Living Life Homecare LLC

“Care planning, coordination, quality of care CFR(s): 484.60 Condition of participation: Care planning, coordination of services, and quality of care. Patients are accepted for treatment on the reasonable expectation that an HHA can meet the patient’s medical, nursing, rehabilitative, and social needs in his or her place of residence. Each patient must receive an individualized written plan of care, including any revisions or additions. The individualized plan of care must specify the care and services necessary to meet the patient-specific needs as identified in the comprehensive assessment, including identification of the responsible discipline(s), and the measurable outcomes that the HHA anticipates will occur as a result of implementing and coordinating the plan of care. The individualized plan of care must also specify the patient and caregiver education and training. Services must be furnished in accordance with accepted standards of practice. This Condition is not met as evidenced by: Based on record review, interview and policy review, the facility failed to ensure the physician was notified when a patient was on a blood sugar medication and had repeated low blood sugars. This affected one (Patient #1) of three patients reviewed. The patient census was 30. See G590.”

“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 record review, interview and policy review, the facility failed to ensure the patient medications were reconciled each certification period with the physician. This affected one (Patient #1) of three medical records reviewed. The patient census was 30. Findings include: Review of the plan of care for Patient #1 revealed the start of care date was 10/05/19. The primary diagnosis was chronic obstructive pulmonary disease. Other diagnoses included dementia, Type 2 Diabetes with diabetic chronic kidney disease, and chronic pain syndrome. Patient #1 was oriented to self only, forgetful, disoriented and agitated. Review of the pharmacy list dated 08/07/24 listed Glipizide 10 milligrams (mg) but did not specify how often it was to be administered. The physician order for the certification periods of 07/10/24 to 09/07/24 and 09/08/24 to 11/06/24 listed Glipizide 10 mg twice a day. There was no medication profile for either certification period to show that the medications were reconciled. During an interview on 11/05/24 at 4:00 PM, the Director of Nursing verified the above findings.”

