Farmers Homecare

“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, record review, and interview, the agency failed to maintain a current medication list for 1 (Client 2) of 2 patients for which home visits occurred. This failure placed patients at risk of undetectable adverse events due to medications. Findings included: Record review of Client 2’s medical record revealed Client 2 had a home health start of care date of 4/3/2026. Further review revealed documents titled “Home Health Plan of Care & Certification” for certification periods 4/3/2026 to 6/1/2026, 6/2/206 to 7/31/2026 and 8/1/2026 to 9/26/2026 showing patient had two recertifications since initial admission. Further record review revealed Mirtazapine 15MG tablet was not listed on any of the “Home Health Plan of Care & Certification” under “Medications” for the above 3 certification periods. Record review of Client 2’s medical record revealed a document titled “Medication Profile” (undated) which included the following active medications: Atorvastatin Calcium Oral 20 MG, 1 tab by mouth daily (lowers bad cholesterol) - start date 4/3/2026 Cranberry Oral Capsule 650 MG, 1 cap by mouth daily (over the counter supplement)– start date 4/3/2026 Eliquis Oral Tablet 5 MG, 1 tab 2 times a day (blood thinner) – start date 4/3/2026 Flecainide Acetate Oral Table 50 MG, 1 tab 2 times a day (treats abnormal heart rhythms) – start date 4/3/2026 Gabapentin Oral Capsule 300 MG, 1 cap 2 times a day (treats nerve pain) – start date 4/3/2026 hydrALAZINE HCl Oral Tablet 100MG, 1 tab 2 times a day (treats blood pressure) – start date 4/3/2026 KLS Aller-Fex Oral Tablet 180 MG, 1 tab by mouth daily as needed (PRN) allergy – start date 4/3/2026 Melatonin Oral Tablet 5MG, 1 tab by mouth once daily at bedtime as needed for insomnia – start date 4/3/2026 Metoprolol Succinate ER Oral Tablet Extended Release 24 hours 50 MG, 1 tab by mouth daily (treats blood pressure) – start date 4/3/2026 Multivitamin Adults Oral Tablet, 1 tab by mouth daily (over the counter supplement) – start date 4/3/2026 Myrbetriq Oral Tablet Extended Release 24 Hour 50MG, 1 tab by mouth daily (treats overactive bladder) – start date 4/3/2026 Olmesartan Medoxomil Oral Tablet 40MG, 1 tab by mouth daily (treats blood pressure) – start date 4/3/2026 oxyCODONE-Acetaminophen Oral Table 5-325MG, 1 tab 2 times a day as needed for pain – start date 4/3/2026 Pantoprazole Sodium Oral Tablet Delayed Release 40MG, 1 tab by mouth daily (treats acid reflux) - start date 4/3/2026 Tylenol Extra Strength Oral Tablet 500MG, 1 tab 2 times a day as needed for pain – start date 4/3/2026 Observation and Interview in the home of Client 2 on 9/9/2026 at 9:00AM home visit. The Surveyor observed RN A speaking with Client 2 in Korean. When RN A completed the assessment of Client 2, Surveyor asked RN A if she questioned Client 2 regarding their medications. RN A stated she did and the patient had no medication changes. The Surveyor requested to review Client 2’s medication bottles and Client 2 consented. The Surveyor found one medication discrepancy. Client 2 had a medication bottle for Mirtazapine 15MG (treats depression) with a fill date of 6/1/2026, which was not listed on the current medication list obtained from Agency A’s EMR, despite the patient having a recertification visit on 8/1/2026. The Surveyor asked Client 2 if the Mirtazapine was a medication they were currently taking, and Client 2 confirmed that they were. The Surveyor asked Client 2 how long they have been taking the medication, and Client 2 stated “for a while.” Interview with RN A, away from Client 2, during the home visit conducted on 9/9/2026. The Surveyor asked how often RN A reviewed the medications with the patients. RN A stated that she reviewed medications during every visit. When asked how often she reviewed the medication bottles with the current medication list in the EMR, RN A stated that she usually reviewed the bottles at every visit, but she did not do so during this visit. The surveyor asked if the medications were reconciled during the recertification visit on 8/1/2026 conducted by RN A and RN A stated that she believed she had, but she must have missed that one medication. RN A was asked why it was important the medications were reconciled and updated, and she stated so the records could be accurate. Interview with the Administrator and CFO on 9/9/2026 at 1:38 PM. The Surveyor asked about the agency’s expectations for nurses regarding review and updates to the medication record, and the Administrator stated that nurses were expected to ensure the medications listed were consistent with the physician’s orders and that patients understood their medications. The Administrator further stated that nurses were responsible for reviewing the medications against the plan of care and communicating with the physician as needed. When asked how frequently this review was expected to occur, the Administrator stated that nurses were expected to complete the review at every visit. The CFO stated that several patients traveled to Korea and sometimes returned with medications that they did not always disclose to the nurses when asked. The Surveyor explained that the identified medication discrepancy was discovered by comparing the medication bottles present in the home with the current medication list documented in the agency’s EMR. When asked why it was important to maintain an accurate and current medication profile, the Administrator stated that the medication list needed to accurately reflect the medications prescribed by the patient’s providers. The administrator further stated that maintaining an accurate medication profile was important to allow for the identification of potential medication interactions. Review of the agency’s policy titled, “Medication List and Monitoring,” last reviewed 120118, read in part: “I. The Agency will maintain a current, accurate list of all prescription and over-the­counter (OTC) medications taken by the patient/[patient]…Professional clinical staff will update the medication list with any change in the medication regimen.””