Baptist Memorial Home Care

“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 review of policy review, record review, observations, and interviews, the agency failed to ensure that the wound was appropriately accessed and measured for 3 of 3 observed (Patient #1, #4, and #5) home visits observed. The findings included: 1. Review of the agency policy titled “WOUND ASSESSMENT, DOCUMENTATION, AND PHOTOGRAPHY,” dated 9/1/2024, revealed “The assessment includes measurement of the length, width and depth, undermining and tunneling, wound bed description...At each dressing change, the clinical should record the wound bed description, wound edges, exposed tissue types, drainage and condition of the periwound…Wounds will be assessed in person by the Registered Nurse…Depth is measured at the deepest area using a cotton tipped applicator (CTA) or foam tipped applicator (FTA)...” 2. Medical record review for Patient #1 revealed a Start of Care (SOC) date of 10/28/2024 with diagnoses of Type 2 Diabetes, Chronic kidney Disease, Congestive Heart Failure, Atrial Fibrillation, Stage 4 Pressure Ulcers, and a Cardiac Defibrillator. Review of the Home Health Certification and Plan of Care dated 12/27/2024 through 2/24/2025, revealed “…SKILLED NURSE TO PERFORM/ INSTRUCT/REINFORCE WOUND CARE TO STAGE IV PRESSURE ULCER TO SACRUM DAILY AND P.R.N. [as needed] FOR WOUND WORSENING/SOILAGE…” Review of the “Visit Note Report,” dated 1/22/2025 revealed “…SACRAL, MID, PU [Pressure Ulcer] STAGE IV [four]…LENGTH x [by] WIDTH x DEPTH (CM) [centimeters]…4 X 3 X 0.5…DEPTH DESCRIPTION…FULL THICKNESS…UNDERMINING SIZE (CM)/ LOCATION- 6-9 O’CLOCK…2…UNDERMINING SIZE (CM)/ LOCATION- 9-12 O’CLOCK…2…TUNNELING [a type of chronic wound characterized by a narrow channel or tunnel that extends from the wound surface into deeper tissue]…NO…” During an in-home visit on 1/22/2025 at 10:30 AM, revealed after removing Patient #1’s old sacral dressing, Registered Nurse (RN) #1 measured the length, width, and depth of the sacral wound using a small, retractable, tape measure. RN #1 failed to use a CTA or FTA to assess the depth of the wound. RN #1 did not use a CTA or FTA assess the undermining or to determine if the wound was tunneling. During an interview on 1/22/2025 at 10:30 AM, when RN #1 was asked if the wound on the sacrum was tunneling, RN #1 stated, “...Yes, to the left...” 3. Record review for Patient #4 revealed a SOC date of 1/8/2025 with diagnoses of Urinary Tract Infection, Heart Failure, Chronic Kidney Disease, and Pressure Ulcer. During an in-home visit on 1/22/2025 beginning at 1:33 PM, revealed Patient #4 was observed to have pressure ulcers. Licensed Practical Nurse (LPN) #1 measured the coccyx pressure ulcer with a paper tape measure by folding it in half, then inserted the paper tape measure into the wound bed to measure the depth of the wound. LPN #1 confirmed the measurement was 5.0 cm x 4.0 cm x 3.0 cm. LPN #1 measured the right greater trochanter (hip area) pressure ulcer with a paper tape measure, by folding it in half and inserted the paper tape measure into the wound bed to measure the depth. LPN #1 confirmed the measurement was 5.0 x 3.5 x 3.0 cm. LPN #1 failed to use a CTA or FTA to assess the depth of the wound. The “Visit Note Report,” dated 1/22/2025, revealed “...COCCYX...UNSTAGE...PU [Pressure Ulcer] ...APPROXIMATELY 5X4X3 MEASUREMENT DUE TO NOT HAVING PROPER EQUIPMENT IN THE HOME…GREATER TROCHANTER, RT [Right]... APPROXIMATE Measurement 5X3X3 DUE TO NOT CORRECT MEASURE IN HOME…” 4. Record review for Patient #5 revealed a SOC dated 5/22/2024 with diagnosis of Heart Failure, Atrial Fibrillation, Diabetes, Cystitis, Hypokalemia, and Pressure induced Deep Tissue Damage of Right Hip. During an in-home visit on 1/23/2025 beginning at 8:30 AM, revealed Patient #5 was observed to have pressure ulcers to the Right and Left Greater Trochanter unstageable, and the Left Heel unstageable. The Licensed Practical Nurse (LPN) #2 failed to measure the left greater trochanter during the wound care observation. Review of the “Visit Note Report,” dated 1/23/2025, revealed “...GREATER TROCHANTER, LT [left] UNSTAGE PU [pressure ulcer] ...CHANGE IN STATUS...NONE...MEASUREMENT TAKEN...NO...” During the wound care observation on 1/23/2025 beginning at 9:00 AM, revealed Family Member #1 confirmed the wound to the left greater trochanter looked worse. During an interview on 1/23/2024 at 9:55 AM, Register Nurse (RN) # 2 was asked if she should have measured all the wounds during wound care. RN #2 confirmed she should have measured all the wounds during wound care. During an interview on 1/23/2024 at 2:00 PM, the Executive Director (ED) confirmed that it’s the agency’s policy to use a CTA or FTA when assessing the depth of a wound. The agency’s nursing staff failed to accurately access the patient’s wounds during wound care.”

