Medi Home Health & Hospice

“Be free from abuse CFR(s): 484.50(c)(2) Be free from verbal, mental, sexual, and physical abuse, including injuries of unknown source, neglect and misappropriation of property; This Element is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the agency failed to report signs of possible neglect and or unsafe living conditions to adult protective services for 1 of 21 records reviewed [#13]. Findings included: The policy, Patient Abuse, Neglect or Exploitation [4/2025], was provided by the agency administrator on 4/22/26 at approximately 8:30 am. The policy stated, “______ [agency name] is committed to maintaining a safe and abuse-free environment for all patients. Reporting suspected or confirmed abuse, neglect, exploitation, or misappropriation of property is a mandatory legal requirement in all states in which the agency operates...All employees are mandated reporters and must report suspected or confirmed cases of abuse, neglect, self-neglect, or exploitation...Reports must be made immediately....” Patient # 13 had Start of Care date of 3/18/26 with admitting diagnoses of hypertensive heart and chronic kidney disease [cardiorenal syndrome where high blood pressure damages both organs simultaneously, accelerating failure] with heart failure [heart no longer pumps effectively], type 2 diabetes mellitus with diabetic chronic kidney disease [elevated blood sugar damages kidneys], and type 2 diabetes mellitus with other specified complications. Review of the Plan of Care [POC] for the certification period 3/18/26-5/16/26 included orders for SN [skilled nursing] 2 times a week for 2 weeks, 1 time a week for 6 weeks, 1 time a week for 1 week; home health aide [hha] 2 times a week for 8 weeks; PT [physical therapy] effective 4/4/26 2 times a week for 3 weeks. Review of the clinical record revealed on 3/18/26, RN # 7 completed the admission assessment and documented the following information, “...Pnt [patient] lives at home with multple [sic] cats. Strong urine smell [sic] in the home and cats are defacating [sic] on floor. Litter box is full and pnt is unable to empty or clean it. Trash is all over the floor with the appearance of dropped items that pnt is unable to pick up. Pnt has difficulty navigating walker and oxygen tubing safely and gets tangled up in oxygen tubing...” LPN # 3 conducted a routine visit on 3/20/26 and documented the following information, “...Patient reports that she had diarrhea this morning in the guest bathroom. Guest bathroom is to the leftof [sic] the front door. Stool and paper towels are still on the bathroom floor. Cat feces on the floor throughout the home, and old food on diningtable [sic] and kitchen counters... Patient states “I’m starving, I have noessential [sic] food [sic] my son says that I can order groceries myself...” PTA # 8 conducted a visit on 4/10/26 and documented the following conversation with the patient, “Educated patient on medications. “I haven’t eaten all day. I haven’t taken my medicine. I don’t know if I’m supposed to take two of these green pills.” LPN # 3 conducted a routine visit on 4/13/26 and documented the following information, “ Patient has not had a hospital follow up appointment with PCPsince [sic] hospital discharge. SN observed patient call and schedule PCP appointment. Hospital follow up schedule [sic] for 4/14. Patient thencalled [sic] her son to ask if he would drive her. Patient son is unavailable to drive patient to hospital. Follow up on tomorrow 4/14. Patient statesthat [sic]she will try to drive herself...” PTA # 8 made a routine visit on 4/15/26 and documented the following information, “Patient upset today due to a fender bender in which she was responsible”. Further review of the clinical record revealed no report to adult protective services [APS] was made by the agency staff due for possibility of neglect/unsafe living situation. During an interview with the agency administrator on 4/22/26 at approximately 2 pm the administrator reported, “I believe APS has been involved in the past. We should have made a report.””