“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 record review, interview and policy review, the facility failed to ensure the physician was notified when a patient was on a blood sugar medication and had repeated low blood sugars. This affected one (Patient #1) of three patients reviewed. The patient census was 30. Findings include: Review of the plan of care for Specified Patient (SP) #1 revealed the start of care date was on 10/05/19. SP #1’s primary diagnosis was chronic obstructive pulmonary disease. Other diagnoses included dementia, Type 2 diabetes with diabetic chronic kidney disease, and chronic pain syndrome. SP #1 was oriented to self only, forgetful, disoriented and agitated. SP #1 required assistance with activities of daily living and utilized a wheelchair and a walker. The certification period reviewed was from 07/10/24 to 09/07/24 and 09/08/24 to 11/06/24. The orders were for skilled nursing seven times a week for nine weeks, and home health aide (HHA) 98 hours a week times nine weeks; six hours in the morning, two hours in the afternoon, and six hours late shift. The pharmacy list dated 08/07/24 listed Glipizide 10 milligrams (mg) but did not specify how often it was to be administered. Glipizide 10 milligrams (mg) twice a day was added to the recertification period for 09/08/24 to 11/06/24. The plan of care for nursing stated the nurse was to assess diabetic status, identify any signs and symptoms of impaired diabetic function, report significant changes to the physician, perform finger stick for blood glucose analysis every day, monitor blood sugar levels to assess efficacy of medication and dietary therapy and coordinate care with physician for need to change the plan of care. It did not state any parameters for the blood sugar results or when the physician should be notified. Review of the nursing notes dated 07/13/24, 07/14/24, and 07/16/24 revealed no documentation that SP #1’s blood sugar was checked or that all medications were given. On 07/17/24, there was no documentation the blood sugar was checked. The primary care physician (PCP) ordered a urinalysis for possible urinary tract infection (UTI) and was obtained this morning, will follow up, confusion but took her meds. On 07/18/24 there was no documentation the blood sugar was checked. Meds were given, confusion remains and awaiting results from urinalysis. On 07/19/24, SP #1 was started on antibiotic for UTI but there was no documentation the blood sugar was checked. On 07/20/24, meds given with antibiotic but there was no documentation the blood sugar was checked. On 07/21/24, the morning meds were given, but there was no documentation the blood sugar was checked. On 07/30/24, SP #1 was confused and showing aggressiveness, refuses finger stick and meds, power of attorney (POA) and PCP notified. On 08/04/24, SP #1 refused meds and there was no documentation a blood sugar was checked or the physician was notified. On 08/14/24, SP #1 had a blood sugar of 62 and the Glipizide was held. There was no documentation the physician was notified. On 08/16/24, there was no blood sugar documented. SP #1 showed increased confusion and refused medications. The physician office was notified and a message was left with an answering service; will await return call when office opens. There was no documentation the physician called back. On 08/19/24, SP #1’s blood sugar was 52. The Glipizide was held but the physician was not notified. On 08/20/24, SP #1’s blood sugar was 65. The Glipizide held and the physician was notified about Glipizide being held and the changes in blood sugar; awaiting a call back. There was no documentation the physician returned the call. On 08/28/24, unable to obtain vital signs after breakfast. SP #1 refused medications, will notify physician when office opens to inform of SP #1’s refusal. There was no documentation the blood sugar was checked or the physician was notified. On 09/02/24, SP #1’s blood sugar was 42. The Glipizide was held and the physician was notified. On 09/07/24, SP #1’s blood sugar was 68. The Glipizide was held and there was no physician notification. Review of a nursing note dated 09/08/24 documented SP #1 showed increased confusion. Her blood sugar was 82. She refused medications saying she didn’t know who the nurse was and was getting aggressive as well. Physician notified of medication refusal. Review of a nursing note dated 09/09/24 at 8:03 AM documented SP #1 was up and confused. She was refusing morning meds unless she is taken outside to look for her dog. The nurse took SP #1 and her dog out for a walk with the caregiver. The nurse was able to talk SP #1 into taking meds and eating breakfast. There was no documentation the blood sugar was checked. Review of a nursing note dated 09/10/24 documented SP #1 continued to show an increase in confusion/ Blood sugar was 72 this morning, and sugar medication was not given. The physician was notified to clarify current medications and, also called them into the pharmacy for refills. Review of a nursing note dated 09/11/24 documented SP #1 showed “lots of confusion today”, visiting physicians aware and planning on a visit next week. Blood sugar was 89 but SP #1 refused Ensure or anything to eat. All other meds given but Glipizide. Requesting to lay back down, request granted. Review of the incident log dated 09/11/24 revealed SP #1 fell in the living room at 5:00 PM, because of increased confusion. The fall was witnessed by the HHA. SP #1 was sent to the emergency department (ED) for evaluation. Review of the discharge summary from the hospital revealed SP #1 presented to the emergency department on 09/10/24 with a low blood sugar of 32 and a left hip fracture. She was discharged to home on 09/15/24. During an interview on 10/30/24 at12:16 PM, the HHA who provided care to SP #1 in the evenings stated when it was time for SP #1 to take her medications, she gave her the cup with the medications already in it and a glass of water to take the medications with. Sometimes she would take the medications and sometimes she would not. She lets the nurse know when she refuses her medications. There was a day when SP #1 was not acting right and she fell on the living room floor. She called the nurse to let her know and the nurse also called her daughter. This happened between 5 PM and 6 PM in the evening and she had not taken her bedtime medications yet. The HHA states she called 911 for SP #1 to be transferred to the hospital. She did not remember the date this happened. During an interview on 11/05/24 at 9:20 AM, the DON stated the physician visited SP #1 in the home but does not remember the date. The physician called the Glipizide to the pharmacy. The DON called the physician’s office and talked to the nurse and asked if the physician wanted SP #1 on the Glipizide because she has not had any problems with SP #1’s blood sugar. The last time SP #1 was on Glipizide was in 2023. She stated the Glipizide bottle was never opened and she never gave the Glipizide.”