Every finding on record at Visiting Nurse Services, Inc of Southern Ct

Unannounced visits were concluded at Visiting Nurse Services, Inc of Southern Connecticut on 09/19/2024 for the purpose of reviewing the Emergency Preparedness Code of Federal Regulations at 484.102, Condition of Participation for Home Health Agencies (HHA). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits concluded on 09/19/2024 at Visiting Nurse Services, Inc of Southern Connecticut for the purpose of a recertification survey. Standard-level deficiencies were identified.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on clinical record reviews, review of agency policies and interviews with agency personnel, for one of seven patients (Patient #11) in the survey sample who required blood glucose monitoring, the agency nurses failed to provide a necessary assessment. The findings include: a. Patient #11 had a start of care date of 08/14/2024 with diagnoses that included rhabdomyolysis, chronic kidney disease, type two diabetes, respiratory failure and falls. The physician’s orders for the certification period of 08/14/2024 to 10/12/2024 included nursing services twice per week for two weeks and once per week for seven weeks for nursing assessments, blood glucose monitoring, reporting a fasting blood glucose of less than 70 or greater than 250 and reporting a random blood glucose of less than 100 or greater than 350 to the Patient’s physician. i. Interview and review of Patient #11’s clinical record with the Director of Clinical Services on 09/19/2024 at 10:00 AM, identified the agency’s nurses failed to document the Patient’s blood glucose levels for the month of August and September of 2024. Review of the agency’s Plan of Care policy identified the clinicians would follow a patient’s plan of care expressly as written.

Communication with physicians CFR(s): 484.75(b)(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care; This ELEMENT is not met as evidenced by: Based on clinical record reviews, review of agency policies, and interviews with agency personnel for one of seventeen patients (Patient #15) who required nursing assessments, the agency failed to notify the patient's health care provider of a change in a patient's condition. The findings include: a. Patient #15 had a start of care date 03/09/2024 with diagnoses of type two diabetes, hypertension, chronic obstructive pulmonary disease and anemia. The physician orders for the certification period of 04/27/2024 to 06/25/2024 included nursing services once per week for nursing assessments. i. Interview and review of Patient #15’s nursing note dated 05/23/2024 with the Director of Clinical Services on 09/19/2024 at 10:15 AM, identified the Patient complained of shortness of breath and the nurse advised the Patient to stay inside and use the air conditioner for respiratory ease. Additionally, a nurse’s note dated 05/24/2024, identified the Patient expired at home on 05/24/2024. The Director of Clinical Services identified the nurse failed to notify the Patient’s physician of a change in condition in accordance with the agency’s policy. Review of the agency’s Change in Condition policy, identified the clinical staff would notify the attending physician within twenty-four hours, when a patient’s condition suggested that outcomes were not being achieved or an observed decline.

Unannounced visits were concluded at Visiting Nurse Services, Inc of Southern CT on 10/25/21 for the purpose of verifying compliance with the Emergency Preparedness Codes of Federal Regulations at §484.102, Condition of Participation for Home Health Agencies (HHAs). The agency was in compliance with the requirements at the time of the survey.

Unannounced visits were concluded at Visiting Nurse Services Inc. of Southern Connecticut on 10/25/21 for the purpose of recertification. Standard-level 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 review of the clinical record, interview with agency personnel and policy review for one of one patient (Patient#4) who required weekly medication pre-pour, the agency nurses failed to pre-pour medication in accordance with the physician's order. The findings include: Patient#4 had a start of care date of 4/24/2021 and diagnoses that included end stage renal disease, dysphagia, status post of a jejunostomy tube (J-tube) placement, hyperlipidemia. The physician's orders for the certification period of 10/13/21 through 12/11/21 included nursing services once a week for a medication pre-pour, vital signs assessment, and general assessments. Physician's orders for the certification period of 10/13/21 though 12/11/21 included Aspirin 81 mg1 tablet daily, Coreg 12.5 mg 1/2 tab bid Monday, Wednesday, Friday, Sunday, Lansoprazole 30 mg 1 tab daily, Phosphorous Supplement packet daily, renal vitamin 1 tab daily, and Ticagrelor 90 mg 1 tab bid. During a joint home visit with Registered Nurse/RN#1 on 10/20/21 at 9:20 am, RN#1 pre-poured all the medications including Lipitor 80 mg 1 tab absent a physician order. Review of Pt#4''s medication profile and interview with RN#1 on 10/20/21 at 9:25 am failed to identify an order for Lipitor. RN#1 stated the patient had been on Lipitor " for a long time", she further stated that she knew the patient well and was not sure why the medication was not on physician's orders. The review of the physician's orders for the certification periods 6/15/21 though 8/13/21, 8/14/21 through 10/12/21, and 10/13/21 though 12/11/21 with the Administrator on 10/20/21 at 12:15 pm did not contain Lipitor 80 mg 1 tab daily. The Administrator identified that Pt#4 was prescribed Lipitor 80 mg 1 tab once a day in May 2021, she further indicated that the patient was switched to another payor source in June of 2021, and she was not sure why the patient's Lipitor did not come over, but Lipitor was current medication, and failed to identify that the patient's medications were verified before being pre-poured and the discrepancy was not identified until 10/20/2021. The agency policy on Medication management directed patients to have a medication profile that accurately reflected medications as listed on the Physicians Plan of Care (485) and subsequent verbal orders.

Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This ELEMENT is not met as evidenced by: Based on review of clinical records, interviews with agency personnel and policy review for two of two patients (Patient #4 & # 12) who had an arterio-venous (AV) fistula utilized for dialysis treatment and one of one patient ( Patient# 5) who had Peripherally Inserted Central Catheter (PICC), and one of one patient (Pt#16) who had a percutaneous endoscopic gastrostomy (PEG) tube utilized for feeding, the agency nurses failed to complete assessments: The findings include: Patient #12 had a start date of 10/9/21 and a diagnosis that included Type II Diabetes Mellitus, Cellulitis on Left finger, Peripheral Vascular Disease, Atrial Fibrillation Hypertension and End Stage Renal disease. The physicians order for the certification period of 10/9/21 through 12/7/21 included nursing services 1x per week x 7 weeks for assessments and care of cellulitis. The initial nursing assessment dated 10/9/21 _ identified the presence of a central venous catheter to the Left upper arm for dialysis. A review of the nurses notes dated 10/14/21, 10/16/21 and 10/17/21 with the administrator on 10/25/21 at 11:30am failed to identify the assessment of the dialysis access IV site. Patient #16 had a start of care date of 08/14/2021 with diagnoses that included cancer of the throat, hypertension, and cardiac disease. During the Patient’s hospital stay of 08/2021, a PEG tube (a surgically placed tube which allows a patient who is unable to take in oral nutrition to receive nutrition through the stomach) was placed prior to Patient #16’s discharge to home. The initial start of care assessment on 08/14/2021, identified the presence, appearance and management of Patient #16’s PEG tube. The physician’s order for the certification period of 08/14/2021 through 10/12/2021, included nursing services twice per week for three weeks then one time per week for 6 weeks for physical assessments, patient teaching and assessment of the Patient’s PEG tube site for signs of infection upon each visit. Interview and review of LPN #1’s nursing notes dated 08/17/2021 and 08/20/2021 with the Administrator on 10/21/21 at 1:30 PM, failed to identify LPN #1 evaluated Patient #16’s PEG tube for signs of infection as directed by a physician’s order. A further review identified no additional nursing visits were made as the Patient returned to the hospital the week of 08/22/2021 and expired. Review of the agency’s policy Assessment of Patient identified initial and ongoing assessments are reflective of ongoing observations which require professional nursing or therapist judgements. Upon each visit, a patient would require an assessment and documentation in the clinical notes of problems, needs, evidence of teaching and response to teaching. Review of the agency’s LPN responsibilities / essential functions, identified an LPN must review and follow the plan of care established by the supervising RN. 1.Patient#4 had a start of care date of 4/24/2021 and diagnoses that included end stage renal disease, dysphagia, status post of a jejunostomy tube (J-tube) placement, hyperlipidemia. The physician's orders for the certification period of 10/13/21 through 12/11/21 included nursing services once a week for a medication pre-pour, vital signs assessment, and general assessments. The nursing assessment dated 4/24/2021 identified the presence of an AV fistula to the right arm. Interview and review of the nurse's notes dated 8/18/21, 8/25/21, 9/1/21, 9/8/21, 9/15/21, 9/22/21, 9/29/21, 10/6/21, 10/13/21 with the Administrator on 10/25/21 at 12:20 pm failed to identify the assessment of an AV fistula for bruit and thrill. 2.Patient #12 had a start date of 10/9/21 and a diagnosis that included type II diabetes mellitus, cellulitis on left finger, peripheral vascular disease, atrial fibrillation, hypertension and end stage renal disease. The physician's order for the certification period of 10/9/21 through 12/7/21 included nursing services one time per week for seven weeks for assessments and care of cellulitis. The initial nursing assessment dated 10/9/21 identified the presence of a central venous catheter to the left upper arm for dialysis. Interview and review of the nurse’s notes dated 10/14/21, 10/16/21 and 10/17/21 with the Administrator on 10/25/21 at 11:30 am failed to identify the assessment of the dialysis access IV site at every visit. 3. Patient#5 had a start date of date of 9/12/21 and diagnoses that included an infection of the left below the knee amputation stump, type II diabetes mellitus, peripheral vascular disease, and hypertension. The physician's orders for the certification period of 9/12/21 through 11/10/21 included nursing services three times a week for six weeks for vital signs, general assessments, and wound care. The Start of Care nursing note dated 9/12/21 identified that Patient#5 had a PICC line for antibiotic therapy. Interview and review of nursing notes dated 9/12/21, 9/20/21, 9/22/21, 9/24/21, 9/27/21, 9/29/21, 10/1/21, 10/4/21, 10/6/21, 10/8/21, 10/11/21, 10/13/21, 10/18/21, 10/20/21 with the Administrator on 10/25/21 at 12:15 pm failed to identify the assessment of the PICC line site at every visit. 4.Patient #16 had a start of care date of 08/14/2021 with diagnoses that included cancer of the throat, hypertension, and cardiac disease. The physician’s order for the certification period of 08/14/2021 through 10/12/2021, included nursing services twice per week for three weeks then one time per week for 6 weeks for physical assessments, patient teaching and assessment of the PEG tube site for signs of infection upon each visit. The initial start of care assessment on 08/14/2021, identified the presence, appearance and management of Patient #16’s PEG tube. Interview and review of LPN #1’s nursing notes dated 08/17/2021 and 08/20/2021 with the Administrator on 10/21/21 at 1:30 PM, failed to identify LPN #1 documented the observations of the PEG tube site for signs and symptoms of infection. Review of the agency’s policy Assessment of Patient identified initial and ongoing assessments are reflective of ongoing observations which require professional nursing or therapist judgements. Upon each visit, a patient would require an assessment and documentation in the clinical notes of problems, needs, evidence of teaching and response to teaching.