Advance Home Health Care Provider Corp

“Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This Standard is not met as evidenced by: Based on a review of clinical records, observation and interview during home visits and staff interview, it was determined the Agency failed to ensure staff provide service, as ordered by the Physician, and indicated in the POC. This was found in 2 of 7 (Pts. #2 and 6) clinical records reviewed. 2. Pt. #6 was admitted to Home Care Services on 03/15/23 with Diagnosis: Primary Generalized Osteoarthritis. The clinical record was reviewed on 02/06/24 at 1:00 PM. The clinical record contained a POC for certification period 09/11/23 to 11/09/23 that required SN to notify frequency of 1 visit every other week for 9 weeks. The clinical record contained a completed SN visit dated 09/21/23 (week 3) of certification period. No other SN visits completed for weeks 4 to week 9. The clinical record contained a SN discharge assessment visit dated 11/02/23 (week 9). 3. During interviews conducted with the Administrator and Director of Nursing on 2/7/24 at 10:00 AM, and 2/8/24 at 11:00 AM findings of Agency staff not following physicians’ orders were confirmed. Findings include: 1. Pt. #2 was admitted to home health services on 7/19/23 with the primary diagnosis of Hypertensive Heart and Chronic Kidney Disease with Heart Failure and with Stage 5 Kidney Disease / End Stage Renal Failure. The clinical record was reviewed on 2/5/24. The record contained the PsOC for the certification period of 11/16/23 and 1/14/24 and effective 1/15/24 requiring, “SN to perform medication review each skilled nursing visit and reconcile medications...” The PsOC included: “Metoprolol Succinate 25 MG oral tablet, extended release 1 daily by mouth (PO), Potassium Chloride 1 daily by mouth (PO)”. A home visit was conducted with Employee #1 on 2/6/23 at 9:30 AM, during the home visit the patient’s medications were observed and interviews were conducted with the Pt. and Employee #1. Observed the prescription bottle labeled, “Metoprolol Tartrate 25 MG Tablets Take 1/2 Tablet by mouth in the morning and in the evening, the bottle was dated 1/21/24, the Pt. stated “I just had it refilled”, and that this medication was taken for “a couple of years”, it replaced Metoprolol Succinate. Observed the prescription bottle labeled Potassium Chloride 10 % LIQ (20 MEQ/15 MG) Take 7.5 ML by mouth twice daily, the Pt. stated this was taken for “over a year, I told the doctor I can’t take the pill.” During an interview with Employee #1, it was stated she was aware the Pt. takes the Metoprolol Tartrate and Potassium Chloride 10% LIQ, and that the medications should be reconciled during every SN visit to assess for any changes or new medications. The Pt. and Employee #1 stated there were no recent changes to the patient’s medications. The PsOC dated 11/16/23 and 1/15/24 required: “Notify Physician of...Blood Sugar, Fasting: Greater Than (>) 130 Less Than () 250 Less Than (”

“Participate in care CFR(s): 484.50(c)(4)(i,ii,iii,iv,v,vi,vii,viii) Participate in, be informed about, and consent or refuse care in advance of and during treatment, where appropriate, with respect to-- (i) Completion of all assessments; (ii) The care to be furnished, based on the comprehensive assessment; (iii) Establishing and revising the plan of care; (iv) The disciplines that will furnish the care; (v) The frequency of visits; (vi) Expected outcomes of care, including patient-identified goals, and anticipated risks and benefits; (vii) Any factors that could impact treatment effectiveness; and (viii) Any changes in the care to be furnished. This Element is not met as evidenced by: Based on clinical records review and staff interview, it was determined the Agency failed to ensure informed consents contained the frequency of visits for the disciplines that will provide care. This was found in 7 of 7 (Pts. # 1, 2, 3, 4, 5, 6 and 7) clinical records reviewed. Findings Include: 1. The following clinical records were reviewed between 02/05/24 and 02/07/24. Pt. #1 SOC: 7/19/23 Pt. #2 SOC: 7/19/23 Pt. #3 SOC: 1/19/24 Pt. #4 SOC: 1/19/24 Pt. #5 SOC: 11/2/23 Pt. #6 SOC: 3/15/23 Pt. #7 SOC: 12/18/23 The patients informed consents lacked the frequency of the disciplines that will provide care. 2. During interviews conducted with the Administrator and Director of Nursing on 2/7/24 at 10:00 AM, and 2/8/24 at 11:00 AM the Administrator confirmed the findings.”

“Influenza and pneumococcal vaccines CFR(s): 484.60(b)(2) Influenza and pneumococcal vaccines may be administered per agency policy developed in consultation with a physician, physician assistant, nurse practitioner, or clinical nurse specialist, and after an assessment of the patient to determine for contraindications. This Element is not met as evidenced by: Based on a review of clinical records and staff interview, it was determined the Agency failed to ensure staff assess Pts. for administration of the Pneumococcal Pneumonia vaccine. This was found in 3 of 7 (Pts. #2, 3 and 4) clinical records reviewed. Findings include: 1. Pt. #2 was admitted to home health services on 7/19/23 with the primary diagnosis of Hypertensive Heart and Chronic Kidney Disease with Heart Failure and with Stage 5 Kidney Disease / End Stage Renal Disease. The clinical record was reviewed on 2/5/24. The record contained a form titled, “Immunization Consent” completed by the RN and dated 7/19/23. The form provided 2 options for the Pneumococcal Pneumonia vaccine: “I give my consent to receive the pneumonia vaccination” or “I decline the pneumonia vaccine”, both inquiries were left blank. The form lacked a response indicating whether the Pt. consented to receive or declined the Pneumococcal Pneumonia vaccine. 2. Pt. #3 was admitted to home health services on 1/19/24 with the primary diagnosis of Essential (Primary) Hypertension. The clinical record was reviewed on 2/5/24. The record contained the form titled, “Immunization Consent” completed by the RN and dated 1/19/24. Sections of the form inquired whether the Pt. consented to receive the Pneumococcal Pneumonia vaccine, or declined the vaccine, both sections were left blank. 3. Pt. #4 was admitted to home health services on 1/19/24 with the primary diagnosis of Unspecified Chronic Obstructive Pulmonary Disease. The clinical record was reviewed on 2/5/24. The record contained the form titled, “Immunization Consent” completed by the RN and dated 1/19/24. Sections of the form inquired whether the Pt. consented to receive the Pneumococcal Pneumonia vaccine, or declined the vaccine, both sections were left blank. 4. During an interview with the Administrator on 2/5/24 at 9:30 AM, the Administrator stated the RN conducts the SOC comprehensive assessment, during this visit the RN completes a standardized immunization form which indicates whether, the Pt. wants or refuses the Pneumococcal Pneumonia vaccine. 5. During an interview with the Administrator, Director of Nursing, and the Survey Consultant on 2/7/24 at 11:00 AM, the Administrator confirmed the Agency failed to ensure staff assessed Pts. for administration of the Pneumococcal Pneumonia vaccine.”