Amedisys Home Health of Fayetteville

“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 direct observation, agency policy, and staff interview, the agency failed to maintain a current medication record for 1 of 3 observed home visits with medication reviews (Patients #14). Findings included: Policy MA-002, last reviewed 12/01/23 and titled, “Drug Regimen Review” was received from the agency director on 10/15/24 at 3:28 PM. This policy revealed, “ Patient #14 was admitted to the agency 06/04/24 with diagnoses including hemiplegia followed by a cerebral infarction (paralysis to one side of the body after a stroke) and dysphagia (difficulty swallowing). Plan of Care from 10/02/24 to 11/30/24 revealed orders for skilled nursing, speech therapy, and occupational therapy services. Employee #3, certified occupational therapy assistant, conducted an observed home visit on 10/15/24. During the visit, Employee #3 asked to see Patient #14’s medications and identified In an interview on 10/16/24 at 10:35 AM, Employee #4, clinical manager, stated that it was the expectation for clinicians to review medications during each visit and said, “Usually they go through them one by one. They enter what’s in the home in the chart. Every visit.” In an interview on 10/16/24 at 11:00 AM, Employee #3 stated, “We do medication review every visit.””

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on direct observation, agency policy, and staff interview, the agency failed to meet standard infection prevention practices for 3 of 6 home visits observed (Patients #14, #16). Findings included: A policy, Hand Hygiene (reviewed 06/26/24) received on 10/15/24 from the Director of Operations at approximately 3:28 PM stated, “Perform hand hygiene as follows: Before donning gloves… After removing gloves.” 2. Patient #16 was admitted on 10/11/24 with a diagnosis of Parkinson’s disease. The plan of care for 10/11/24-12/09/24 included orders for physical therapy (PT) 1 time a week for 1 week, 2 times a week for 6 weeks, and 1 time a week for 2 weeks. During a home visit conducted on 10/15/24 at approximately 11:15 AM PT #6 donned clean gloves, assessed vital signs and applied an alcohol-based hand sanitizer to the gloves, disinfected the thermometer, pulse oximeter, and blood pressure cuff, and applied alcohol-based hand sanitizer to the gloves. During an interview at 10:55 AM on 10/16/24 with PT # 6 “No [I don’t usually use hand sanitizer on gloves], I think it was because I was nervous, I accidently did that. Normally I wouldn’t wear gloves to take vital signs.” During an interview conducted on 10/15/24 at 12:05 PM the clinical manager stated, “We [agency] don’t use hand sanitizer on gloves.” Policy PCP-001, last reviewed 06/26/24 and titled, “Hand Hygiene” was received from the agency director on 10/15/24 at 3:28 PM. This policy revealed “The term hand hygiene includes both handwashing with soap and water and use of alcohol-based products that do not require the use of water…Perform hand hygiene as follows…before having direct contact with patients, before donning gloves, after contact with a patient’s intact skin, after contact with…wound dressings, after contact with inanimate objects [e.g. medical equipment] in the immediate vicinity of the patient, after removing gloves…” 1. Patient #14 was admitted to the agency 06/04/24 with diagnoses including hemiplegia followed by a cerebral infarction (paralysis to one side of the body after a stroke) and dysphagia (difficulty swallowing). Plan of Care from 10/02/24 to 11/30/24 revealed orders for skilled nursing, speech therapy, and occupational therapy services. Employee #3, certified occupational therapy assistant, conducted an observed home visit on 10/15/24. During the visit, Employee #3 obtained vital signs and worked directed Patient #14 in a set of exercises. After the exercises were completed, Employee #3 gave the patient a rest-break. During the break, Employee #3 used a cleansing wipe to clean the equipment used to obtain vital signs, placed the equipment on a clean barrier, and returned to assisting the patient with a new set of exercises without performing hand hygiene. In an interview on 10/16/24 at 11:00 AM, Employee 3 stated that she was nervous during the observed home visit and said, “I usually do clean my hands [after cleaning equipment]”….”

