Every finding on record at Visiting Nurse Home and Hospice

A State and Federal Emergency Preparedness survey was completed at this Home Care Agency. Deficiencies were identified.

EP Testing Requirements CFR(s): 484.102(d)(2) §416.54(d)(2), §418.113(d)(2), §441.184(d)(2), §460.84(d)(2), §482.15(d)(2), §483.73(d)(2), §483.475(d)(2), §484.102(d)(2), §485.68(d)(2), §485.542(d)(2), §485.625(d)(2), §485.727(d)(2), §485.920(d)(2), §491.12(d)(2), §494.62(d)(2). *[For ASCs at §416.54, CORFs at §485.68, REHs at §485.542, OPO, "Organizations" under §485.727, CMHCs at §485.920, RHCs/FQHCs at §491.12, and ESRD Facilities at §494.62]: (2) Testing. The [facility] must conduct exercises to test the emergency plan annually. The [facility] must do all of the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or (A) When a community-based exercise is not accessible, conduct a facility-based functional exercise every 2 years; or (B) If the [facility] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required community-based or individual, facility-based functional exercise following the onset of the actual event. (ii) Conduct an additional exercise at least every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [facility's] emergency plan, as needed. *[For Hospices at 418.113(d):] (2) Testing for hospices that provide care in the patient's home. The hospice must conduct exercises to test the emergency plan at least annually. The hospice must do the following: (i) Participate in a full-scale exercise that is community based every 2 years; or (A) When a community based exercise is not accessible, conduct an individual facility based functional exercise every 2 years; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospital is exempt from engaging in its next required full scale community-based exercise or individual facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (3) Testing for hospices that provide inpatient care directly. The hospice must conduct exercises to test the emergency plan twice per year. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or (B) If the hospice experiences a natural or man-made emergency that requires activation of the emergency plan, the hospice is exempt from engaging in its next required full-scale community based or facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop led by a facilitator that includes a group discussion using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the hospice's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the hospice's emergency plan, as needed. *[For PRFTs at §441.184(d), Hospitals at §482.15(d), CAHs at §485.625(d):] (2) Testing. The [PRTF, Hospital, CAH] must conduct exercises to test the emergency plan twice per year. The [PRTF, Hospital, CAH] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the [PRTF, Hospital, CAH] experiences an actual natural or man-made emergency that requires activation of the emergency plan, the [facility] is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an [additional] annual exercise or and that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [facility's] response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the [facility's] emergency plan, as needed. *[For PACE at §460.84(d):] (2) Testing. The PACE organization must conduct exercises to test the emergency plan at least annually. The PACE organization must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or (B) If the PACE experiences an actual natural or man-made emergency that requires activation of the emergency plan, the PACE is exempt from engaging in its next required full-scale community based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, a facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the PACE's response to and maintain documentation of all drills, tabletop exercises, and emergency events and revise the PACE's emergency plan, as needed. *[For LTC Facilities at §483.73(d):] (2) The [LTC facility] must conduct exercises to test the emergency plan at least twice per year, including unannounced staff drills using the emergency procedures. The [LTC facility, ICF/IID] must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise. (B) If the [LTC facility] facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging its next required a full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the [LTC facility] facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the [LTC facility] facility's emergency plan, as needed. *[For ICF/IIDs at §483.475(d)]: (2) Testing. The ICF/IID must conduct exercises to test the emergency plan at least twice per year. The ICF/IID must do the following: (i) Participate in an annual