Vanura Home Health Services, Inc.

“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 observation, interview, and record review, the facility failed to ensure medication reconciliation (a review of all medications the patients were taking) was conducted for one of five sampled patients (Patient 4) when there was a discrepancy between Patient 4’s plan of care (an individualized treatment plan) and Patient 4’s medication profile (a comprehensive record of all the medications that a patient is currently taking). This failure resulted in the facility to have an inaccurate list of current medications Patient 4 was taking and being unable to identify any potential adverse effects (unintended outcome) from medication interactions, which could negatively affect Patient 4’s health and safety. Findings: During a review of Patient 4’s “Patient Profile” (contains medical and demographic information), undated, the “Patient Profile” indicated Patient 4 had a start of care date of December 6, 2024, with diagnoses which included acute respiratory failure with hypoxia (a sudden inability of the respiratory system to maintain adequate oxygenation of the blood), metabolic encephalopathy (a change in brain function caused by an illness or chemical imbalance in the body), and fracture of unspecified lower leg, subsequent encounter for closed fracture with routine healing (a lower leg fracture that is healing normally after the initial treatment, with no open wound at the fracture site). During a concurrent home visit observation, interview, and record review on August 19, 2026, at 10:08 AM, with Licensed Vocational Nurse 1 (LVN 1), and in the presence of Patient 4, Patient 4’s physical medications were compared with Patient 4’s “Medication Profile,” dated with the episode period of July 29, 2026, through September 26, 2026. The “Medication Profile,” indicated Patient 4 was taking Sildenafil (a medication used to treat erectile dysfunction) 50 milligrams (mg – unit of measure) one tablet by mouth as needed. However, the physical medication bottle which Patient 4 had was Sildenafil 100 mg one tablet by mouth as needed. Patient 4 stated he did not have any other Sildenafil medication bottles in the home and he received the bottle with 100 mg doses in December 2025. The physical medication bottle for Sildenafil 100 mg indicated “date filled 12/15/25 [December 15, 2025].” LVN 1 confirmed there was a 50 mg discrepancy of Sildenafil when comparing Patient 4’s physical medication bottle and “Medication Profile.” During a review of Patient 4’s “Home Health Certification and Plan of Care” (Plan of Care), with a certification period of July 29, 2026, through September 26, 2026, the Plan of Care indicated Patient 4’s medication list had Sildenafil 50 mg tablet, one tablet as needed. During an interview on August 19, 2026, at 10:48 AM, with LVN 1, LVN 1 stated each visit, licensed staff [LVN and/or Registered Nurses (RN)] were supposed to compare patients’ physical medications bottles with patients’ “Medication Profile,” to ensure the “Medication Profile,” was accurate. LVN 1 further stated she had checked Patient 4’s physical medications on her prior visits to Patient 4’s home within the last few weeks but she did not review the physical medication bottle of Sildenafil because of the sensitive nature of the medication. LVN 1 further stated that since Patient 4 kept the medication bottle in his room and LVN 1 did not identify that there was a discrepancy in the dose. During an interview on August 20, 2026, at 4:00 PM, with the Director of Patient Care Services (DPCS), the DPCS stated during each patient home visit, LVN and/or RN were supposed to perform medication reconciliation by comparing the patients’ physical medications with the medications listed on the “Medication Profile,” to make sure each medication, dosage, and frequency (frequency in which the medication is taken) matched. The DPCS stated the nursing staff were supposed to ask patient if a physician had made any changes to medications and all changes or discrepancies needed to be reported to the case manager so the medication profile could be updated, and clarification of doctors’ orders can be obtained if needed. During a review of the facility’s policy and procedure (P&P) titled, “Medication Profile,” dated November 2020, the P&P indicated, “To define the use of the medication profile in evaluating a patient’s medication regimen, including over-the-counter (OTC) medications, nutrition supplements, herbal remedies, vitamins and minerals. Policy – Patient receiving medications administered by the organization will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications, new, and/or discontinued medications…””

