Amedisys Home Health of Missouri

“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 policy review, record review, observation, and interview, the home health provider failed to ensure staff maintained an accurate/updated medication profile in two of three home visit observations (Records/Patients #1 and #3). This deficient practice has the potential to affect all patients served by the provider. RECORD/PATIENT #1: Review of the record showed the patient was admitted to home health services on 04/03/2024. The patient had a history of meningioma (a tumor that grows from the membranes that surround the brain and spinal cord) and craniotomy (brain surgery). Observation and interview during the patient’s home visit showed the following medication discrepancies with the provider’s medication profile: -The physical therapist (PT) provided care for the patient. The PT did not request to look at the patient’s medications. At the end of the visit, the surveyor requested to review the medications; -The medication profile showed an order for Prednisolone (used to treat inflammation in the eyes) eye drops. The patient stated that he/she had not used these for quite some time; -The patient had a bottle dated 04/22/2024, of brimol/timolol (used to treat glaucoma) 0.2%/0.5% one drop two times a day that he/she used. This was not included on the medication profile; -The medication profile showed an order for metformin (diabetic medication) 500 milligrams (mg) two tablets two times a day. The patient stated that he/she usually took one tablet twice a day; -The patient took Colace (stool softener) 100 mg one in the morning and night since home from the hospital. This was not included on the medication profile; -The patient took naproxen (anti-inflammatory) 220 mg occasionally. The patient stated that he/she never took more than two at a time. This was not included on the medication profile; and -The patient took Goli sleep medication two gel caps at night for about two weeks. This was not included on the medication profile. During an interview on 05/14/2024, beginning at 12:10 PM, the administrator stated that each discipline should have the patient get their medication out at every visit and compare them to the medication list. RECORD/PATIENT #3: Review of the clinical record showed the patient admitted to home health services on 01/17/2024 with a primary diagnosis which included falls, an open wound on the left foot, and diabetes (a condition of excess sugar in the blood). The patient lived at home alone. Observation and interview on 5/13/2024 at 2:30 PM, during the patient’s home visit, showed the following medication discrepancies with the provider’s medication profile: -The medication profile showed an order for Nitroglycerin (a medication which widens blood vessels) 0.4 milligram (mg) tab to be taken sublingually (SL) as needed for chest pain (The patient stated that he/she had not used the medication and was currently out of the medication for a couple weeks; -The medication profile showed an order for Lidocaine Topical Patch (a medication to relieve pain) 5% to be applied to the skin daily for back pain. The patient stated that he/she no longer used the patch; -The patient took Xphozah (a medication used to lower phosphorus in the body) 30 mg tablet twice daily. This was not included on the medication profile; -The patient took Centrum Silver (a multi- vitamin supplement) 1 tablet daily. The medication was not included on the medication profile; -The patient took Ared 2 (a multi- vitamin eye supplement) 1 tablet daily. The medication was not included on the medication profile; -The patient took Garlic (a dietary supplement) 1000 mg, 1 tablet daily. The medication was not included on the medication profile; and -The patient took Biotan (a dietary supplement) 5000 micrograms (mcg) 1 tablet daily. The medication was not included on the medication profile. During an interview on 05/13/2024 at 3:00 PM, RN-E stated each patient should have their medication checked and compared to the current medication list during each visit to ensure accuracy. During an interview on 05/14/2024 at 12:10 PM, the administrator stated that each discipline should have the patient get their medication out at every visit and compare them to the medication list.”