“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 policy review, medical record review, observation and interview, the facility failed to ensure an updated and accurate medication profile for 3 of 5 (Patient #2, #4 and #5) sampled patients with home visits. The findings included: 1. Review of the agency’s policy titled, “MONITORING MEDICATIONS,” dated 7/1/2024, revealed “…To provide a process to ensure continuous monitoring of medications in the patient’s home…For patients receiving skilled nursing and therapy services, the skilled nurse is responsible for medication review and reconciliation throughout the episode. The therapist will participate by monitoring and reporting any identified medication issues or non-compliance to the Patient Care Manager…The physician is contacted immediately if any discrepancies between agency information and patient medications are found…” 2. Record review for Patient #2 revealed a Start of Care (SOC) dated 11/29/2024 with diagnosis of Diabetes, Anxiety Disorder, Chronic Kidney Disease, and Heart Failure. Review of the Medicine List dated 1/22/2025, revealed Aspirin 81 (used to prevent blood from clotting) Milligram (mg) one tablet daily, Benzonatate (cough suppressant) 200 Mg one capsule 3 time daily, Fexofenadine (antihistamine)180 Mg one tablet daily, Hydralazine (treat high blood pressure) 50 MG one tablet every 8 hours, Lantus (long acting insulin that lower blood sugar levels) 100 Unit/mililiter (mI) 10 unit at bedtime, Tresiba Flextouch (a type of long acting insulin that lower blood sugar levels in those with diabetes; this medication comes in a pen the patient turns the dial to the prescribed amount and injects into the body) 100 unit/MI 14 units daily. Observation during a home visit on 1/22/2024 revealed Aspirin 325 Mg one tablet daily, Benzonatate 200 Mg one capsule 3 time daily, Zyrtec (treats allergy) 10 Mg one tablet daily, Lantus 100 Unit/MI 10 unit at bedtime, Admelog (fast acting insulin) four time a day per sliding scale (a specific amount of insulin is given depending on what the blood sugar level is), Tresiba Flextouch 100 unit/MI 10 units daily, Tylenol 650 Mg every 8 hours as needed, Cranberry 15,000 daily, and Vitamin D-2 1.25 MG/50,000 one every week. During an interview on 1/22/2024 at 9:40 AM, Patient #2 stated “…the doctor changed the Aspirin 325 MG for circulation some time ago…the Benzonatate ran out of them and stopped taking them…Fexofenadine ran out and started taking Zyrtec…No longer taking the Lantus…changed to Admelog…Tylenol was increased to 650 MG…Vitamin D and the Cranberry was added over a week ago…” 3. Record review for Patient #4 revealed a SOC date of 1/8/2025 with diagnoses of Urinary Tract Infection, Heart Failure, Chronic Kidney Disease, and Pressure Ulcer. Review of the Medication list dated 1/22/2025 revealed Daily Probiotic (treats digestive health) 4 billion Cell Capsule oral (by mouth) 2 capsules daily, Docusate Sodium (stool softener) 100 mg tablet oral 2 times daily. Observations during a home visit on 1/22/2025 revealed Daily Probiotic 10 billion Colony-Forming Units (CFU) Adult Gummy one daily, Docusate Sodium 100 mg oral capsule one daily, and Prenatal Multivitamin Gummy one daily. During an interview on 1/22/2025 at 2:20 PM, Family Member #2 verified the Daily Probiotic Gummy, Docusate Sodium, and Prenatal Multivitamin were taken once daily. During an interview on 1/22/2025 at 2:21 PM, Licensed Practical Nurse (LPN) #1 confirmed the medications were not updated on the Medication List. 4. Record review for Patient #5 revealed a SOC dated 5/22/2024 with diagnosis of Heart Failure, Atrial