. Patient #3’s medications were reviewed during the visit and confirmed with Patient #3’s wife. The following medication discrepancies were identified based on the current Medication Profile provided by the Home Health Agency and medications Patient #3 was receiving: Xanax 0.5mg tablet – take 1 tablet every 12 hours - on Medication Profile but not present in the home. Patient #3’s wife said he no longer took Xanax. She said his last dose had been 2 months ago. She said the nursing staff do not check his medications each visit. An interview was conducted on 04/18/2023 at 1:15 p.m. with S4RN. She said the nursing staff should reconcile Patient #3’s medications each visit. She said she was unaware Patient #3 no longer took Xanax. An interview was conducted on 04/19/2023 at 12:00 p.m. with S1DON. She said each patient’s medications should have been reconciled every visit by the Home Health Agency nurse. She confirmed Patient #1 and Patient #3’s medications should have been accurate on their medication profile.

Services by skilled professionals CFR(s): 484.75(a) Standard: Provision of services by skilled professionals. Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures. This STANDARD is not met as evidenced by: Based on interviews and record reviews, the home health agency failed to ensure the RN provided home health agency services in accordance with current clinical practice guidelines and accepted professional standards for 3 (#3, #6, and #7) of 3 (#3, #6, and #7) patients reviewed for pressure ulcers. The agency failed to ensure the RN assessed and staged Patient #3, #6 and #7’s pressure wounds on a weekly basis. Review of the Louisiana State Board of Nursing, Declaratory Statement Scope of Practice for Registered Nurses - Wound Care Management revealed, in part, the following: Registered nurses render care that is directed towards the prevention and the treatment of wounds. Scope of Practice - The Louisiana State Board of Nursing recognizes that assessment, planning, intervention, teaching, evaluation, and supervision are the major responsibilities of the registered nurse in the practice setting. The Registered nurse initiates appropriate wound prevention measures, stages wounds and collaborates with the wound care team in the implementation and evaluation of nursing interventions as prescribed by the authorized prescriber. Wound care management requires the registered nurse to collaborate with other members of the interdisciplinary team to ensure that the individual's nutritional and psychosocial needs are being met and to provide for preventive and therapeutic measures. The Registered Nurse should consult with the physician and/or CWCN (certified wound care nurse) to assure safe, quality nursing measures that facilitate appropriate skin and wound management. Review of the National Pressure Ulcer Advisory Panel Prevention and Treatment of Pressure Ulcers: Quick Reference Guide revealed, in part, the following: Pressure Ulcer Assessment 1. Assess the pressure ulcer initially and re-assess it at least weekly. 1.1. Document the results of all wound assessments. Assess and document physical characteristics including: location, Category/Stage, size, tissue type(s), color, peri-wound condition, wound edges, sinus tracts, undermining, tunneling, exudate, and odor. Patient #3 Review of the Clinical Record for Patient #3 revealed the patient began receiving services with the agency on 10/13/2022 and had a current certification period of 04/11/2023 – 06/09/2023. Patient #3 had diagnoses, which included, Pressure Ulcer of Sacral Region/Stage 4, Paraplegia and Heart Failure. Review of the current Physician’s Orders for Patient #3 revealed the following, in part: 04/11/2023-Wound care: Cleanse with wound cleanser. Apply Medi honey to wound bed. Cover with abdominal pad using clean/aseptic technique. Review of the nursing visits conducted for Patient #3 for the certification period of 02/10/2023 – 04/10/2023 revealed he was seen by an LPN on the following weeks: 02/12/2023, 02/19/2023, 02/26/2023, 03/05/2023, 03/12/2023, 03/19/2023, 03/26/2023, and 04/09/2023. Patient #3’s Sacral Pressure Ulcer was not assessed by a RN on the weeks of 02/12/2023, 02/19/2023, 02/26/2023, 03/05/2023, 03/12/2023, 03/19/2023, 03/26/2023, and 04/09/2023. Patient #6 Review of the clinical record for Patient #6 revealed the patient began receiving services with the agency on 11/16/2022 and had a current certification period of 03/16/2023 – 05/14/2023. Patient #6 had a diagnosis, which included, Pressure Ulcer of Sacral Region, Stage 4. Review of the current Physician’s Orders for Patient #6 revealed the following, in part: Clean wound with wound cleanser or Normal Saline. Apply Adaptic to wound bed. Apply Betadine soaked gauze over the Adaptic. Cover with abdominal pad. Secure with tape. Review of the nursing visits conducted for Patient #6 for the certification period of 03/16/2023 – 05/14/2023 revealed he was seen by LPN on the following weeks: 03/19/2023, 04/9/2023 and 04/16/2023. Patient #6’s Pressure Ulcer of Sacral Region, Stage 4 was not assessed by a RN on the weeks of 03/19/2023, 04/9/2023 and 04/16/2023. Patient #7 Review of the clinical record for Patient #7 revealed the patient began receiving services with the agency on 03/24/2023 and had a current certification period of 03/24/2023 – 05/22/2023. Patient #7 had a diagnosis, which included, Pressure Induced Deep Tissue Damage of Right Heel. Review of the current Physician Orders for Patient #7 revealed the following, in part: Cleanse with wound cleanser or Normal Saline. Apply sugar-dine on to area of eschar to right heel. Cover with abdominal pad and secure with Kerlix and Coban/Ace wrap. Review of the nursing visits conducted for Patient #7 for the certification period of 03/24/2023 – 05/22/2023 revealed she was seen by an LPN on the following weeks: 03/26/2023 and 04/02/2023. Patient #7’s Pressure Induced Deep Tissue Damage of Right Heel was not assessed by a RN on the weeks of 03/26/2023 and 04/02/2023. An interview was conducted on 04/20/2023 at 12:30 p.m. with S1DON. She verified pressure wounds should be assessed and measured by an RN at least weekly. She confirmed an RN had not assessed or measured Patient #3, #6 and #7’s wounds listed above weekly.

12 hours inservice every 12 months CFR(s): 484.80(d) Standard: In-service training. A home health aide must receive at least l2 hours of in-service training during each 12-month period. In-service training may occur while an aide is furnishing care to a patient. This STANDARD is not met as evidenced by: Based on record review and interview, the Home Health Agency failed to ensure the home health aide received at least 12 hours of in-service training during each 12-month period, as evidenced by failure to have documented evidence that such training had been conducted by the agency. The agency failed to ensure S2CNA received yearly ongoing in-service training. Review of the personnel record for S2CNA revealed no documented in-service training for year 2022. Further review revealed S2CNA had completed year 2022’s training on 04/20/2023. An interview was conducted on 04/20/2022 at 2:00 p.m. with S1DON. She said S2CNA did not complete any in-service training for year 2022. She confirmed she had no documentation to present to indicate the regulatory requirement had been met related to aide in-service training for year 2022.