Thomas Home Health

“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 observations, agency policy and procedure, and interviews with staff, it was determined the agency failed to ensure the staff observed hand hygiene and bag technique policy. This deficient practice affected three of seven home visit (HV) patients including HV # 3, HV # 4, HV # 5, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Hand Hygiene Policy Number: 8.004 Revised: 5/1/19 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: Staff performs hand hygiene... b. before performing an aseptic task (...wound care). c. after contact with ... wound dressings, or contaminated surfaces... e. after contact with inanimate objects (including medical equipment...) in the immediate vicinity of the patient... Agency Policy: Home Care Bag Protocol Job Aid Policy Number: None Listed Revised: 5.10.21 ...4. Hand washing supplies (...waterless hand-washing gel...) shall be kept in the outermost pocket of the home care bag for easy accessibility. This pocket is referred to as the “dirty” section of the bag... 14. Never return soiled equipment to the bag. Items such as stethoscopes shall be cleaned per policy/procedure and allowed to dry prior to returning them to the bag... Agency Policy: Cleaning of Re-Useable Equipment Policy Number: 8.006 Revised: 6/1/22 Purpose: To assure equipment required for patient care is clean and sanitized to prevent the spread of infections. ...Definitions: Low-Level Disinfection - destroys most bacteria...Examples include at least 70 % isopropyl alcohol/ethyl alcohol. Intermediate - Level Disinfection - destroys vegetative bacteria...Dwell time and dry time must be allowed when cleaning with an intermediate levey disinfectant. Examples include Sani Cloth and Micro Kill. Non-Critical Items - Equipment that is only meant to come in contact with intact patient skin...(...stethoscopes, blood pressure cuffs, pulse oximeters...) ...An intermediate level disinfection may be used...as long as appropriate dwell time and dry time...is observed. Semi-Critical Items - Equipment that comes in contact with mucous membranes or non-intact skin...All other semi-critical items will undergo intermediate level disinfection... 1. HV # 3 was admitted on 10/4/24 and recertified for home care from 12/3/24 to 1/31/25 with diagnoses including Hypertensive Chronic Kidney Disease, Bronchitis, and Iron Deficiency Anemia, Unspecified. A HV was conducted on 1/14/25 at 12:10 PM to observe care provided by Employee Identifier (EI) # 5, Licensed Practical Nurse (LPN). After obtaining the vital signs, EI # 5 removed hand sanitizer from the left pocket of the scrub top, performed hand hygiene and replaced the hand sanitizer back in the pocket. EI # 5 then removed gloves from the right scrub top pocket and donned. EI # 5 then retrieved the scissors from the clean barrier and cut the soiled dressing from HV # 3’s left arm. EI # 5 then placed the contaminated scissors back on the clean barrier. EI # 5 failed to clean the scissors before returning them to the clean area and contaminated the barrier. EI # 5 then removed gloves, removed the hand sanitizer from his/her pocket, performed hand hygiene, and returned the hand sanitizer to the pocket. EI # 5 then removed gloves from the pocket and donned. EI # 5 then wiped the scissors with sanitizing wipes and placed the scissors back on the now contaminated barrier. EI # 5 then removed gloves, performed hand hygiene with hand sanitizer in the pocket and donned gloves which were removed from the pocket. EI # 5 cleaned the open wound with wound cleanser and patted dry with gauze. EI # 5 then removed gloves and donned gloves from the right pocket. EI # 5 failed to perform hand hygiene after removing gloves. EI # 5 then used the scissors from the contaminated barrier to cut the Xeroform dressing and applied the Xeroform dressing and 4 x 4 gauze to the wound site. An interview was conducted on 1/16/25 at 1:20 PM with EI # 1, Director, who confirmed the agency failed to ensure the staff performed hand hygiene and cleaned re-useable equipment per agency policy. 2. HV # 4 was admitted on 1/7/25 with a diagnosis of Chronic Obstructive Pulmonary Disease. A HV was conducted on 1/14/25 at 2:45 PM to observe care provided by EI # 6, Registered Nurse. After care was provided, EI # 6 performed hand hygiene, donned gloves and wiped the re-useable items including the blood pressure cuff, stethoscope, and pulse oximeter with disinfecting wipes and dropped each into the bag immediately after wiping. EI # 6 failed to allow the items to air dry prior to placing back in the bag. An interview was conducted on 1/16/25 at 1:20 PM with EI # 1 who confirmed the agency failed to ensure the staff followed the agency policy for bag technique. 3. HV # 5 was admitted on 1/1/25 with diagnoses including Aftercare following Joint Replacement Surgery and Presence of Left Artificial Hip Joint. A HV was conducted on 1/15/25 at 8:45 AM to observe care provided by EI # 7, Physical Therapist Assistant. After setting up clean and dirty barriers on the counter top, EI # 7 removed items including the Pulse Oximeter from the bag. EI # 7 dropped the Pulse Oximeter onto the floor, picked the item up, replaced the batteries, then placed the contaminated item onto the clean barrier with the other clean items. EI # 7 failed to disinfect the Pulse Oximeter after contact with the floor. An interview was conducted on 1/16/25 at 1:20 PM with EI # 1 who confirmed the agency failed to ensure the staff followed agency policy for cleaning of equipment.”

