Mmcare

“Plan of care CFR(s): 484.60(a)(1) Each patient must receive the home health services that are written in an individualized plan of care that identifies patient-specific measurable outcomes and goals, and which is established, periodically reviewed, and signed by a doctor of medicine, osteopathy, or podiatry acting within the scope of his or her state license, certification, or registration. If a physician or allowed practitioner refers a patient under a plan of care that cannot be completed until after an evaluation visit, the physician or allowed practitioner is consulted to approve additions or modifications to the original plan. This Standard is not met as evidenced by: Based on observation, interview, and record review the agency failed to provide one of eight (#3) patients reviewed for care received services that were written in an individualized POC in that: Patient #3 received physical therapy twice instead of once a week as written in his POC. This failure could affect all agency patients who received care and services and could result in treatment failure or deterioration of symptoms. The findings were: Record review of Patient #3’s POC (certification date 03/24/2024 to 05/22/2024) revealed a SOC date of 01/24/2024, diagnosis included Parkinson’s disease (a progressive disorder that affects the nervous system and the parts of the body controlled by the nerves) with Dyskinesia (involuntary, erratic, writhing movements of the face, arms, legs or trunk) , without mention of Fluctuations. Further review of this POC revealed PT visits for 1w5 (1 time a week for 5 weeks). Record review of Patient #3’s visit logs from 03/26/2024 to 04/26/2024 revealed therapy visits twice a week instead of once per week according to Patient #3’s POC. During a home visit observation on 04/30/2024 at 10:00 a.m., PT B provided therapy services for Patient #3. Interview with PT B at this time revealed Patient #3 received therapy services twice a week. During interview on 05/01/2024 at 02:28 p.m., the Administrator revealed PT B documented the frequency as once a week on the recertification (03/21/2024) but told the scheduler two visits a week. Further interview revealed the frequency should be two times a week for four weeks. The Administrator also revealed if the physician ordered twice a week for four weeks (2wk4) but was scheduled (1wk5)once a week for five weeks, the patient wouldn’t get the therapy they needed. During an interview on 05/02/2024 at 09:36 a.m., PT B revealed when he conducted his last assessment, had planned to decrease to once a week visits, but switched it to two times a week, as he fluctuated in his function. PT B further revealed he did not remember submitting the order for a frequency of twice per week or if there was a miscommunication somewhere. Record review of Patient #3’s clarification order (provided by the Supervising RN on 04/30/2024) signed by the physician on 04/30/2024 revealed a clarification order for PT 2w4 (two visits a week for 4 weeks), after surveyor intervention. Record review of the agency’s policy and procedure titled “Plan of Care (03/17/2023)”, read in part, “...V. Each patient must receive the home health services that are written in an individualized POC that identifies patient measurable outcomes and goals...””

“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 observation, interview, and record review the agency failed to identify all medications that the patient was taking (prescription and non-prescription) for two (#1, and #7) of 17 patients reviewed for medication management in that: 1. Patient #1 was no longer taking Citalopram Hydrobromide but was listed on the agency’s current medication profile. 2. Patient #7 medication profile listed Entresto Oral 49-51 mg tab twice daily but no physician order was listed in the chart. This failure could affect all patients in the agency and could result in medication error. The findings were: A. Record review of Patient #1’s POC (certification period 02/20/2024 to 04/19/2024) revealed a SOC of 02/20/2024, diagnosis included Infection Following a Procedure, Deep Incisional Surgical Site. During a home visit on 05/01/2024 at 09:10 a.m., Patient #1’s current medications were observed and reviewed with the agency’s current medication profile. Further review revealed the agency’s medication profile listed Citalopram Hydrobromide ( used to treat depression) 20 mg oral one tab daily but was not currently used by Patient #1. During interview on 05/01/2024 at 09:10 a.m., Patient #1 revealed she had been off Citalopram Hydrobromide Oral 20 mg 1 tab daily for two months. Patient #1 further revealed she told the nurse but could not remember when or who but the nurses usually asked her if there were any changes in her or new medications but did not look at her medications on hand. During an observation on 05/01/2024 at 09:27 a.m., LVN A was observed providing care for Patient #1. Further observation revealed LVN A did not review Patient #1’s medications or reconciled Patient #1’s medications. During interview after the home visit on 05/01/2024 at 09:30 a.m., LVN A stated during the initial assessment, the RN writes down the patient’s medications, the LVN’s ask every visit if they had any new medications or orders. LVN A Further reviewed if there were any new medications, the LVNs write the order and send it to the physician. Further interview revealed she did not look at the patient’s medications on-hand every visit, they did not have to because the RN’s reconciled medications (during recertification). During an interview on 05/01/2024 at 02:28 p.m., the Supervising RN (with the presence of the Administrator) revealed if patient’s informed the nurse they’re taking a medication during a visit, the LVN’s add it to the medication profile, RN’s are supposed to reconcile medications every 60 days, but LVNs are supposed to ask the patient’s for any medication changes when they visit. The Supervising RN further revealed if there’s a new medication, they look at the bottle of the medication. The Supervising RN further revealed this process was overseen by the Supervising RN. The Supervising RN revealed she was not aware of any orders to discontinue Patient #1’s Citalopram. B. Record review of Patient #7’s current POC (certification period 04/01/2023 to 05/30/2023) revealed a SOC of 01/31/2023, diagnosis included Disruption of Internal Operation (surgical) Wound. Record review of Patient #7’s current medication profile (unknown date) revealed Entresto (a heart medicine used in adults with chronic (long-term) heart failure ) oral 49-51 mg one tab oral twice daily (start date 04/14/2023). Further record review of Patient #7’s clinical record revealed Entresto was not listed on Patient #7’s current POC, nor was there a physician order for Entresto. During an interview on 05/01/2024 at 02:28 p.m., the Supervising RN (with the presence of the Administrator) revealed if patient’s informed the nurse they’re taking a medication during a visit, the LVN’s add it to the medication profile, RN’s are supposed to reconcile medications every 60 days, but LVNs are supposed to ask the patient’s for any medication changes when they visit. The Supervising RN further revealed if there’s a new medication, they look at the bottle of the medication. The Supervising RN further revealed this process was overseen by the Supervising RN. The Supervising RN revealed she was not aware of any orders to discontinue Patient #1’s Citalopram. During an interview on 05/01/2024 at 02:28 p.m., the Supervising RN revealed the RN’s were required to do a full medication reconciliation in the patient’s home and ask and see the medication bottles, prescription and over-the-counter. When she received an order by the nurses, she updated the medication profile and conducted a medication reconciliation and sent the order to the physician. The Supervising RN further revealed she oversaw this process and was not aware Patient #7’s Entresto was in the medication profile. Record review of the agency’s policy and procedure titled “Medication List and Monitoring (02/2023)”, read in part, “..Procedure: The agency will maintain a current, accurate list of all prescription and over-the-counter (OTC) medications taken by the patient...””