“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 agency policy, clinical record review, and staff interviews the Plan of Care [POC] failed to include all/correct medications the patient was ordered for 1 of 3 patients [#8] who received a home visit; and failed to include appropriate safety measures for 5 of 9 patients [#1, 3, 4, 6, 7] who received an anti-platelet medication [medication that inhibits blood clotting]; and failed to include the amount of insulin to be given based on sliding scale for 1 of 8 patients [#10] with a diagnosis of diabetes; and failed to include supplemental oxygen on the POC for 2 of 3 patients [#13 and 16] with orders for supplemental oxygen. The findings included: The policy, Medication Monitoring and Medication Safety [4/2025] was provided by the agency administrator on 4/21/26 at approximately 1 pm. The policy stated,” ...A system is in place to ensure that patient medications are accurate, necessary, and do not interfere with ...Medication reconciliation and medication review is conducted, at a minimum: All OASIS [Outcome and Assessment Information Set] time points...New medication addition...Any change, or update, to any medication...” The policy, Care Plan Implementation [9/2025], was provided by the agency administrator on 4/22/26 at approximately 8:30 am. The policy stated, “...Each patient shall have a written POC that specifies the care and services to be provided, measurable outcomes, responsible disciplines, and patient/caregiver education needs...” 1. Patient # 8 had a Start of Care date of 3/18/26 with admitting diagnoses of hypertensive heart and chronic kidney disease [elevated blood pressure affects blood flow to the kidneys] and acute on chronic diastolic [congestive] heart failure [the heart doesn’t pump effectively] and type 2 diabetes mellitus with diabetic chronic kidney disease [elevated blood sugars damage kidneys]. Review of the Plan of Care [POC] for the certification period 3/18/26-5/16/26 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 8 weeks. On 4/21/26 at 9 am a joint visit was conducted with RN # 10. A medication review was conducted using a medication profile provided by the agency. The following discrepancies were noted: The medication profiled listed Metoprolol Succinate ER 50 mg [blood pressure medication]. Take 1 pill daily. During the visit the patient stated, “The doctor changed that to 25 mg each day when I went for my follow-up earlier this month.” This medication was not included on the POC. The patient presented a bottle of Oxycodone 5mg/325 mg [opioid]. Take 1 pill every 6 hours as needed for pain. During the visit the patient reported, “I have taken that for a long time, but I only take it when I needed it. This medication was not included on the POC. The patient presented a bottle of Isodril 10 mg [chest pain]. Take 1 pill every 8 hours. During the visit the patient stated, “I don’t know exactly when that was ordered, but it has been a while.” This medication was not included on the POC. During an interview with RN # 5 on 4/22/26 at approximately 11:30 am, RN # 5 confirmed the POC did not include all/correct medications the patient was ordered. 2. Patient # 1 had a Start of Care date of 5/19/25 with admitting diagnoses of other cystitis [inflammation of the bladder] without hematuria [blood in the urine] and vascular dementia, unspecified severity. Review of the Plan of Care [POC] for the certification period 5/19/25-7/17/25 revealed the patient was ordered Plavix [antiplatelet-inhibits formation of blood clots] 75 mg daily. Further review of the POC revealed bleeding precautions were not listed as a safety precaution. 3. Patient # 3 had a Start of Care date of 9/5/25 with an admitting diagnosis of unspecified dementia. Review of the Plan of Care [POC] for the certification period 9/5/25-11/3/25 revealed the patient was ordered Plavix [antiplatelet-inhibits formation of blood clots] 75 mg daily. Further review of the POC revealed bleeding precautions were not listed as a safety precaution. 4. Patient # 4 had a Start of Care date of 7/18/25 with an admitting diagnosis of multiple fractures of pelvis without disruption of pelvic ring. Review of the Plan of Care [POC] for the certification period 7/18/25-9/15/25 revealed the patient was ordered aspirin [antiplatelet-inhibits clotting of blood] 81 mg every day. Further review of the POC revealed bleeding precautions were not listed as a safety precaution. 5. Patient # 6 had a Start of Care date of 4/2/26 with an admitting diagnosis of ataxia [a neurological condition characterized by a loss of muscle coordination, balance, and control] following cerebral infarction [stroke]. Review of the Plan of Care [POC] for the certification period 4/2/26- 5/31/26 revealed the patient was ordered aspirin [antiplatelet-inhibits clotting of blood] 81 mg every day. Further review of the POC revealed bleeding precautions were not listed as a safety precaution. 6. Patient # 7 had a Start of Care date of 2/8/26 with an admitting diagnosis of hypertensive chronic kidney disease [high blood pressure affects blood flow to the kidneys]. Review of the Plan of Care [POC] for the certification period 4/9/26-6/7/26 revealed the patient was ordered aspirin [antiplatelet-inhibits clotting of blood] 81 mg every day. Further review of the POC revealed bleeding precautions were not listed as a safety precaution. During an interview with the agency administrator on 4/22/26 at approximately 2:30 pm, the administrator confirmed the POCs should have included bleeding precautions. 