“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 (MRs), observations, agency policy and interviews with staff, it was determined the agency failed to ensure medications were reconciled in five of seven Home Visits (HV) conducted. This affected HV # 7, HV # 6, HV # 3, HV # 4, HV # 5, and had the potential to negatively affect all patients served by this agency. Findings include: Agency Policy: Medication Management Policy Number: 10.008 Date Revised: 07/01/24 Purpose: To Provide a process to ensure continuous monitoring of medications in the patient’s home. Policy: A drug regimen 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: 1.The discipline responsible for the drug regimen review will: a. Compare medication list obtained...to actual medications patient is taking. b. Review all medications including over the counter (OTC) medications, vitamins, herbs... creams and topical ointments... 2. ...During the patient’s episode of care the following will occur: a. Through a collaborative process the care team will: i. Compare medications patient is currently taking with medications ordered for the patient in order to identify and resolve discrepancies. 3. HV # 3 was admitted on 10/4/24 and recertified for continued care from 12/3/24 to 1/31/25 with diagnoses including Hypertensive Chronic Kidney Disease, Bronchitis, and Iron Deficiency Anemia. Review of the HHC and POC dated 12/3/24 revealed physician’s orders for SN one visit per week for two weeks, one visit every two weeks for two weeks, one visit for one week, one visit every two weeks for two weeks, then one visit for one week. A HV was conducted on 1/14/25 at 12:10 PM to observe care provided by EI # 5, LPN. EI # 8, Clinical Director, Coastal Home Health Branch, accompanied the surveyor on the visit. A review of the medications was conducted with EI # 5 and HV # 3. The following is a list of the discrepancies identified from the ML dated 1/14/25 provided by the agency prior to the HV and the medications HV # 3 was currently taking at home: a. Diltiazem CD 240 mg take one capsule daily was listed on the ML. In the home the surveyor observed prescriptions bottles of Cardizem 240 mg, take one daily, prescription dated 10/16/23, and Tiazac 240 mg take one daily, prescription dated 9/1/24. EI # 5 confirmed that both Cardizem and Tiazac were brand names of the generic medication Diltiazem. HV # 3 stated he/she had been taking both the medications since the prescriptions were filled. b. Gemtesa 75 mg take one daily and Gemtesa 75 mg take one every other day were listed separately on the ML. HV # 3 stated he/she had been taking only one Gemtesa every day. c. Celebrex 200 mg take one every day was on the ML. HV # 3 stated he/she had not been taking the medication for two to three months. d. Aspirin 81 mg take two tablets as needed for pain was on the ML. HV # 3 stated he/she was not taking the Aspirin and did not remember when the the last dose was taken. There was no Aspirin medication bottle with the patient’s medications. e. Esomeprazole Magnesium 40 mg take one daily and Nexium 40 mg take one daily was on the medication list. EI # 5 confirmed that Esomeprazole and Nexium were different names for the same medication. HV # 3 stated he/she was currently only taking the Esomeprazole daily. f. Mybetriq 50 mg take one daily was on the ML. HV # 3 stated he/she had not been taking the medication for two to three months. The following over the counter medications were in the home but not listed on the ML: a. Centrum Men’s Silver 50 Plus. HV # 3 stated he/she had been taking daily every day “forever.” b. Iron Slow Release 45 mg. HV # 3 stated he/she had been taking the medication daily for over a year. c. Vitamin C 500 mg. HV # 3 stated he/she had been taking the medication daily every day forever. d. Glucosamine Chondroitin 1500 mg. HV # 3 stated he/she had been taking the medication daily taking for over a year. e. L-Arginine 500 mg. HV # 3 stated he/she had been taking the medication daily for over a year. f. CO-Q 10 200 mg. HV # 3 stated he/she had been taking the medication daily for over a year. g. Meta Fiber Gummies 5 grams. HV # 3 stated he/she had been taking the medication three times a day for two weeks. An interview was conducted on 1/16/25 at 1:05 PM with EI # 1 who confirmed the agency failed to ensure the staff reconciled the medications per agency policy and included all current medications on the ML. 4. HV # 4 was admitted on 1/7/25 with diagnoses including Chronic Obstructive Pulmonary Disease, Acute and Chronic