Premiere Home Health

“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 an accurate medication review and/or update of the patient medications was completed, in three of five full records reviewed (Records/Patients #1, #2, and #3). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Named Provider” Policies and Procedures,” dated reviewed “9/2025”, under section: Comprehensive Assessments of Patients, beginning on page 21, showed in part: - “Named provider” will complete a review of all medications the patient is currently using in order to identify any potential adverse effects and drug reactions including duplicate drug therapy and noncompliance with drug therapy; - The clinical record will identify all medications the patient is taking as well as number of times a day and routes; - All drugs will be reconciled, and any discrepancies will be confirmed/resolved with the physician in a timely manner; -Upon completion of the drug regimen review, the clinician will use their professional judgement to determine whether any potential or actual issues warrant communication with a physician, physician designee or allowed practitioner and completion of prescribed/recommended actions to resolve the issue by either midnight of the next calendar day or within three business days after start of care day; and - As part of the initial assessment, when new medications are prescribed or discovered in the home, at least every 60 days, and on an ongoing basis, a provider nurse will review all patient medications, both prescription and non- prescription. RECORD/PATIENT #1: Review of the clinical record, showed, in part: The patient was admitted to home health services on 10/17/2025 with primary diagnosis of venous insufficiency (leg veins struggle to send blood back to the heart, causing blood to pool, often due to damaged valves, leading to leg swelling, aching, heaviness, skin discoloration, and eventually ulcers). The patient resided alone at his/her home. Observation and interview on 12/30/2025 at 1:30 PM showed: - The provider’s medication list had docusate sodium (stool softener) 50 milligrams (mg) once a day. The patient stated that he/she had been taking one capsule twice a day for nine months. RECORD/PATIENT #5: Review of the clinical record, showed, in part: The patient was admitted to home health services on 11/21/2025 with a primary diagnosis of hemiplegia (paralysis affecting one side of the body) and hemiparesis (muscular weakness on one side of the body) following cerebral infarction (stroke) affecting left non-dominant side, cerebral amyloid angiopathy (specific proteins deposit in the walls of small to medium blood vessels of the central nervous system and meninges), anemia, hyponatremia (low sodium in the blood), hypertension (elevated blood pressure), hypothyroidism (endocrine disease in which the thyroid does not produce enough thyroid hormones), peptic ulcer (a sore in the stomach or small intestine lining, leading to burning stomach pain that may worsen between meals or at night) without hemorrhage (excessive bleeding from a damaged blood vessel) or perforation (a hole or opening), and depression. The patient resided at an assisted living facility (ALF). Observation and interview on 12/29/2025 at 3:00 PM showed the following discrepancies between the provider’s current medication profile and the ALF medication list: - The provider’s profile showed Acetaminophen quick-melt (convenient, water-free forms of mild pain reliever that deliver powered acetaminophen directly to the tongue) 325 milligrams (mg) two every four hours as needed for mild pain. The ALF profile failed to list Acetaminophen quick-melt; - The provider’s profile showed levothyroxine (thyroid hormone to treat hypothyroidism) 25 micrograms (mcg) one daily. The ALF profile medication list had one tablet daily except Sunday; - The provider’s profile showed miconazole (antifungal medication) 2% topical powder, one application topically two times a day as needed for rash. The ALF medication list had apply topically once daily as needed, cleanse peri area with hygiene wipes and foam cleanser, pat dry. With gloved hands combine calmoseptine (provides a moisture barrier that prevents and helps heal skin irritations) and miconazole powder to form a paste (indications for use: skin), and the ALF medication list had apply topically twice daily as needed, cleanse peri area with hygiene wipes and foam cleanser, pat dry. With gloved hands combine calmoseptine and miconazole powder to form a paste (indications for use: skin); - The provider’s profile showed mirtazapine (antidepressant) 7.5 mg take once a day at bedtime. The ALF profile failed to list mirtazapine; - The provider’s profile showed ondansetron (antiemetic) 4 mg one every six hours as needed for nausea. The ALF profile failed to list ondansetron; - The provider’s profile showed pantoprazole (proton pump inhibitor that reduces stomach acid) 40 mg delayed release tablet, take one daily. The ALF profile failed to list pantoprazole; - The provider’s profile showed lidocaine (local anesthetic) 5% topical film, apply one patch topical once a day [comments: apply to low back]. The ALF medication list had lidocaine pain relief-4% patch, apply one patch topically every day for 12 hours, then leave off for 12 hours (indications for use: pain); and - The provider’s profile failed to show calmoseptine. The ALF medication listed combining with miconazole powder to form a paste. During an interview on 12/31/2025 at 12:30 PM the administrator stated that he/she would expect the clinician to get a medication list from the facility every two weeks and check the medications. The medications should match (what the patient was taking at the ALF/the current provider’s medication profile). RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 12/07/2025 with a primary diagnosis of an acute exacerbation (a sudden, significant worsening of a chronic disease’s symptoms) of Myasthenia Gravis (A chronic autoimmune disease causing fluctuating weakness in voluntary muscles (eyes, face, chewing, swallowing, limbs, breathing) that worsens with activity and improves with rest, stemming from nerve signal disruption at the neuromuscular junction. The patient lived in his/her own with their spouse. Review of the initial plan of care dated 12/07/2025 to 02/04/2026 showed: - Aspirin (over the counter medication used to prevent blood clots from forming) 81 milligrams (mg) one tablet daily; and - Probiotic one capsule daily. Review of a physician’s order dated 12/07/2025 showed Eliquis (a prescription blood thinner used to prevent blood clots) 5 mg one tablet two times daily. Observation and interview on 12/30/2025 at 10:30 AM showed: - The provider’s medication list had Aspirin 81mg one tablet daily. The patient’s spouse stated that the patient had not taken the aspirin since the Eliquis was started (12/11/2025); and - The provider’s medication list had Probiotic (a beneficial microorganism that improves digestion) one capsule daily. The patient’s spouse stated that the patient had not taken the probiotic since he/she was in the hospital (prior to admission).”

