Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 017027 (X3) Date Survey Completed 07/14/2022
Name of Provider or Supplier Hga Homecare, Llc Street Address, City, State 2050 Beltline Rd Sw, Decatur, AL
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
G0536 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 review of medical records (MR), observations, policy and procedure, and interviews with staff, it was determined the agency failed to update the patients medication profile, and review the profile in order to identify any potential adverse effects.




This affected four of seven Home Visits (HV) conducted, including HV # 2, HV # 3, HV # 6, and HV # 4, and had the potential to affect all persons served by the agency.




Findings include:




Agency Policy: Monitoring Medications




Policy number: 10.008




Revised date: 05/01/19




Purpose:




To provide a process to ensure continuous monitoring of medications in the patient's home.




Policy:




A drug regimen review will be performed on all patients in conjunction with all comprehensive assessments. Additionally, all clinicians will participate in 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...




Procedure:




1. The discipline responsible for the drug regimen review will:




...b. Review all medications including over the counter medications, vitamins, herbs, and herbal products, creams and topical ointments... to identify issues such as:




...iv. Drug allergies;




...vii. Duplicate drug therapy;




...2. All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate patient medication information throughout the episode of care...




a. Through a collaborative process the care team will:




i. Compare medications patient is currently taking with medications ordered for the patient in order to identify and resolve discrepancies.





























2. HV # 3 was admitted to the agency on 6/25/22 with diagnoses including Encounter for Changes or Removal of Nonsurgical Wound Dressing and Type 2 Diabetes with Diabetic Peripheral Angiopathy without Gangrene.




Review of the HHC and POC dated 6/25/22 to 8/23/22 revealed an order for SN one time a week for one week, two times a week for eight weeks and 1 time a week for 1 week.




A HV was conducted 7/12/22 at 2:42 PM to observe care provided by EI # 5, License Practical Nurse (LPN).




During the HV, HV # 3's medications were compared to the ML provided to the surveyor on 7/12/22 by the agency. The following discrepancies were observed:




a. Lunesta 3 mg take one tablet at bedtime, with fill date of 6/22/22 was observed with HV # 3's medications and was not on the ML. The patient stated, he/she has been taking at night as ordered, since medication filled.




b. Oxybutynin ER 10 mg take one tablet two times a day, with fill date of 6/9/22 was observed with HV # 3's medications and was not on the ML. The patient stated, he/she has been taking almost a year.




c. Bydureon Bcise 2 mg/0.85 ml (milliliters) Subcutaneous (SQ) Auto-Injector, inject 2 mg SQ every seven days, with fill date of 6/9/22 was observed with HV # 3's medications and was not on the ML. Patient stated, he/she gives self shot in abdomen every Wednesday for almost a year.




An interview was conducted on 7/14/22 at 11:45 AM with EI # 1, who confirmed the medications had not been reconciled per agency's policy.




3. HV # 6 was admitted to the agency on 1/12/22 with diagnoses including Spinal Stenosis, Lumbosacral Region and Anxiety Disorder, Unspecified.




Review of the HHC and POC dated 7/11/22 to 9/8/22 revealed an order for Physical Therapy (PT) one time a week for four weeks.




A HV was conducted 7/12/22 at 12:00 PM to observe care provided by EI # 6, License Physical Therapy Assistant (LPTA). EI # 7, Patient Care Manager (PCM) was also present during visit.




During the HV, HV # 6's medications were compared to the ML provided to the surveyor on 7/12/22 by the agency. The following discrepancies were observed:




a. Linzess 290 mcg capsule, take one capsule every AM was observed on ML. HV # 6 stated, he/she stopped that medication about three months ago.




b. Tizanidine 4 mg tablet, take one tablet daily was listed on ML. The instructions on the bottle read take as needed. HV # 6 stated, he/she is taking medication as written on bottle.




c. MetaMucil 25 mg, over the counter (OTC), individual packets was observed with HV # 6 medications and not on ML. HV # 6 stated, he/she has been taking medication as needed for about four and one half years.




An interview was conducted on 7/14/22 at 11:09 AM with EI # 1, who confirmed the medications had not been reconciled per agency's policy.











4. HV # 4 was admitted to the agency on 5/17/22 with diagnoses including Infection/Inflammation Reaction Due To Internal Right Hip Prosthesis and Essential Primary Hypertension.




Review of the HHC and POC dated 5/17/22 to 7/15/22 revealed an ordered SN visit frequency of one time a week for nine weeks.