“All orders recorded in plan of care CFR(s): 484.60(a)(3) All patient care orders, including verbal orders, must be recorded in the plan of care. This Element is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure the plan of care (POC) was updated with a complete physician order in one of five full records reviewed (Record/Patient #1). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s policy titled, “Physician Orders and Medical Supervision of the Plan of Care,” revised 06/22/2023, showed in part that all patient care orders from all physicians/allowed practitioners including verbal orders, must be recorded/integrated in the POC to assure coordination of services and interventions provided. RECORD/PATIENT #1: Review of the record showed the patient was admitted to home health services on 04/03/2024. The patient had history of meningioma (a tumor that grows from the membranes that surround the brain and spinal cord) and craniotomy (brain surgery). Review of a PTA (physical therapy assistant) visit note dated 04/25/2024, showed he/she notified the physician’s nurse of fluid weeping from the patient’s incision. Review of a patient information report dated 04/25/2024, showed the PTA notified the physician’s nurse of the patient’s report of fluid weeping from his/her head. The patient reported a wet pillow and wet hair from the fluid. The PTA could not see any open areas. The nurse was calling in an antibiotic for prevention and to educate the patient to use peroxide to clean the area two to three times a day and pat dry. The PTA relayed all instructions to the patient and spouse. They verbalized understanding. The physician’s nurse requested a report on 04/29/2024. The spouse would pick up the antibiotic. Review of an RN (registered nurse) phone call note dated 04/25/2024, showed the RN called to check on the incision. The patient stated that the incision had been leaking. The PTA saw the patient that day and had spoke with the surgeon’s office regarding the drainage and the patient was started on an antibiotic for the drainage. The RN educated the patient to call the home health provider’s office if he/she developed a foul odor to the drainage, fever, chills, or increased pain. The patient verbalized understanding. Review of physician order dated 04/29/2024, showed an order for cephalexin (antibiotic) 500 milligrams (mg) one capsule four times a day with a start dated of 04/25/2024. The order failed to include the order to educate the patient to clean the area with peroxide two to three times daily and pat dry. During an interview on 05/14/2024, beginning at 12:10 PM, clinical manager A stated that there should have been an order update to the POC.”

“Interdisciplinary assessment of the patient CFR(s): 484.75(b)(1) Ongoing interdisciplinary assessment of the patient; This Element is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure the nurse documented a full assessment after the patient reported fluid weeping from his/her incision in one of five full records reviewed (Record/Patient #1). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of the provider’s policy titled, “Patient Assessment/Reassessment,” revised 11/06/2023, showed in part that additional assessments/updates will be conducted as frequently as the patient’s condition warrants. RECORD/PATIENT #1: Review of the record showed the patient was admitted to home health services on 04/03/2024. The patient had history of meningioma (a tumor that grows from the membranes that surround the brain and spinal cord) and craniotomy (brain surgery). Review of a PTA (physical therapy assistant) visit note dated 04/25/2024, showed he/she notified the physician’s nurse of fluid weeping from the patient’s incision. Review of a patient information report, dated 04/25/2024, showed the PTA notified the physician’s nurse of the patient’s report of fluid weeping from his/her head. The patient reported a wet pillow and wet hair from the fluid. The PTA could not see any open areas. The nurse was calling in an antibiotic for prevention and to educate the patient to use peroxide to clean the area two to three times a day and pat dry. The PTA relayed all instructions to the patient and spouse. They verbalized understanding. The physician’s nurse requested a report on 04/29/2024. The spouse would pick up the antibiotic. Review of an RN (registered nurse) phone call note dated 04/25/2024, showed the RN called to check on the incision. The patient stated that the incision had been leaking. The PTA saw the patient that day and had spoke with the surgeon’s office regarding the drainage and was started on an antibiotic for the drainage. The RN educated the patient to call the home health provider’s office if he/she developed a foul odor to the drainage, fever, chills, or increased pain. The patient verbalized understanding. The nurse failed to physically assess the weeping wound. Review of a PTA visit note, dated 04/29/2024, showed the PTA left a message for the physician’s nurse that the patient had started his/her antibiotic, but continued to have some weeping from his/her incision. Review of physician order, dated 04/29/2024, showed an order for cephalexin (antibiotic) 500 milligrams (mg) one capsule four times a day for incision infection with a start dated of 04/25/2024. The order did not include the order for the patient to clean the area with peroxide two to three times daily and pat dry. Review of an RN visit note, dated 04/30/2024, showed no abnormal findings in the integumentary (pertaining to the skin) assessment. The documentation failed to show any documentation regarding the patient’s incision and/or fluid weeping from the head. Review of an SN (skilled nurse) telehealth phone visit, dated 05/07/2024, showed the patient had not