Advantage Home Health Services, LLC

“Conformance with physician orders CFR(s): 484.60(b) Standard: Conformance with physician or allowed practitioner orders. This Standard is not met as evidenced by: Based on a review of clinical records (CR), agency policy, and staff interviews (EMP), the agency did not administer treatments in accordance with the plan of care for two (2) of fifteen (15) CRs reviewed. (CR2 and CR15) Findings Included: A review of agency policy, “Medical Record Content,” on 12/15/23 at approximately 1:00 pm revealed, “Procedure…4. Each medical record will contain the following: …initial and ongoing assessments, including comprehensive assessment and all assessments of the most recent home health admission…Identification of problems, interventions and goals (care planning) for each discipline and updates to the plan of care…Actions/interventions/procedures…Patient’s response to all interventions, including medication administration, treatments and services and responses to those interventions.” A clinical record review conducted on 12/12/23 at approximately 2:30 pm for CR2: Start of Care (SOC) 11/11/23, Certification period reviewed 11/11/23 – 1/9/24 found: Document titled, “Home Health Care Certification and Plan of Care” signed 11/15/23 read, “SN [skilled nursing]: Assess weight change: report gain of 2 lbs in one day or 5 lbs in one week. SN: Patient/caregiver monitors patient’s weight and weight changes and reports any weight gain to clinician…” CR2 Skilled Nursing Visits for period 11/11/23-12/8/23 revealed the following: 11/20/23: no documented weight assessment 11/24/23: no documented weight assessment. Narrative note reads, “…Pt continues to not have a scale or weigh [themselves]. …” 11/27/23: no documented weight assessment. 12/1/23: no documented weight assessment. Narrative note reads, “…Pt continues to not have a scale or weigh [themselves]. …” 12/4/23: no documented weight assessment. Narrative note reads, “…Pt continues to not have a scale or weigh [themselves]. …” 12/8/23: no documented weight assessment. 12/11/23: no documented weight assessment. Narrative note reads, “…Pt continues to not have a scale or weigh [themselves]. …” An offsite clinical record review conducted on 12/15/23 at approximately 1:00 pm for CR15: SOC: 10/13/23, Certification period reviewed 10/13/23 – 12/11/23 found: Document titled, “Home health Care Certification and Plan of Care” signed 10/18/23 read, “…SN: Assess compliance with CHF treatment and regimen…SN: Patient to weigh self daily and notify MD if gains 2-3 pounds in a day or 5 pounds or more in a week. …” CR15 Skilled Nursing Visits for period 10/13/23-10/23/23 revealed the following: 10/23/23: no documented weight assessment. Narrative note reads, “Patient has not been compliant with daily weights.” The above findings were confirmed with EMP1, VP of Clinical Compliance, during an interview on 12/19/23.”

“In accordance with current clinical practice CFR(s): 484.105(f)(2) All HHA services must be provided in accordance with current clinical practice guidelines and accepted professional standards of practice. This Element is not met as evidenced by: Based on supply room observations (OBS), policies, and employee interviews (EMP), the agency did not follow accepted clinical practice to maintain patient safety and prevent infections related to expired and outdated medical supplies for one (1) of one (1) observation. (OBS1) Findings include: Agency policy titled, “Supply Maintenance,” reviewed 12/11/23 read, “Procedure…At the agency site(s)..Supplies will be checked for expiration date prior to use. If outdated, the supplies will be immediately removed from stock and discarded…” During a tour (OBS1) of the agency’s supply room on 12/11/23 at approximately 9:30 am the following outdated and undated supplies were found: 72 -Vacutainer 4mL clot activator, red top tubes with expiration date of 9/30/23 1 - package of Hand Sanitizing Alcohol wipes with an expiration date of 9/30/2023 2 - Apogee Catheter insertion kits with an expiration date of 6/1/23 1 - CADD administration set with an expiration date of 4/27/23 4 - 22 gauge Insyte Autoguard Winged shielded IV catheters with an expiration date of 10/31/23 1 – Sorba view central line dressing with an expiration date of 11/2023 2 – 2 – small bore extension sets with expiration date of 12/1/23 1 – Vygon PICC removal tray with an expiration date of 10/31/23 69 – urine transfer collection devices, unable to discern expiration date, not in original box, no manufacturer date or expiration date 1 – Bard leg bag unable to discern expiration date 2 – 16 French Kendall/Tyco catheters unable to discern expiration date on packaging 2 – 6.0 mL Vacutainer red top tubes with an expiration date of 9/30/23 4 – 5.0 mL Vacutainer SST tubes with an expiration date of 7/31/23 3 – 4.5 mL Vacutainer PST tubes/gel and lithium heparin with an expiration date of 7/31/23 During an interview on 12/11/23 at approximately 10:30 am the procedure for stocking and reviewing the agency’s supplies was discussed with EMP2, clinical director. EMP2 verified that no system existed at this time for monitoring shelf-life of sterile and nonsterile supplies in undated packaging. The finding of expired supplies was also reviewed on 12/14/23 at approximately 1:30 pm with EMP1, VP of Clinical Compliance.”