Intermountain Home Care of Cassia

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on medical record review and staff interview, it was determined the agency failed to ensure patients received all services written in the POC for 1 of 8 patients (Patient #2) whose records were reviewed. Failure to ensure Patient #2 received all services as outlined in the POC caused OT to be ordered but not provided. Findings include: Patient #2 was a 74 year old female admitted to the agency on 11/14/24 with a primary diagnosis of aftercare following joint replacement surgery. Additional diagnoses included dysphagia and hypercholesterolemia. She received SN and PT services. She was discharged on 11/27/24. Patient #2’s medical record included a referral order dated 11/14/24 which stated, “Per Fax: Occupational Therapy.” Patient #2’s medical record included a POC dated 11/14/24 which stated that occupational therapy was included on the referral order. Patient #2’s medical record was reviewed but no OT visits were conducted. The DCS was interviewed on 1/08/25 beginning at 1:20 PM and Patient #2’s medical record was reviewed in her presence. She confirmed OT was listed on the referral order. She confirmed no OT visits were provided for Patient #2. She stated the Occupation Therapist was on leave when Patient #2 was admitted so they were not provided. She confirmed there was no documentation in Patient #2’s record why the OT visits were ordered but not provided. The agency failed to ensure services were provided in accordance with the POC.”

“Make complaints to the HHA CFR(s): 484.50(c)(3) Make complaints to the HHA regarding treatment or care that is (or fails to be) furnished, and the lack of respect for property and/or person by anyone who is furnishing services on behalf of the HHA; This Element is not met as evidenced by: Based on policy review, grievance report review, and staff interview, it was determined the agency failed to ensure complaints were investigated and resolved for 1 of 8 patients (Patient #2) whose records were reviewed. Failure to investigate complaints had the potential for repeated patient care problems. Findings include: An agency policy titled, “Patient Complaint and Grievance,” updated April 2024 stated, “A grievance is considered resolved when the patient/patient representative is satisfied with the investigation.” This policy was not followed. An example includes: Patient #2 was a 74 year old female admitted to the agency on 11/14/24 with a primary diagnosis of aftercare following joint replacement surgery. Additional diagnoses included dysphagia and hypercholesterolemia. She received SN and PT services. She was discharged on 11/27/24. Grievances were reviewed and included an event from 11/18/24 for Patient #2. The event stated, “HH [home health] 24/7 call center did not return patient’s call resulting in a trip to the ER.” The investigation into the event was requested and reviewed. A note within the event reporting system stated, “The patient [Patient #2 name] had stated she had a left knee replacement surgery on 11/13 and there were hot spots and it was burning, she … wanted to talk to someone … he [call center operator] gets back on the line with the patient and explains he’s having difficulty reaching the nurse … [patient #2] then asks if she should just head to the ER. The operator said … she could consider that option … Unfortunately, I cannot find a ticket, so I have no documentation of the nurse called or if the nurse was tried again or if the admin was tried again.” The investigation into the event did not include a reason why Patient #2 could not reach the on call nurse. The DCS was interviewed on 1/08/25 beginning at 1:20 PM and Patient #2’s grievance was reviewed in her presence. When asked what happened with the answering system and availability of the on-call nurse, the DCS stated “we weren’t able to determine what happened.” She confirmed the grievance was not fully resolved. She confirmed additional investigation would have been helpful to ensure the same event did not happen again. The agency failed to ensure grievances were resolved.”

“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 medical record review and staff interview, it was determined the agency failed to ensure the physician reviewed all medications to address significant drug interactions for 1 of 8 patients (Patient #4) whose records were reviewed. Failure to review drug interactions had the potential for the patient to experience negative medication side effects. Findings include: Patient #4 was a 73 year old male admitted to the agency on 12/05/24 with a primary diagnosis of non chronic pressure ulcer. Additional diagnoses included type 2 diabetes and heart failure. He received SN and PT services. His record for the certification period 12/05/24 to 2/02/25 was reviewed. Patient #4’s POC and medication lists included aspirin 81 mg once daily, and Eliquis 5 mg twice daily. Both aspirin and Eliquis are antiplatelet medications which can cause bleeding. When used in combination, these medications put Patient #4 at risk for increased bleeding. Patient #4’s POC and medications were not signed off by the physician until 1/02/25, almost a month after Patient #4 began services with the HHA. Patient #4’s record included an RN note dated 12/05/24 which stated, “Medication interactions/duplicate therapy identified and reported as part of POC verification: Focus and plan of care verified with Dr [name] on 12/6/24 via left a message.” It was unclear if the medication interactions were addressed by the physician since the nurse left a message and did not verbally communicate with the physician. The DCS was interviewed on 1/08/25 beginning at 1:20 PM and Patient #4’s record was reviewed in her presence. She confirmed leaving a message was not sufficient to ensure medication interactions were addressed with the physician prior to 1/02/25. The agency failed to ensure the physician reviewed Patient #4’s record to ensure significant drug interactions were addressed.”