“Last 5 days of every 60 days unless: CFR(s): 484.55(d)(1)(i,ii,iii) The last 5 days of every 60 days beginning with the start-of-care date, unless there is a- (i) Beneficiary elected transfer; (ii) Significant change in condition; or (iii) Discharge and return to the same HHA during the 60-day episode. This Element is not met as evidenced by: Based on agency policy review, clinical record review, and staff interview, the agency failed to document consistent wound measurements for 1 of 15 records reviewed (Patient #2) and failed to notify the physician of documented changes in the patient condition for 2 of 15 records reviewed (Patients #6, #8). Findings included: Policy WC-001, titled “The Provision of Wound and Skin Care” was received from the agency director on 10/15/24 at 11:45 AM. This policy revealed, “In accordance with best practice and standard of care, wounds will be measured a minimum of one time a week” and “…anytime during the plan of care a wound is discovered upon assessment…the physician is to be contacted to update and obtain orders for care…” 1. Patient #2 was admitted to the agency on 04/04/24 with diagnoses including a right-sided pelvic fracture, right and left knee pain, muscle wasting, high blood pressure, and high cholesterol. Plan of Care from 04/04/24 to 6/02/24 revealed orders for skilled nursing one time per week for five weeks, physical therapy two times per week for one week and one time per week for seven weeks, occupational therapy one time per week for one week, and medical social work one time per month for two months. On 04/10/24, 04/18/24, and 04/25/24, Employee #11, licensed practical nurse, documented the presence of a Stage 2 pressure ulcer wound (an open wound extending into lower skin layers) on Patient #2’s right buttocks. For each visit, Employee #11 documented the presence and treatment of the Stage 2 wound including teaching pressure relief, using and barrier ointment and eating healthy protein rich food.” There were no documented wound measurements and there was no evidence that the physician was notified regarding the wound in the clinical record. In an interview on 10/16/24 at approximately 11:30 AM, Employee #1, agency director, stated that the expectation would be that the physician would be notified, and treatment orders would be obtained as necessary. 2. Patient #6 was admitted to the agency on 04/24/24 with diagnoses including hypertensive (related to high blood pressure) heart and chronic kidney disease with heart failure (heart’s inability to pump blood effectively). Plan of Care from 04/24/24 to 06/22/24 revealed orders for skilled nursing one time per week for four weeks and physical therapy one time per week for one week, two times per week for one week, and one time per week for seven weeks. On 04/24/24, Employee #10, registered nurse, conducted the initial skilled nursing visit for Patient #6. For this visit, Employee #10 documented that the patient was not checking her blood sugar levels and she needed a glucometer (machine used to check blood sugar levels). There was no documented evidence that the physician was notified that the patient was not checking her blood sugar levels. In an interview on 10/16/24 at 11:10 AM, Employee #10 stated that she did not remember whether or not she notified the doctor and stated that the agency had worked with the patient’s daughter on getting her a glucometer. In an interview on 10/16/24 at approximately 11:30 AM, Employee #1, agency director, stated that the expectation would be that the physician would be notified, and treatment orders would be obtained as necessary. 3A. Patient #8 was admitted to the agency on 09/10/24 with diagnoses including alcoholic cirrhosis of the liver with ascites, acute kidney failure and chronic kidney disease, encounter for fitting and adjustment of urinary device, and unspecified protein-calorie malnutrition. Plan of Care from 09/10/24 to 11/08/24 revealed orders for skilled nursing one time per week for five weeks, physical therapy once per week for nine weeks, and medical social worker one time per week for one week. On 09/17/24, Employee #13, licensed practical nurse, conducted a skilled nursing visit and documented that Patient #8 was “not taking lactulose [oral medication to help reduce ammonia levels] as prescribed due to increased BMs [bowel movements]” There was no evidence that the physician was notified that Patient #8 was not taking medication as prescribed. On 09/26/24, Employee #13 conducted a skilled nursing visit and documented that Patient #8’s abdomen was more distended (a swollen abdomen) and “pt [patient] states it feels a little more distended too…attempted to call primary MD [medical doctor] to report findings. Office closed for lunch. Will attempt later.” There was no documented evidence of any follow-up contact with the physician regarding abdominal distention. On 10/03/24, Employee #5, registered nurse, conducted a skilled nursing visit and documented that Patient #8’s abdomen was noted to be distended and that the patient felt it was a little more distended too. There was no documented evidence that the physician was notified regarding abdominal distention following this visit. In an interview on 10/16/24 at 11:24 AM, Employee #13 stated, “I more than likely probably followed up at the end of the day and did not document as I should have…” In an interview on 10/16/24 at 10:42 AM, Employee #5 stated, “… She had already been in contact with her doctor about the constipation and they were going to set her up with a GI [gastrointestinal] doctor so she wouldn’t have to go to the hospital…If I didn’t [document contact with the physician] I guess I should have. I thought because she had already had these issues it was documented somewhere.” In an interview on 10/16/24 at 11:30 am, Employee #1, agency director, stated, “I would expect them to document that but then I would expect them to call back again until they could speak to somebody or get a message to somebody.” 3B. On 09/17/24, Employee #8, physical therapy assistant, conducted a physical therapy visit and documented, “Pt [patient] states it hurts when she pees” and “she has difficulty getting comfortable with the [urinary] catheter.” There was no documented evidence in the clinical record that Employee #8 reported this information. In an interview on 10/16/24 at 10:50 AM, Employee #8 stated, “I don’t believe I did [notify anyone regarding the patient’s reported discomfort]. I think she was going to discuss it with the doctor but, I didn’t follow up myself.”In an interview on 10/16/24 at 10:51 AM, Employee #1, agency director, stated that the expectation would be that clinicians, “…call the doctor and notify them of that. Even if the caregiver says that they had done so…” and they should also notify the clinical manager or director.”

“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 agency policy, clinical record review, and staff interviews, the agency failed to provide services as ordered for 1 of 12 active patients. (patient #7) Findings included: A policy, Initial Referral/Admission Process (reviewed 10/10/24) received on 10/15/2024 at approximately 11:45 AM from the Director of Operations stated, “If the agency cannot provide services as ordered, the physician/allowed practitioner/referral source will be notified…” The agency received the referral for services on 08/14/2024. The referral included orders for skilled nurse (SN), physical therapy (PT), occupational therapy (OT), home health aide (HHA), medical social worker (MSW), and speech therapy (ST). Clinical record review revealed the OT and ST assessments were not conducted and there was no evidence of the physician, allowed practitioner, or referral source being notified. An interview with the Area Vice President on 10/16/24 revealed that the agency documentation system will only allow 3 disciplines to be added at 1 time and it may have been an oversight.”