Every finding on record at Well Done Home Care Inc

During the home health survey conducted on 1/11/2021, at Well Done Home Care, Emergency Preparedness was reviewed. Well Done Home Care is in compliance with Emergency Preparedness per Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for Home Health Agencies.

A recertification survey was completed on 1/11/2021 to 1/13/2021 at Well Done Home Care Inc. The facility was not in compliance with requirements for Code of Federal Regulations (CFR) 42, Part 484.22, Condition of Participation for 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 record review and staff interview, the agency failed to update the medication profile for 1 of 14 sampled patients. (Patient #2). The findings include: Record review for Patient #2 revealed Start of Care (SOC) date 10/6/20. The certification period 10/6-12/4/20. Review of the Skilled Nurse (SN) visit note dated 10/13/20 revealed an order to collect urine for culture and sensitivity. The urine was collected on 10/14/20, the results found E-coli organism and the physician ordered antibiotic Macrobid 100 mg 2 x day x 5 days. Start date 10/21/20-10/26/20. Review of the medication profile was not updated to include Macrobid. Patient #2 was seen for a home visit by her physician on 10/28/20. During the visit the physician documented that family had requested pain medication. An order was given for Tramadol on 10/26/20 every 6 hours x 5 days. Also during the visit labs were reviewed regarding thyroid function. An order was given to increase thyroid medication, Levothyroxine from 88 mcg to 100 mcg daily. Review of the medication profile did not include the pain medication or increased dose of thyroid medication. An interview was conducted with the Director of Nursing on 1/12/21 at 2:42pm. She was asked how often was the medication profile updated. She said whenever there were any changes in medications prescribed. She was asked to review the medication profile for Patient #2 dated 10/6/20. She was asked if Tramadol, Macrobid or change in dose for Levothyroxine were found on the form. She verified the medications were not listed. She was asked what date was Patient #2 discharged, she said on 11/3/20. She was asked to provide a copy of the medication profile sent with the patient when she was transferred to another agency. The copy provided was dated 10/6/20. She was asked if an updated list was sent to the new provider, she said that was the copy sent with the transfer records. Review of the agency policy Medication Monitoring included: educate patient /caregiver the importance of reporting any and all medication being taken, changes in medications including dose or frequency, any side effects. During each nursing visit, the medication profile is compared to the patient's medications in the home, update the medication profile and use to educate the patient regarding potential side effects.

Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) to any changes in the patient's condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This ELEMENT is not met as evidenced by: Based on record review and staff interview, the agency failed to report to the physician, caregiver and Skilled Nurse observations of non verbal signs and symptoms of pain for 1 of 14 sampled patients (Patient #2). The findings include: Record review for Patient #2 revealed a 73 year old female with a Start of Care (SOC) date 10/6/20. The certification period was 10/6/20-12/4/20. The diagnosis included: septic shock, cardiac arrest with anoxia, stroke with paralysis, dysphasia, aphasia, diabetes, Parkinson's disease. She had a tracheotomy, peg tube and Foley catheter. She was bedbound, required total care, non-verbal, blind in left eye, bilateral hands and arms contracted. She was ordered 9 liters of oxygen via mask and insulin via sliding scale. She also had two open blisters to left thigh and right buttock. Review of the Plan of Care (POC) certification period Start of Care (SOC)10/6/20-12/4/20 included: Skilled Nursing (SN): 3wk1, 2wk2, 1wk2, 3 PRN trach, 3 PRN peg tube and catheter SN to assess, evaluate and document on visit note every vital: vital signs, cardiac, respiratory status, medication effectiveness, wound healing, nutrition, infusion medications, diabetes signs/symptoms and recent glucometer results. Interventions: teaching and caregiver response. Physical Therapy (PT): 1wk1, 2wk1, 1wk2 Occupational Therapy (OT): 1wk1, 2wk4 Medical Social Services (MSW) order 10/19/20 to assist with community resources. Second order 11/2/20 Speech Therapy (ST): 1wk1 eval wk. of 10/12/20 new order 10/17/20 ST 2wk2, 1wk3 Home Health Aide (HHA): 2wk3 Medications on the POC included: Levothyroxine 88 mcg qd. Ipratropium-albuterol 0.5-2.5 3 ml inhalation sol 1 vial 4 x day Levetiracetam 1000 mg 1-tab bid Famotidine 20 mg 1 tab qd Sertraline 100 mg 1-tab qd Tizanidine 2 mg 1-tab q 6 hr prn restlessness Montelukast sodium 10 mg 1-tab qd Insulin Aspart Protamine & Aspart Flex Pen sliding scale 150-200 give 2 units, 201-250 4 units, 251-300 6 units, 301-350 8 units, 351-400 10 units daily Carbidopa-Levodopa 25-100 mg 3 x day via peg tube. Review of the SN notes for 10/9, 10/14, 10/15, 10/29 and 11/2/20 revealed the nurse documented that family reported facial grimacing, making small noises and not sleeping and felt she was in pain. On 10/15/20, the SN assessed Patient #2 for pain asking her to blink once for yes and twice for no. She blinked once indicating she was in pain. Further review of the records found no documentation that the physician was notified of Patient #2 having signs of pain and request for pain medication. Review of the physician history & physical dated 10/14/20 revealed patient had history of chronic pain and was relieved by medication. She received Percocet while in the skilled nursing facility (SNF), the family requested pain management and would be referred to hospice palliative care. No pain medication was ordered. No referral found for pain management. No order was found for pain medication until 10/26/20 when Tramadol was ordered for 5 days. There was no documentation by the SN regarding pain medication initiated. An interview was conducted with the Director of Nursing (DON) on 1/13/21 at 9:20 am. She was asked if there was documentation for Patient #2 regarding notifying the physician regarding pain. The SN documented during 5 visits that family reported grimacing, making noises and not sleeping from pain. After review of the record she said no documentation was found that the nurse notified the physician. She said Patient #2 was complex and SN was in contact with the physician, however, did not document when she communicated with him. She was asked if there were any orders obtained for pain medication, she said she found no orders. Review of the agency policy Physician/Staff Collaboration and Responsibilities included: availability for physician communication 24 hours per day, assign clinically competent personnel, ongoing reassessment of the patients condition with appropriate revision in the plan of care, Provision of direct care and patient education, timely and periodic communication to the physician of useful and accurate information.