full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise; or. (B) If the ICF/IID experiences an actual natural or man-made emergency that requires activation of the emergency plan, the ICF/IID is exempt from engaging in its next required full-scale community-based or individual, facility-based functional exercise following the onset of the emergency event. (ii) Conduct an additional annual exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the ICF/IID's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the ICF/IID's emergency plan, as needed. *[For HHAs at §484.102] (d)(2) Testing. The HHA must conduct exercises to test the emergency plan at least annually. The HHA must do the following: (i) Participate in a full-scale exercise that is community-based; or (A) When a community-based exercise is not accessible, conduct an annual individual, facility-based functional exercise every 2 years; or. (B) If the HHA experiences an actual natural or man-made emergency that requires activation of the emergency plan, the HHA is exempt from engaging in its next required full-scale community-based or individual, facility based functional exercise following the onset of the emergency event. (ii) Conduct an additional exercise every 2 years, opposite the year the full-scale or functional exercise under paragraph (d)(2)(i) of this section is conducted, that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or an individual, facility-based functional exercise; or (B) A mock disaster drill; or (C) A tabletop exercise or workshop that is led by a facilitator and includes a group discussion, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (iii) Analyze the HHA's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the HHA's emergency plan, as needed. *[For OPOs at §486.360] (d)(2) Testing. The OPO must conduct exercises to test the emergency plan. The OPO must do the following: (i) Conduct a paper-based, tabletop exercise or workshop at least annually. A tabletop exercise is led by a facilitator and includes a group discussion, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. If the OPO experiences an actual natural or man-made emergency that requires activation of the emergency plan, the OPO is exempt from engaging in its next required testing exercise following the onset of the emergency event. (ii) Analyze the OPO's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the [RNHCI's and OPO's] emergency plan, as needed. *[ RNCHIs at §403.748]: (d)(2) Testing. The RNHCI must conduct exercises to test the emergency plan. The RNHCI must do the following: (i) Conduct a paper-based, tabletop exercise at least annually. A tabletop exercise is a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan. (ii) Analyze the RNHCI's response to and maintain documentation of all tabletop exercises, and emergency events, and revise the RNHCI's emergency plan, as needed. This STANDARD is not met as evidenced by: Based on record review and staff interview, it has been determined that the Agency failed to conduct a full-scale exercise that is a community or facility based functional exercise, a mock disaster drill, or a tabletop exercise to test the emergency plan vulnerabilities identified in the hazard assessment conducted by the facility or analyze the Agency’s response to and revise the emergency plan, as needed. Findings are as follows: Review of the Agency’s emergency preparedness documentation lacked evidence that an additional exercise was conducted in 2023 that was opposite the year of a full-scale or functional exercise. Further review of the documentation revealed a community disaster drill exercise was conducted, and a series of “Icon” broadcast text messages were sent out to employees on the following dates and times: - 1/21/2025 at 3:30 PM - 1/21/2025 at 3:31 PM - 1/24/2025 at 2:16 PM Additionally, review of the above-mentioned text messages lacked evidence that all employees received confirmed notification and therefore participated in the above-mentioned disaster drill exercise. Review of the emergency preparedness meeting minutes, dated 2/11/2025, lacked evidence that the Agency analyzed the response of the drill and revised the Icon broadcast texts to include all employees. Further review of the meeting minutes, dated 3/14/2025, revealed in part, “Facilities Perform safety checks…HR Provide Icon text service update…” During a surveyor interview with Facilities Manager on 3/24/2025 at 11:13 AM, he acknowledged that exercises of the emergency preparedness plan were not conducted in 2023. In addition, he was unable to provide evidence that revisions to the Icon text service were made in the emergency preparedness plan, as needed.