Fibrillation, Diabetes, Cystitis, Hypokalemia, and Pressure induced Deep Tissue Damage of Right Hip. Review of the Medicine List dated 1/22/2025, revealed Cystex Prebiotic (defend against bacteria) 90 MG-800 MG/15 ML take one daily, Glimepiride (lower level of blood glucose) 2 MG table take on daily, Methimazole (treats excess thyroid hormone in the body) 5 Mg tablet daily, Nystatin (used to treat fungal infections) 100,00 Unit/Ml Oral Suspension 5 ML 3-times daily, and Stool Softener 100 Mg capsule daily/PRN (as needed). Observation during a home visit on 1/23/2024 revealed Cystex Prebiotic 90 MG-800 MG/15 ML take one daily, Glimepiride 2 MG table take on daily, Methimazole 5 Mg tablet every Tuesday, Thursday, and Saturday, Nystatin 100,00 Unit/Ml Oral Suspension 5 ML 3-times daily, Caldesene (treats diaper rash, chafing, minor skin irritations) powder daily as needed, and PreserVision eye vitamin, Stool Softener 100 Mg capsule daily/PRN (as needed). During an interview on 1/22/2024 at 9:44 AM, Family Member #1 stated “…Stop taking the Cystex back in December 2024…not taking the Glimepiride last filled on 11/11/2022… Methimazole was changed to 5 Mg daily… Nystatin no longer taking…started Caldesene 3 years ago or more…now taking the PreserVision eye vitamin…no longer taking the stool softener 100 Mg…” During an interview on 1/23/2025 at 1:45 PM, The Executive Director (ED) reported that if the Registered Nurse (RN) finds a medication in the home that is not on the patient’s medication list that may interact with their current medication therapy, the RN is to document the medication in order for the doctor to approve the medication. She stated if the RN finds a prescription pill bottle, the prescription may be added to the patient medication profile because it was already prescribed by the provider. The ED confirmed that the physical therapy only reviews medication with the initial certification, and with their 30-day reassessment. If physical therapy finds medication not on the patient’s medication list, they are to enter the medication information into their tablet, and nurse will either place the prescription on the medication profile or notify the patient’s provider.”

“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 policy review, medical record review and interview, the agency failed to ensure a discharge summary was sent to the physician or other healthcare professional responsible for care after discharge from the agency within 5 days of discharge for 1 of 4 (Patient #10) sampled discharged patients. The findings included: 1. Review of the agency’s “PATIENT DISCHARGE/TRANSFER PROCESS” policy with a revision date of 10/1/2023 revealed, “...To ensure continuity of care when a patient is discharged, transferred…A discharge summary including admission and discharge dates, reason for admission to home health, reason for discharge…a brief summary of care provided…is sent to the physician or other health care professional responsible for care after discharge from the agency within 5 business days of patient’s discharge...” 2. Medical record review for Patient #10 revealed a Start of Care date of 2/2/2024 with diagnoses which included Atrial Fibrillation, Pressure Ulcer, Heart Failure, and Malignant Neoplasm of Uterus. The facility discharge date was 7/5/2024. There was no documentation the discharge summary was sent to the physician or other healthcare professional responsible for care. 3. During an interview on 1/23/2025 at 11:22 AM, the Executive Director confirmed Pt. #10 had been discharged from services on 7/5/2024 and was unable to provide documentation a completed discharge summary been sent to the physician.”