“HH aide supervision elements CFR(s): 484.80(h)(4)(i-vi) Home health aide supervision must ensure that aides furnish care in a safe and effective manner, including, but not limited to, the following elements: (i) Following the patient’s plan of care for completion of tasks assigned to a home health aide by the registered nurse or other appropriate skilled professional; (ii) Maintaining an open communication process with the patient, representative (if any), caregivers, and family; (iii) Demonstrating competency with assigned tasks; (iv) Complying with infection prevention and control policies and procedures; (v) Reporting changes in the patient’s condition; and (vi) Honoring patient rights. This Element is not met as evidenced by: Based on interview, and record review, the agency failed to ensure Certified Home Health Aide 1 (CHHA 1) furnished care in a safe and effective manner for one of one patient (Patient 5) when CHHA 1 was not aware of Patient 5’s specific vital sign (VS- basic measurements that show how well a person’s body is working that includes temperature, blood pressure [BP—how strongly blood is pushing through arteries], heart rate [HR—how fast the heart is beating every minute], respiratory rate [R—how fast a person is breathing], and oxygen level [SPO2- how much oxygen is in the blood]) parameters identified in the care plan (an individualized, written guide that outlines which tasks the home health aid will perform in the patient’s home), for notifying appropriate healthcare professionals. This failure had the potential to result in delayed recognition and reporting of abnormal vital signs, delayed assessment and treatment by healthcare providers and deterioration in the patient’s condition. Findings: A review of Patient 5’s “Home Health Certification and Plan of Care,” (Plan of Care—contains medical and demographic information), with a certification period of July 25, 2026, through September 22, 2026, the Plan of Care indicated Patient 5 had a start of care date of May 26, 2026. Additionally, the Plan of Care indicated Patient 5 had diagnoses which included cardiomegaly (enlarged heart), chronic obstructive pulmonary disease (long-term lung disease that causes persistent airflow limitation), and hypertension (persistently elevated blood pressure). During further review of Patient 5’s “Home Health Certification and Plan of Care,” with a certification period of July 25, 2026, through September 22, 2026, the Plan of Care indicated Patient 5 was supposed to receive home health aide services one time a week for eight weeks. Additionally, the Plan of Care indicated “…home health aide to assist patient with personal hygiene needs, measure vital signs…” Identified “goals” for this Plan of Care included, “Patient will remain hemodynamically stable [heart, blood vessels, and blood volume are effectively delivering oxygen and nutrients to organs] without cardiac [heart] complications…Patient will remain free of symptoms requiring emergency medical intervention…Patient will maintain stable respiratory status without COPD exacerbation…Patient will maintain blood pressure within physician-ordered parameters…” During a review of Patient 5’s “Home Health Aid Care Plan” (Care Plan), dated July 27, 2026, the Care Plan indicated the Home Health Aide was to measure patients’ vitals which included temperature (temp), pulse (heart rate), respirations, blood pressure , and pain level (a pain assessment tool where 0 indicated no pain and 10 as highest pain). The care plan further indicated, “Parameters to notify care manager…Temp > [greater than] 101…BP > 160 or 90 or 110, 24, the Patient 5’s vital signs. CHHA 1 further stated she was not aware of any specific vital sign parameters in which she was to inform the agency or healthcare staff and stated that she relied on her experience of over 30 years to determine what vital sign results would be considered acceptable. CHHA 1 again stated there was no vital sign parameters documented or indicated anywhere that she was aware of. CHHA 1 stated she did not have Patient 5’s “Home Health Aid Care Plan” with her and had left it at home. During an interview on August 20, 2026, at 4:00 PM, with the Director of Patient Care Services (DPCS), the DPCS stated all CHHAs should be aware of the parameters for each patients vital signs as provided on each patients plan of care and his expectation was that CHHAs are familiar with the parameters and notify the appropriate individual when vital signs are outside acceptable parameters. During a review of the facility’s policy and procedure (P&P) titled, “Care/Service coordination,” dated November 2020, the P&P indicated, “…All personnel will be knowledgeable regarding patient needs, goals of care, and services…” During a review of the facility’s P&P titled, “Home Health Aide Plan of Care,” dated November 2020, the P&P indicated, “Each patient receiving home health aide services will have an individualized plan developed by an appropriate professional and utilized to direct the care performed by the assigned aide…2. The home health aide plan of care will be individualized to the specific patient and will include at least: A…the performance of simple procedures as an extension of therapy or nursing services…k. Reporting changes in patient’s condition and needs…Home health aides are members of the interdisciplinary team and shall report changes in the patient’s condition to a registered nurse or other appropriate skilled professional....” During a review of the facility’s job description titled, “Certified Home Health Aide,” dated January 2015, the job description indicated, “Job Summary: Provides health care tasks, personal hygiene services, housekeeping tasks and other related support services essential to the home health patient’s health needs under the supervision of a registered nurse or a therapist. Observes, records/documents and reports all changes and care performed to supervisor. All HHA’s must demonstrate competence in performing the necessary skills and only perform those skills on the plan of care…reports to: Director of Patient Care Services…””