Decatur Morgan Homecare

“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 observation, agency policy and procedure, and interview, it was determined the home health agency failed to ensure staff followed standard precautions for infection control while performing wound care. This deficient practice affected Home Visit (HV) # 5, one of five HV’s conducted for a patient with a wound, and had the potential to affect all patients served by this agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revised Date: 05/01/19 Purpose: To help prevent the spread of microorganisms and infection by cross-contamination and to provide practice guidelines. Policy: Staff are required to perform hand hygiene prior to, at specified time points during, and following patient contact... Procedure: 1. Staff performs hand hygiene by handwashing with soap and water or using an alcohol based hand sanitizer: ...c. after contact with blood, body fluids or excretions, mucous membranes, non-intact skin, wound dressings... ...e. after contact with inanimate objects (including medical equipment)... ...f. before and after removal of personal protective equipment (PPE) 1. HV # 5 was admitted for home health services on 3/28/25 with a primary diagnosis of Chronic Diastolic (Congestive) Heart Failure. HV # 5 had multiple venous stasis ulcers to his/her bilateral lower extremities. Review of the Home Health Certification and Plan of Care for certification period 3/28/25 to 5/26/25 revealed orders for the skilled nurse (SN) to visit one time a week for nine weeks and perform wound care each visit as follows: Cleanse wound with wound cleanser and gauze. Pat dry with gauze. Cover wound bed with Xeroform (gauze), Calcium Alginate, and absorbent pad. Wrap with rolled gauze and Coflex using clean technique. A HV was conducted on 5/20/25 at 2:37 PM to observe care provided by Employee Identifier (EI) # 4, Registered Nurse (RN). EI # 4 performed hand hygiene and applied gloves to perform wound care which included utilizing scissors. Immediately upon completion of wound care, EI # 4 was observed cleaning his/her scissors with a sanitizing wipe wearing the same gloves worn during the wound care. EI # 4 failed to remove his/her gloves and perform hand hygiene after contact with the wound. An interview was conducted on 5/22/25 with EI # 2, Area Administrator, who confirmed the SN did not follow policy and perform hand hygiene after performing wound care.”

“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 medical records (MR), observations, agency policy and procedure and interviews, it was determined the agency failed to keep the medication profile current. This did affect three of seven Home visits (HV) conducted including HV # 3, HV # 5 and HV # 4, and had the potential to affect all persons served by the agency. Findings include: Agency Policy: Monitoring Medications Policy Number: 10.008 Date Revised: 7/1/2024 Purpose: To provide a process to ensure continuous monitoring of medications in the patient’s home. Policy: A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode... Procedure: 1a...Compare medication list to actual medications the patient is taking. 1b. Review all medications including over the counter (OTC) medications, vitamins, herbs and herbal products, creams and topical ointments... 3. HV # 4 was admitted for home health services on 2/24/25 with a primary diagnosis of Hypertensive Heart and Chronic Kidney Disease with Heart Failure and Stage 1-4/ Unspecified Chronic Kidney Disease. Review of physician’s orders dated 5/11/25 revealed orders for the Speech Therapist (ST) to visit once a week for four weeks effective 5/11/25. A HV was conducted on 5/20/25 at 11:39 AM to observe care provided by EI # 5, ST. During the HV, HV # 4’s medicine list was compared to the medications the patient was currently taking. The following discrepancy was observed: Metoprolol Succinate ER 25 mg tablet, Extended Release 24 hour-oral tablet, take one tablet two times daily was documented on the medicine list. Metoprolol Succinate ER 50 mg tablet, Extended Release 24 hour-oral tablet, take one tablet one time daily was present in the home with a filled date of 4/16/25. The dosages and amount of tablets to take did not match. An interview was conducted on 5/22/25 at 1:21 PM with EI # 2, who confirmed staff failed to follow the policy for monitoring medications. 2. HV # 5 was admitted for home health services on 3/28/25 with a primary diagnosis of Chronic Diastolic (Congestive) Heart Failure. Review of the HHC and POC for certification period 3/28/25 to 5/26/25 revealed orders for the SN to visit one time a week for nine weeks. A HV was conducted on 5/20/25 at 2:37 PM to observe care provided by EI # 4, Registered Nurse (RN). During the HV, HV # 5’s medicine list was compared to the medications the patient was currently taking. The following discrepancies were observed: a. Cyclobenzaprine ER (extended release) 15 mg capsule, take one capsule three times daily was on the list. HV # 5 stated his/her physician had stopped the Cyclobenzaprine about six months ago and changed to Tizanidine, which was also on the list. b. Omeprazole 20 mg delayed release capsule, take one capsule daily, was on the list. HV # 5 stated he/she stopped taking the Omeprazole about six months ago, and began taking Protonix instead. A bottle of Protonix 40 mg, take one tablet daily, with fill date 2/13/25 was observed in the home. Protonix was not on the medicine list. An interview was conducted on 5/22/25 at 1:29 PM with EI # 2, Area Administrator, who confirmed staff failed to follow the policy for monitoring medications. 1. HV # 3 was admitted to the agency on 4/22/25 with a primary diagnosis of Wedge Compression Fracture of Unspecified Thoracic Vertebra, Subsequent Encounter for Fracture with Routine Healing. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 4/22/25 to 6/20/25 revealed orders for the skilled nurse (SN) to visit once a week for nine weeks. A HV was conducted on 5/20/25 at 2:30 PM to observe care provided by Employee Identifier (EI) # 3, Physical Therapist. During the HV, HV # 3’s medicine list was compared to the medications the patient was currently taking. The following medications were observed in the home but not listed on the medicine list: a. Tamsulosin 0.4 milligrams (mg) tablet daily. HV # 3 reported he/she has been taking the medication for a “long time”. b. Fluticasone Propionate Nasal Spray 50 micrograms 2 sprays per day as needed. HV # 3 stated he has been using it “a few weeks”. An interview was conducted on 5/22/25 at 1:20 PM with EI # 1, Executive Director, who confirmed staff failed to follow the policy for monitoring medications.”

