Every finding on record at Upmc Home Healthcare of Central Pennsylvania

Based on the findings of an onsite unannounced Medicare recertification and state relicensure survey conducted 3/8/2024 through 3/15/2024, UPMC Home Healthcare of Central Pennsylvania was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies – Emergency Preparedness.

Based on the findings of an onsite unannounced Medicare recertification and state relicensure survey conducted 3/8/2024 through 3/15/2024, UPMC Home Healthcare of Central Pennsylvania was found not to be in compliance with the following requirement of 42 CFR, Part 484, Subparts B and C, Conditions of Participation.

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 a review of agency policy and procedure, patient observations visits (OBV), medical record (MR) and staff (EMP) interview, it was determined that the agency failed to maintain an accurate medication profile to ensure review of all medications the patient was taking, address potential adverse effects, drug reactions, ineffective drug therapy, significant side effects and drug interactions for three (3) of seventeen (17) MR’s reviewed (MR4-OBV6, MR7-OBV3, MR10). Findings Included: Review of agency policy and procedure on 3/13/2024 at approximately 12:45 PM revealed, "Category: M MEDICATIONS MEDICATION MANAGEMENT RECONCILIATION… Accurate and complete reconciliation of medications should occur across the continuum of care…EQUIPMENT Patient medication(s) and delivery method, Discharge summary, Agency patient Medication List, patient documentation record access (Medication Profile) PROCEDURE…4. All ordered medications must be listed accurately on a paper list and entered electronically into the medical record…9. If needed, create the Patient Medication List that includes ALL medications the patient is taking. The sources of information for the Patient Medications List should include: a. Patient pill containers, prescriptions, OTC medications, vitamins, herbal supplements, topicals, IV medications/flushes, eye drops. b. Hospital discharge list of medications, if applicable, and referral information. C. Medications listed in the electronic record from previous admissions. d. Medication lists created by the patient. e. Information elicited from patient by questioning i.e. medications they may take occasionally, or medications kept in different parts of the home…f. Information about medications taken infrequently i.e., B12, Fosamax. g. Medications not reordered following a change in the plan of care (i.e., following a hospitalization). 14.Assess the patient’s allergy history. If the patient has a known or suspected allergy/adverse reaction history or sensitivity to a medication, I will not be administered. Contact the physician, PA or CRNP for further direction. (Therapy staff refer to a nurse) for assistance…17. Check for adverse interactions and notify physician, PA, or CRNP if severity Level 1 drug interaction is identified. Therapy staff refer to a nurse for assistance…” Review of (OBV6 MR4) was conducted on 3/14/2023 at approximately 1:55 PM, a review of the plan of care listed the start of care 3/1/2024 for a current certification period starting 3/1/2024 and ending 4/29/2024. The primary diagnosis was urinary tract infection, site not specified. The agency "Medication profile" dated 3/12/2024 was compared to the facilities "PHYSICIAN’S ORDERS date printed 3/14/2024. The following medication was not listed on the agency medication profile. “POT CL MICRO TAB 10MEQ ER…TAKE 1 TABLET BY MOUITH ONCE DAILY…3/6/2024.” Review of (OBV3-MR7) on 3/14/2024 at approximately 10:28 AM revealed, a review of the plan of care with a start date of 1/12/2023 and a current certification period starting 1/19/2024 and ending 3/18/2024. The primary diagnosis was other complications of procedures, not elsewhere classified. The home health certification and plan of care and medication profile did not list one of two patient allergies. Allergies listed on the agency medication profile printed 3/12/2024 and the plan of care was “Lisinopril.” Listed on the agency “Patient Information Facesheet… Allergies metoprolol…lisinopril” Review of MR10 on 3/12/2024 at approximately 1:48 PM revealed, a review of the plan of care with a start date of 3/7/2023 and a current certification period starting 3/1/2024 and ending 4/29/2024. The primary diagnosis was acute tracheitis without obstruction. The home health certification and plan of care and medication profile was compared to the medical record document “Continuity of Care Document 2/26/2023.” The agency documentation did not list three (3) of four (4) patient allergies. Allergies listed on the agency medication profile printed 3/11/2024 and the plan of care was “cefepime.” Listed on the continuity of care document was “Allergies, Adverse Reactions, Alerts…propofol…cefepime1…Lactated Ringers Irrigation…Plasma-Lyte…” An exit interview with the senior director of regional home health services, vice president of clinical operations, manager of quality and compliance, director of clinical operations. Via conference call the following staff joined the exit conference: president of home health and hospice, senior director of quality and compliance, director of quality and compliance, senior manager of quality and compliance, physical therapy director rehab services, occupational therapy coordinator, (two) 2 quality and compliance coordinators and (nine) 9 clinical managers on 3/15/2024 at approximately 11:55 AM confirmed the above findings.