A Federal and State recertification survey was completed at this agency. State and Federal deficiencies were identified.

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 record review and staff interview, it has been determined that the Home Health Agency (HHA)failed to ensure that skilled nursing services are provided in accordance with the HHA’s policies and procedures, for 1 of 2 Patient’s reviewed relative to weekly measurements of pressure wounds, Patient ID #1. Findings are as follows: Review of the agency policy, titled “Provision of Care, Treatment, and Services” revealed in part, “…To provide guidelines to the clinical staff in the management of wounds and ulcers…measure wound weekly…” Review of the Patient’s wound report revealed that s/he has a Stage 4 pressure ulcer (full-thickness tissue loss that extends into muscle, tendon, or bone. These ulcers may have necrotic tissue and can involve significant undermining or tunneling) to the coccyx (tailbone) with an onset date of 1/11/2023. Review of the record revealed his/her start of care date was 10/14/2024. Further review of the record lacked evidence of measurements for the stage 4 pressure ulcer on the following weeks: - 11/17/2024 through 11/23/2024 - 11/24/2024 through 11/30/2024 - 12/1/2024 through 12/7/2024 - 1/5/2025 through 1/11/2025 - 1/12/2025 through 1/18/2025 - 1/19/2025 through 1/25/2025 - 1/26/2025 through 2/1/2025 - 3/2/2025 through 3/8/2025 During a surveyor interview with the Director of Nursing Services on 3/24/2025 at 2:28 PM, she was unable to provide evidence that the pressure wound was measured weekly. During a surveyor interview with the Administrator on 3/25/2025 at approximately 1:00 PM, she was unable to provide evidence that the Agency’s wound treatment policy was followed.

A Federal complaint survey was conducted at this agency due to an allegation of non-compliance. A Federal deficiency was identified.

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: A Federal complaint survey was conducted at this agency on 1/6/2023, due to an allegation of non-compliance related to intake 95051. A deficiency was identified. Based on record review, and family member and staff interview, it has been determined that the agency failed to complete a comprehensive assessment which includes a review of all medications which the patient is currently taking for 1 of 1 sample patients with a reported medication error (Patient ID #1). Findings are as follows: According to the home care policy titled, “Provision of Care, Treatment, and Services” states in part, “…As part of each visit a medication reconciliation is completed… Procedure: -Verify-complete and accurate medication list with all medications including OTC and supplements. -Validate-Current medication including new, duplicate, omitted, and discontinued drugs -Clarify-Clarify orders at SOC/ROC and every care transition -Reconcile-All medications the patient is currently taking is confirmed with the physician and on a current updated medication list…” Patient ID #1 was seen at his/her Primary Care Physician office on 12/30/2022 following a discharge from a skilled nursing facility who had also organized home care services for rehabilitation following this discharge. During this office visit, Patient ID #1’s Physician Assistant (PA) reported that Patient ID #1’s spouse presented to the office with 5 pre-packaged medication blister packs with another person’s name on the prescription labels. The five medications identified included: Eliquis, Diltiazem, Duloxetine, Isosorbide, and Rosuvastatin. According to Patient ID #1’s spouse, she/he was unaware that the medication blister packages were not for Patient ID #1, which she/he had been administering to Patient ID #1 since his/her discharge from the skilled nursing facility 5 days ago. Review Patient ID #1’s “Continuity of Care Form (COC)” from the skilled nursing facility, did not reveal the five medications identified in the blister packs by the PA. Further review revealed that the medications listed on the COC were the correct medications for Patient ID #1 according to the physician orders. Review of the clinical record revealed that Patient ID #1 was admitted by the Home Care Agency Nurse, Staff A, on 12/28/2022. On 1/6/2023 attempts to contact Staff A by phone for an interview were unsuccessful. During an interview on 1/6/2023 at approximately 11:30 AM, with Home Care Agency Staff C, she stated that she spoke with Staff A after being informed of the incident. She stated Staff A, when questioned, stated he had no knowledge of blister packs being given to Patient ID #1 or his/her spouse. During an interview on 1/6/2023 at approximately 11:30 AM with Staff B, Home Care Agency Nursing Supervisor, she reports that she spoke to Staff A regarding this incident, and he stated that he reviewed Patient ID #1’s discharge medications. When asked what process is followed for medication review and reconciliation, Staff B stated that the discharge medication list is compared with the vials/bottles of medication the patient has in the home. During an interview with Home Care Agency Staff D regarding the policy for medication reconciliation, she verified that the process for medication review and reconciliation is to review the discharge medication list from the discharge instructions and compare it to the vials/bottles of medication the patient has in the home. She indicated that if there are any discrepancies, they are to notify the physician. During a surveyor home visit to Patient ID #1 on 1/6/2023 at 3:00 PM accompanied by an Agency Physical Therapist, the surveyor completed an interview with Patient ID #1’s spouse who is Patient ID #1’s primary caretaker. According to Patient ID #1’s spouse, Staff A presented to his/her home for the initial visit on 12/28/2022, 2 days prior to Patient ID #1’s visit to the Primary Care office. The patient’s spouse was asked by the surveyor if the nurse had reviewed the patients’ medications which were prescribed upon discharge from the skilled nursing facility. The patient’s spouse presented a handwritten list which she/he indicated was presented to Staff A on the 12/28/2022 visit. (This list did have the correct medications). When asked if the nurse reviewed the blister packages, the patient’s spouse stated she/he did not offer them to him. When asked if the nurse requested to see bottles or vials of medications, the patient’s spouse stated “no”. Based on the information provided and the interviews conducted, Agency Nurse Staff A, failed to verify medications for accuracy by comparing the list of medication to the bottles/vials in Patient ID #1’s home.

