| Statement of Deficiencies | (X1) Provider/Supplier/CLIA Identification Number 017037 | (X3) Date Survey Completed 05/11/2023 |
| Name of Provider or Supplier Alabama Homecare Of Montgomery, Llc | Street Address, City, State 400 South Union Street Suite 285, Montgomery, 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 observations, agency policy and procedure, medical record (MR) review, and interviews, it was determined the agency failed to ensure the medications were reconciled and all current medications were listed on the Client Medication Report (CMR). This deficient practice affected three of seven home visits (HV) including HV # 5, HV # 2, and HV # 6, and had the potential to affect all patients admitted to this agency. Findings include: Agency policy: Monitoring of Medications Policy number: 10.008 Revised: 05/01/19 Policy: A drug regimen review will be performed on all patients in conjuction with all comprehensive assessments. Additionally, all clinicians will participate in medication review and reconciliation throughout the episode... 2. All clinicians participating in the patient's care are responsible to assist with the maintenance of accurate medication information... i. Compare medications patient is currently taking with medications ordered for the patient... 2. HV # 2 was admitted to the agency on 5/3/22 and recertified for care 4/28/23 to 6/26/23 with diagnoses including Encounter for Orthopedic Aftercare Following Surgical Amputation and Type Two Diabetes with Diabetic Peripheral Angiopathy without Gangrene. Review of the HHC and POC dated 4/28/23 revealed orders for SN visits two times a week for eight weeks. A HV was conducted on 5/9/23 at 12:42 PM to observe care provided by EI # 3, Licensed Practical Nurse (LPN). During the HV, the patient's home medications were compared to the CMR dated 4/28/23. The following discrepancies were observed: Aspirin 81 mg, take one tablet daily, date filled 4/18/23 was observed in the home but not listed on the CMR. The patient stated," I have taken that on and off for several years now." An interview was conducted on 5/11/23 at 12:22 PM with EI # 1, who confirmed the medications had not been reconciled per agency policy. 3. HV # 6 was admitted to the agency on 5/4/23 with diagnoses including Heart Failure, Unspecified and Acute Kidney Failure, Unspecified. Review of the HHC and POC dated 5/4/23 revealed orders for SN visits one time a week for one week, two times a week for two weeks and one time a week for four weeks. PT visits two times a week for four weeks effective 5/7/23. Medical Social Worker (MSW) one time a week for one week. A HV was conducted on 5/9/23 at 2:00 PM to observe care provided by EI # 7, MSW. During the HV, the patient's home medications were compared to the CMR dated 5/8/23. The following medications were observed in the home but not listed on the CMR: a. Tylenol 325 mg as needed (PRN) every 4-6 hours. The patient stated, "I only take this when I have a little ache or pain. I have taken that for several months now." b. Iron tablets with Vitamin C 100/250 mg tablet, one per day, date filled 3/14/23. The patient stated, "I have taken this for quite a while now, for several years." c. Latanoprost Ophthalmic Solution 125 mg/2.5 ml one drop/day each eye. The patient stated, "I have been on those drops since my hospital stay in the last two months." d. Centrum Silver Multivitamin one per day. The patient stated," I have been on those vitamins for years." e. Refresh Tears lubricant eye drops artificial tears 1-2 drops prn. The patient stated, "I only need those every now and again but have had them for several months." f. Trelegy Ellipta inhale one puff by inhalation every day at the same time daily last filled 5/28/21. The patient stated, "I have been on that for a couple of years now to help me breathe but I don't need it very often." g. Entresto 49 mg one tablet per day was observed in the home, Entresto 24 mg take one daily was listed on the CMR. An interview was conducted on 5/11/23 at 10:23 AM with EI # 1 who confirmed the medications had not been reconciled per agency policy. 1. HV # 5 was admitted on 4/20/23 with diagnoses including Hypertensive Heart Disease, Heart Failure, and Post Procedure Hematoma of Skin. Review of the Home Health Certification (HHC) and Plan of Care (POC) dated 4/20/23 revealed orders for Skilled Nurse (SN) one visit per week for one week then two visits per week for three weeks, Physical Therapy (PT) one visit per week for one week the two visits per week for three weeks, and Occupational Therapy (OT) one visit per week for four weeks. A HV was conducted on 5/9/23 at 12:50 PM to observe care provided by Employee Identifier (EI) # 6, PT. During the HV the patient's home medications were compared to the CMR dated 5/9/23, the following discrepancies were observed: Furosemide 40 mg (milligrams) take one tablet daily and Klor-Con 8 meq (milliequivalents) take one tablet daily were listed on the CMR. HV # 5 stated he/she was only taking the the Furosemide and the Klor-Con as needed for swelling and the last dose was three weeks earlier. An interview was conducted on 5/9/23 at 3:45 PM with EI # 1, Executive Director, who confirmed the medications had not been reconciled per agency policy. |