Respiratory Failure, and Unspecified Atrial Fibrillation. Review of the HHC and POC dated 1/7/25 revealed physician’s orders for SN one visit per week for nine weeks. A HV was conducted on 1/14/25 at 2:45 PM to observe care provided by EI # 6, RN. EI # 8 accompanied the surveyor on the visit. A review of the medications was conducted by EI # 6 and HV # 4 and compared to the current ML dated 1/14/25. The following discrepancies were identified: a. Metoprolol 50 mg take one daily was on the ML. Metoprolol 100 mg take one daily, filled 11/19/24, was in the home. HV # 4 stated he/she had been taking the 100 mg tablets since the prescription was filled. b. Chlorthalidone 25 mg take one daily, filled 10/7/24, was in the home but not on the ML. HV # 4 stated he/she had been taking the medication since the prescription was filled. c. Paricalcitol 2 micrograms (mcg) take one two times a week, filled 11/25/24, was in the home. Zemplar (brand name for Paricalcitol) 2 mcg take one daily was on the ML. HV # 4 stated he/she had been taking the Paricalcitol two times a week since the prescription was filled. d. Levothyroxine 150 mg take one daily, filled 11/26/24, was in the home. Levothyroxine 175 mg take one daily was listed on the ML. HV # 4 stated he/she had been taking the 150 mg tablets since the prescription was filled. e. Farxiga 10 mg take one daily, filled 11/26/24, was in the home but not on the ML. HV # 4 stated he/she had been taking the medication since the prescription was filled two months ago. f. Carbazepine 200 mg take one daily, filled 11/26/24, was in the home but not listed on the ML. HV # 4 stated he/she had been taking the medication daily since the prescription was filled. g. Jantovan (brand name for Warfarin) 1 mg, filled 8/14/23, and Jantovan 5 mg, filled 10/3/24, was in the home. Warfarin 5 mg take one daily was on the ML. HV # 4 stated he/she sometimes took 6 mg daily and sometimes he/she would take 5 mg. An interview was conducted on 1/16/25 at 1:40 PM with EI # 1 who confirmed the agency failed to ensure the staff reconciled the medications per agency policy and included all current medications on the ML. 5. HV # 5 was admitted on 1/1/25 with diagnoses including Aftercare following Joint Replacement Surgery, Presence of Left Artificial Hip Joint, and Anemia, Unspecified. A HV was conducted on 1/15/25 at 8:45 AM to observe care provided by EI # 7, Physical Therapy Assistant. A review of the home medications was conducted with EI # 7 and HV # 5 and compared to the current ML dated 1/14/25. The following is a list of the discrepancies: a. Omeprazole 40 mg take one daily as needed, filled 10/7/24, was in the home but not on the ML. HV # 5 stated he/she is currently taking the medication as needed. b. Sucralfate 1 gram take daily as needed, filled 10/7/24, was in the home but not on the ML. HV # 5 stated he/she is currently taking the medication as needed. An interview was conducted on 1/16/25 at 1:40 PM with EI # 1 who confirmed the agency failed to ensure the staff reconciled the medications per agency policy and included all current medications on the ML. 1. HV # 7 was admitted to the agency on 11/6/2024 and recertified for continued care from 1/5/25 to 3/5/25 with the diagnosis of Cyst of Pancreas. Review of the Home Health Certification (HHC) and Plan of Care (POC) for the dates of 1/5/25 to 3/5/25 revealed physician’s orders for the Skilled Nurse (SN) to visit one time a week for nine weeks. A home visit was conducted on 1/14/25 at 11:05 AM to observe care provided by Employee Identifier (EI) # 4, Licensed Practical Nurse (LPN). EI # 2, Area Director was also present during the HV. A comparison was made between medications observed in the home and the Medication List (ML) dated 1/14/25 provided by the agency prior to the HV. The following medications were listed, but not in the patient’s home: a. Morphine 30 mg (milligram) Immediate Release Tablet Oral, take one tablet two times daily. HV #7 reported he/she stopped taking the medication two months ago. b. Seroquel 50 mg tablet, take one tablet at bedtime. HV # 7 reported he/she stopped taking the medication about one month ago. An interview conducted on 1/16/25 at 1:52 PM with EI # 1, Director, confirmed the agency staff failed to ensure medications were reconciled and all current medications were included on the ML. 2. HV # 6 was admitted to the agency on 2/6/24 and recertified for continued care from 12/22/24 to 2/19/25 with the diagnosis of Pressure Ulcer of Sacral Region Stage Three. Review of the HHC and