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 clinical record review and staff interview it has been determined that the agency failed to assure that the patient’s clinical record identifies all medication the patient is currently taking for 4 of 4 sample patients, Patient’s ID #’s 1,2,3, and 6, reviewed during home visits. Findings are as follows: Review of the agencies policy titled “Medication Reconciliation” MM-16.00, states in part; “Purpose: To provide a complete list of current medications, including over the counter as well as prescriptions medications to avoid unintended medication errors. Procedure: “1. On every visit, medications are reconciled. The clinician ensures the following is complete and accurate.” … d. Upon Admission and resumption of care, the RN/Therapist will: … Verify, Validate, Clarify, and Reconcile all medications that the patient is currently taking, prescribed and OTC (over the counter) are confirmed with physician and on a current updated medication list.” 1. Review of the medications during a home visit with the nurse, Staff A, on 3/14/2022 at 1:00 PM revealed that client ID # 1’s, who was admitted to the agency on 2/25/2022, with a plan of care certification dated 2/25/2022-4/25/2022, failed to list Coumadin and listed Acetaminophen 500mg 2 tablets three times a day for pain. During the surveyor’s review of the medications in the home, the resident informed the surveyor that s/he is taking Coumadin. The resident states that s/he gets weekly blood test and that s/he is currently taking Coumadin 2mg (milligrams) on Wednesday & Thursday’s and Coumadin 1mg the rest of the week. The patient stated that the doctor’s office calls him/her to let s/he know how much Coumadin to take after the blood work is reported. The patient also told the surveyor that s/he has been on Coumadin a long time. Surveyor review of the Coumadin bottles in the home, reveal a bottle with 2mg and a bottle with 1mg both dated 8/23/2021. The patient also has Acetaminophen 650 mg tablets in the home, which s/he takes two tablets when necessary for pain. During the visit, the surveyor interviewed the nurse, Staff A, about the Coumadin that was not on the patient’s medication list or certification, and she acknowledged that she unaware that the patient was on Coumadin, or not taking the Acetaminophen 500 mg two tablets three times a day as listed on the plan of care. 2. Review of the medications during a home visit with the nurse, Staff B, on 3/14/2022 at 3:30 PM revealed that client ID # 2’s, who was admitted to the agency on 2/12/2022, with a plan of care certification dated 2/12/2022-4/12/2022, revealed the following discrepancies. Review of the current medication list revealed the following: Hydroxyzine HCL 25 mg 1 tablet once a day as needed for allergies. During surveyor review of the medications in the home, the patient and spouse stated the patient does not have the Hydroxyzine as it makes h/him too “sleepy”, he uses Wal-Finate 4mg tablets which he has in the home and takes for allergies. Additionally, the nurse had Triad cream which she applied to the patient’s pressure ulcer areas, which is not listed on the medication list or in the physicians’ orders. During the surveyor’s review of the medications in the home, and interview with the nurse Staff B, she was unaware that the patient did not have the Hydroxyzine and had Wal-Finate for allergies. She also acknowledged that there was not a physician’s order for the Triad Cream as a treatment for the patient’s pressure ulcers. 3. Review of the medications during a home visit with the Health Aide, Staff C, on 3/15/2022 at 11:00 AM revealed that client ID # 3’s, who was admitted to the agency on 1/21/2022, with a plan of care certification dated 1/21/2022-3/21/2022, revealed the following. The Medication list printed on3/14/2022 reveals an order for Glimepiride 1 mg, take 2 tablets daily for blood sugar. During review of the medications in the home, with the patient and spouse, the patient takes one tablet of Glimepiride not two as noted on the record. The patient stated that it was change sometime in December but did not know the exact date. Review of the continuity of care form, from the hospital dated 1/20/2022, states Glimepiride 1 mg once a day. The surveyor interviewed the Director of Nurses on 3/15/2022 at approximately 2:00 PM, who was unable to explain why the agencies plan of care certification and medication list, stated 2 tablets, when the Continuity of care from the hospital stated one tablet, or provide evidence that the medications had been reconciled when the patient was readmitted to service on 1/21/2022. 4. Review of the medications during a home visit with the Social Worker, Staff F, on 3/16/2022 at 11:00 AM revealed that client ID # 6’s, who was admitted to the agency on 1/31/2022, with a plan of care certification dated 1/31/2022-3/31/2022, revealed the following. The surveyor reviewed the patient’s medications that are in a “Med Pack” filled by the pharmacy. Review of the Bedtime pack revealed that it contained Gabapentin 300 mg. Review of the physicians’ current orders state, Gabapentin 100mg take 2 capsules three times a day. The surveyor interviewed the patient’s nurse, Staff G, on 3/21/2022, who stated that she had not reviewed the Med Pack or noted that the Gabapentin was increased to 300mg. The surveyor contacted the pharmacy on 3/21/2022 at 2:15 PM, and spoke with the pharmacist, who confirmed that the order was for Gabapentin 300mg and that it had been changed by the physician on 2/9/2022. During surveyor interview with the Director of Nurses on 3/21/2022 at approximately 2:30 PM she was unable to provide evidence that the medications were reconciled per the agency policy.

