Kindred at Home 1

“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 clinical record review and staff interview, it was determined SN (skilled nurse) failed to create or maintain accurate, all-inclusive medication lists for three (#1, #2, #3) of 17 records reviewed (#1-#17) This includes a review 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. 1) Review of clinical record #1 revealed the following: A document titled Home Health Certification and Plan of Care with episode dates from 3/02/25 through 4/30/25 revealed relevant diagnosis of ‘Dependence on Supplemental Oxygen’ A document titled ‘Client Medication Report’ with same certification dates show Oxygen isn’t listed. A ‘Visit Note Report’ entered into the EMR (Electronic Medical Record) on 3/02/25 noted “Currently on 2 L (liters) oxygen vial nasal cannula, continuously.” This surveyor asked Agency Staff for clarification. On 3/20/25 at 11:50 Representative #1 stated, “The patient is on oxygen, it was left off the medication list by mistake.” 2) Review of clinical record #2 revealed: A Document titled ‘Client Medication Report’ showed Daptomycin 550 mg/11 ml I.V. (intravenously) Daily highlighted in the color blue on the computer viewing screen. The EMR utilized by the Agency highlights medications in blue when their computer system doesn’t check a medication for interactions against all other medications on the patient’s medication record. This surveyor requested documentation of the medication being checked with a different interaction checker (like Drugs.com or WebMD.com). None was provided. This surveyor reconciled the medications on Drugs.com for this particular medication regimen and found there was potential for a moderate interaction between the Daptomycin and another medication the patient was taking each day. Agency Representatives were informed. Same document titled ‘Client Medication Report’ printed for survey use on 3/19/25 Showed the dosage of Daptomycin to be 550 mg/ 11 ml I.V. The EMR revealed an order entered 3/13/25 read,” Dosage change to infusion-Daptomycin 850 mg/ 17 ml I.V. Push over 5 minutes once daily.” 3) Clinical Record #3 showed: A document titled ‘Client Medication Report’ lists “Florastor 250 mg Capsule orally two times daily. A client coordination note entered 2/25/25 by SN read, “Not on Florastor” This surveyor asked for clarification. Agency Representative #2 stated, “The patient had stopped taking the Florastor but the nurse didn’t D/C (discontinue) it on the Medication Record.””

“Patients receive education and training CFR(s): 484.60(d)(5) Ensure that each patient, and his or her caregiver(s) where applicable, receive ongoing education and training provided by the HHA, as appropriate, regarding the care and services identified in the plan of care. The HHA must provide training, as necessary, to ensure a timely discharge. This Element is not met as evidenced by: Based on Clinical Record review and staff interview, it was determined the SN failed to provide patient and/or caregiver education about prescribed oxygen use in 2 (#4, #5) of 17 (#1-#17) clinical records reviewed. This lack of education has the potential to affect all patients on oxygen as it is a practitioner prescribed medical gas therapy individualized for each patient’s needs. If this deficient practice isn’t corrected, this has the potential to impact the coordination of care delivery by not including the prescriber of oxygen to be an active member of the patients care team thus impacting overall care and outcomes. Medical Record #4 revealed: A ‘Home Health Certification and Plan of Care” dated 3/5/25 through 5/3/25 lists medication “Oxygen Gas for Inhalation 5 liter” A document titled “Vital Sign Report” showed the following entries 3/7/25 of ‘on Oxygen 5.5 L (Liters)’, 3/10/25 ‘on Oxygen 5 L’, on 3/14 ‘on Oxygen 6 L’, on 3/17/25 ‘on Oxygen 6.5 L’, on 3/18/25 ‘on 7 L’. Medical Record #5 showed: A Home Health Certification and Plan of Care lists medication “Oxygen Gas for Inhalation 5 liter” A document titled “Vital Sign Report” showed the following: 2/25/25 of ‘on Oxygen 5 L’, on 2/28/25 ‘on Oxygen 5.5 L’, on 3/11/25 ‘on Oxygen 6 L’ The EMR did not show any evidence of teaching concerning varying or deviating from the dose/amount of Oxygen at the level prescribed by the practitioner nor any communication from the Agency staff regarding the varying dose used by the patient.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on clinical record review and staff interview, it was determined the Agency failed to ensure practitioner ordered, focused assessment was completed and documented each visit for 1 (#4) of 17 (#1-#17) clinical records reviewed. This failed practice had the potential to affect all patients on census in that direct caregivers would not have a full and accurate assessment to focus care towards or an accurate assessment to report to the patients practitioner to allow for real time changes to care if needed. A document titled Home Health Certification and Plan of Care with dates from 3/5/25 through 5/3/25 with a physician’s order to report “ankle circumference greater than 23.” Although the patient was seen a total of 7 times over the course of 16 days, only two ankle measurements were recorded- once on 3/5/25 at the start of care, and again on 3/18/25. Agency representatives were allowed to provide additional information. None was forthcoming.”