Amedisys Home Health

“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 record review, observation and interview, the staff failed to adhere to current infection control standards of practice for three (#1, #2 and #3) of four (#1 - #4) patients observed during home visits. Patient #1 Review of POC for SOC period 06/27/25 - 08/25/25 showed primary diagnosis of Osteoporosis and Fractured Right Femur with orders for PT and OT services. During a home visit on 07/08/25 at 9:30 AM, the OT was observed to place the clinician bag directly on the patients dining table without a protective barrier to prevent transmission of infections. Patient #2 Review of the POC for SOC period 06/06/25 - 08/04/25 showed a primary diagnosis of Metabolic Encephalopathy and Malignant Neoplasm of the Tongue with wound care orders of 06/27/25 for SN to perform wound care 2 times a week to the left forearm graft site and the left thigh graft site. On 07/08/25 at 10:30 AM, the SN was observed to place the clinician bag directly on the patients dining table without a protective barrier. During the wound care procedure, the SN failed to sanitize hands between glove changes, failed to change gloves between removing old dressing to new dressing, reused opened single-use products on the wounds and entered clinician bag with gloves on. Patient #3 Review of the POC for initial certification period 06/28/25- 08/26/25 showed a primary diagnosis of Hypo-osmolarity and Hyponatremia with orders for SN to provide wound care 2 times a week. During a home visit on 07/08/25 at 2:30 PM, the SN was observed during the procedure to place the clinician bag and wound care supplies on a barrier directly on the floor. During an interview on 07/09/25 at 9:45 AM, Staff A stated the clinicians failed to follow infection control practices for Patients #1, #2 and #3.”

“5 calendar days after start of care CFR(s): 484.55(b)(1) The comprehensive assessment must be completed in a timely manner, consistent with the patient’s immediate needs, but no later than 5 calendar days after the start of care. This Element is not met as evidenced by: Based on record review and interview, the Physical Therapist failed to conduct a PT evaluation timely as part of the comprehensive assessment for two (#3 and #4) of eight (#1-#7 and #10) records reviewed with orders for PT services. Patient #3 Review of the POC for initial certification period 06/28/25- 08/26/25 showed a primary diagnosis of Hypo-osmolarity and Hyponatremia with referral orders of 06/26/25 for SN and PT evaluations. Further review failed to provide evidence a PT evaluation was completed as of the date of this survey and no documentation as to the reason for the delay. Patient #4 Review of the POC for initial certification period 06/04/25- 08/02/25 showed a primary diagnosis of Acute Cystitis and Hematuria with SOC orders of 06/04/25 for a PT evaluation. Further review showed a PT evaluation was completed as part of the comprehensive assessment on 06/10/25, 1 day late with no documentation as to the reason for the delay. During an interview on 07/09/25 at 9:45 AM, Staff C stated the PT failed to conduct the evaluations timely.”

“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 record review and interview, the agency failed to provide an individualized POC based on the assessed needs of the patient for three (#5, #6 and #10) of ten (#1 - #10) records reviewed. Patient #5 Review of the POC for initial certification period 06/20/25 - 08/18/25 showed a primary diagnosis of Type 2 Diabetes Mellitus with Hyperglycemia and Polyneuropathy and long-term use of oral Hypoglycemic drugs with orders for “Diabetes Management”. “Diabetes Management specified by the POC included orders for RN/LVN/LPN “to...assess, observe and teach ... instructions of diabetic care to include: ...to observe and teach patient/caregiver ability to perform and record blood glucose testing as ordered and to report abnormal findings to physician. ...RN/LVN/LPN may perform blood glucose test as needed. ... to report to physician blood glucose readings greater than 300 or less than 70 mg/dl...instruct patient on importance of HCBA1C monitoring”. Review of SOC RN Visit note 06/20/25 stated “ Patient’s A1C on 6/11/25 was at 7.7 which is up from 7.1 6 months prior...placed on new med Sitagliptin. No current orders to monitor daily blood glucose levels as patient is not on insulin, no glucometer in home, knowledge deficit of T2DM”. Further record review failed to provide evidence of DME/ Supplies for CBG testing or orders for testing frequency on the POC and no documentation the SN staff notified the physician of the need for CBG testing supplies and orders for testing frequency. The Vital Signs Record showed no CBG results documented for SN visits conducted 6/20/25, 6/27/25, 7/2/25 and 7/9/25 Patient #6 Review of the POC for initial certification period 05/20/25 - 07/18/25 showed a primary diagnosis of Orthopedic Aftercare and secondary diagnosis of Type 2 Diabetes Mellitus with Neuropathy with orders for SN “Diabetes Management” Further review of the POC failed to include DME /Supplies for CBG testing. Patient #10 Review of the POC for re-certification period 04/08/25 - 06/06/25 showed a primary diagnosis of Chronic Obstructive Pulmonary Disease and secondary diagnosis of Hypertensive Heart Disease with Heart Failure and Type II Diabetes Mellitus with orders for SN “Oxygen Therapy’ and “Diabetes Management.” Further review of the POC failed to include DME /Supplies for CBG testing or Safety Measures for Oxygen Precautions. During an interview on 07/09/25 at 9:45 AM, Staff C stated the POC for Patients #5, #6 and #10 were not individualized to meet the patients’ needs based on the documented assessments.”

“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 record review, observation and interview the SN failed to provide wound care as ordered for one (#2) of two (#2 and #3) wound care procedures observed. Patient #2 Review of the POC for SOC period 06/06/25 - 08/04/25 showed a primary diagnosis of Metabolic Encephalopathy and Malignant Neoplasm of the Tongue with wound care orders of 06/27/25 for SN to perform wound care 2 times a week to the left forearm graft site and the left thigh graft site. On 07/08/25 at 10:30, the SN was observed performing wound care: Current wound care orders to the left forearm specified: Cleanse with wound cleanser, pat dry, apply hydrofera blue to hyper granulated area, apply Aquaphor to dry skin of forearm, wrap with kerlix, secure with coban. The SN applied an opened single-use Xeroform dressing to the wound instead of hydrofera blue as ordered, did not apply Aquaphor to forearm and informed the patient she would contact the physician to get wound care orders changed. Current wound care orders to the left thigh specified: Cleanse with wound cleanser, pat dry, apply Xeroform to the wound, cover with meplix. The SN applied Xeroform to the wound and covered with a bordered dressing the patient had ordered to use for comfort. The SN informed the patient she would contact the physician to get orders for a new dressing. During an interview on 07/09/25 at 09:45 AM, Staff A stated the SN did not provide wound care as ordered for Patient #2.”