Amedisys Home Health of Charleston East

“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 observation and interview, the Home Health Agency (HHA) Skilled Nurses (SN #1 and #2) failed to follow basic Personal Protective Equipment standards to prevent cross contamination when performing wound care for 2 patients of 2 patients observed for wound care (Patient #2 and #3). Findings included: Observation during a home visit on 04/16/2024 at 10:56 AM revealed Patient #2 in a room, with wounds on both lower extremities which were open to air. SN #2 donned gloves, cleansed the wounds with wound cleanser, patted dry with gauze, then applied a new dressing without removing gloves, performing hand hygiene, and donning new gloves. During an interview on 04/16/2024 at 11:30 AM, SN #2 stated that s/he thought s/he had changed gloves. Observation during a home visit on 04/16/2024 at 10:34 AM for Patient #3 showed SN #1 donned gloves, removed the old dressing, cleansed wounds with wound cleanser, patted dry with gauze, then applied a new dressing without removing gloves, performing hand hygiene and donning new gloves. During an interview on 04/16/2024 at 11:56 AM, SN #1 stated gloves and hand hygiene should be performed after old dressing is removed and wounds are cleaned.”

“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 reviews and interviews, the home health agency failed to ensure physician orders for patients were followed for 6 of 17 patients reviewed. (Patients #2,#4,#5,#9,#10,#12) Findings included: Record review on 04/17/24 at 10:15 PM of Pt#5 revealed Pt#5 was admitted to home health on 02/19/24 for Hydronephrosis. The patient had orders dated 02/19/24 which called for the patient to be seen once a week for 9 weeks plus 2 as needed visits for nephrostomy care by the nurse. The Licensed Practical Nurse (LPN) visited the patient beginning week 3, 03/03/24, 2 weeks after the orders were issued. There were no Nurse visits weeks 2,4,6 or 8 with no Missed Visit Notes to explain the absences. The Registered Nurse (RN) did the only supervisory visit in week 9. In an interview on 04/17/24 3:15 PM at with the Director of Operations verified the findings. Record review on 04/17/24 at 10:40 AM for Pt#10 revealed Pt#10 was admitted on 05/28/2022 with multiple diagnosis including Diabetes, Skin Ulcers, Chronic Kidney Disease and Pacemaker. Physician orders were for the Nurse to visit once a week for 8 weeks with 2 as needed visits, and the Physical Therapist (PT) to visit once a week for 9 weeks. During week 2 of care, the Physician ordered an increase of the nurse visits to 3 times per week. There were 2 missed nurse visits in Weeks 2, 3, 4, 6,7,8 and 9 with no Missed Visit Notes. Week 5 missed 3 nurse visits with no Missed Visit Notes to explain the absences. The Physician orders included recording the patient’s weight: “Report increased edema or weight gain of >2 pounds in 1 day or >5 pounds in 1 week or more. May measure abdominal girth if unable to weigh”. There were no measurements of weight or girth recorded/reported by either the RN/LPN, or the PT, during the entire 9 week episode. In an interview on 04/17/24 3:22 PM the Director of Operations verified the findings. Record review on 04/15/24 at 1:02 PM for Pt#12 revealed Pt#12 was admitted on 02/22/23 with Quadriplegia related to a motor vehicle accident. Physician orders were for the Nurse to visit once for sacral wound care and Physical Therapy to visit once per week for 9 weeks. The patient was discharged 04/18/23 having “reached maximum potential”. The nurse attempted a visit on 02/25/23 and 03/09/23 but entered a Missed Visit Note on both occasions. The nurse never made the visit before the patient was discharged. In an interview on 04/17/24 3:25 PM the Director of Operations verified the findings. Observation home visit on 04/16/2024 at 10:56 AM for Patient #2 showed on arrival to patient’s room, wounds of bilateral lower extremities were open to air. SN #2 donned gloves, cleansed wounds with wound cleanser, covered wounds with xeroform gauze, covered with border dressing. Physician orders dated 04/11/2024 report “Cleanse wounds with wound cleanser. Pat dry with gauze. Apply med honey to wounds. Covered (sic) with xeroform secured with stratsorb dry dressing”. SN #2 did not apply med honey to wounds as ordered. During an interview on 04/18/2024 at 10:30 AM, Director of Operations #1 stated orders state med honey to be used. Review of Patient #4 medical record on 04/16/2024 at 3:11 PM showed physician orders for Home Health Aide (HHA) visits 1 visit per week starting 03/26/2024. There is no documentation for a HHA visit the week of 03/31/2024. During an interview on 04/18/2024 at 10:350 AM, Director of Operations #1 stated that the visit was not scheduled. Review of Patient #9 medical record on 04/17/2024 at 12:30 PM showed on the Skilled Nurse (SN) note for 04/06/2024, the SN had cleaned the incision area of patient’s scalp with water and applied a dressing. There are no documented physician orders for incision care. During an interview on 04/18/2024 