7. Patient # 10 had a Start of Care date of 4/4/26 with admitting diagnoses of chronic respiratory failure with hypercapnia [excessive amount of carbon dioxide in the blood] and type 2 diabetes mellitus with diabetic chronic kidney disease [high blood sugars damage kidney functioning]. Preview of the Plan of Care [POC] for the certification period 4/4/26-6/2/26 included orders for PT [physical therapy] 1 time a week for 1 week, 2 times a week for 2 weeks, 1 time a week for 6 weeks. Review of the POC revealed the following medication: Humalog [insulin] KwikPen 100 units/ml. Take 0-15 units prior to meals for diabetes mellitus. Further review of the POC revealed no sliding scale numbers for guidance on the amount of insulin to take. During an interview with RN # 5 on 4/22/26 at approximately 11 am, the RN confirmed the medication order on the POC was incomplete. 8. Patient # 13 had Start of Care date of 3/18/26 with admitting diagnoses of hypertensive heart and chronic kidney disease [cardiorenal syndrome where high blood pressure damages both organs simultaneously, accelerating failure] with heart failure [heart no longer pumps effectively], type 2 diabetes mellitus with diabetic chronic kidney disease [elevated blood sugar damages kidneys], and type 2 diabetes mellitus with other specified complications. Review of the Plan of Care [POC] for the certification period 3/18/26-5/16/26 included orders for SN [skilled nursing] 2 times a week for 2 weeks, 1 time a week for 6 weeks, 1 time a week for 1 week. Review of the admission assessment completed by RN # 7 on revealed the patient was ordered supplemental oxygen at 2 liters via nasal canula as needed for shortness of breath. Review of the POC revealed oxygen was not listed with the medications. 9. Patient # 16 had a Start of Care date of 3/30/26 with admitting diagnoses of hypertensive heart and chronic kidney disease with heart failure [elevated blood pressure affects blood flow to the kidneys] and acute on chronic diastolic [congestive] heart failure [ the heart doesn’t pump effectively]. Review of the Plan of Care [POC] for the certification period 3/30/26-5/28/26 included the following nursing interventions to assess/instruct patient/caregiver on oxygen use, storage, and safety precautions...” Further review of the POC revealed oxygen was not included in the medication list. During an interview with the administrator on 4/22/26 at approximately 10 am, the administrator reported, “The patient is on oxygen at all times at home. The oxygen should have been on the POC with the flow rate.””

“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 clinical record review and staff interviews, the agency failed to notify the physician of low oxygen saturation readings for 1 of 3 patients [1] on supplemental oxygen; and failed to notify the physician of a patient’s complaints of being dizzy for 1 of 5 [#4] discharged records. The findings included: . Patient # 1 had a Start of Care [SOC] date of 5/19/25 with admitting diagnoses of other cystitis [inflammation of the bladder] without hematuria [blood in the urine] and vascular dementia, unspecified severity. Review of the Plan of Care [POC] for the certification period 5/19/25-7/17/25 orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 5 weeks. The POC also included an order for supplemental oxygen 2 liters via nasal canula continuously. Review of the clinical record revealed RN # 2 conducted a routine visit on 5/27/25 and documented the following information, “...Patient wearing oxygen pernasal [sic] cannula at 2LPM‘s[liters per minute]. Vital signs taken within normal limits except O2 sats at 85%, skilled nurse increased 02 [oxygen] to 3LPM‘s and O2 satsup [sic] to 90%...” Review of the clinical record revealed no evidence the RN notified the physician of the oxygen saturations. During an interview with RN # 5 on 4/22/26 at approximately 2 pm, RN # 5 confirmed RN # 2 failed to notify the physician of the oxygen saturation readings. 2. Patient # 4 had a Start of Care date of 7/18/25 with an admitting diagnosis of multiple fractures of pelvis without disruption of pelvic ring. Review of the Plan of Care [POC] for the certification period 7/18/25-9/15/25 revealed orders for PT [physical therapy] 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 4 weeks. Review of the clinical record revealed PT # 11 conducted a routine visit on 7/22/25 and documented the following information, “Patient reported, ‘I have been lightheaded today and sick on my stomach today. I’m sorry I just don’t want to get out of the bed today because I feel dizzy...” On 7/24/25, PT # 11 documented the following information, “Blood sugar was down this am and I had diarrhea this morning too. I just don’t want to stand or try to walk. I am sorry. I can’t do this today.” On 7/28/25, PT # 11 documented the following information, “Patient-I think my blood pressure has been down. Discussion with patient on BP [blood pressure] levels for systolic is 100’s and she reports this is on the lower side for her. Patient will contact cardiologist. “Review of the clinical record revealed no evidence PT # 11 notified the physician of the patient’s concerns/complaints. During an interview with the administrator on 4/22/26 at approximately 2 pm, the administrator reported, “The clinicians know they need to report changes to the physicians.””

