Every finding on record at United Home Care

The following reflects the findings of the California Department of Public Health during an EMERGENCY PREPAREDNESS SURVEY conducted 7/11/23 through 7/13/23. Representing the Department of Public Health: Health Facilities Evaluator Nurse (HFEN), 43247 HFEN, 34980 HFEN, 36681 HFEN, 46872 HFEN, 45882 The agency reported 683 unduplicated annual admissions. The patient sample size was 13 and 5 home visits were conducted. The Department was unable to substantiate a violation of the Emergency Preparedness regulations.

The following reflects the findings of the California Department of Public Health during a Recertification Survey conducted 7/11/3 through 7/13/23. Representing the Department of Public Health: Health Facilities Evaluator Nurse-HFEN, 43247 HFEN, 34980 HFEN, 36681 HFEN, 46872 HFEN, 45882 The agency reported 683 unduplicated annual admissions. The patient sample size was 13 and 5 home visits were conducted.

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 Home Health Agency (HHA) failed to ensure that one of 13 sampled patients (Patient 13) had an accurate medication profile when the medication profile did not reflect Patient 13's medications in the home. This failure had the potential for Patient 13 to receive incorrect medication dosage or experience an adverse effect. A review of Patient 13's "Home Health Care Certification and Plan of Care (POC)," for certification period 6/30/23 to 8/28/23, indicated that Patient 13 had a Start of Care (SOC) date with the HHA on 6/30/23 and had multiple diagnoses including diabetes (too much sugar in the blood), acute kidney failure (kidneys cannot filter waste from the blood), and pulmonary hypertension (high blood pressure that affects the arteries in the lungs and heart). The POC, certification period 6/30/23 to 8/28/23, indicated; "...Medication: ...Revatio [medication for pulmonary hypertension] 20 mg [milligrams] oral tablet: Take 1 tab(s) orally 3 times a day Start Date: 06/30/2023... Orders/Treatments; ...Skilled Nursing to Assess and Evaluate 6/29/23 through 7/1/23...Skilled Nursing; 2 wk 1 wk [two times a week for one week]; Beginning during week of 7/2/2023 - Ending on 7/8/23...Skilled Nursing: 1 wk 5 wk [one time a week for five weeks]: Beginning during week of 7/9/23 - Ending on 8/12/23..." A review of Resident 13's "Medication Profile," printed 7/11/23, indicated: "...Start Date...6/30/2023 Revatio 20 mg oral tablet; Take 1 tab(s) orally 3 times a day..." A review of Patient 13's "Skilled Visit Note," dated 7/12/23, indicated "...Medication Profile reviewed for new or changed medications and identification of possible issues with both prescription and non-prescription medications Issues identified: Other: Surveyor found discrepancies in med [medication] regime...NARRATIVE NOTES...State surveyor reviewed med regime with Sn [skilled nurse] and pt [patient]. There is a discrepancy with her Revitio [sic] dosing. Sn to call MD [medical doctor] to clarify..." During a concurrent observation and joint interview with Licensed Nurse (LN) and Patient 13 on 7/12/23 at 9:20 a.m., LN stated that medication reconciliation was not done for every patient at every visit. LN stated she asks patients during visit if there have been any medication changes. LN stated that medication reconciliation was completed at first visit or if patient had a physician's visit and may have had medication changes. During an observation of Patient 13's medication bottle labeled "... Revatio Tabs 20 mg... Take 2 tablets Three Times A Day..." with LN and Patient 13, LN confirmed Patient 13's "Medication Profile" indicated Revatio dosage was 1 tablet three times a day and did not accurately reflect how Patient 13's medication bottle was labeled in the home. Patient 13 stated she was not sure of the dosage instructions as her daughter manages her medications by placing them in a pill organizer box. During an interview on 7/12/23 at 10:26 a.m. and subsequent interview on 7/12/23 at 10:51 a.m. with the Director of Clinical Services (DCS), the DCS stated the nurse should ask patients at each visit if there are any new medications or medication changes. The DCS stated that at the SOC visit the nurse should see every bottle and compare with the medication profile. The DCS stated a complete medication reconciliation is not done at every visit but should be done if needed based on the patient's knowledge level. The DCS acknowledged the discrepancy between Patient 13's dosage of Revatio on her "Medication Profile" and on the medication bottle in the home. The DCS stated the discrepancy should have been identified during medication reconciliation at the SOC visit on 6/30/23. The DCS stated that there was no documentation that the medication dosage had been changed at the SOC on 6/30/23 or after the SOC visit. A review of the HHA policy and procedure (P&P) titled "Medication Reconciliation," revised 2/21, the P&P indicated "...The Agency will reconcile patient's medications at time of admission and on an ongoing basis 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 non-compliance with drug therapy...At time of admission, the admitting RN [registered nurse], PT [physical therapist], or SLP [speech language pathologist] will create and document a complete list of medications that patient is taking at home, including dose, strength, route, and frequency...Any concerns or discrepancies will be reconciled by a RN with the patient's physician/practitioner..."

Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient's needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This ELEMENT is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) failed to ensure that services were coordinated for one of thirteen sampled patients (Patient 10) when the facility did not conduct Interdisciplinary Group (IDG) Meetings for Patient 10 for two out of five certification periods. This failure had the potential to disrupt the coordination and continuity of care and services provided to Patient 10. Review of Patient 10's clinical record indicated Patient 10 had a Start of Care (SOC) date with the HHA on 8/18/22 for multiple diagnoses including Parkinson's disease (disorder of the nervous system that affects movement), dementia (impairment of memory and abstract thinking), and failure to thrive (weight loss, decreased appetite, and poor nutrition). Review of Patient 10's clinical record indicated Patient 10's "Home Health Care Certification and Plan of Care (POC)" certification periods were: 8/18/22 to 10/16/22,10/17/22 to 12/15/22, 12/16/22 to 2/13/23, 2/14/23 to 4/14/23, 4/15/23 to 6/13/23, and the current certification period 6/14/23 to 8/12/23. Review of Patient 10's clinical record indicated: "Interdisciplinary Group Conference Communication," dated 8/31/22, for initial certification period 8/18/22 to 10/16/22, and "Interdisciplinary Group Meeting," dated 12/7/22, for recertification period 10/17/22 to 12/15/22, and "Interdisciplinary Group Meeting," dated 2/8/23, for recertification period 12/16/22 to 2/13/22. During a joint interview on 7/11/23 at 9:59 a.m. with the Administrator (ADM) and the Director of Clinical Services (DCS), the ADM stated that care conferences or IDG meetings to coordinate care are held weekly. The DCS stated that new admissions, recertifications, and patients with concerns are discussed during the IDG meetings. During an interview and record review on 7/11/23 at 3:14 p.m. with the ADM, reviewed Patient 10's certification periods and IDG meetings dated 8/31/22, 12/7/22, and 2/8/23. The ADM acknowledged that there were no IDG meetings documented for recertification periods 2/14/23 to 4/14/23 and 4/15/23 to 6/13/23. The ADM stated, "It is the expectation that an IDG meeting will be done during initial certification period and during each recertification period." A review of the HHA policy and procedure (P&P) titled "Coordination of Care," revised 2/21, the P&P indicated "...Agency staff members regularly communicate to ensure that efforts are coordinated effectively and ultimately support the objectives outlined in the plan of care...To ensure that quality services are being provided to patients: to provide a mechanism for representatives from various disciplines to discuss patient care in a group meeting; and to determine eligibility for care... Case conferences are held on an ongoing basis to discuss any new admissions, patients to be recertified within the next 30 days and any problems. Documentation of case conferences will be maintained in the patient's medical record..."