Integrate all orders CFR(s): 484.60(d)(2) Integrate orders from all physicians or allowed practitioners involved in the plan of care to assure the coordination of all services and interventions provided to the patient. This ELEMENT is not met as evidenced by: Based on record review and staff interview it has been determined that the agency failed to assure coordination of all services, for 1 of 1 patient with a speech therapy consult, patient ID # 6. Findings are as follows: Review of the resumption of care, physicians’ orders, dated 3/4/2022, states “speech therapy to evaluate to determine the type, severity and prognosis of a cognitive, communication/swallow disorder and develop plan of care…” Review of the record, failed to reveal that a speech therapy evaluation had been completed. During surveyor interview with the Director of Nurses on 3/17/2022 at approximately 10:45 AM, she was unable to produce evidence that the speech therapy evaluation had been completed as ordered.

Integrate all services CFR(s): 484.60(d)(3) Integrate services, whether services are provided directly or under arrangement, to assure the identification of patient needs and factors that could affect patient safety and treatment effectiveness and the coordination of care provided by all disciplines. This ELEMENT is not met as evidenced by: Based on record review and staff interview it was determined that the agency failed to integrate services for 1 of 1 patient, patient ID # 1 relative to blood work for Coumadin. Findings are as follows: Review of the record for patient ID #1, who was admitted to service on 2/25/2022, and has a plan of care certification dated 2/25/2022-4/25/2022, fails to include any information relative to patient’s blood work, INR (international normalized ratio) or orders for Coumadin. During surveyor interview with the patient, s/he stated that s/he went to the lab for h/his blood work and that the INR was 1.6 and the doctor’s office called and changed the Coumadin to 2mg (milligram) on Wednesday and Thursday and 1 mg every other day. During interview with the nurse, staff A, during the visit, she stated that she was not aware that the patient was on Coumadin and did not have any information as to when the patient was scheduled for blood work. She was unable to provide evidence that the agency coordinated services with the lab and or physicians’ office relative to the INR’s or Coumadin.