“Provide services in the plan of care CFR(s): 484.75(b)(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care; This Element is not met as evidenced by: Based on agency policy, clinical record review, and staff interviews, the skilled nurse increased supplemental oxygen flow to 3 liters when the physician’s order was for 2 liters per minute for 1 of 3 patients [#1] with supplemental oxygen; and the skilled nurse failed to measure a midline site [catheter inserted into an upper arm vein designed for intermediate therapy] every visit for 1 of 1 patient [#8] with a midline catheter. The findings included: The policy, Physician Telephone/Verbal Orders [11/2025], was received from the agency administrator on 4/22/26 at 8:30 am. The policy stated, “...______ [name of agency] provides all care, treatment, and services only according to current, signed, and authorized orders...” 1. Patient # 1 had a Start of Care [SOC] date of 5/19/25 with admitting diagnoses of other cystitis [inflammation of the bladder] without hematuria [blood in the urine] and vascular dementia, unspecified severity. Review of the Plan of Care [POC] for the certification period 5/19/25-7/17/25 orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 5 weeks. The POC also included an order for supplemental oxygen 2 liters via nasal canula continuously. Review of the clinical record revealed RN # 2 conducted a routine visit on 5/27/25 and documented the following information, “...Patient wearing oxygen pernasal [sic] cannula at 2LPM‘s[liters per minute]. Vital signs taken within normal limits except O2 sats at 85%, skilled nurse increased 02 [oxygen] to 3LPM‘s and O2 satsup [sic] to 90%...” RN # 2 conducted a routine visit on 6/2/25 and documented the patient’s oxygen flow was 2-3 liters per minute. Further review of the POC revealed no order for the oxygen flow to be increased. During an interview with RN # 5 on 4/22/26 at approximately 2 pm, RN # 5 confirmed the order for oxygen was for 2 liters. 2. Patient # 8 had a Start of Care date of 3/18/26 with admitting diagnoses of hypertensive heart and chronic kidney disease [elevated blood pressure affects blood flow to the kidneys] and acute on chronic diastolic [congestive] heart failure [the heart doesn’t pump effectively] and type 2 diabetes mellitus with diabetic chronic kidney disease [elevated blood sugars damage kidneys]. Review of the Plan of Care [POC] for the certification period 3/18/26-5/16/26 included orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 8 weeks. The POC included a nursing intervention to, “SN to access RUA [right upper arm] midline [catheter inserted into an upper arm vein designed for intermediate therapy] every visit to remain patent”. Review of the clinical record revealed LPN # 3 conducted routine visits on 3/23/26, 3/25/26 and 3/30/26. There is no evidence the LPN assessed the midline site. During an interview with RN # 5 on 4/22/26 at 2:30 pm, RN # 5 confirmed the LPN failed to assess the Midline site in accordance with the physician’s order.”

“Preparing clinical notes CFR(s): 484.75(b)(6) Preparing clinical notes; This Element is not met as evidenced by: Based on agency policy review, clinical record reviews, and staff interviews, the skilled nurse failed to document appropriate/consistent/or weekly wound measurements for 2 of 6 patients [#1 and 11] with a wound. The findings included: The policy, Wound Care Standards [7/2025], was provided by the agency administrator on 4/22/26 at 8:30 am. The policy stated, “...Measure and document the wound at least weekly, unless the plan of care states otherwise...Wounds must be measured consistently using length...x width...x depth...Undermining and Tunneling...Presence and depth of tunneling and undermining, noting position using the clock method...” 1A. Patient # 1 had a Start of Care [SOC] date of 5/19/25 with admitting diagnoses of other cystitis [inflammation of the bladder] without hematuria [blood in the urine] and vascular dementia, unspecified severity. Review of the Plan of Care [POC] for the certification period 5/19/25-7/17/25 orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 5 weeks and “...SN to instruct patient and caregiver on wound care as follows: rt [right] heel: apply skin prep, cover withduoderm [sic] , change [sic] weekly or as neededto [sic] right knee trauma wd [wound] - clean with saline, pat dry, apply xeroform, cover with gauze, wrap inkerlix [sic], secured with tape. change dailyto [sic] right 5th toe pressure ulcer: clean with saline, apply betadine, open to air...” Review of the clinical record revealed RN # 4 completed the SOC on 5/19/25. RN # 4 documented the wound measurements of right heel [stage 1- intact skin with non-blanchable redness that does not turn white when pressed] Length - 3.5cm, Width - 3.5cm, Depth - 0.1cm. During an interview with RN # 5 on 4/22/26 at approximately 2 pm, it was confirmed a stage I pressure ulcer cannot have a depth, as the skin is still intact. 