POC for the dates of 12/22/24 to 2/19/25 revealed physician’s orders for the SN to visit one time a week for eight weeks. A home visit was conducted on 1/14/25 at 12:44 PM to observe care provided by EI # 3, Register Nurse (RN). EI # 2 was also present during the HV. A comparison was made between medications observed in the home and the ML dated 1/14/25 provided from the agency prior to the HV. The following medications were in the home, but were not listed on the ML: a. Aspirin 81mg take one daily. The Caregiver (CG) reported HV # 6 started taking the medication on 12/4/24. b. Plavix 75 mg take one daily. The CG reported HV # 6 started taking the medication on 12/4/24. An interview conducted on 1/16/25 at 1:52 PM with EI # 1, confirmed the agency staff failed to ensure medications were reconciled and all current medications were included on the ML.”

“Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This Element is not met as evidenced by: Based on medical record (MR) review, agency policy and procedure, and interview it was determined the agency failed to ensure a comprehensive assessment was completed within the last five days of the re-certification. This deficient practice did affect one of six MR reviewed with recertifications including Home Visit (HV) # 3 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Patient Assessment, Initial and Reassessment Policy Number: 2.1.002 Revised: 9/1/24 Purpose: To describe the process of patient assessments... Procedure: ...5. A qualified clinician performs a comprehensive assessment or reassessment visit in the following situations: ...c. Periodic reassessment during the last 5 (five) days of the re-certification, or at least every 60 days... 8. Patients are assessed for continued need and response to care and services... HV # 3 was admitted on 10/4/24 and recertified for home care from 12/3/24 to 1/31/25 with diagnoses including Hypertensive Chronic Kidney Disease, Bronchitis, and Iron Deficiency Anemia. Review of the Visit Note Report, RN (Registered Nurse) Recert with Skill note dated 12/4/24 revealed the comprehensive assessment was not completed prior to the end of the prior certification period. An interview was conducted on 1/16/25 at 1:05 PM with Employee Identifier # 1, Director, who confirmed the comprehensive assessment had not been completed within the last five days of the prior certification.”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(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 medical record (MR) review, agency policy and procedures, and interviews with staff it was determined the agency failed to ensure the physician was notified of significant changes in the patient condition. This deficient practice affected one of 17 MR reviewed including MR # 4 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Coordination of Care, From Admit Through Discharge Policy Number: 2.1.017 Revised: 9/1/24 Purpose: To establish processes and criteria so that the coordination of patient care will be optimal from admit through discharge. ...Procedure: ...4. Coordination of care with physician/authorized practitioner: At admission, throughout care, and at discharge, coordination of services is promoted through routine communication with the patient’s physician. a. When changes occur in the patient’s condition or response to treatment. ...e. When there is a need to change the patient’s plan of care. MR # 4 was admitted on 12/22/24 with diagnoses including Type 2 Diabetes Mellitus with Ketoacidosis without Coma, Atherosclerotic Heart Disease, Hypertensive Heart Disease, and Heart Failure. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 12/22/24 revealed physician’s orders for Skilled Nurse (SN) two visits per week for one week then one visit per week for seven weeks, and SN may perform up to two PRN (as needed) visit. Review of the SN Visit Note Report (VNR) dated 1/1/25 revealed the SN documented “...SN arrived to patient home to find patient severley intoxicated and soiled. Patient urinated on (self) in the bed...Patient had cigarette butts and ashes in bed that almost burned hole in bed...Caregiver...in Louisiana...unaware of condition...Patient unable to get up alone. Patient is a severe fall risk. Patient barely eats and drinks anything but alcohol”. There was no documentation the SN notified the physician of the patient changes. An interview was conducted on 1/16/25 at 2:05 PM with Employee Identifier # 1, Director, who confirmed the physician was not notified of the changes in the patient condition.”