“Plan of care must include the following CFR(s): 484.60(a)(2)(i-xvi) The individualized plan of care must include the following: (i) All pertinent diagnoses; (ii) The patient’s mental, psychosocial, and cognitive status; (iii) The types of services, supplies, and equipment required; (iv) The frequency and duration of visits to be made; (v) Prognosis; (vi) Rehabilitation potential; (vii) Functional limitations; (viii) Activities permitted; (ix) Nutritional requirements; (x) All medications and treatments; (xi) Safety measures to protect against injury; (xii) A description of the patient’s risk for emergency department visits and hospital re-admission, and all necessary interventions to address the underlying risk factors. (xiii) Patient and caregiver education and training to facilitate timely discharge; (xiv) Patient-specific interventions and education; measurable outcomes and goals identified by the HHA and the patient; (xv) Information related to any advanced directives; and (xvi) Any additional items the HHA or physician or allowed practitioner may choose to include. This Element is not met as evidenced by: Based on record review and staff interview, it was determined the agency failed to ensure POCs were complete for 2 of 8 patients (Patients #3 and #7) whose records were reviewed. This resulted in omissions to POCs of relevant interventions, goals, and medications. It had the potential to interfere with quality and clarity of patient care. Findings include: A. Relevant diagnosis and interventions were missing from Patient #3’s POC. Examples include. Patient #3’s medical record included a RN admission visit, dated 11/16/24, signed by the RN. The admission visit note included “Patient is an 88 year old female who has an extensive cardiac history and HTN [hypertension]. Patient recently had a syncopal episode that resulted in a hospital stay. Patients receive an implantable heart monitor at this time. Patient had episodes of hypotension and bradycardia during her hospitalization. Patient was discharged home and continues to be very “weak and tired”. Patient has a caregiver that comes to her home for 3 hours per day, six days per week.” Additionally, the note included Patient #3 had an incision to her left chest wall with a dressing. Patient #3’s POC was reviewed. Her POC did not included goals or interventions related to her newly placed pacemaker and ongoing cardiac and hypotension issues. Additionally, there were no orders for the assessment and monitoring of her surgical incision site. The DCS was interviewed 1/08/25 beginning at 9:45 AM, and Patient #3’s record was reviewed in her presence. She confirmed Patient #3’s POC should have included goals and interventions for her cardiac issues and orders for care for Patient #3’s surgical site incision. The agency failed to ensure Patient #3’s POC included all relevant interventions and goals. B. Relevant medications were missing from Patient #3’s POC. Examples include: Patient #3’s medical record included a RN recert visit, dated 11/20/24, signed by a RN. The note included, that Patient #3 was experiencing diarrhea her son asked the RN about putting her on Imodium (anti-diarrheal medication.) The RN documented that the patient and caregiver were educated on the use of Imodium. It was unclear if the patient was started on Imodium. Patient #3’s POC including medication list was reviewed. There was no Imodium listed on her medication list. The DCS was interviewed 1/08/25 beginning at 9:45 AM, and Patient #3’s record was reviewed in her presence. She confirmed Patient #3’s POC and medication list should have included Imodium. The Agency failed to ensure all medications were listed on Patient #3’s medication list. B. Patient #7 was an 82 year old female admitted to the agency on 10/11/24 with a primary diagnosis of hypertensive heart disease with heart failure. Additional diagnoses included depression and hyperlipidemia. She received SN services. Her record for the certification periods 10/11/24 to 12/09/24 and 12/10/24 to 2/07/25 were reviewed. Patient #7’s record included an SN visit note from 11/15/24 which stated, “Patient reports constipation this week … Patient encouraged to start taking miralax daily to keep her bowel movements regular.” Patient #7’s record included an SN visit from 12/31/24 which stated, “I just have pain in my neck and shoulders usually at night that I take Aleve for. And that does the trick.” Patient #7’s medication list was reviewed. Aleve and miralax were not in Patient #7’s medication list. The DCS was interviewed on 1/08/25 beginning at 1:20 PM and Patient #7’s record was reviewed in her presence. She confirmed Aleve and miralax were not documented in Patient #7’s medication list.”

“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 policy review, medical record review, and staff interview, it was determined the agency failed to ensure services were administered only as ordered by a physician for 1 of 8 patients (Patient #4) whose records were reviewed. Lack of approval of the POC caused lack of physician involvement in patient care and potential for unsafe care to be delivered to the patient. Findings include: An agency policy titled, “Verbal Telephone Proposed Orders Policy,” undated, stated, “Telephone order (TO) – an order received from a prescriber who may be contacted by telephone … which then may be entered into the medical record.” Patient #4 was a 73 year old male admitted to the agency on 12/05/24 with a primary diagnosis of non chronic pressure ulcer. Additional diagnoses included type 2 diabetes and hear failure. He received SN and PT services. His record for the certification period 12/05/24 to 2/02/25 was reviewed. Patient #4’s POC was dated 12/05/24 and was completed by the RN. It was signed off by the physician on 1/02/25. It was unclear if the physician reviewed and approved the POC prior to 1/02/25. Patient #4’s record included an RN note dated 12/05/24 which stated, “Focus and plan of care verified with Dr [name] on 12/6/24 via left a message.” It was unclear if POC was approved by the physician since the nurse left a message and did not verbally communicate with the physician. The DCS was interviewed on 1/08/25 beginning at 1:20 PM and Patient #4’s record was reviewed in her presence. She confirmed leaving a message was not sufficient to approve the POC. She stated there should have been communication from the physician. The agency failed to ensure the POC was approved by the physician.”