at 9 AM, Director of Operations #2 stated that there were no orders in the chart and verified the finding. Findings included: Observation during a home visit on 04/16/2024 at 10:56 AM revealed Patient #2 in the room, with wounds of both lower extremities that were open to air. Skilled Nurse (SN) #2 donned gloves, cleansed the wounds with wound cleanser, covered the wounds with xeroform gauze, then covered the xeroform with a border dressing. Review of Physician orders dated 04/11/2024 revealed “Cleanse wounds with wound cleanser. Pat dry with gauze. Apply med honey to wounds. Covered (sic) with xeroform secured with stratsorb dry dressing”. During the wound care observation, SN #2 did not apply med honey to wounds as ordered. During an interview on 04/18/2024 at 10:30 AM, the Director of Operations #1 stated the physician orders were for med honey to be used. Review of Patient #4’s medical record on 04/16/2024 at 3:11 PM showed physician orders for a Home Health Aide (HHA) to visit 1 time per week starting on 03/26/2024. There was no documentation that a HHA visited the patient the week of 03/31/2024. During an interview on 04/18/2024 at 10:350 AM, the Director of Operations #1 stated that the visit had not been scheduled. Review of Patient #9’s medical record on 04/17/2024 at 12:30 PM showed on the Skilled Nurse (SN) note for 04/06/2024, that the SN had cleaned the incision area of the patient’s scalp with water and applied a dressing. There were no documented physician orders for incision care. During an interview on 04/18/2024 at 9:00 AM, the Director of Operations #2 stated that there were no orders in the chart and verified the finding. Record review on 04/17/24 at 10:15 AM revealed Patient (Pt) #5 was admitted to home health on 02/19/24 with a diagnosis of Hydronephrosis. The patient had orders dated 02/19/24 which called for the patient to be seen once a week for 9 weeks; plus 2 (as needed) visits for nephrostomy care by the nurse. The Licensed Practical Nurse (LPN) visited the patient beginning week 3, on 03/03/24, which was 2 weeks after the orders were issued. There were no Nurse visits for weeks 2, 4, 6, or 8: with no Missed Visit Notes to explain the absences. The Registered Nurse (RN) did the only supervisory visit in week 9. During an interview on 04/17/24 at 3:15 PM, the Director of Operations verified the findings. Record review on 04/17/24 at 10:40 AM revealed Pt#10 was admitted on 05/28/2022 with multiple diagnoses including Diabetes, Skin Ulcers, Chronic Kidney Disease, and Pacemaker. Review of physician orders revealed the Nurse was to visit once a week for 8 weeks, with 2 (as needed) visits. The Physical Therapist (PT) was to visit once a week for 9 weeks. During week 2 of care, the Physician ordered an increase in the nurse visits to 3 times per week.There were 2 missed nurse visits in weeks 2, 3, 4, 6, 7, 8 and 9; with no missed visit notes. During week 5 there were 3 missed nurse visits with no missed visit notes to explain the absences. The physician orders included recording the patient’s weight: “Report increased edema or weight gain of >2 pounds in 1 day or >5 pounds in 1 week or more. May measure abdominal girth if unable to weigh”. There were no measurements of weight or girth recorded/reported by either the RN/LPN, or the PT; during the entire 9 week episode. In an interview on 04/17/24 3:22 PM, the Director of Operations verified the findings. Record review on 04/15/24 at 1:02 PM revealed Pt#12 was admitted on 02/22/23 with the diagnosis of Quadriplegia related to a motor vehicle accident. Physician orders revealed the nurse was to visit once to provide sacral wound care and Physical Therapy to visit once per week for 9 weeks. The patient was discharged 04/18/23 having “reached maximum potential”. The nurse attempted a visit on 02/25/23 and 03/09/23 but entered a Missed Visit Note on both occasions. The nurse never made the visit before the patient was discharged. In an interview on 04/17/24 3:25 PM the Director of Operations verified the findings.”

“Nursing services supervised by RN CFR(s): 484.75(c)(1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of §484.115(k). This Element is not met as evidenced by: Based on record review and interview, the Home Health Agency (HHA) failed to ensure the Licensed Practical Nurse (LPN) was supervised by the Registered Nurse (RN) for 1 of 1 patients receiving LPN services, Patient #10. Findings included: Record review on 04/17/24 at 12:15 PM revealed Patient (Pt) #10 was admitted to home health on 05/28/22 with diagnoses including Right Lower Leg Ulcer, Diabetes, and Heart Failure. The patient had physician orders for the nurse to visit once a week for 8 weeks, and the Physical Therapist (PT) to visit once a week for 9 weeks. Review of the care episode 09/20/23 – 11/18/23 revealed the Licensed Practical Nurse (LPN) began visiting the patient on 09/26/23. The PT performed the supervisory visits for the LPN on 10/11/23, 11/08/23 and 11/15/23. In an interview on 04/17/24 at 3:18 PM, the Director of Operations verified the findings.”