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, the agency failed to coordinate care and services including obtaining glucometer, insulin instructions and caregiver education for 1 of 14 sampled patients (Patient #2). The findings include: Record review for Patient #2 revealed a 73 year old female with a Start of Care (SOC) date 10/6/20. The certification period was 10/6/20-12/4/20. The diagnosis included: septic shock, cardiac arrest with anoxia, stroke with paralysis, dysphasia, aphasia, diabetes, Parkinson's disease. She had a tracheotomy, peg tube and Foley catheter. She was bedbound, required total care, non-verbal, blind in left eye, bilateral hands and arms contracted. She was ordered 9 liters of oxygen via mask, insulin via sliding scale. She also had two open blisters to left thigh and right buttock. Review of the Plan of Care (POC) certification period Start of Care (SOC)10/6/20-12/4/20 included: Skilled Nursing (SN): 3wk1, 2wk2, 1wk2, 3 PRN trach, 3 PRN peg tube and catheter SN to assess, evaluate and document on visit note every vital: vital signs, cardiac, respiratory status, medication effectiveness, wound healing, nutrition, infusion medications, diabetes signs/symptoms and recent glucometer results. Interventions: teaching and caregiver response. The medication orders included: Insulin Aspart Protamine & Aspart Flex Pen sliding scale 150-200 give 2 units, 201-250 4 units, 251-300 6 units, 301-350 8 units, 351-400 10 units daily There was no clarification of the order as to how often the blood sugar to be monitored and when insulin to be given as Patient #2 was receiving tube feeding. The POC included: assess, evaluate and document diabetes, signs and symptoms and recent glucometer results. Review of the SOC summary dated 10/6/20 found on the POC revealed that patient did not have all medications as needed, supplies for injection and glucometer. An interview was conducted with Director of Nursing (DON) on 1/13/21 at 9:20 am. She was asked how often insulin was ordered for Patient #2 , she said it was sliding scale based on glucometer readings. She was asked if Patient #2 had her own glucometer. She said one was ordered at the time when she was discharged from the skilled nursing facility, however, there was delay of receiving the orders from the physician. When asked how were blood sugars monitored prior to receiving the glucometer. She said the registered nurse (RN) assigned to her had a glucometer and was able to obtain blood sugar readings. The DON was asked who provided diabetic education to the caregiver, she said the RN. When asked where was the documentation regarding caregiver teaching and written instructions. She said in the skilled nursing note. She was asked to provide the caregiver teaching and written instructions. After review of the record, she said none was found.