Nhc Homecare

“Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This Element is not met as evidenced by: Based on interview, and record review, the Home Health Agency (HHA) failed to report an allegation of abuse to the required authorities for 1 of 1 patient reviewed for complaints of a total sample of 11 patients (#11). Findings: Review of the complaint log for 2024 revealed patient #11 called the HHA on 5/28/24 and requested to speak with the Administrator. Review of the Service Recovery Investigation Follow-up form dated 5/18/24 completed by the Administrator revealed when patient #11 called, she mentioned she was going to report the HHA to Elder Abuse if she could not speak to the Administrator “immediately.” The Administrator wrote patient #11 “called to let me know how upset she was with her PT (physical therapy) visit . . . on 5/25/24.” The patient stated the physical therapist was “abusive, intimidating, standing over me, pointing finger at me and didn’t explain anything to me. I finally asked her to leave. . . . (patient #11) also said her neighbors were in the back and witnessed everything.” The form showed the Administrator contacted the Physical Therapist (PT) to get the details of what occurred. The form read, (PT) “said that she did not yell at the patient or do anything that would be perceived as abusive.” The form included, “When I spoke with (PT), she made a comment that (patient #11) was ‘very stubborn’.” On 7/10/24 at 3:00 PM, the Administrator stated this was a personality conflict issue. She explained patient #11 called the office on Tuesday 5/28/24 to speak with her. The Administrator indicated patient #11 thought the PT was being abusive, pointed finger, and stood over her. She explained the PT was trying to get her consent and permission for care, and the PT was pointing at the tablet. The Administrator read the form and repeated patient #11 referred to the PT as “abusive, intimating, standing over me and pointing finger at me.” The Administrator stated that was how patient #11 perceived it. She explained patient #11 was not admitted to the agency, the visit was billed, and she was offered another therapist but patient #11 told her she had already contacted another agency for services. The Administrator explained she listened to find out what patient #11 meant by abusive, and she only mentioned “standing over me and pointing finger.” When asked why this was not reported as an allegation of abuse, the Administrator stated she would have reported it if this was a “severe case.” The Administrator stated she could not identify “true abuse” based on her professional experience. She indicated she had received various compliments about this clinician. She validated she did not call any other patients assigned to this PT nor investigate it further. The Administrator stated she determined by the end of the call this did not rise to the level of reporting. She shared her definition of abuse as “something severe, causing harm or endangerment. Abuse can be physical, verbal, safety, sexual. Something that warrants to be escalated.” Review of the Patient Orientation for Home Health Care Book given to the new patients during the start of care visit included Section 3. Patient Rights and Responsibilities. It read, “Your rights . . . . Be free from mistreatment, neglect, verbal, mental, sexual and physical abuse, . . . . Agency staff who identify, notice, or recognize these incidents or circumstances must report their findings immediately to the home health agency and other appropriate authorities in accordance with state law.” Review of the agency’s Abuse Policy, not dated, revealed patients had the right to voice complaints about mistreatment or abuse. The policy and procedure titled Complaints and Grievances read, “All complaints/grievances are received and processed according to established procedure and NHC policy, and in compliance with applicable state and federal laws.””

“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 interview and record review, the Home Health Agency failed to review all medications the patient was taking after a resumption of care (ROC) and failed to update the medication list appropriately for 1 of 6 patients reviewed for medications of a total sample of 11 patients, (#1). Findings: Review of the medical record revealed patient #1’s start of care date was 6/04/24. His diagnoses included pressure ulcer of the sacral region stage 4, chronic respiratory failure with hypoxia, chronic obstructive pulmonary disease, diabetes type 2, dysphagia, gastrostomy status, and tracheostomy status. Review of the ROC order dated 6/20/24 included the following medications: Albuterol Sulfate 2.5 milligrams (mg)/3 milliliters (ml) solution, clotrimazole-betamethasone cream, diclofenac gel, Glucerna 1.5 calories, Humulin 70/30 sliding scale, insulin glargine 3 ml pen, levothyroxine 50 micrograms (mcg), and midodrine 10 mg. During a home visit on 7/08/24 starting at 2:30 PM, patient #1’s son stated he managed his father medications. He showed the medications his father was taking. The medications included Albuterol Sulfate 2.5 mg/3 ml solution, clotrimazole-betamethasone cream, diclofenac gel, Glucerna 1.2 calories, Humulin 70/30, insulin glargine 3 ml pen, Humulin R, levothyroxine 50 mcg, midodrine 10 mg, Pantoprazole 40 mg, Eliquis 5 mg, and an emptied bottle of quetiapine. The quetiapine label, dated 6/5/24, indicated 50 mg for 30 days. Patient #1’s son stated the quetiapine was given and finished “the other day.” He indicated he had given 5 units of Humulin R one time and referred to it as the “long lasting one.” He mentioned he administered the Humulin R based on “how his father feels.” He acknowledged he did not use the sliding scale guidance as posted on a white board in the home. He explained his father used Glucerna 1.5 before but due “to high blood sugar” it was changed to 1.2. Review of the hospital’s Home Medication List dated 6/19/24 listed new medications including Eliquis 5 mg to be taken twice a day. It also included the medications patient #1 was to continue at home, including Humulin R, 0-20 unit every 6 hours. Review of the medications in the home with the written medication list in the patient’s folder and the electronic medical record (EMR) revealed Eliquis, Humulin R, Pantoprazole and Quetiapine were never added. There was no evidence in the medical record the medications were reconciled at ROC visit on 6/20/24 or during subsequent visits performed by skilled nursing on 6/27, 7/1, 7/3, 7/5, 7/8. Review of the agency’s folder in patient #1’s home included a list of medications dated 6/04/24. On 7/08/24 at 4:00 PM, Registered Nurse (RN) A stated she “try to check every visit” when asked how often she reviewed the medications in the patient’s home with the EMR. On 7/09/24 at 4:41 PM, the Administrator stated all clinicians should ask about any new medications and update the medication profile during their home visit. She said, “I expect that (medication list) be updated.” On 7/10/24 at 10:48 AM, the Administrator stated she verified the medication list at pt #1’s home was not updated and instructed the nurse to update it on today’s visit. The Administrator mentioned the medication list received from the skilled nursing facility before his admission to the agency showed Pantoprazole and Seroquel were stopped in 2023 and were not on the medication list they received. The Clinical Manager (CM) indicated RN A told her she forgot to include the new medications. The CM stated Glucerna 1.5 was a typo and should read 1.2. Review of the agency policy and procedure titled Medication Review and Reconciliation, revised on 5/22 revealed the intent “To establish processes that maximize patient safety and outcomes related to medications and to comply with related state and federal regulations and clinical best practice.” The document read, “Medication review and reconciliation is completed as a part of all comprehensive assessments (at start of care, resumption of care, recertification, and discharge) and with every medication change.” The policy indicated medication compliance, effects and changes were assessed at every skilled visit with the primary goals of optimal patient care, safety, and outcomes. The policy revealed the medication review and reconciliation process was to be performed via interview and observation techniques and included eyes-on all medications the patient was taking, a comparison of the medications listed on discharge instructions and assessment to medication compliance.”