“Only as ordered by a physician CFR(s): 484.60(b)(1) Drugs, services, and treatments are administered only as ordered by a physician or allowed practitioner. This Element is not met as evidenced by: Based on medical record (MR) review, agency policy and procedures, and interview, it was determined the home health agency failed to ensure the skilled nurse (SN) obtained a physician order to include the strength of medication being administered intravenously at each SN visit. This deficient practice affected MR # 5, one of one MR’s reviewed with a mediport (an implanted central venous catheter), and had the potential to affect all patients receiving medications intravenously. Findings include: Agency Policy: Physician Orders Policy Number: 2.1.008 Revised Date: 10/01/23 Policy: No medications...will be administered without the order of a qualified physician or authorized practitioner... Procedure: ...11. Orders containing medication must be entered into the software system or written legibly in ink and at a minimum include: a. Name of medication, dose, dilution... ...c. Dosage expressed in metric system except when it must be expressed otherwise as in units. Agency Policy: Medication Administration Policy Number: 10.002 Revised Date: 12/01/23 Purpose: To provide a process to ensure safe administration of medications in the home. Procedure: 1. The physician’s order will contain: a. Name of medication, dose, dilution.. b. Dosage expressed in metric system except when it must be expressed otherwise as in units... 2. The nurse will observe the ‘five rights” when administering or preparing medications. ... (2) right dose 1. MR # 5 was admitted for home health services on 4/23/25 with a primary diagnosis of Malignant Neoplasm of Rectum. Review of the Home Health Certification (HHC) and Plan of Care (POC) for certification period 4/23/25 to 6/21/25 revealed orders for the SN to visit one time for one week, then one visit every two weeks for eight weeks with two additional visits as needed for IV (intravenous) complications. Continued review of the HHC and POC revealed orders for the SN to instruct the patient and caregiver on administering one liter of normal saline every other Wednesday and flush the IV site with ten milliliters (ml) of normal saline before infusion and again after infusion followed by Heparin 5ml. Review of the 4/23/25 OASIS (Outcome and Assessment Information Set) Admission Visit Note Report revealed the SN documented under “Infusion Access,” that MR # 5 had a mediport to the left chest. The SN also documented under, “Indicate Heparin Flush Strength and Number of ML/CC,” (cubic centimeters) that he/she administered 5ML. There was no documentation of the strength of Heparin Flush administered. The SN failed to contact the physician and obtain an order to clarify the strength of Heparin to be administered. An interview was conducted on 5/22/25 at 1:59 PM with Employee Identifier # 1, Executive Director, who confirmed there was no order for the strength of Heparin to be administered, and the SN failed to contact the physician for an order to clarify the strength of Heparin.”

“Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This Element is not met as evidenced by: Based on medical record (MR) review, agency policy and procedure, and interview, it was determined the home health agency failed to ensure the skilled nurse (SN) assessed and documented wounds per policy. This deficient practice affected one of five records reviewed with wounds, including home visit (HV) # 5, and had the potential to affect all patients with wounds served by this agency. Findings include: Agency Policy: Wound Assessment, Documentation, and Photography Policy Number: 2.2.001 Revised Date: 09/01/24 Purpose: To ensure the accurate and consistent assessment and documentation of wounds. Policy: Upon initial visit and subsequently as indicated below, all wounds will be assessed with appropriate documentation within the MR... ...Unless otherwise ordered by the physician, the qualified clinician...will assess wounds at least: ...Every other week for patients receiving wound care by the agency at a frequency less than daily. ...Reassessments will be documented on the Wound Assessment Tool. The assessment includes measurement of the length, width and depth... Procedure: ...3. Document the following in the MR: ...c. Wound size: Length, Width and Depth are measured in centimeters... 1. HV # 5 was admitted for home health services on 3/28/25 with a primary diagnosis of Chronic Diastolic (Congestive) Heart Failure. Review of the 3/28/25 SN OASIS (Outcome and Assessment Information Set) admission visit note revealed HV # 5 had multiple venous stasis ulcers to his/her bilateral lower extremities. Review of the Home Health Certification and Plan of Care for certification period 3/28/25 to 5/26/25 revealed orders for the SN to visit one time a week for nine weeks to provide wound care, and also two PRN (as needed) visits were ordered for issues/complications that included an increase in wound size and/or staging of the wound. Review of SN visit notes dated 3/28/25, 4/1/25, 4/8/25 and 4/22/25 revealed HV # 5’s wounds were not measured. The SN documented he/she was “unable to measure due to no beginning or end of wound.” Review of SN visit notes dated 4/29/25, 5/8/25, 5/14/25, and 5/20/25 revealed HV # 5’s wounds were not measured. The SN documented no measurements were taken and the reason documented was “unable.” There was no documentation within the MR the SN had measured the wounds on any visit. The SN failed to measure and document the wounds every other week per agency policy. An interview was conducted on 5/22/25 at 1:29 PM with Employee Identifier # 2, Area Administrator, who confirmed the wounds were not measured and documented per policy.”