“Coordinate care delivery CFR(s): 484.60(d)(4) Coordinate care delivery to meet the patient’s needs, and involve the patient, representative (if any), and caregiver(s), as appropriate, in the coordination of care activities. This Element is not met as evidenced by: Based on medical record (MR) review, agency policy and procedure, and interview with staff it was determined the agency failed to ensure care was coordinated to meet the patient’s needs. This deficient practice affected one of 17 MR reviewed includint MR # 4 and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Coordination of Care, From Admit Through Discharge Policy Number: 2/1/017 Revised: 9/1/24 Purpose: To establish processes and criteria so that the coordination of patient care will be optimal from admit through discharge. Policy: The agency provides care and services within an integrated continuum of care system. This is accomplished by: Identifying patient needs through assessment and communication with other health care providers. ...Coordinating patient care among various disciplines ... to ensure that services are continuous and coordinated... Procedure: ...5. Coordination of care among disciplines...This includes... c. Appropriate, timely communication with the patient, caregivers, and staff involved in the patient’s care...as well as changes in these... 6. Coordination of services with other organizations and community... b. Communication with other health care providers when there are significant changes in patient care and/or condition... MR # 4 was admitted on 12/22/24 with diagnoses including Type 2 Diabetes Mellitus with Ketoacidosis without Coma, Atherosclerotic Heart Disease, Hypertensive Heart Disease, and Heart Failure. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 12/22/24 revealed physician’s orders for Skilled Nurse (SN) two visits per week for one week then one visit per week for seven weeks, and SN may perform up to two PRN (as needed) visit. Review of the SN Visit Note Report (VNR) dated 1/1/25 revealed the SN documented “...SN arrived to patient home to find patient severely intoxicated and soiled. Patient urinated on (self) in the bed...Patient had cigarette butts and ashes in bed that almost burned hole in bed...Caregiver...in Louisiana...unaware of condition...Patient unable to get up alone. Patient is a severe fall risk. Patient barely eats and drinks anything but alcohol.” There was no documentation care was coordinated among other disciplines or outside agencies to meet the patient’s changing needs including safety concerns, caregiver support, and nutritional needs. An interview was conducted on 1/16/25 at 2:05 PM with Employee Identifier # 1, Director, who confirmed there was no documentation of coordination of care among disciplines to meet MR # 4’s needs. EI # 1 provided a copy of a report to the the Department of Human Resources dated 1/16/25 outlining allegations of substance abuse, physical neglect, and poor physical condition.”

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on review of medical record (MR), agency policy and procedure, and interviews it was determined the agency failed to ensure the staff followed physician’s orders for patient care. This deficient practice affected two of 17 MR reviewed including Home Visit (HV) # 3, HV # 2, and had the potential to affect all patients admitted to this agency. Findings include: Agency Policy: Plan of Care (POC) Policy Number: 2.1.007 Revised: 9/1/24 Purpose: ...To ensure that physician/authorized practioner’s orders are followed... Procedure: ...2. The POC includes: ...i. Patient specific interventions and education; measurable outcomes and goals identified by the agency... 13. Staff reviews the patient’s chart periodically to ensure compliance with physician/authorized practioner’s orders... 2. HV # 2 was admitted on 1/2/25 with a diagnosis of Age Related Osteoporosis with a Pathological Fracture of the Right Femur. Review of the HHC and POC dated 1/2/25 revealed orders including: SN one time a week for five weeks, two times a week for two weeks for two weeks, one time a week for two weeks, and two PRN (as needed) wound issues. Skilled Nurse to provide/instruct to client/caregiver wound care to right upper leg closed incision/suture line. Instruct patient/caregiver signs/symptoms of infection and proper disposal of dressings. Skilled Nurse may perform two PRN visits for surgical wound complications such as increase and/or change in wound drainage color, foul odor to wound/wound drainage, increased pain to wound site, elevated temperature, signs and symptoms of infection, increase in wound size and/or staging. EI # 1, Director, reported when questioned regarding if there were specific wound care orders, the order was on the referral and