Elara Caring Xviii

“Patient/payer will no longer pay for services CFR(s): 484.50(d)(2) The patient or payer will no longer pay for the services provided by the HHA; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure advance beneficiary notice and/or HHCOC notice was provided to a patient prior to discharge from agency services for one (Patient #13) of 13 patients. Findings: Patient #13 A review of the clinical record showed no advance notice of discharge or home health change of care notice prior to discharge from the agency on 09/13/24 for insurance payor denial of services. On 02/14/25 at 3:10 p.m., Staff B stated: 1. There were no ABN or HHCOC notices in the clinical record for patient #13 and; 2. Patient #13 should have received an ABN and/or HHCOC notices prior to being discharged from the agency for insurance payor denial of services.”

“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 and interview, the agency failed to ensure a medication profile was reviewed and updated with ordered medications for two (Patients #5 and #7) of 13 patients. Findings: Patient #5 A review of a POC dated 01/24/25 to 03/24/25 showed orders for Trulicity (a diabetic medication) 0.75 mg subcutaneous injection weekly and Trulicity 1.5 mg subcutaneous injection weekly. A SN visit note dated 01/28/25 documented the patient did not have the medication (Trulicity) available to administer in the residential care facility and the medical provider ordered Glipizide 5 mg by mouth be increased to two times a day. A review of the medication profile showed no communication with the medical provider regarding dual doses of the medication and showed no update to the medication profile. On 02/14/25 at 2:13 p.m., Staff B stated: 1. The Trulicity 0.75 mg dose should have been discontinued at the recertification on or before 01/24/25 and increased to the 1.5 mg weekly dose and; 2. The SN should have clarified with the medical provider if the Trulicity should be discontinued, as it was not available for administration. Patient #7 A review of a POC dated 01/04/25 to 03/04/25 showed a verbal order dated 01/24/25 for Doxycycline 100 mg twice a day starting on 01/20/25. The medication profile showed no end date (duration) for the medication and showed no notifications or changes in orders. On 02/14/25 at 2:20 p.m., Staff B stated the medication profile will not update medication until the 485 (POC, orders) are approved (signed and returned by the medical provider).”

“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 and interview, the agency failed to ensure physician ordered placement of compression stockings for one (Patient #4) of 13 patients. Findings: Patient #4 A review of the POC dated 12/14/24 to 02/11/25 showed orders for SN to assess, instruct and perform blood sugar testing every visit for diabetes management. Documentation showed during SN visits conducted on 01/11/25, 01/17/25 and on 01/31/25 SN applied compression stockings to the bilateral lower extremities. Documentation showed no physician notification and no changes in orders. On 02/14/25 at 2:11 p.m., Staff B stated the POC for patient #4 did not include application of compression stockings to bilateral lower extremities for patient #4.”

“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 record review and interview, the agency failed to ensure: SN notified the physician for weight readings outside of reporting parameters as ordered on the POC for one (Patient #1) of 13 patients. SN notified the physician for blood pressure reading outside of reporting parameters as ordered on the POC for two (Patients #2 and #8) of 13 patients and. SN conducted wound site care ordered on the POC for one (Patients #7) of 13 patients. Findings: Patient #1 A review of a POC dated 01/17/25 to 03/17/25 showed orders for SN to assess, monitor patient’s weight every visit and notify physician of weight gain of 2 to 5 pounds in 1 week. Documentation showed that during SN visits on 01/20/25 patient’s weight was 141 pounds (4-pound gain in 3 days). Documentation showed no physician notifications and no change in orders. On 02/14/25 at 2:00 p.m., Staff B stated the SN should have notified the physician of the patient’s weight gain outside of reporting parameters. Patient #2 A review of a POC dated 01/06/25 to 03/06/25 showed orders for SN to assess, monitor patient’s blood pressure every visit and notify physician of diastolic blood pressure less than 50. Documentation showed during SN visits on 01/20/25 the patient’s diastolic blood pressure was 46. Documentation showed the physician was not notified until 01/28/25 (eight days later) of the patient’s diastolic blood pressure and showed no change in orders. On 02/14/25 at 2:05 p.m., Staff B stated the SN should have notified the physician of the diastolic blood pressure that was outside of reporting parameters at the time of the SN visit. Patient #7 A review of the POC dated 01/04/25 to 03/04/25 showed orders for SN to assess, instruct caregiver and perform wound site care to gluteal skin fold with wound cleanser, apply calcium alginate to wound bed and cover with Opti foam dressing every visit. Documentation showed during SN visits conducted on 01/10/25, 01/24/25, 01/31/25 and on 02/07/25 SN documentation showed no wound site care to gluteal skin fold was conducted during the SN visits. Documentation showed no physician notification and no changes in orders. On 02/14/25 at 2:20 p.m., Staff B stated SN should have completed wound site care to the gluteal skin fold for patient #7 each visit. Patient #8 A review of a POC dated 01/09/25 to 03/09/25 showed orders for SN to assess, monitor patient’s blood pressure every visit and notify physician of diastolic blood pressure less than 50. Documentation showed during ST visits on 01/23/25 the patient’s diastolic blood pressure was 48. Documentation showed no physician notification and showed no change in orders. On 02/14/25 at 2:30 p.m., Staff B stated the ST should have notified the physician of the diastolic blood pressure that was outside of reporting parameters at the time of the ST visit.”

“Discharge and transfer summaries CFR(s): 484.110(a)(6)(i-iii) (i) A completed discharge summary that is sent to the primary care practitioner or other health care professional who will be responsible for providing care and services to the patient after discharge from the HHA (if any) within 5 business days of the patient’s discharge; or (ii) A completed transfer summary that is sent within 2 business days of a planned transfer, if the patient’s care will be immediately continued in a health care facility; or (iii) A completed transfer summary that is sent within 2 business days of becoming aware of an unplanned transfer, if the patient is still receiving care in a health care facility at the time when the HHA becomes aware of the transfer. This Element is not met as evidenced by: Based on record reviews and interviews, the agency failed to ensure a completed discharge summary was provided for two (Patients #12 and #13) of 13 patients. Findings: Patient #12 A review of the clinical record showed discharge from the agency on 12/05/24 to the hospice service provider. Documentation showed no discharge summary was provided to the hospice service provider and was not provided to the physician service provider until 12/12/24 (7 days later). Patient #13 A review of the clinical record documented discharge from the agency on 09/13/24 due to no authorization of payment from insurance payor source. Documentation showed no discharge summary was provided to the physician service provider until 09/20/24 (7 days later). On 02/14/25 at 3:05 p.m., Staff B stated no discharge summaries should have been provided to the receiving service providers for patients #12 and #13 within 48 hours of discharge from the agency.”