A HV was conducted on 7/13/22 at 10:22 AM to observe care provided by EI # 2, Registered Nurse (RN). EI # 1, Executive Director (ED) was also present.




During the HV a comparison was made between the ML provided by the agency on 7/12/22, and medications observed in the home. The following discrepancies were observed:




a. Benadryl 25 mg capsule, one capsule at bedtime was on the ML. The patient stated for the last six months to a year, he/she had only taken the Benadryl as needed for itching, and took two capsules, not one.




b. Ferrous Sulfate 324 mg (65 mg iron) delayed release tablet, one tablet daily was on the ML. The patient stated he/she had stopped taking the iron supplement at least three weeks ago when he/she started receiving the intravenous (IV) antibiotics.




c. The following medications were observed in the home, and not on the ML:




- Over the counter (OTC) Pepto Bismol chew tabs. The patient stated he/she has taken the Pepto Bismol for a couple of years, whenever spicy food eaten.




- OTC Lactaid 9000 unit capsules. The patient stated he/she has taken the lactaid for four to six years, whenever eating ice cream.




- Bottle of Lorazepam 0.5 mg tabs with fill date 6/11/22. The patient stated he/she has been taking lorazepam for thirty two years, and used to take them every day, but currently takes as needed.




- Bottle of Ibuprofen 800 mg with fill date 11/13/19, take one tab three times daily as needed. The patient stated he/she takes the ibuprofen as needed.




- Bottle of Timolol 0.5 % eye drops, with fill date 3/4/22. The patient stated he/she currently places one drop in each eye two times daily.




-Bottle of Dorzolamide 22.3/6.8 mg eye drops, with fill date 3/4/22. The patient stated he/she currently places one drop in each eye two times daily.




-Ondansetron 4 mg tablets with fill date 4/9/21. The patient stated he/she takes the tablets as needed for nausea.




Further review of the ML revealed Clonidine HCL (hydrogen chloride) 0.1 mg tablet, take as needed for high BP (blood pressure) as an active medication. Review of the drug allergies also on the ML had Clonidine listed as an allergy.




In an interview conducted 7/14/22 at 11:22 AM, EI # 1 confirmed the agency failed to update the patient's medication profile per policy, and review all the medications the patient was currently using in order to identify any potential adverse effects.







1. HV # 2 was admitted to the agency on 6/29/22 with diagnoses including Crohn's Disease, Unspecified, Without Complications, and Essential (Primary) Hypertension.




Review of the Home Health Certification (HHC) and Plan of Care (POC), dated 6/29/22 to 8/27/22, revealed a Skilled Nurse (SN) frequency of one time a week for 9 weeks., and a PT (Physical Therapist) ordered frequency of two times a week for one week. An additional order was observed for PT, dated 7/4/22, for one time a week for one week, then two times a week for four weeks.




A HV was conducted on 7/12/22 to observe services provided by Employee Identifier (EI) # 3, MSW (Medical Social Worker). EI # 1, Executive Director, was also present during the visit.




Prior to the HV, the surveyor received a copy of the current Medicine List (ML) dated 7/12/22. The ML was compared to the medications in the home, and the following discrepancies were observed:




a. Dicyclomine 20 mg (milligrams) tablet (tab), one tab three times daily was on the ML. The bottle in the home read two times daily, and date filled was 2/4/22. The patient confirmed the dose, and stated, "I take them as needed."




b. Losartan 100 mg tab, one tab daily, was on the ML. The bottle in the home read Losartan 25 mg, one tab daily. Date filled was 2/9/22.




c. Ondansetron 8 mg tab, one tab every eight hours as needed was on the ML. The bottle in home read twice daily as needed and date filled was 12/19/19. The patient confirmed she/he used this bottle currently.




d. Vitamin C 1,000 mg tab, one tab daily was on the ML. The bottle in the home read 250 mg and HV # 2 stated she/he takes two daily, for the past six weeks.




e. Effexor ER (Extended Release) 75 mg tab, one every morning and two every evening. Date filled was 7/5/18. The patient stated she/he takes them when she/he needs them, and is currently taking one tab twice a day.




g. Acyclovir 800 mg tab, one tab twice daily prn was in the home, and not on the ML. Date filled was 6/14/19. HV # 2 stated she/he used the medication for herpes flare ups.




h. Budesomide 3 mg tab, one tab three times a day prn, was in the home and not on the ML. Date filled was 6/20/19. HV # 2 stated she/he used the medication for Crohn's disease flare ups.




The discrepancies were confirmed onsite with EI # 1, who was present on the HV.