Every finding on record at Vital Home Care Services, LLC

Based on the findings of an onsite unannounced home health agency initial Medicare certification survey conducted September 20, 2023 through September 21, 2023, Vital Home Care Services, LLC., 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 initial Medicare certification survey conducted September 20, 2023 through September 21, 2023, Vital Home Care Services, LLC., was found not to be in compliance with the requirements of 42 CFR, Part 484, Subparts B and C, Conditions of Participation: Home Health Agencies.

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 review of agency policy, clinical records (CR), and interview with the administrator, the agency failed to ensure that a comprehensive assessment included a review of all medications that the patient was 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 for seven (7) of seven (7) CR’S reviewed (CR #1, 2, 3, 4, 5, 6, and 7). A review of agency policy titled “Medication Profile and Review” was conducted on 9/21/23 at approximately 12:30 pm. Policy states, “The comprehensive assessment includes a review of all medication the patient is currently using, both prescription and nonprescription. The drug regimen review shall occur during each clinical visit where medication changes have been identified as an ongoing part of the care of the patient…Medication Assessment: Initially and ongoing in addition to the medication history, the nurse has responsibility to perform and document a medication assessment which includes reconciliation of the medication review and other pertinent information such as: Checking the prescribed medications for correct dosage, frequency, and duration. Any discrepancies must be clarified with the ordering physician and/or the pharmacist…Assessing the actual or potential side effects, toxic effects, allergic reactions, immediate desired effects, unusual and unexpected effects, changes in the patient’s condition that contraindicate continued administration of the medication, and interaction of the prescribed, over the counter, herbal preparations and/or supplements with each other or with various foods...” A review of CR’s conducted on 9/20/23 from 10:15 am through 12:00 pm revealed the following: CR #1, Start of Care: 7/31/23; Certification period reviewed: 7/31/23 through 9/29/23. The medication profile failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. CR #2, Start of Care: 7/31/23; Certification period reviewed: 7/31/23 through 9/29/2. The medication profile failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. CR #3, Start of Care: 8/1/2; Certification period reviewed: 8/1/23 through 9/30/23. The medication profile failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. CR #4, Start of Care: 8/1/23; Certification period reviewed: 8/1/23 through 9/29/23. The medication profile failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. CR #5, Start of care: 8/4/23; Certification period reviewed: 8/4/23 through 10/2/23. The medication profiled failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. CR #6, Start of Care: 8/1/23; Certification period reviewed: 8/1/23 through 9/29/23. The medication profile failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. CR #7, Start of Care: 7/31/23; Certification period reviewed: 731/23 through 9/28/23. The medication profile failed to contain documented evidence stating a review of all medications the patient is currently taking to identify 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 was completed. An interview with the administrator on 9/21/23 at approximately 2:00 pm conformed the above findings.

Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This STANDARD is not met as evidenced by: Based on a review of agency policy, clinical record (CR), and an interview with the administrator, it was determined to agency failed to maintain an accurate medication list per physician orders for two (2) of seven (7) CR's reviewed, (CR #1 and 4). A review of the agency policy titled “Medication Profile and Review” was conducted on 9/21/23 at approximately 12:30 pm. Policy states, “ he drug regimen review shall occur during each clinical visit where medication changes have been identified as an ongoing part of the care of the patient…Medication Assessment: Initially and ongoing in addition to the medication history, the nurse has responsibility to perform and document a medication assessment which includes reconciliation of the medication review and other pertinent information such as: Checking the prescribed medications for correct dosage, frequency, and duration. Any discrepancies must be clarified with the ordering physician and/or the pharmacist…” A review of CR’s conducted on 9/20/23 from 10:15 am through 12:00 pm revealed the following: CR #1, Start of Care: 7/31/23; Certification period reviewed: 7/31/23 through 9/29/23. A review of the medication profile listed Metformin 1000 milligrams, 1 tab oral two times per day. Review of the Home Health Certification and Plan of Care did not list Metformin under the medication section. There was no documentation of a physician order to add this medication. CR #4, Start of Care: 8/1/23; Certification period reviewed: 8/1/23 through 9/30/23. Home Health Certification and Plan of Care contained orders for the following medications: Amlodipine Besylate 10 milligrams, 1 tab, oral daily; Atorvastatin Calcium 40 milligrams, 1 tab, oral daily; and Tylenol 325 milligrams, 2 tabs, oral as needed every 6 hours for pain. Review of the medication profile contained the following medications: Amlodipine Besylate 10 milligrams, 1 tab, oral daily; Atorvastatin Calcium 40 milligrams, 1 tab, oral daily; Lisinopril 10 milligrams, 1 tab, oral daily, Naproxen Sodium Extended Release 500 milligrams, 1 tab, oral 2 times daily; and Tylenol 325 milligrams, 2 tabs, oral as needed every 6 hours for pain. There was no documentation of a physician order to add the Lisinopril or Naproxen. An interview with the administrator was conducted on 9/21/23 at approximately 2:00 pm confirmed the above findings.

Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This STANDARD is not met as evidenced by: Based on clinical home visit observations, a review of agency policies, and an interview with the administrator, the agency failed to follow its policy pertaining to infection control for one (3) of three (3) clinical home visits conducted, (CR#2, 3, and 4.) A review of agency policy titled “Use of Equipment and Supplies” was conducted on 9/21/23 at approximately 12:30 pm. Policy states, “Nursing Bag Technique: When carrying bag into the home it is to be kept on the shoulder until a barrier can be placed on a table or a hard chair. Barrier is discarded after use…If additional supplies are needed during the visit, hands are to be cleansed before re-entering bag. Alcohol-based hand sanitizer gel may be used…All equipment is cleansed with disinfectant after use and before returning to the bag…” On-site clinical home visits were conducted on 9/21/23 from approximately 9:40 am to 11:00 am. CR #4, arrived at 9:40 AM at the home of CR#2. The nurse (PF#1) placed the clinical bag on the couch with no barrier beneath the bag. The nurse removed a zippered leather pouch that contained a blood pressure (BP) cuff and stethoscope from the bag and placed the pouch on the coffee table with no barrier underneath. The nurse took the patient's BP, and then placed the BP cuff and stethoscope on the coffee table with no barrier underneath. The nurse returned to the clinical bag to remove a pulse oximeter without washing hands or using hand sanitizer. The nurse proceeded to check the patient's oxygen saturation level with a pulse oximeter and after use, the nurse placed the pulse oximeter on the coffee table next to the BP cuff and stethoscope. The nurse returned to the clinical bag to remove a thermometer without washing hands or using hand sanitizer. The nurse checked the patient’s temperature and then placed the thermometer on the coffee table next to the other items. The nurse checked the patient’s wrist pulse and respirations using her cell phone as a stopwatch. The nurse then placed her phone on the coffee table with no barrier underneath. Upon completion of visit, the nurse returned the BP cuff, stethoscope, thermometer, pulse oximeter, and empty leather zippered pouch to the clinical bag without sanitizing them, separating them from other clean items in the bag, or placing them into a separate bag. The nurse placed her cell phone in her jacket pocket without sanitizing it. The nurse did not wash her hands or use hand sanitizer prior to leaving the home. The observation revealed that there was no separation between clean equipment and equipment that was used and required sanitization. CR #3, arrived at 10:07 am at the home of CR #3. The nurse (PF#1) placed the clinical bag on the coffee table with no barrier beneath the bag. The nurse removed the blood pressure (BP) cuff and stethoscope from the bag and took the patient's BP, and then placed the BP cuff and stethoscope on the coffee table with no barrier underneath. The nurse returned to the clinical bag to remove the pulse oximeter without washing hands or using hand sanitizer. The nurse proceeded to check the patient's oxygen saturation level with a pulse oximeter and after use, the nurse placed the pulse oximeter on the coffee table next to the BP cuff and stethoscope. The nurse returned to the clinical bag to remove the thermometer without washing hands or using hand sanitizer. The nurse checked the patient’s temperature and then placed the thermometer on the coffee table next to the other items. The nurse checked the patient’s wrist pulse and respirations using her cell phone as a stopwatch. The nurse then placed her phone on the coffee table with no barrier underneath. Upon completion of visit, the nurse returned the BP cuff, stethoscope, thermometer, and pulse oximeter to the clinical bag without sanitizing them, separating them from other clean items in the bag, or placing them into a separate bag. The nurse placed her cell phone in her jacket pocket without sanitizing it. The nurse did not wash her hands or use hand sanitizer prior to leaving the home. The observation revealed that there was no separation between clean equipment and equipment that was used and required sanitization. CR #2, arrived at 10:50 am at the home of CR#2. The nurse (PF#1) placed the clinical bag on the couch with no barrier beneath the bag. The nurse removed the blood pressure (BP) cuff and stethoscope from the bag and took the patient's BP, and then returned the BP cuff and stethoscope to the clinical bag without sanitizing them, separating them from other clean items in the bag, or placing them into a separate bag. The nurse then removed the pulse oximeter from the clinical bag without washing hands or using hand sanitizer. The nurse proceeded to check the patient's oxygen saturation level with a pulse oximeter and after use, the nurse returned the pulse oximeter to the clinical bag without sanitizing them, separating them from other clean items in the bag, or placing them into a separate bag. The nurse then removed the thermometer from the clinical bag without washing hands or using hand sanitizer. The nurse checked the patient’s temperature and then returned the thermometer to the clinical bag without sanitizing them, separating them from other clean items in the bag, or placing them into a separate bag. The nurse checked the patient’s wrist pulse and respirations using her cell phone as a stopwatch. The nurse then placed her cell phone in her jacket pocket without sanitizing it. The nurse did not wash her hands or use hand sanitizer prior to leaving the home. The observation revealed that there was no separation between clean equipment and equipment that was used and required sanitization. An interview conducted with the administrator conducted on September 21, 2023 at approximately 2:00 pm confirmed the above findings.