1B. Patient # 1 had a Start of Care [SOC] date of 5/19/25 with admitting diagnoses of other cystitis [inflammation of the bladder] without hematuria [blood in the urine] and vascular dementia, unspecified severity. Review of the Plan of Care [POC] for the certification period 5/19/25-7/17/25 orders for SN [skilled nursing] 1 time a week for 1 week, 2 times a week for 3 weeks, 1 time a week for 5 weeks and, “...SN to instruct patient and caregiver on wound care as follows... 5th toe pressure ulcer: clean with saline, apply betadine, open to air...” Review of the clinical record revealed RN # 4 completed the SOC visit on 5/19/26 and staged the wound on the right 5th toe as a stage II [a partial-thickness skin injury characterized by an open, shallow wound with a red/pink, moist wound bed, or an intact/ruptured blister] pressure ulcer. Review of the documentation revealed the RN failed to document measurements of the wound to the 5th toe. RN # 6 completed a routine visit on 5/27/25. Further review of the clinical record revealed the RN failed to obtain wound measurements of the right 5th toe. RN # 2 conducted visits on 6/2/25 and 6/9/25. Review of the clinical record revealed no wound measurements for the right 5th toe. During an interview with RN # 5 on 4/22/26 at approximately 2:30 pm, RN # 5 confirmed the RN’s failed to obtain wound measurements of the stage II on the right 5th toe. 2. Patient # 11 had a Start of Care date of 3/12/26 with an admitting diagnosis of necrotizing fasciitis [life-threatening bacterial infection that destroys tissue under the skin]. Review of the Plan of Care [POC] for the certification period 3/12/26-5/10/26 included orders for SN [skilled nurse] 1 time a week for 2 weeks, 2 times a week for 7 weeks and “SN to clean wound with wound cleanser, apply barrier to periwound; skin prep [sic] apply contact layer ifordered [sic]. White foam to tunnels [narrow passageways extending from a wound bed deep into surrounding subcutaneous tissue, creating dead space and high infection risk] at 4 [sic]; 7 [sic]...” The clinical record revealed RN # 1 completed the SOC visit and documented the following wound assessment of the right buttock: “Assessment and Treatment: Size: Length - 14cm, Width - 24cm, Depth - 7cm; Thickness: Full; Edges: Non-Attached; Drainage: Type - Serous, Amount - Copious; Odor: None; Bed: Slough - 5%, Pink/Red - 95%; Surrounding Tissue: Intact; Undermining [occurs when tissue under the wound edges detaches from the underlying subcutaneous tissue, creating a pocket or “shelf” beneath the skin]:From Four O’clock - To Four O’clock - Depth: 5cm, From Seven O’clock - To Eight O’clock - Depth: 4cm; Tunneling: None;...” Further review of the visit documentation for 3/12/26 revealed the following treatment recorded by RN # 1: “Treatment Performed This Visit: Cleansed with wound cleanser, applied skin prep to peri wound, windowpanes with drape, packed 2 pieces white foam to tunnels at 4:7 o’clock, packed remainder with one-piece spiral black foam...” RN # 2 conducted a routine visit on 3/16/26 and documented the following wound assessment “...Right buttock...Assessment... Size: Length - 8cm, Width - 21.5cm, Depth - 3cm... Undermining: None; Tunneling: None...” Treatment Performed This Visit: clean with saline, pack deep depths at 4:00 [sic] and 7:00 [sic] with white foam, apply black foam, secure withocclusive [sic] dressing, connect to cont [sic] suction at 125mmhg...” LPN # 3 conducted a routine visit on 3/23/26 and documented the following wound assessment “...Right buttock...Assessment... Size: Length - 8cm, Width - 20cm, Depth - 0.3cm...Undermining: None; Tunneling:Direction[sic] - Ten O’clock, Depth - 7cm...” LPN # 3 made a routine visit on 3/25/26 and indicated the wound had no undermining or tunneling. RN # 1, RN # 2, nor LPN # 3 were available for interview. During an interview with RN # 5 on 4/22/26 at 2 pm, the RN confirmed the documentation was inconsistent related to tunnels and/or undermining.”