“Promptly alert relevant physician of changes CFR(s): 484.60(c)(1) The HHA must promptly alert the relevant physician(s) or allowed practitioner(s) to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care should be altered. This Element is not met as evidenced by: Based on policy review, record review, and interview, the home health provider failed to ensure clinicians promptly notified the patient’s physician/allowed practitioner of any changes in the patient’s condition or needs that suggested that outcomes were not being achieved and/or that the plan of care should be altered in one of five full records reviewed (Record/Patient #2). This deficient practice has the potential to affect all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Named Provider” Policies and Procedures,” dated reviewed “9/2025”, under section: Care Planning, coordination of services, and quality of care, beginning on page 30, showed in part, “Named provider” will promptly alert the relevant physician or allowed practitioners to any changes in the patient’s condition or needs that suggest that outcomes are not being achieved and/or that the plan of care (POC) should be altered. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 12/07/2025 with a primary diagnosis of an acute exacerbation (a sudden, significant worsening of a chronic disease’s symptoms) of Myasthenia Gravis (A chronic autoimmune disease causing fluctuating weakness in voluntary muscles (eyes, face, chewing, swallowing, limbs, breathing) that worsens with activity and improves with rest, stemming from nerve signal disruption at the neuromuscular junction. The patient lived in his/her own home with their spouse. Review of the initial POC, dated 12/07/2025 to 02/04/2026, showed in part, the patient did not have orders for Tylenol (over the counter pain reliever). Review of the current medication list, provided to the state agent (SA) prior to the home visit, failed to include Tylenol. Review of the physician orders failed to show an order for Tylenol. Review of a physical therapy (PT) note, dated 12/16/2025, showed: - “Pt (patient) took one Tylenol last night, but no other meds for pain”; - Contacts made as a result of this visit: PT visit summary given to all of the home health (HH) disciplines, including primary nurse); and - The record failed to contain documentation that the physician was notified of the patient taking the Tylenol without an order. During an interview on 12/31/2025 at 11:50 AM, the clinical manager stated that he/she was unable to locate documentation that showed the physician had been notified that the patient was taking Tylenol.”

“Revised plan of care CFR(s): 484.60(c)(2) A revised plan of care must reflect current information from the patient’s updated comprehensive assessment, and contain information concerning the patient’s progress toward the measurable outcomes and goals identified by the HHA and patient in the plan of care. This Element is not met as evidenced by: Based on policy review, record review, observation, and interview, the home health provider failed to ensure the plan of care (POC) was revised/updated to address the patient’s needs, in one of five full records reviewed (Record/Patient #2). This deficient practice has the potential to affect the care for all the patients served by the provider. Findings included: Review of the provider’s policy titled, “Named Provider” Policies and Procedures,” dated reviewed “9/2025”, under section: Care Planning, coordination of services, and quality of care, beginning on page 26, showed in part: - Each patient must receive the home health services that are written in an individualized POC that identifies patient specific measurable outcomes and goals and which is established, periodically reviewed, and signed by a Doctor of Medicine, osteopathy, or Podiatry, or allowed practitioner acting within the scope of his or her state license, certification or registration; - The individualized POC must include the types of services, supplies, and equipment required; and - The POC may include orders for treatment or services received from physicians other than the responsible physician, such orders must be approved by the responsible physician and incorporated into an updated POC. RECORD/PATIENT #2: Review of the clinical record showed the patient was admitted to home health services on 12/07/2025 with a primary diagnosis of an acute exacerbation (a sudden, significant worsening of a chronic disease’s symptoms) of Myasthenia Gravis (A chronic autoimmune disease causing fluctuating weakness in voluntary muscles (eyes, face, chewing, swallowing, limbs, breathing) that worsens with activity and improves with rest, stemming from nerve signal disruption at the neuromuscular junction. The patient lived in his/her own home with their spouse. Review of the POC dated 12/07/2025 to 02/04/2026 showed: - Physician A was the patient’s provider; and - There failed to be any other physicians listed. Review of a skilled nurse (SN) visit note dated 12/10/2025, showed “Patient has cardiologist appointment today. Primary care physician ordered chest X-ray and patient to wear Holter (cardiac monitor that continuously records your heart’s electrical activity) monitor for two weeks”. The POC failed to be updated with the cardiac monitor and/or the cardiologist. Review of a patient care order dated 12/11/2025 showed it was received from cardiology NP-A (a registered nurse with advanced education and clinical training). The plan of care failed to be updated to include the cardiologist and/or their delegated agent. Review of the SN visit note dated 12/15/ 2025 showed “since last skilled nurse visit, patient has obtained compression stockings, has been wearing them during the day, taking off at night”. The plan of care failed to be updated to include the use of compression stockings. Observation and interview on 12/30/2025 at 10:30 AM showed: - The patient was wearing compression stockings; - The patient was wearing a cardiac monitor; and - The patient’s spouse stated that the cardiac monitor was mailed to them a couple of weeks ago and the patient has been wearing it since that time. (The patient had been seen by the SN and physical therapy since that time).The POC failed to be updated with the cardiac monitoring device. During an interview on 12/31/2025 at 12:07 PM the administrator stated that: - He/she did not see the compression hose on the POC that the physician signed. He/she only saw it on the care plan and in the nurse’s note; - The care plan was not signed by the physician; - The Holter monitor was on the 12/10/2025 SN visit note, but was not updated on the POC; and - He/she thought that the care plan pulled over to the POC.”