had not been transcribed to the POC. An order was entered as late on 1/15/25: Per referral late entry effective 1/2/25 Right Hip Surgical Incision: Clean with wound cleanser, skin prep to peri wound and apply Optifoam Gentle Post Op. (Brand Name).Change twice weekly and PRN. Review of the start of care nursing documentation dated 1/2/25 revealed # 1 Lateral- Proximal Thigh. Right, Surgical Incision onset date 12/19/24 wound assessment not performed due to covered by a non-removeable dressing or device. Review of the SN Visit Note Report (VNR) dated 1/7/25 revealed # 1 Lateral- Proximal Thigh. Right, Surgical Incision onset date 12/19/24 wound assessment not performed due to caregiver completed the care. An interview was conducted on 1/16/25 at 1:23 PM with Employee Identifier # 1, Director, who confirmed the SN did not perform the wound care as ordered on the referral. HV # 3 was admitted on 10/4/24 and recertified for home care from 12/3/24 to 1/31/25 with diagnoses including Hypertensive Chronic Kidney Disease, Bronchitis, and Iron Deficiency Anemia, Unspecified. Review of the Home Health Certification (HHC) and POC dated 12/3/25 revealed orders including Skilled Nurse (SN) one visit per week for two weeks, one visit every two weeks for two weeks, one visit per week for one week, one visit every two weeks for two weeks, then one visit per week for one week. SN to obtain body measurement of ankles every visit. Review of the SN Visit Note Report (VNR) dated 12/4/24 revealed the SN documented the ankle circumference of the left leg only. Review of the SN VNR dated 12/31/24 revealed no documentation of the ankle measurements. Review of the SN VNR dated 1/14/25 revealed no documentation of the ankle measurements. An interview was conducted on 1/16/25 at 1:05 PM with Employee Identifier (EI) # 1, Director, who stated the ankle measurements should have been obtained from both ankles and the agency failed to ensure the staff followed the physician’s orders for ankle measurements.”

“Patient and caregiver education CFR(s): 484.75(b)(5) Patient and caregiver education; This Element is not met as evidenced by: Based on observations, medical record review, agency policy and procedure, and interviews with staff it was determined the agency failed to provide medication education to prevent duplication of medications. This deficient practice affected one of seven home visit (HV) patients including HV # 3 and had the potential to negatively affect all patients admitted to this agency. Findings include: Agency Policy: Patient Education Purpose: To describe patient and/or caregiver interactions designed to promote and maximize patient health and safety... Procedure: ...2. Education provided is coordinated among the interdisciplanary team, in accordance with the plan of care... 6. Per assessed knowledge deficit, patients and caregivers receive oral and/or written information on medication education to include: a. Dosage, route, duration b. Description, purpose, expected actions... d. Potential drug-food interactions... 1. HV # 3 was admitted on 10/4/24 and recertified for home care from 12/3/24 to 1/31/25 with diagnoses including Hypertensive Chronic Kidney Disease, Chronic Kidney Disease, Bronchitis, and Iron Deficiency Anemia, Unspecified. Review of the Home Health Certification and Plan of Care dated 12/3/24 revealed physician’s orders for Skilled Nurse (SN) one visit per week for two weeks, one visit every two weeks for two weeks, one visit per week for one week, one visit every two weeks, then one visit per week for one week. SN to instruct on new and changed medications, those with assessed knowledge deficit, high risk medications, and any applicable drug interactions. A HV was conducted on 1/14/25 at 12:10 PM with Employee Identifier (EI) # 5, Licensed Practical Nurse. A review of the medications in the home revealed the following duplicate prescriptions of the same medications: a. Cardizem 240 milligram (mg) and Tiazac (brand name for Cardizem) 240 mg was observed in the home. A review of the Medication List (ML) dated 1/14/25 revealed orders for Diltiazem (generic name for Cardizem and Tiazac) 240 mg take one daily for heart rate. HV # 3 stated he/she was currently taking both the Cardizem and the Tiazac and was not aware both medications were the same. A review of the SN Visit Notes from 12/4/24 through1/9/25 revealed no documentation of patient education for Diltiazem, Cardizem, or Tiazac. An interview was conducted on 1/16/25 at 1:05 PM with EI # 1, Director, who confirmed there was no documentation of patient teaching for Diltiazem, Cardizem, or Tiazac prior to the 1/14/25 SN visit and further stated he/she would have expected the medications to have been caught as being the same during medication reconciliation.”