had changes since the last home visit. The documentation failed to show any documentation related to the patient’s weeping drainage from his/her head. Per interview conducted during observation, on 05/13/2024, beginning at 12:30 PM, the patient stated that he/she continued to have weeping from his/her head, and that the physician was aware. During an interview on 05/14/2024, beginning at 12:10 PM, clinical manager B stated that the weeping should have been specifically addressed. The area vice president of operations stated that if there were no open areas it would fall under general assessment findings. The weeping should have been specifically addressed. During an interview on 05/15/2024, at approximately 9:45 AM, clinical manager B talked with the nurse. The nurse stated that there was not any drainage when he/she looked at the incision. The administrator stated that there should have been more documentation.”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on review of Missouri state statute Section 192.2490.12 RSMo, review of Missouri code of federal regulations 19 CSR 30-26.010 (1) (B), policy review, employee file review, and interview the home health provider failed to check the employee disqualification list (EDL; a list that shows individuals who have been determined to have abused or neglected, misappropriated funds or property, or falsified documentation that delivery of services were provided to a patient, client, resident or consumer) prior to hire in two of five employee files reviewed (Employees #1 and #4), and failed to ensure Alzheimer’s and dementia training was provided during orientation for two of five employee files reviewed (Employees #4 and #5). This deficient practice has the potential to affect all patients served by the provider. Findings included: Review of Missouri state statute Section 192.2490.12 RSMo: “No person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) to (7) of subsection 11 of this section shall knowingly employ any person who is on the employee disqualification list.” Review of 19 CSR 30-26.010 (1) (B) required: “Licensed home health agencies shall provide dementia-specific training about Alzheimer’s disease and related dementias to their employees and those persons working as independent contractors who provide direct care to or may have daily contact with residents, patients, clients or consumers with Alzheimer’s disease or related dementias. 1. The training for persons providing direct care shall address the following areas, at a minimum: (A) An overview of Alzheimer’s disease and related dementias; (B) Communicating with persons with dementia; (C) Behavior management; (D) Promoting independence in activities of daily living; and (E) Understanding and dealing with family issues. 2. Employees or independent contractors who do not provide direct care for, but may have daily contact with, persons with Alzheimer’s disease or related dementias shall receive dementia-specific training that includes, at a minimum: (A) An overview of Alzheimer’s disease and related dementias; and (B) Communicating with persons with dementia. 3. Dementia-specific training about Alzheimer’s disease and related dementias shall be incorporated into orientation for new employees with direct patient contact and independent contractors with direct patient contact. The training shall be presented by an instructor who is qualified by education, experience, and knowledge in the current standards of practice regarding individuals with Alzheimer’s disease and other related dementias. The training shall be provided annually and updated as needed. “ Review of the provider’s policy titled, “Background Checks,” revised 10/31/2023, showed in part that as part of the new hire application process, the human resources department will utilize an approved third-party vendor to perform a criminal background check on all employees. When hiring/employing or re-hiring a candidate, the results of the approved third-party vendor background check will stipulate that an offer of employment is “conditional” upon background check results being favorable to the individual. In Missouri the provider will make an inquiry to the department of health and senior services whether the person is listed on the employee disqualification list. Review of the provider’s policy titled, “Competency Plan – RN (registered nurse)/LPN (licensed practical nurse)” revised 10/05/2023, showed in part that in Missouri dementia-specific training about Alzheimer’s disease and related dementias shall be incorporated into orientation for new employees with direct patient contact and independent contractors with direct patient contact. The training shall be presented by an instructor who is qualified by education, experience, and knowledge in the current standards of practice regarding individuals with Alzheimer’s disease and other related dementias. EMPLOYEE #1: Review of the employee file showed: - Date of hire 05/12/2021; and - EDL check 05/12/2021 (not completed prior to hire). EMPLOYEE #4: Review of the employee file showed: - Date of hire 07/05/2023; - EDL check 07/05/2023 (not completed prior to hire); and - No evidence of Alzheimer’s and dementia training during orientation. EMPLOYEE #5: Review of the employee file showed no evidence of Alzheimer’s and dementia training during orientation. During an interview on 05/14/2024, at 11:15 AM, the administrator stated that the office manager completed the EDL checks on hire. The administrator and office manager acknowledged the EDL checks had not been completed prior to hire. During an interview on 05/14/2024, at 11:30 AM, the administrator stated that the training had not been assigned during orientation. They were aware it needed to be done during orientation.”