Based on the findings of an onsite unannounced state relicensure and Medicare re-certification survey completed March 9, 2021, Upmc Home Healthcare Of Central Pennsylvania was found to be in compliance with the requirements of 42 CFR, Part 484.22, Subpart B, Conditions of Participation: Home Health Agencies-Emergency Preparedness.

Based on the findings of an onsite unannounced home health agency Medicare recertification survey completed March 9, 2021, Upmc Home Healthcare Of Central Pennsylvania , was found to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician is consulted to approve additions or modifications to the original plan. This STANDARD is not met as evidenced by: Based on review of agency policy, clinical records, and staff interview (EMP), the agency failed to ensure the plan of care included pain control goals for one (1) of one (1) consumers (CR) who required pain management. (CR#6) Finding include: On 3/9/2021 at approximately 1:49 PM, review of agency policy #202, titled "Care Planning", revealed the following: "An individualized, physician ordered plan of treatment /care for all services is established ... D. Integration of assessment findings into care planning: 1. Development of a plan of care, treatment and services is based on the data from assessments. The plan of care includes identified and individualized patient needs, reasonable and measurable goals ... 2. Assessment findings will be used to address the individual patient ' s problems and needs. Goals will be developed for care, treatment or services and are revised as necessary based on the patients/caregiver ' s: Limitations, strengths and needs, Condition, ... " CR6's record was reviewed on 3/8/2021 at approximately 11:10 a.m. Review of CR6 revealed start of care (SOC) 2/26/2021. CR6 primary diagnosis was necrotizing fasciitis (a rare infection of the skin and tissues below it, sometimes referred to as flesh eating bacteria) and that skilled nursing (SN) was to provide the following treatment to the right groin surgical wound as documented on the "Home Health Certification and Plan of Care" for the recertification period of 2/26/2021 through 4/26/2021: NPWT (negative pressure wound therapy)/VAC (a wound vacuum that helps a wound heal) Cleanse the wound with either NSS (Normal Saline Solution), wound cleanser or mild soap and water. Frequency of dressing change 3 times per week, pressure set 125 mmHg, therapy setting continuous, type of dressing black sponge. Medications included Oxycodone 5mg take one tablet by oral route every four hours as needed for moderate to severe pain. Review of "Wound Assessment" documentation by the RN (EMP#4) dated 2/26/2021 revealed the right groin wound measured 25 cm x 4 cm x 4.1 cm with tunneling at 3 o ' clock measuring 5 cm. Review of "Skilled Nursing Assessment " documentation by the RN (EMP#4) dated 2/26/21 revealed pain in the right groin, acute, sharp, shooting, intensity 10, best response to control measures a 3, worse with wound vac change, pain controlled when wound vac not being changed, frequency of pain interfering with patients activity or movement all the time Review of "Plan for Next Visit " documentation by the RN (EMP#4) dated 2/26/21 revealed " instructed to take pain med approx 1 hour prior to vac dressing being changed " . Nursing Teaching Instructions by the RN (EMP#4) dated 2/26/21 read " Pain management/evaluation of pain control taught. " Review of "Skilled Nursing Assessment " documentation by the RN (EMP#4) dated 3/3/21 revealed pain in the right groin, acute, sore, tender, worst pain over last 24 hours 6, current pain 3, control measures rest, medication, best response to control measures a 3. Review of "Plan for Next Visit " documentation by the RN (EMP#4) dated 3/3/21 revealed " pain assessed ...pt states pain has decreased " Review of "Skilled Nursing Assessment " documentation by the RN (EMP#4) dated 3/5/21 revealed pain in the right groin, acute, sore, tender, worst pain over last 24 hours 7, precipitating factors wound vac change, current pain 3, control measures rest, pain is better when wound care is done, best response to control measures a 3, worse with wound vac change, pain controlled when wound vac not being changed, frequency of pain interfering with patients activity or movement all the time. Review of "Plan for Next Visit " documentation by the RN (EMP#4) dated 3/5/21 revealed " wound care completed ...assessed pain ... patient does have pain with wound vac change but patient states pain has improved and does go away after wound care is finished. Pt has not been taking her oxycodone because she does not like the side effects and she does understand how to take it if she needs it " The "Home Health Certification and Plan of Care" for the recertification period of 2/26/2021 through 4/26/2021 contained no goal for pain control. Findings confirmed during exit interview on 3/9/2021 at approximately 2:45 pm with Administrator (EMP1), Director of Therapy/Back Up Administrator (EMP2), Vice President of Clinical operations (EMP3) and Clinical Compliance Coordinator (EMP6).

Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician as indicated in the plan of care; This ELEMENT is not met as evidenced by: Based on review of agency procedure, clinical records (CR), and staff (EMP) interview, it was determined that the agency failed to ensure wounds were assessed and measured weekly for three (3) of nine (9) CR's reviewed. (CR9 & CR16-17) Findings include: On 3/9/2021 at approximately 9:30 AM, review of agency procedure, titled "Integumentary", revealed the following: "Wounds are to be measured weekly, preferably on the first visit of the week and/or when the wound status changes. " Review of clinical records on 3/5/2021 between approximately 1:50 pm and 3:15PM, 3/8/2021 between approximately 10 am and 3:45 pm, and 3/9/2021 between approximately 9:10 am and 1pm revealed: CR9, start of services (SOS) 10/29/2020, period reviewed 10/29/2020-12/27/2020, SOS visit identified a surgical left groin wound. CR contained nurse visit frequency of 2 times a week. The week of 11/22/2020 and had missed visit documentation for 11/23/2020. Visit conducted on 11/25/2020 for week dated 11/22/2020-11/28/2020. No wound measurement documented this visit. CR16, SOS 2/14/2021, period reviewed 2/14/2021-4/14/21, CR contained nurse visit frequency of week one, 3 times per week, week two, two times per week, and week three and four, 1 time a week. Start of care visit 2/14/2021 listed a stage 1 pressure ulcer to the coccyx with no measurements. Visit conducted on 2/17/2021 and 2/19/2021 contained no wound measurements. Visit 2/22/21 lists wound measurements as 0cmx0cmx0cm, note text reads " redness noted to area, no open areas noted. " 3/1/2021 Wound assessment reads " coccyx pressure ulcer Stage 1 " but lists no measurements. CR17, SOS 2/12/2021, period reviewed 2/12/2021-4/12/21, CR contained nurse visit frequency of week one, one time per week, then two times per week. Start of services/week one visit 2/12/2021 listed two unstageable pressure ulcers to the posterior right lower back, and one Stage 3 pressure ulcer to the right posterior back. No measurements of the wounds were included. Findings confirmed during exit interview on 3/9/2021 at approximately 2:45 pm with Administrator (EMP1), Director of Therapy/Back Up Administrator (EMP2), Vice President of Clinical operations (EMP3) and Clinical Compliance Coordinator (EMP6).