“Required items in clinical record CFR(s): 484.110(a)(1) The patient’s current comprehensive assessment, including all of the assessments from the most recent home health admission, clinical notes, plans of care, and physician or allowed practitioner orders; This Element is not met as evidenced by: Based on interview and record review, the Home Health Agency (HHA) staff failed to document weekly wound measurements in the comprehensive assessments to provide up to date information to the physician and HHA staff for 3 out of 6 applicable patients (Patient #2, #3 and #11). Findings include Review of Patient #2’s medical record on 04/17/2024 at 2:55 PM showed physician orders for wound care of both lower extremities starting with admission on 03/24/2024. There were no measurements of wounds for the weeks of 03/24/2024 and 03/31/2024. During an interview on 04/18/2024 at 10:30 AM, the Director of Operations #1 stated that they were unable to find measurements on those weeks and verified the finding. Review of Patient #3’s medical record on 04/17/2024 at 10:10 AM showed physician orders for wound care of the right lower extremity starting 03/19/2024. There were no documented wound measurements for the week starting 03/19/2024. During an interview on 04/18/2024 at 10:40 AM, the Director of Operations #1 stated, “The registered nurse started care on 03/22/2024 and should have taken wound measurements”. Review of Patient #11’s medical record on 04/17/2024 at 1:05 PM showed physician orders for wound care of chronic venous stasis ulcers on both lower extremities. There was no documentation of wound measurements for the weeks of 01/21/2024 and 03/03/2024. During an interview on 04/18/2024 at 9:42 AM, the Director of Operations #3 stated that they were unable to find wound measurements for those weeks and verified the finding.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on observation, interview and record review, the Home Health Agency (HHA) staff failed to maintain an accurate, up to date medication list matching the facility Medication Administration Record (MAR) or home medication list for 4 out of 7 applicable patients (Patient #1, Patient #2, Patient #3 and Patient #4). Findings included: Observation during a home visit on 04/16/2024 at 9:28 AM for Patient #1 showed Cefdinir 300 mg 1 capsule by mouth daily for 5 days starting 03/04/2024.This medication remains active on the agency medication list. Gabapentin 300 mg 1 capsule by mouth twice a day starting 03/2042024 for 5 days.This medication remains active on the agency medication list. Pyridium 100 mg 1 tablet by mouth 3 times a day.This medication is not on the Assisted Living Facility (ALF) MAR. The ALF MAR lists Preservision AREDS 2 soft gels by mouth twice a day. This medication is not on the HHA medication list. During an interview on 04/18/2024 at 10:25 AM, the Director of Operations #1 stated that it is often difficult for the HHA staff to find a facility staff member to go over the medication updates. Observation during a home visit on 04/16/2024 at 10:56 AM for Patient #2 showed Acyclovir 400 mg 1 tablet by mouth daily starting 03/12/2024. This medication is not part of the HHA medication list. Centrum Silver 1 tablet by mouth daily starting 03/12/2024. This medication is not part of the HHA medication list. The HHA medication list reports Amlodipine 10 mg 1 tablet by mouth daily starting 03/11/2024.This medication is not on the ALF medication list. During an interview on 04/18/2024 at 10:30 AM, the Director of Operations #1 stated that it is often difficult for the HHA staff to find a facility staff member to go over the medication updates and verified the findings. Observation during a home visit on 04/16/2024 at 11:34 AM for Patient #3 showed; Preservision AREDS 1 tablet by mouth twice a day starting 05/17/2021. This medication is not part of the HHA medication list. Cholecalciferol 1000 unit 1 tablet by mouth daily. This medication is not part of the HHA medication list. Cyanocobalamin 1000 mcg 1 tablet by mouth daily. This medication is not on the ALF medication list. During an interview on 04/18/2024 at 10:40 AM, the Director of Operations #1 stated that it is often difficult for the HHA staff to find a facility staff member to go over the medication updates and verifies the findings. During observation during a home visit on 04/16/2024 at 12:45 PM for Patient #4, the caregiver reported the patient was taking Myrbetriq 50mg, 1 tablet by mouth daily, and Fosamax 70 mg 1 tablet by mouth daily. Both of these medications were not on the HHA medication list. During an interview on 04/18/2024 at 10:50 AM, the Director of Operations #1 stated that these two medications were not on the HHA list and verified the finding.”

“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 Home Health Agency (HHA) failed to ensure a discharge summary had been documented for two of five discharged patients (Patients #12, #14). Findings included: Record review on 04/15/24 at 12:15 PM revealed Patient (Pt) #12 was admitted to home health on 02/22/23 with a diagnosis of Quadriplegia related to a motor vehicle accident. The patient was discharged on 04/17/23 with no discharge summary in the patient record. In an interview on 04/17/24 at 9:13 AM, the Director of Operations verified the findings. Record review on 04/15/24 at 2:15 PM revealed Pt #14 was admitted to home health on 06/07/23 with a diagnosis of Parkinson’s disease. The patient was discharged on 06/10/23 with no discharge summary in the patient record. In an interview on 04/17/24 at 9:25 AM, the Director of Operations verified the findings.”